Pit and fissure sealants in pediatric dentistry

Presented by
Karuna sharma
Babu G, Mallikarjun S, Wilson B, Premkumar C.
Pit and fissure sealants in pediatric dentistry. SRM J Res
Dent Sci 2014;5:253-7.

 Dental caries remains as one of the most
widespread disease of mankind.
 It is the single most common chronic childhood
disease.
 Caries in children begins shortly after eruption of
the deciduous teeth and continue to increase at a
remarkable rate in their school age.

 Deep pits and fissures favor food retention and are
difficult to clean by routine brushing.
 It provides a favorable environment for the oral
microorganisms to thrive and convert the
carbohydrates to acids, leading to demineralization
of the enamel.
Muthu MS, Sivakumar N. Pediatric dentistry. Principles and
Practice.1st ed. New Delhi: Elsevier; 2009.

 The most efficient way to prevent pit and fissure
caries is by effectively sealing the fissures using
resins called pit and fissure sealants.

 There have been many attempts made within past
decades to prevent the development of caries, in
particular occlusal caries as it was once generally
accepted that pits and fissures of teeth would
become infected with bacteria within 10 years of
erupting into the mouth .

 Years Authors Contribution
 1895 Wilson Placement of zinc phosphate
 cement in pits and fissures
 1923 Hyatt Prophylactic odontomy
 1942 Kline and Knutson Treatment with ammoniacal silver
 nitrate
 1955 Buonocore Sealing of pits and fissure with
 bonded resin material
 1971 Pit and fissure sealant recognized
 by ADA
 1978 Simonson Preventive resin restoration
 1986 Garcia-Godoy Preventive glass ionomer restoration
ADA: American dental association
Bowen in 1965 reported BIS-GMA material development.

 BIS-GMA resin is the reaction product of bisphenol
A and glycidylmetharylate.
 It is the base resin to most of the current
commercial resin.
 Urethane dimethacrylate and other dimethacrylates
resins are also used in the sealant materials.

Based on filler content
 Sealants are classified into filled and unfilled resin
systems in regard to the presence or absence of
filler particles in the system, but most of the self-
cured resins are unfilled.
Kervanto-Seppälä S, Pietilä I, Meurman JH, Kerosuo E. Pit and
fissure sealants in dental public health — Application criteria
And general policy in Finland. BMC Oral Health 2009;9:5.

 The filled sealants contain microscopic
glass beads, quartz particles, and other
fillers used in composites resins.
 The fillers are coated with products such as
silane, to facilitate their combination with
the bisphenol A and glycidyl methacrylate
(BIS-GMA) resin.

The fillers make the resin more resistant to abrasion
and wear.
In contrast, unfilled sealants wear quicker, but
usually do not need occlusal adjustment.
Unfilled resins will penetrate deeper into the fissure
system, and therefore perhaps be better retained.

 Filled resins have shown to be effective in
caries prevention.
Brown MR, Foreman FJ, Burgess JO, Summitt JB. Penetration of
gel and solution etchants in occlusal fissures. ASDC J Dent Child
1988;55:265-8.

 Filled resins are opaque and are available in
tooth-colored or white shades.
 Unfilled resins are color less or tinted
transparent materials.
Simonsen RJ. Pit and fissure sealant: Review of the literature.
Pediatr Dent 2002;24:393-414.

 They can be CLEAR or TINTED
 In March 1977, the first colored sealant (3M™
ESPE™Concise™ White Sealant) was introduced to
the US market.
Donly KJ, García-Godoy F. The use of resin-based composite in
children. Pediatr Dent 2002;24:480-8.
 These sealants are easily visible and chair side time
is saved at follow-up.

 Furthermore, parents are reassured when they can
see the sealants on their child’s teeth.
 As the sealant is clearly visible to the child, it is of
benefit to encourage the child to look periodically
for any sealant loss.
 This constant reminder of the presence of a
preventive agent will help in the motivational
aspects of preventive program.
Gray GB. An evaluation of sealant restorations after 2 years. Br
Dent J 1999;186:569-75.

 Tinted and opaque fissure sealants have the
advantage of more accurate evaluation by the
dentist at recall.
 In 2001, dental manufacturers have introduced
sealants that change colour during polymerization.

 The Helioseal Clear Chroma Ivoclar Vivadent AG
changes from clear to green after photo —
polymerization.
 The 3M™ ESPE™ Clinpro™ Sealanth as a pink color
when applied and converts to a white opaque mass
after light curing.
Lussi A. Validity of diagnostic and treatment decisions of
Fissure caries. Caries Res 1991;25:296-303.

 Based on polymerization methods
A. Self activation
B. Light activation
1.First generation
2.Second generation
3.Third generation
4. Fourth generation

 The first sealant material that utilized the acid etch
technique was introduced in the mid 1960’s and
was a cyanoacrylate (CA) substance.
Pinkham J, Casamassimo P. Pediatric Dentistry. Infancy through
Adolescence. 4th ed. New Delhi: Saunders; 2005.
 CAs were activated with an ultraviolet light source
at a wavelength of 365 nm. Nuva Seal® was the
first successful commercial sealant in market, in
1972.

 CAs were not suitable as sealant material owing to
bacterial degradation of the material in the oral
cavity overtime.
 To overcome these CAs were replaced with second
generation sealant materials, which were found to
be resistant to degradation and produced a
tenacious bond with etched enamel.

Cyanoacrylates were first described in 1949 and their
potential as adhesives was quickly recognized.
Various homologues of CA adhesive have been
studied and used, including methyl-, ethyl-,
isobutyl-, isohexyl-, and octyl-CA.
Its clinical applications in dentistry and medicine,
specially as tissue adhesives and sealing materials.

CA adhesive is a compound synthesized by
condensation of a cyanoacetate with formaldehyde in
the presence of a catalyst.
Lesser D. An overview of dental sealants. J Public Health Dent
2001;91/7:1-8.

In preventive dentistry, CA was also the first
material modified for use as a pit and fissure
sealant to help prevent dental decay, especially
on the occlusal surface.
However, because this material biodegrades
and does not last long in the oral cavity, it was
later replaced with other dental materials, such
as GMA dimethacrylate.

 The second generation sealants are the
dimethacrylates, which represent the reaction
product of BIS-GMA ,which is considered by its
originator to be a hybrid between a methacrylate
and an epoxy resin.
 Second generation sealants are auto polymerizing
and set upon mixing with a
chemical catalyst — accelerator system.

They are generally “self-cured” or “chemically cured”
without the need of an external ultraviolet source.
Most commercial sealants available today are BIS-
GMA dimethacrylates or urethane dimethacrylates based
products.

Auto polymerizing resins generally performed better
than the early ultraviolet light initiated resin
sealants.
Cohen L, Sheiham A. The use of pit and fissure sealants in the
General Dental Service in Great Britain and Northern Ireland. Br
Dent J 1988;165:50-3.
Ripa (1985) reviewed the results of >5 dozen clinical
studies on the effectiveness of first generation
(ultraviolet — initiated) and second generation
(chemically initiated) sealants.

The sealants were evaluated from 1 to 7 years after
placement, second generation sealants provided
superior retention and caries protection than the
first generation sealants.
L.W. Ripa. Sealants Revisited: An Update of the Effectiveness of
Pit and Fissure Sealants. Caries Research 1993;27:77-82.

 The third generation sealants are photo activated
resins which contain a diketone initiator such as
Camphoroquinone and a reducing agent such as
tertiary amine to initiate polymerization.

Use of visible light source requires eye protection
due to the intensity of the light created.
The evaluation of third-generation or visible light
activated sealants falls into the present era of
clinical testing in which retention, rather than
caries inhibition, constitutes the principle criterion
of success.

Retention of sealant material is the main
determinant for the caries preventive effect of
sealant.
L.W. Ripa. Sealants Revisited: An Update of the Effectiveness of
Pit and Fissure Sealants. Caries Research 1993;27:77-82.

A study was conducted to compare the retention of
autopolymerized and light polymerized Delton
fissure sealants in 207 sealed tooth for 5 years
showed that, there was 59% complete retention of
auto polymerized sealants and 48% of the light
polymerized sealants at the end of the study
period.
Welbury R, Raadal M, Lygidakis NA, European Academy of
Paediatric Dentistry. EAPD guidelines for the use of pit and
Fissure sealants. Eur J Paediatr Dent 2004;5:179-84.

Fluoride the pivot of preventive dentistry continues
to be the cornerstone of caries prevention
programs.
In order to maximize the exposure time of fluoride
on enamel for improved prevention of dental caries,
fluoride-releasing materials have been developed.
Asmussen E. Clinical relevance of physical, chemical,
and bonding properties of composite resins. Oper
Dent 1985; 10:61-73.

The literature has reported a decrease in enamel
solubility and secondary caries on treatment with
fluoride dental materials based on the fact that
increased fluoride uptake by adjacent enamel
prevents demineralization and promotes
mineralization.
Brown LJ, Selwitz RH. The impact of recent changes
in the epidemiology of dental caries on guidelines
for the use of dental sealants. J Public Health Dent
1995;55:274-91.

 Early in the development of sealants, it was
recognized that the addition of fluoride to a
sealant, or perhaps to the enamel prior to sealant
application, could have the potential benefit of
additional caries protection.

 Brown and Selwitz was the first to formulate a
polyurethane fluoride containing sealant material
that would release fluoride on the enamel surface
for an extended period of 24 h to 30 days.
Cohen L, Sheiham A. Importance of variables affecting pit and
fissure sealant use in the United Kingdom. Community Dent
Oral Epidemiol 1988;16:317-20.

 Two methods of fluoride incorporation into pit and
fissure sealants are used. In first method, fluoride
is added to unpolymerized resin in the form of a
soluble fluoride salt.
 After the sealant is applied to the tooth, salt
dissolves and fluoride ions are released, Helioseal-
F is produced based on this procedure.

 The second method of incorporating fluoride is by
addition of an organic fluoride compound that is
chemically bound to the resin to form an ion
exchange resin; Teethmate F-1 is based on this
method.
Brown LJ, Selwitz RH. The impact of recent changes in the
epidemiology of dental caries on guidelines for the use of
Dental sealants. J Public Health Dent 1995;55:274-91.

 More recently, a commercially available sealant
with fluoride was marketed that purportedly
releases fluoride (fluoroshield).
 Fluoride releasing sealants have shown
antibacterial properties as well as greater
resistance to artificial caries in comparison to
nonfluoridated sealants.
Asmussen E. Clinical relevance of physical, chemical, and
Bonding properties of composite resins. Oper Dent 1985;
10:61-73.

 The glass ionomer cement (GIC) developed by
McLean and Wilson in 1960’s have been indicated
as restorative materials, bases and cementing
agents.
 It is also used as sealing agents for pits and
fissures, due to their improved properties such as:
Siegal M. Promotion and use of pit and fissure sealants: An
introduction to the special issue. J Public Health Dent 1995;
55:259-60.

 1. Hydrophilic properties and good adhesion to
tooth structure.
 2. Biocompatibility of the polycarboxylate cements
with the translucency and hardness.
 3. Fluoride release of the silicate cements.

 The glass ionomer sealant was believed to be a
useful product, based on the chemical
composition, handling and fluoride release
properties, despite reports that these sealants have
very low retention rates.
Workshop on Guidelines for Sealant Use: Recommendations. The
Association of State and Territorial Dental Directors, the New York
State Health Department, the Ohio Department of Health and the
School of Public Health, University of Albany, State University of
New York. J Public Health Dent 1995;55:263-73.

 GIC is more suitable for use in young children with
incompletely erupted molars.
Rubenstein LK, Dinius A. Dental sealant usage in Virginia. J
Public Health Dent 1986;46:147-51.

 The primary advantage of GIC over conventional
BIS-GMA sealants is the capability of glass ionomer
to release fluoride, which among other beneficial
effects may result in an increased resistance of
fissures to demineralization.
Eronat N, Bardakçi Y, Sipahi M. Effects of different preparation
techniques on the microleakage of compomer and resin fissure
sealants. J Dent Child (Chic) 2003;70:250-3.

 Simonsen concluded that differences in
caries prevention between resinbased and
glass ionomer sealants remain equivocal.
Mascarenhas AK, Moursi AM. Use of fissure sealant retention as
an outcome measure in a dental school setting. J Dent Educ
2001;65:861-5.

 The caries preventive effect of a glass ionomer
sealant depends on both retention of the sealant
and fluoride release.
 The poor retention of glass ionomer sealants
probably precludes them from use as sealants,
particularly in lieu of evidence of superior caries
prevention despite the poor retention.

 In the literature, caries preventive effects are
reported to prevail even after the visible loss of the
GIC sealant.
Seth S. Glass ionomer cement and resin-based fissure sealants
Are equally effective in caries prevention. J Am Dent Assoc
2011;142:551-2.

 One main reason for the loss of the glass ionomer
sealants could be inadequate adhesion of the
cement to the enamel surface.
Eronat N, Bardakçi Y, Sipahi M. Effects of different preparation
techniques on the microleakage of compomer and resin fissure
 In addition, glass ionomer sealants may have been
exposed to saliva before it had completely set,
which could predispose to surface degradation and
early loss of sealant.
Subramaniam P, Konde S, Mandanna DK. Retention of a resin-
Based sealant and a glass ionomer used as a fissure sealant: A
Comparative clinical study. J Indian Soc Pedod Prev Dent
2008;26:114-20.

 With the introduction of resin modified
glass ionomer, properties regarding,
adherence, esthetics and manipulation have
been improved.

 In addition, maintenance of anticaries and
cariostatic effect has been obtained due to
their continuous fluoride release.
Workshop on Guidelines for Sealant Use: Recommendations.
The Association of State and Territorial Dental Directors, the
New York State Health Department, the Ohio Department of
Health and the School of Public Health, University of Albany,
State University of New York. J Public Health Dent 1995;55:263-
73.

 The disease susceptibility of the tooth should be
considered when selecting teeth for sealants not
the age of the individual.
 1. Ages 3 and 4 years are the most important
times for sealing the eligible deciduous teeth.
 2. Ages 6-7 years for the first permanent molars.
 3. Ages 11-13 years for the second permanent
molars and premolars.
Brown LJ, Selwitz RH. The impact of recent changes in the
epidemiology of dental caries on guidelines for the use of
dental sealants. J Public Health Dent 1995;55:274-91.

 Occlusal fissures are classified into five types U, V,
Y, I, IK based on fissure morphology.
Selwitz RH, Nowjack-Raymer R, Driscoll WS, Li SH.
Evaluation after 4 years of the combined use of fluoride and
dental sealants. Community Dent Oral Epidemiol 1995;23:30-5.
 The shallow wide V and U shaped fissures tend to
be self-cleansing and somewhat caries resistant.
 The deep narrow I and IK shaped fissures are
susceptible to caries.

CRITERIA INDICATIONS CONTRAINDICATIONS
Tooth age Recently erupted Teeth remains caries
free
for 4 or >4 years
Tooth type Molar Premolar except when
caries risk is high
Occlusal
morphology
Deep narrow
retentive pit and
fissures
Narrow wide self-
cleansing
pit and fissures
Status of
proximal
surface
Sound Carious
General
caries activity
Many occlusal lesions
few proximal lesions
Many proximal lesions
Other
preventive
measures
Patient receiving
approach systemic
and topical F therapy
and are still caries
active

Few clinical sealant trials have measured effectiveness on
buccal surfaces of mandibular molars and lingual surfaces
of maxillary molars.
Those few that report on these surfaces generally report greater
failures on buccal and lingual sealants than on occlusal
sealants.
More recent work suggests that sealants can be placed
successfully on buccal and Lingual surfaces.
Of particular interest is the observation that adding an
intermediate layer of bonding agent primer and adhesive is
more advantageous on these surfaces than it is on occlusal
surfaces.

This may be due to the added flexibility
and stress-breaking effect afforded by the unfilled
adhesive layer and the benefit this flexibility has on
the sealant bond to a buccal or lingual surface
Undergoing continuous flex in the process of
mastication.

Cleaning the pit and fissure surfaces
 Plaque and debris might interfere with the etching
process or sealant penetration.
 Historically, it has been advocated to clean the
surfaces with bristle brush and pumice.
 Use of prophy pastes, especially those with fluoride,
have been discouraged because it was thought that
the fluoride might make the enamel surface less
reactive to the etchant and thereby reduce the bond
strength.
 Air abrasion also has been suggested for preparation
of the occlusal surface before sealant application.

For years there existed an opinion that a recent fluoride
exposure, such as in-office fluoride treatment, would
Interfere with the etching pattern and, therefore, the
Retention of sealants.
This opinion is not correct. It has been dispelled
in several reports using sealant bonding and
Orthodontic bracket bonding to test the
hypothesis.Therefore, sealant application can be
planned to follow fluoride treatment during the same
office appointment if desired.
Brannstrom M, Nordenvall KJ, Malmgran O. The effect of various pretreatment
methods on the enamel in bonding procedures. Am J Orthod. 1955;74:522-530.
Warren DP, Infante NB, Rice HC, Turner SD, Chan JT. Effect of topical fluoride on
retention of pit and fissure sealants. J Dent Hygiene. 2001;75:21-24.

 Adequate isolation is the most critical aspect of the
sealant application process.
 Salivary contamination of a tooth surface during or
after acid etching will have a deleterious effect on the
ultimate bond between enamel and resin.
 The rubber dam, when properly placed, provides the
best, most controllable isolation, and for an operator
working alone, it ensures isolation from start to
finish.
 Cotton roll isolation offers some advantages over
rubber dam isolation.

 Introduction of acid etch technique has made the
sealing of occlusal surfaces more effective.
 The most critical step in sealant application
technique is acid conditioning or acid etching
procedure.
 Etching enhances the tooth’s receptivity to bonding
with the sealant.

 During this critical step, meticulous maintenance of
a dry tooth surface is essential for bonding to be
successful.
Gillet D, Nancy J, Dupuis V, Dorignac G. Microleakage and
Penetration depth of three types of materials in fissure
sealant: Self-etching primer vs etching: An in vitro study.
J Clin Pediatr Dent 2002;26:175-8.
 The conventional 60 s etching was first used by
Ripa and Cole.

 Increased etching time for deciduous teeth is
attributed to various reasons like:
1. Deciduous teeth have less mineral and more
organic material in the enamel.
2. Deciduous teeth have a larger internal pore
volume and thus more exogenous organic material.
3. Deciduous teeth have more prism less enamel on
their surface than do permanent teeth.
4. The prism rods in deciduous teeth approach the
surface at a greater angle and thus are more
difficult to etch.

Three characteristic etching patterns occur following
exposure of sound enamel to phosphoric acid.
Gray GB. An evaluation of sealant restorations after 2 years. Br
Dent J 1999;186:569-75.
1. Type 1 etching pattern: Prism cores lost but Prism
peripheries remain — honeycomb appearance.

2. Type 2 etching pattern: Prism peripheries are lost,
Prism cores appear to be relatively intact — cobble
stone appearance.
3. Type 3 etching pattern: Some regions of etched
Enamel show a generalized surface roughening and
porosity with no exposure of prism cores or
peripheries.

 Earlier it was recommended that the etching time
for primary teeth be doubled than that of the
permanent teeth.
 Many studies have used different etching timing
from 15 to 60 sec.
 Tandon S.et al have proposed an etching timing of
15 sec to be sufficient for primary teeth.

 Many of the sealant manufacturers recommend
rinsing the tooth for 20-30 s to remove the etchant.
 An exact rinse time is probably not as important as
ensuring that the rinse is long enough and thorough
enough to remove all of the etchant
from the surface.
Drying the tooth with compressed air is likewise done
not for a specific time but rather for a specific result.

 A tooth that is completely dried will exhibit a
chalky, frosted appearance.

 During sealant application, all the susceptible pits
and fissures should be sealed for maximum caries
protection.
 This includes buccal pits of mandibular molars and
lingual grooves of maxillary molars.
 The sealant material can be applied to the tooth in
a variety of methods.
 Many sealant kits have their own dispensers, some
preloaded that directly apply the sealant to the
tooth surface.

 Some common problems occur during
sealant application.

 Small bubbles may form in the sealant material.
 If these are present, they should be teased out
with a brush before polymerization.
 Unfilled sealants have a low viscosity that makes
them prone to pooling in the distal pit area of
maxillary molars due to patient position and
gravity.
 This can be rectified by applying the sealant
judiciously or by removing excess amounts with a
brush.

 The sealant should be visually and tactually inspected
for complete coverage and absence of voids or
bubbles.
 Attempts should be made to dislodge the sealant
with an explorer.
 If the sealant is dislodged, the tooth should be
carefully inspected to see that no debris has been left
in the fissure, which may have interfered with the
bond.
 Small voids in the sealant can be repaired simply by
adding new material to the void and polymerizing.

 Some sealants will be completely or partially lost
and will require reapplication.
 During routine recall examinations, it is necessary
to re-evaluate the sealed tooth surface both
visually and tactually for loss of material, exposure
of voids in the material and caries development.
 The need for reapplication of sealants is usually
highest during the first 6 months after placement.

A previous review of sealant clinical trials show a
failure rate (judged by sealants needing repair,
replacement or restoration) to be between 5% and
10% each year.
This number is supported in many large sealant
studies and in numbers from private pediatric
practices using the best of sealant procedures.

Without appropriate clinical follow-up of these
sealants, the failures would compound over a
few years, leaving most of the surfaces equally
susceptible to caries as surfaces that were never
sealed.
Long-term success of sealant therapy, therefore, is
dependent upon vigilant recall and repair when
necessary.
With such follow up, sealant success is very high.

Caries is a problem for patients of all ages.
Along with proper diet, fluoride, and biofilm control,
pit and fissure sealants should be considered as part
of an overall preventive program rather than an
isolated procedure.
Ideally, high-risk patients should have sealants
placed on all posterior permanent teeth upon
eruption.

The dental practitioner should be familiar with the
various categories of sealants and the specific
application methods for each product.
With proper placement and maintenance, sealants
can last years.

The dental literature supports:
1. Bonded resin sealants, placed by appropriately
trained dental personnel, are safe and effective in
preventing pit and fissure caries on at-risk
surfaces. Effectiveness is increased with good
technique and appropriate follow up and resealing
as necessary.
.

2. Sealant benefit is increased by placement on
surfaces judged to be at high risk or surfaces that
already exhibit incipient carious lesions. Placing
sealant over minimal enamel caries has been
shown to be effective at inhibiting lesion
progression. Appropriate follow-up care, as with
all dental treatment, is recommended

3. Presently, the best evaluation of risk is done by an
experienced clinician using indicators of tooth
morphology, clinical diagnostics, past caries history,
past fluoride history and present oral hygiene.

4. Caries risk, and therefore potential sealant
benefit, may exist in any tooth with a pit or fissure,
at any age, including primary teeth of children and
permanent teeth of children and adults.

5. Sealant placement methods should include careful
cleaning of the pits and fissures without removal of
any appreciable enamel. Some circumstances may
Indicate use of a minimal enameloplasty technique.
6. A low-viscosity, hydrophilic material bonding layer
as part of or under the actual sealant has been
shown to enhance the long-term retention and
effectiveness.

7. Glass ionomer materials have been shown to be
ineffective as pit and fissure sealants, but could be
used as transitional sealants.
8. The profession must be alert to new preventive
methods effective against pit and fissure caries.
These may include changes in dental materials or
technology.
Feigal Use of fissure sealants Pediatric Dentistry – 24:5, 2002

1. Muthu MS, Sivakumar N. Pediatric dentistry.
Principles and Practice 1st ed. New Delhi: Elsevier;
2009.
2. Strassler HE. Pit and fissure sealants. Supervised
Self — Study Courses from Benco Dental; 2009. p.
89-95.
3. Morris B. Textbook of Pediatric Dentistry. 2nd ed.
New Delhi: CBS Publications; 1985.

4. Mathewson, Primosch. Fundamentals of Pediatric
Dentistry. 3rd edUK Quintessence Publishing Co;
1995.
5. Subramaniam P, Konde S, Mandanna DK. Retention
of a resin-based sealant and a glass ionomer used
as a fissure sealant: A comparative clinical study. J
Indian Soc Pedod Prev Dent 2008;26:114-20.
6. Pinkham J, Casamassimo P. Pediatric Dentistry.
Infancy through Adolescence. 4th ed. New Delhi:
Saunders; 2005.
7. Cohen L, Sheiham A. The use of pit and fissure
sealants in the General Dental Service in Great
Britain and Northern Ireland. Br Dent J
1988;165:50-3.

8. Kervanto-Seppälä S, Pietilä I, Meurman JH, Kerosuo
E. Pit and fissure sealants in dental public health —
Application criteria and general policy in Finland. BMC
Oral Health 2009;9:5.
9. Brown MR, Foreman FJ, Burgess JO, Summitt JB.
Penetration of gel and solution etchants in occlusal
fissures. ASDC J Dent Child 1988;55:265-8.
10. Simonsen RJ. Pit and fissure sealant: Review of the
literature. Pediatr Dent 2002;24:393-414.
11. Donly KJ, García-Godoy F. The use of resin-based
composite in children. Pediatr Dent 2002;24:480-8.

12. Gray GB. An evaluation of sealant restorations after 2
years. Br Dent J 1999;186:569-75.
13. Lussi A. Validity of diagnostic and treatment decisions of
fissure caries. Caries Res 1991;25:296-303.
14. Lesser D. An overview of dental sealants. J Public Health
Dent 2001;91/7:1-8.
15. L.W. Ripa. Sealants Revisited: An Update of the
Effectiveness of Pitand Fissure Sealants. Caries Research
1993;27:77-82.
16. Welbury R, Raadal M, Lygidakis NA, European Academy
of Paediatric Dentistry. EAPD guidelines for the use of pit
and fissure sealants. Eur J Paediatr Dent 2004;5:179-84.

17. Asmussen E. Clinical relevance of physical, chemical,
and bonding properties of composite resins. Oper Dent
1985; 10:61-73.
18. Brown LJ, Selwitz RH. The impact of recent changes in
the epidemiology of dental caries on guidelines for the
use of dental sealants. J Public Health Dent
1995;55:274-91.
19. Cohen L, Sheiham A. Importance of variables affecting
pit and fissure sealant use in the United Kingdom.
Community Dent Oral Epidemiol 1988;16:317-20.
20. Siegal M. Promotion and use of pit and fissure
sealants: An introduction to the special issue. J Public
Health Dent 1995; 55:259-60.

21. Workshop on Guidelines for Sealant Use: Recommendations.
The Association of State and Territorial Dental Directors, the
New York State Health Department, the Ohio Department of
Health and the School of Public Health, University of Albany,
State University of New York. J Public Health Dent 1995;55:263-
73.
22. Rubenstein LK, Dinius A. Dental sealant usage in Virginia. J
Public Health Dent 1986;46:147-51.

23. Eronat N, Bardakçi Y, Sipahi M. Effects of
different preparation techniques on the
microleakage of compomer and resin fissure
24. Mascarenhas AK, Moursi AM. Use of fissure
sealant retention as an outcome measure in a
dental school setting. J Dent Educ 2001;65:861-5.
25. Seth S. Glass ionomer cement and resin-based
fissure sealants are equally effective in caries
prevention. J Am Dent Assoc 2011;142:551-2.

26. Lussi A. Validity of diagnostic and treatment
decisions of fissure caries. Caries Res
1991;25:296-303.
27. Boksman L, Gratton DR, McCutcheon E, Plotzke
OB. Clinical evaluation of a glass ionomer cement
as a fissure sealant.Quintessence Int 1987;18:707-
9.
28. Selwitz RH, Nowjack-Raymer R, Driscoll WS, Li
SH. Evaluation after 4 years of the combined use of
fluoride and dental sealants.Community Dent Oral
Epidemiol 1995;23:30-5.

29. Gillet D, Nancy J, Dupuis V, Dorignac G.
Microleakage and penetration depth of three types
of materials in fissure sealant: Self-etching primer
vs etching: An in vitro study. J Clin Pediatr Dent
2002;26:175-8.

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