ICP 15 - Fissure Sealants

Question 1

What is a fissure sealant

Answer 1

A fissure sealant is a material that is placed in the pits and fissures of teeth in order to prevent or arrest the development of dental caries - the material destroys the fissures and removes the sheltered environment in which caries can thrive

Question 2

Why do we use fissure sealants

Answer 2

• Almost 50% of caries in school children was found occlusally
• Tooth surfaces with pits and fissures are particularly vulnerable to caries development - doesn’t receive same level of caries protection from fluoride

Question 3

How are patients generally selected for fissure sealing

Answer 3

• Children with special needs
• Children with extensive caries in primary dentition
• Children with caries in permanent molars

Question 4

How are teeth selected to be fissure sealed

Answer 4

Generally - 6’s, E’s, 4’s, 5’s, 2’s

• Molars with deep pits and fissures
• Incisors with deep cingulum pits
• Molars with complex fissure patterns
• Molars with stained tissues

Question 5

What types of materials are used for fissure sealing

Answer 5

• Unfilled resin
• Filled resin
• GIC

Question 6

What are the key points of the fissure sealing procedure

Answer 6

1. Clean tooth
2. Isolate
3. Etch
4. Wash and dry (+re-isolate)
5. Seal

Question 7

When do we clean the tooth in fissure sealing and what brush is used

Answer 7

This prophylaxis doesn’t improve retention but advisable if abundant plaque present. A dry brush better than paste/pumice as these can be retained in fissures

Question 8

What is used to isolate the teeth that are trying to be sealed

Answer 8

Cotton wool tolls and suction shown to be effective

Question 9

What is done in the etch stage of fissure sealings

Answer 9

37% phosphoric acid used for 20 seconds

Question 10

What is done is the wash and dry stage of fissure sealing

Answer 10

10-15 seconds with 3 in 1 - verify frosted appearance

Question 11

Why might you need to re-isolate the tooth after the wash and dry phase of fissure sealing

Answer 11

Salivary contamination will allow the precipitation of glycoproteins onto the enamel surface, greatly reduce the bond strength of the FS, hence re-etch if needed.

Question 12

What can be done if complete isolation is impossible after the wash and dry phase of fissure sealing

Answer 12

Placement of a bonding agent on the wet enamel prior to placing FS can produce a bond strength comparable to normally etched and dried enamel and FS

Question 13

Describe the Seal phase of fissure sealing

Answer 13

• Apply FS to cover all the fissures/pits/grooves up to one third of cusp incline
• Light cure for 20 seconds as close to the tooth surface as possible without touching the tooth
• Inspect for defects, remove any excess with probe
• Check occlusion
• Follow up and review as per patients risk category

Question 14

What does the cost-effectiveness of Fissure sealants depend on

Answer 14

• Caries in population
• Tooth to be sealed (molars more cost effective than premolars)
• Retention of the FS

Question 15

How long do FS last

Answer 15

75% of FS are intact after 3 years of placement