Fissure sealants

Question 1

What are the two main types of pits and fissures?

Answer 1

1. Shallow, wide, V-shaped fissure – not as concerning
2. Deep, narrow I-shaped (bottle neck) fissure – concerning as can act as a niche for biofilm accumulation, biofilm stagnation.

Question 2

What is a fissure sealant?

Answer 2

It is a low viscosity material which is flowed into a pre-treated pit or fissure which fills the pits/fissures & physically alters the morphology.

Question 3

How does a fissure sealant prevent caries?

Answer 3

1. Mechanical barrier in the pit/fissure of the tooth
2. Eliminate the environment conducive to cariogenic bacteria
3. Make pit/fissures easier to clean by tooth brushing and mastication

Question 4

What are the indications for fissure sealing?

Answer 4

1. Caries risk status
2. Tooth morphology
3. Moisture control

Question 5

What are the contraindications for fissure sealing?

Answer 5

1. Factors relating to tooth morphology
2. Factors relating to caries risk
3. Presence of existing caries
4. Factors that relate to moisture control
5. Resin-based fissure sealants would not be recommended in these situation – partially erupted teeth and no excellent moisture control

Question 6

What are the two main materials used for fissure sealing?

Answer 6

1. Composite resin – low viscosity, hydrophobic, requires etching, polymerized by chemical reaction and visible light curing
2. Glass Ionomer Cement – Fuji 9 and Fuji 7

Question 7

What are advantages and disadvantages of self-curing sealant?

Answer 7

Advantages: No polymerization shrinkage and does not require expensive light source
Disadvantages: No control of setting time and air porosities can be incorporated

Question 8

What are advantages and disadvantages of light cures fissure sealant?

Answer 8

Advantages: Can control the time of set, no mixing of resins and great viscosity
Disadvantages: Polymerization shrinkage and cost of unit

Question 9

Why is moisture control very important when placing a CR fissure sealant?

Answer 9

1. Salivary contamination which prevents adaptation of the sealant
2. Easier access

Question 10

What does etching do?

Answer 10

The etch is able to create enamel etching patterns (enamel tags or microporosities) that allow for greater surface area of fissure sealant bonding. This is called micromechanical bonding.

Question 11

What are the steps to fissure selant placement and what are their reasons?

Answer 11

1. Moisture isolation – salivary contamination and easier access
2. Clean the surface of plaque/debris – if the debris is there fissure sealant won’t bond
3. Rense the tooth and dry – remove debris and tooth needs to be dry
4. Etch – phosphoric acid remove pellicle, remove old enamel surface, increases surface area by creation of porosities thus creating micromechanical bonding
5. Rinse tooth – stop etching process and remove enamel products
6. Dry tooth – remove debris and tooth needs to be dry for bonding
7. Apply the fissure sealant to the etched surface
8. Probe the entire surface in order to check for potential imperfection – make sure the fissure sealant does not create niches for bacteria to accumulate

Question 12

How can we evaluate a fissure sealant?

Answer 12

CAMS
C- Coverage
A- Amount
M- Margins
S- Surface