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PIT AND FISSURE SEALANTS
Pits and fissures are enamel faults such as depressions or cracks that are vulnerable to dental caries. Fissure sealants are materials placed in pits and fissures to prevent caries. They have evolved from early dental cements to modern resin-based sealants cured with light. Sealants are indicated for teeth with deep fissures and those opposite teeth with caries. The procedure involves isolating and drying the tooth before applying the sealant. Preventive resin restorations integrate sealants with restorative resin to treat early caries in fissures.
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PIT AND FISSURE SEALANTS
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- 2. CONTENTS • Introduction • Definition •History • Types • Indications • Contraindications • Procedure for sealant application • Preventive resin restoration • References 2
- 3. INTRODUCTION • Fluorides arehighly effective in reducing the number of carious lesions occurring on the smooth surfaces of enamel and cementum. • Unfortunately, fluorides are not equally effective in protecting the occlusal pits and fissures, where 95% of all carious lesions occurs. • Considering the fact that the occlusal surfaces constitute only 12% of total number of tooth surfaces, it means that pits and fissures are approximately 8 times as vulnerable as the smooth surfaces. 3
- 4. What are Pitsand Fissures? • Pits and fissures are enamel faults; narrow shafts or cracks at some length whose blind ends are directed more or less towards the DEJ. • Pits are small pinpoint depressions located at the junction of developmental grooves or at terminals of those grooves. • Fissures are long clefts between cusps or ridges. 4
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- 6. DEFINITION A fissure sealantis a material that is placed in the pits and fissures of teeth in order to prevent or arrest the development of dental caries. -European Academy of Pediatric Dentistry 6
- 7. HISTORY Wilson reported the placementof DENTAL CEMENT in pit and fissures to prevent caries. 1895 Application of silver nitrate by miller 1905 again in 1936 •Hyatt advocated the early insertion of small restorations in deep pit and fissures before carious lesion had the opportunity to develop. •He termed this procedure prophylactic odontotomy. 1923 Bodecker suggested widening the fissures mechanically so that they would be less retentive to food particles and called it as ‘fissure eradication’ 1929 Buonocore introduced a method of adhering resin to an acid-etched enamel surface 1955 Bowen and associates developed the Bis-GMA resin which is the chemical reaction product of Bisphenol A & Glycidyl methacrylate 1962 7
- 8. TYPES OF PIT AND FISSURE SEALANTS •First generation • Second generation • Third generation • Fourth generation Based on curing • Tinted • Clear • Opaque • Pink Based on color • Unfilled • Semi filled Based on fillers 8
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- 10. INDICATIONS • A deepocclusal fissure, fossa or lingual pit. • A sealant is probably indicated if: • The fossa selected for sealant placement is well isolated from another fossa with a restoration. • An intact occlusal surface is present where the contralateral tooth surface is carious or restored; this is because teeth on opposite sides of the mouth are usually equally prone to caries. • An incipient lesion exists in the pit and fissure. 10
- 11. CONTRAINDICATIONS • Patient behaviordoes not permit the use of adequate dry-field technique through out the procedure. • An open occlusal carious lesion exists. • Caries exist on other surfaces of the same tooth. • A large occlusal restoration is already present. 11
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- 13. REQUISITES FOR SEALANTRETENTION There are four commandments for successful sealant placement, and they cannot be violated • Should have a maximum surface area. • Should have deep, irregular pits and fissures. • Should be clean. • Should be absolutely dry at the time of sealant placement and uncontaminated with saliva. 13
- 14. PREVENTIVE RESIN RESTORATIONS(PRR) •Is a natural extension of the use of occlusal sealants. • Integrates the preventive approach of the sealant therapy for caries susceptible pit and fissure with therapeutic restoration of incipient caries with composite resin that occur on the same occlusal surface. • They are the conservative answer to conventional “ extension for prevention” philosophy of class 1 amalgam cavity preparation. 14
- 15. TYPES OF PRR(SIMONSEN- 1978) • Type A -Suspicious pit and fissures where caries removal is limited to enamel. • Type B –Incipient lesion in dentin that is small and confined. Appropriate base is placed in areas of dentin exposure, composite resin is placed and remaining area is covered with sealants. • Type C –More extensive dentinal involvement and requires restorations with posterior composite material. Local anesthesia is required 15
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- 17. REFERENCES • Essentials ofpreventive and community dentistry - Soben peter (fifth edition). • Textbook of public health dentistry- SS.Hiremath (third edition). 17
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Editor's Notes
- #17 Type A -Suspicious pit and fissures where caries removal is limited to enamel. Type B –Incipient lesion in dentin that is small and confined. Appropriate base is placed in areas of dentin exposure, composite resin is placed and remaining area is covered with sealants. Type C –More extensive dentinal involvement and requires restorations with posterior composite material. Local anesthesia is required