Pits and fissure sealants are materials applied to tooth surfaces to prevent decay by filling pits and grooves where plaque can accumulate. They are needed because the morphology of teeth makes fissures prone to decay, acting as natural food traps. There are several generations of sealants from chemically cured to light cured varieties containing fluoride. Application involves isolating the tooth, etching with acid to increase surface area, rinsing and drying before applying the sealant and curing it with light for 20 seconds. Sealants must be checked periodically as moisture contamination can cause early failure.

1. PITS AND FISSURE
SEALANTS

2. MUJTABA NADEEM
BDS 2nd year
 Roll number 124


3. Annuit coeptis
Novus Ordo Seclorum

4. WHAT ARE PITS AND FISSURE SEALANTS?
Defined as

A material applied to occlusal surfaces of the teeth in
order to obliterate the occlusal fissures and remove
the sheltered environment in which caries may thrive.

5. WHY PIT & FISSURE ARE SEALANTS
NEEDED?

6. TOOTH MORPHOLOGY
 Why
fissures are
caries susceptible

8. CLASSIFICATION OF SEALANTS

9. GENERATIONS OF PITS AND FISSURE
SEALANTS

First Generation


Second Generation


Chemically cured (auto polymerized),
Third Generation


Ultraviolet Light cured
Visible Light cure
Fourth Generation

Those containing Fluorides

10. A. TYPES OF FISSURE SEALANTS

Plastics based Sealants
Polyurethanes
 Cyanoacrylates
 Bisphenol a glycidyl methacrylae (BIS-GMA)

Resin based Sealants
 Glass Ionomer Sealants
 Fluoride containing Sealants


11. B. TYPES OF FISSURE SEALANTS
Filled and Unfilled
 Light cured and Chemically cured
 Clear and Tinted


12. A. TYPE CLASSIFICATION SEALANTS
Plastic Sealants
(Bis-GMA) Bisphenol
A-glycidyl methacrylate
resins
 Urethane-based resin
 Sealant of choice


13. A. TYPE CLASSIFICATION SEALANTS
Glass Ionomer Cement
Clinical advantage of chemically bonding to
dentine and enamel without the acid-etch
technique.
 Less vulnerable to moisture
 Fluoride release
 Active fissure system
 Not for long term.
 Exerts a cariostatic effect even after removal of
GIC.


14. B. TYPE CLASSIFICATION SEALANTS
Filled and Unfilled
Addition of fillers make the sealants more resistant
to abrasion.
 Fillers are coated with products such as silane, to
facilitate combination with the BIS-GMA plastic.


15. TYPES OF CURING FOR SEALANTS
Chemical cured – “Autopolymerization”
 Base and catalyst
Monomer & Initiator + Diluted monomer & 5%
Organic Amine Accelerator = Sealant
Visible light cured – “photopolymerization”
 Pre-mixed
Dimethacrylate + Diluent + Activator + Light =
Sealant

16. CHEMICAL CURE SEALANT MATERIALS
Advantages
 No cure light or risk of eye damage
 Can apply sealants to several teeth
Disadvantages
 Variation in setting time (appx 2 min)
 Voids from mixing material
 Changes in viscosity over time

17. LIGHT CURED SEALANT MATERIALS
Advantages
 Short setting time (appx 20 seconds)
 No mixing required
 Won’t set-up – longer working time
 Does not get thick
Disadvantages
 Potential eye damage due to light cure
 Additional cost of cure light
 Cure time increased with number of teeth sealed
 Difficult to manipulate cure light for posterior teeth

18. CURING UNITS
Conventional cure light with halogen bulb = 20
seconds cure for each surface
 Plasma arc or laser = 5-10 seconds


19. Clear and tinted
Depends on induvidual preferences.
 Vary form translucent to white,pink and yellow.
 Coloured pemits a more precise placement of the
sealant.
 On the other hand clear may be considered more
aesthetically acceptable.


20. SEALANT SHADES
 Clear
 Tinted
 Opaque

21. REQUISITES FOR SEALANTS
RETENTION

22. The tooth surface must have
 Maximum surface area


Pits and fissure depth



Deep irregular pits and fissure offer a much more
favorable surface contour for sealant retention.
Deep fissures protect the plastic sealant from shear
forces as a result of mastication.
Surface cleanliness



Surface area can be increased by tooth conditioners or
etchants(30-50%phosphoric acid).
Thorough prophylaxis paste should be applied.
All heavy strains, debris and deposits be removed
before application.
Dryness



Saliva interposes between the tooth and sealant.
Air stream be checked for moisture contamination.
Directing the air stream onto a cool mouth mirror.

23. APPLICATION PROCEDURE

24. INDICATIONS
Deep fissures
 Incomplete or ill formed pits
 Newly erupted teeth
 High caries rate
 Children
 Molars


25. CONTRAINDICATIONS
Shallow fissures
 Well coalesced pits
 Fluoride rich enamel
 Low caries rate
 Occlusal or proximal caries
 Adults


26. ACID ETCH
 Gel
 Liquid

27. ACID ETCH
Phosphoric acid 35%-40%-50%
 Dissolves organic portion of
enamel
 “micromechanical retention”


28. ACID ETCH - CONTINUED
 Creates
more
surface area for
better adhesion

29. ACID ETCH - PRECAUTIONS
 Avoid
contact with
adjacent teeth or soft
tissues
 Can use mylar strips
or matrix bands

30. DRYING AGENT
 Acid
etching and
Primadry (alcohol
based) allows
enamel to be easily
“wetted”

31. ACCEPTED SEALANT MATERIALS
ADA COUNCIL ON SCIENTIFIC
AFFAIRS












3M ESPE – Clinpro Sealant
Confi-Dental Products Company
Dental Technologies
Dentsply International - FluroShield
Ivoclar Vivadent, Inc. - Helioseal
Kuraray America Inc. – Teethmate F-1
PracticeWares Dental Supply
Pulpdent Corporation
Southern Dental Industries
Tru-Tain Prime Dental
Ultradent Products, Inc. - Ultraseal
Zenith/DMG Dental Manufacturing

32. ISOLATE TOOTH/TEETH
 Rubber
dam
 Cotton rolls
 Cotton roll holders

33. DRY TOOTH
Test air/water syringe
before applying blast
of air

34. APPLY ACID ETCH
 15-20
seconds
 Use blue micro tip or
brush tip
 Apply only in pit and
fissures
 For liquid – dab but
do not rub
 Re-etch 10 seconds
if saliva
contamination

35. APPLY ACID ETCH
 Etch
pit and fissures
 Extend 1-2 mm beyond
pit and fissures
 Avoid cusp tips

36. ACID ETCH - CONTINUED
Etch longer
 Deciduous teeth
 Saliva contamination
 Air abrasion or
prophy jet used
 Highly mineralized
teeth
Do not use explorer

37. RINSE TOOTH/TEETH
 Use
HVE and
a/w syringe
 Proper – usually
20 seconds rinse
 Avoid saliva
contamination
 Re-isolate

38. DRY TOOTH/TEETH
 Should
appear
chalky or frosty white
if etched
 If not, re-etch for
another 10 seconds
if not contaminated
with saliva

39. APPLY DRYING AGENT
 Use
brush tip
 Apply and leave for 5
seconds
 Gently blow air to dry
 DON’T RINSE

40. APPLY BOND AGENT
A
bond agent will
improve retention

41. APPLY SEALANT MATERIAL






Most posterior tooth first
Extend 1-2 mm beyond pit
and fissures
Gently work into pits and
fissures
Avoid lifting off tooth
Don’t overfill
“pop” bubbles in sealant
with explorer or brush tip
before curing

42. LIGHT CURE FOR 20 SECONDS
 20
seconds each
tooth
 Don’t touch tip of
cure light to sealant
material
 Don’t let saliva
contaminate the
field…..yet

43. LIGHT CURE FOR 20 SECONDS – AIR
INHIBITION THEORY
Sealant will appear
shiny/wet

44. CHECK SEALED TEETH
 Use
explorer
 Tooth should be
smooth but not soft
 Re-apply sealant, if
necessary
(Remove uncured
sealant with wet
cotton roll)

45. GIVE PATIENT INSTRUCTIONS
The sealant is hard so you don’t have any
restrictions on eating
 If it feels “high” after you go home – you can come
in to get it adjusted
 We will keep checking the sealant at subsequent
appointments
(if using unfilled corposite sealant the bite will self
adjust in 2-3 days)


46. FAILURE OF SEALANTS
cause –
moisture
contamination
 Maxillary and
mandibular 2nd
molars
 Early loss means
less retention of the
resin
 Main