ICP L15: Fissure sealants Flashcards
What is a fissure sealant
Material that is placed in the pits and fissures of teeth in order to prevent or arrest the development of dental caries - the material obliterates the fissures and removes the sheltered environment in which caries thrives
Why should teeth be fissure sealed
Because it protects teeth that are vulnerable to caries by changing the morphology of the enamel so it doesn’t favour plaque accumulation as normally this area of the tooth will not receive the same level of caries protection from fluoride
What are the indications of fissure sealing
Patient selection
- Children with special needs
- Children with XS caries in primary dentition
- Children with caries in permanent molars
Which teeth are fissure sealants used on
- Molars with deep pits and fissures
- Incisors with deep cingulum pits
- Molars with complex fissure patterns
- Molars with stained fissures
6s, Es, 4s, 5s, 2s
How should patients with fissure sealants be managed
On each visit all existing sealants should be checked and worn sealants should be topped up if the child is still at increased caries risk
Should check with flat straight ended probe and go around all of the margins, trying to scratch it off and lift up to ensure it is secure
What materials can be used for fissure sealants
- Unfilled resins (these are more flowable); light/chemical cure, clear, tinted or opaque
- Filled resin (more viscous); light/chemical cure, clear, tinted or opaque, contains filler particles
- GICs; useful when isolation is problematic and in partially erupted teeth in high caries risk child
Why are GICs useful as fissure sealants
Because unlike composites, they do not require complete isolation and moisture control and so they can be placed in the presence of saliva around the gum operculum - they also do not require etching and can bond well to the enamel and dentine
Why is it better to use a tinted/opaque fissure sealant rather than a clear one
Because these can be easily spotted so it is easier to see if they need replacing
Outline the procedure of fissure sealant placement
- Clean the tooth
- Isolate tooth
- Etch using 37% phosphoric acid for 20 seconds
- Wash and dry with 3 in 1 for 10-15 seconds
- Seal
How is the tooth cleaned for a fissure sealant
- Dry brush = more abrasive than wet brush
- Paste = prophy paste contains oils so could make etching ineffective
- Pumice = ground stone slurry in a rubber cup - this is needed when there is much debris and must be throughly washed after
- Rubber cup is less abrasive than a brush
How is the tooth isolated
- Cotton wool rolls (bend before placing into lingual and buccal aspects) hold down with non-working hand for more effective isolation
- Suction
- Dry guard (pointing out towards parotid duct) - wet before placing
How should the tooth appear after washing and drying
Frosted appearance - if worried about contamination must be re-etched
Why would a tooth need to be re-isolated in the application of fissure sealant
If there is salivary contamination which will cause precipitation of glycoproteins onto the enamel surface which will reduce the bond strength of the fissure sealant
What can be done if the complete isolation is impossible and you are using a composite fissure sealant
A bonding agent can be placed onto wet enamel prior to placing the fissure sealant
How is the sealing stage carried out
Fissure sealant is applied to cover all the fissure/pits/grooves up to one third of the cuspal incline and it is light cured for 20 seconds as close to the tooth surface without touching the tooth
