Fissure sealants and preventative resin restorations Flashcards
What is a fissure sealant?
A material that is placed in the pits and fissures of teeth in order to prevent the development of dental caries
What are the uses of fissure sealants?
Primary prevention of caries
Secondary prevention to inhibit the progression of non cavitated carious lesions
Why are fissure sealents used what are their advantages?
- Fissure sealants are effective at preventing decay
- Pits and fissures account for 12.5% of tooth surface
66% of carious lesions develop in the pits and fissures
What did the cochrane library find in regards to fissure sealants?
Found fissure sealants reduce the decay rate by 51%
How many studies did the cochrane library carry out when loooking at fissure sealants?
Included 38 studies and 7924 participants between age 5-16 yrs
Who get fissure sealants?
All children at high risk of dental caries
Which teeth do we usually place fissure sealants on?
Permanent molars
Susceptible sites of permanent teeth
List some patent factors we consider when choosing patients who may need fissure sealants
- Caries in primary teeth
- Caries in other permanent molar
- Does the patient have nay underlying medical physical ot emotional problems
- Risk factors
List some tooth factors we consider when choosing patients who may need fissure sealants
- Depth of fissures
- Hypomineralisation
- Hypoplasia
- Inaccessible areas that are hard to clean
List the steps we carry out when placing a fissure sealant
- Clean the pit and fissures
- Isolate the tooth
- Etch, wash and dry
(4. Apply a bonding agent) - Apply sealant
- Evaluate
Why do you need to isolate the tooth when carrying out a fissure sealant?
To achieve moisture control
Why is using a bonding agent when placing a fissure sealant a debated topic?
As some say it will make sure the fissure sealant seal better
BUT
It introduces another step and requires the child to sit still for longer
What does the cochrane library say about bonding fissure sealant?
Etching and bonding doesn’t statically improve retention of fissure sealants
What do we use to place our fissure sealant?
Use a microbrush
How do we evaluate our fissure sealant?
Can use a small spoon excavator to check for overhang and check sealing of the sealant
What material is the fissure sealant we use made up of?
Resin
When would be use a GIC fissure sealant
If you have an uncooperative patient or need a quick temporary protective cover over the 6
How would you place a GIC fissure sealant
Using your thumb and place the GIC onto the molar and let set
Then check occlusion
How can we imporve behaviour management in younger children?
- Tell-show- do using a tooth model or glove
- Distractions (count light on the ceiling)
- Reinforce positive behaviour
When are failure rates of fissure sealants higher?
- When placed on newly erupted teeth
2. Placed in mouth with previous high caries rate
What is a preventative resin restoration?
Restoration of a small carious lesion into dentine, where the lesion in limited areas of the tooth not bearing occlusal loads
What is the difference between preventive resin restorations and fissure sealants
There’s some caries removal involved in preventative resin restoration
And PRR is more for the prevention of the SPREAD of caries
When do we do PRR?
- When caries is minimally into the dentine
2. Lesion is limited to areas of tooth not bearing occlusal load
What would you do if the caries lesion is too extensive for PRR
Do an occlusal composite restoration
Why do we use preventive resin restoration?
To conserve the tooth structure
How much of the tooth surface is removed in PRR in comparison to amalgam
PRR: 5%
Amalgam: 25%
What are the advantages of PRR?
- Aesthetics
- Shorter prep time
- Minimal wear
- Improved seal
How do we carry out a PRR?
(1. give LA)
2. Isolate the tooth
3. Use high speed ands slow speed to remove caries
4. Etch, wash and dry
5. Apply bonding agent
6. Restore with composite
7. Apply sealant
8. Evaluate
How deep should we make our cavity to optimise PRR?
2mm so that the composite sets well
How do we monitor PRRs?
Recall the patient according to their caries risk (6mths-2yr)
Take radiographs
