Fissure Sealants Flashcards
Indications for pit and fissure sealants
- High caries risk patients.
- Deep, narrow fissure patterns with stagnating plaque.
- Newly erupting molars in children with high caries in deciduous teeth.
Fissure sealant definition
A material that is introduced into the pits and fissures of caries-susceptible teeth forming a protective layer that prevents the development of decay.
Placement of fissure sealants helps to prevent…
- Pits and fissure caries.
- Progression of incipient caries.
- Extensive tooth preparation and restoration.
Patient selection
- Children with dental anomalies (Amelogenesis imperfecta).
- Children with extensive cares in primary dentition.
- Children from socio-economically disadvantaged backgrounds.
- Children with special needs (medically compromised, physically disabled, learning difficulties).
Tooth selection
- Greatest benefit on occlusal surfaces of first permanent molars.
- Buccal pits in lower molars.
- Palatal pits in upper molars.
- Cingulum pits in upper incisors.
If caries occurs in a first molar…
All other molars should be sealed.
Seal teeth as soon as the tooth is erupted enough to allow for good moisture control.
Fissure sealant materials
- BisGMA resin.
- Glass polyalkenoate cements (GIC).
- Wetbond.
Placement of GIC
- Isolate and dry enamel surface.
- Mix and apply (can use finger press technique).
- Inspect.
- Apply vaseline to surface.
Placement of hydrophobic resin fissure sealant
- Isolate with cotton wool rolls.
- Enamel surface preparation (dry bristle brush).
- Apply etchant to fissure system for 20-30 seconds.
EITHER
- Dry (etched enamel appears frosty and opaque).
- Seal (encourage penetration and leave for 20 seconds).
OR
- Dry with cotton wool pledget.
- Thoroughly apply Prime and Bond.
- Keep wet for 20 seconds.
- Remove excess.
- Do not cure.
- Seal and remove excess with micro-brush.
- Light cure.
- Inspect (check retention, integrity of margins, and occlusion).
Placement of hydrophilic resin fissure sealant
Use if poor patient compliance or poor moisture control.
- Isolate and etch for 15 seconds.
- Wash.
- Dry lightly for 10 seconds. Can use cotton wool pledget to remove any pooling.
- Apply sealant.
- Light cure.
- Check retention.
Fissurotomy benefits (explore the lesion with drill)
- Extent of lesions may be difficult to determine without mechanical exploration.
- Enhanced sealant penetration.
- Enhanced sealant adhesion.
- Enhanced marginal adaptation.
- Increased microbial elimination.
- Increased sealant retention.
- Decreased marginal leakage.
- Decreased bubble formation.
Retention is effected by
- Stage of eruption of tooth.
- Patient compliance.
- Technique/material.
Sealants should be higher on occlusal surfaces than buccal and lingual pits/fissures.
Review
- Sealants should be reviewed at every appointment.
- Re-seal if necessary.
- Sealed teeth are not immune from caries.
Glass ionomer or resin-modified GI cements
- May be used when moisture control is poor (e.g when newly erupting).
- High failure rates due to poor mechanical strength.
Extra tips for completing sealants
- Etch 30-60 seconds to allow the etch to penetrate the fissures.
- Agitate the etchant and sealant to encourage movement into the fissures.
- Wait a little before curing to allow sealant to flow into the fissures.
- Use ball ended probe to apply sealant.
- Etched marginal enamel is painted with bond, then light cure.
- Surface may be gently rubbed with cotton wool pledget to remove oxygen-ihibites layer.
