Prevention: fissure sealants

Question 1

When is a fissure sealant indicated?

Answer 1

• Sealants are used in cases where risk for caries are high
• Fissure anatomy: people with deep fissures would have higher plaque retention, and it’s harder to brush
• Fissure sealants can be used as a primary procedure and as a secondary procedure (up to ICDAS 3)
• Not every person needs fissure placements. It is different to the preventive modality of fluoride.

Question 2

Describe the evidence on the effectiveness of sealants in caries prevention

Answer 2

• Effectiveness: measures success in real world situations

In a 5-year study involving 352 people, one of each contra-lateral tooth pair was sealed and the other was not sealed and acted as the control.

After 5 years, these results show that for the:
• Sealant all missing group: 52% of teeth that were previously sealed were now carious, compared with 60% of the teeth that were never sealed
• Sealant partly missing group: 7% of teeth that had sealant partly missing were now carious compared with 41% of the teeth that were never sealed
• Sealant all present group: Less than 1% of the fully sealed teeth were now carious, compared with 18% of teeth that were never sealed.

Question 3

Describe the relationship between sealant retention and sealant efficacy

Answer 3

• Pits and fissures are a high-risk site for the manifestation of the disease dental caries
• Partially retained sealants partially prevent caries
• Surfaces that lose sealants revert to their prior vulnerability

Question 4

Describe the clinical considerations before choosing materials that are to be used for the placement of fissure protections

Answer 4

GIC:
• Chemical adhesion : via an ion exchange layer
• Moisture control is necessary but “desiccation” is not essential
• Less technique sensitive
• Fluoride release ( depending on the type of GIC ) and re-uptake to adjacent surfaces

Resin-based materials
• Can be filled or unfilled, thus it affects retention considerations
• Micro-mechanical adhesion
• Moisture control is absolutely necessary (i.e Rubber dam)
• Technique sensitive
• Possible Fluoride release (depending on the type of resin material) or no Fluoride re-uptake
• Longevity