Pit and fissure sealant seminar

Trends in caries
Epidemiology
2

Caries Developments in Recent Decades
• Dental caries reached a climax in the 19th and 20th centuries due to the
increased availability of sugar for the general population of developed countries.
• Only with the extensive use of fluorides, the rapid rise of the disease of dental
hard tissue was diminished.
Rugg-Gunn, A. Dental caries: Strategies to control this preventable disease. Acta Med. Acad. 2013, 42,117–130
Petersen, P.E. The world oral health report 2003: Continuous improvement of oral health in the 21st century—The approach
of the who global oral health programme. Community Dent. Oral Epidemiol. 2003, 31, 3–23
3

• Nevertheless, dental caries is one of the most common intraoral diseases,
with serious consequences for both the individual patient and for the public in
terms of medical, social, and economic concerns.
• Recent reports have confirmed an increase in caries on a worldwide scale,
confirming its status as an important global oral health burden.
Bagramian, R.A.; Garcia-Godoy, F.; Volpe, A.R. The global increase in dental caries. A pending
public health crisis. Am. J. Dent. 2009, 22, 3–8
?Need to check the Trends in caries Epidemiology
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Dental caries
Smooth surface caries Occlusal caries
Increased worldwide access to fluoride
Significant decline Decrease in occlusal surface caries had
not kept pace with the decrease in
smooth surface caries
Carvalho, J.C. Caries process on occlusal surfaces: Evolving
evidence and understanding. Caries Res. 2014, 48, 339–346
5

American Dental Association. Center for Evidence-Based Dentistry. ADA clinical practice
guidelines handbook: 2013 update. Chicago: Ill; 2013. http://ebd.ada.org/~/media/EBD/
Files/Α_Clinical_Practice_Guidelines_Handbook-2013.ash. Accessed 20 May 2017
According to American Dental Association (2013-2017)
• Among school children, pit and fissure caries have been accounted for
approximately 80–90% of all caries in permanent posterior teeth.
• The occlusal surfaces of permanent molars are highly susceptible to
caries development, especially during the first few years after tooth
emergence in the oral cavity.
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WHY OCCLUSAL SURFACE OF TOOTH IS
MORE PRONE TO CARIES ????
ANATOMICAL FEATURES : PITS AND FISSURES
Natural cleaning mechanisms through the
tongue, lips, and cheeks during chewing and
swallowing are Less effective in pit and fissures
The occlusal surfaces are especially affected by
the reduced ability of cleaning
Bacteria and food residues can accumulate in the pits and fissures,
produce a biofilm, and lead to demineralization and caries
7

Preventive interventions, such as the addition of fluoride to water and toothpastes as
well as topical fluoride application, more effectively reduced caries on smooth
surfaces than in pits and fissures
Ahovuo-Saloranta, A.; Forss, H.; Hiiri, A.; Nordblad, A.; Makela, M. Pit and fissure sealants versus
fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents.
Cochrane Database Syst. Rev. 2016
NEED TO SEAL : PORTAL OF CARIES ENTRANCE
PIT AND FISSURE SEALANTS
8

Pit and fissure sealants
Simonsen RJ, Neal RC. A review of the clinical application and performance of pit and fissure
sealants. Aust Dent J. 2011;56(1 Suppl):45–58.
Material that is introduced into the occlusal pits and fissures of caries-
susceptible teeth, thus forming a micromechanically bonded,
protective layer, cutting access of caries-producing bacteria from their
source of nutrients.
According to Simonsen RJ
10
“A fissure sealant is a material that is placed in the pits and fissures of
teeth in order to prevent or arrest the development of dental caries”.
According to WELBURY

Pits and fissures of tooth ??
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PITS: Ash and Nelson
• Small pinpoint depressions located at the junction of developmental
grooves or at terminals of those grooves.
FISSURE: Orbans
• Deep clefts between adjoining cusps.
• These defects occur on occlusal surfaces of the molars and premolars,
with tortuous configurations that are difficult to assess from the
surfaces.
12

Tooth development : at the end of the fifth week I.U
Primary Epithelial Band and ectomesenchyme below
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Ectoderm (oral epithelial cells)
Ectomesenchymal cells (connective tissue)
Tooth development is a complex and continuing interplay of ectodermal epithelial cells
derived from the first pharyngeal arch and the ectomesenchyme of the neural crest
Reciprocal induction
DENTAL LAMINA
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DEVELOPMENTAL STAGES
MORPHOLOGICAL
1. Dental lamina
2. Bud stage
3. Cap stage
4. Early bell stage
5. Advanced bell stage
6. Formation of enamel
and dentin matrix
PHYSIOLOGICAL
Initiation
Proliferation
Morphodifferentiation
Histodifferentiation
Apposition
15

TOOTH
GERM
Bud shape
Enamel
organ
Dental
Papilla
Bud stage at 8 Week of IU life
16

Bud stage Cap stage
Outer enamel epithelium
Inner enamel epithelium
Dental papilla
Dental Sac/follicle
Stellate reticulum
17

Significance of bell
stage
Morphodifferentiation Histodifferentiation
Tooth crown assumes its final
shape
Cells that will be making the hard
tissue of the crown (ameloblasts,
odontoblasts) aquire their distinctive
phenotype
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Bell stage
Advanced or late bell stage: which
begins by formation of the first layer
of dentin.
Early bell stage:
before any hard tissue formation
Epithelial cells of the enamel organ differentiate into ameloblasts producing enamel
Crown formation pattern
19

How details of crown
(cusps/fissures ) formed ???
Crown formation pattern
What makes variations in the anatomy ???
Patterning of the dentition.
Gene play
Signalling molecules
and growth factors
Odontogenic
homeobox theory
controls tooth morphology defines the future tooth shape,
including crown with their cusps, ridges, and fissures
FIELD theory CLONE theory
Tucker AS. Molecular genetics of tooth morphogenesis and patterning: the right shape in the right place. J Dent Res..
20

TOOTH CUSPS AND FISSURES DEVELOPMENT
ENAMEL KNOT – A SIGNALLING
CENTRE FOR ENAMEL DEVELOPMENT
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Enamel knot and cord
• A condensation of ectodermal cells (nondividing
epithelial cells) in the central region of the inner
enamel epithelium
• It extends towards the outer enamel epithelium
forming a strand of cells (Enamel cord).
• They are both transient structures
• They have a role in determining the cusp,
PITS AND FISSURE position in molars and
premolars.
Enamel cord
Enamel knot
Organizational centre for
cuspal morphogenesis22

.
Enamel knots are the signalling centers of the developing enamel and
therefore define the anatomy of the cusps
Teeth with at least two cusps have fissures,
including deciduous molars, permanent premolars, and molars.
The distance of the signalling centers affects the enamel thickness
of the cusps and defines the morphology of the fissures
Deep fissures are formed if the
signaling centers lie far apart and
fusion of the cusps occurs late
Bekes K. et al. The Morphology of Pits and Fissures Springer International Publishing Switzerland 2018
23

Bekes K. et al. The Morphology of Pits and Fissures Springer International Publishing Switzerland 2018
24

• A pit is a small, deep well originating on the lingual, occlusal, or buccal
surface of both maxillary and mandibular molars
• Pits occur where several developmental lines converge.
• It is usually situated at the junction of developmental grooves or at
terminals of these grooves
25

The Morphology of Pits and Fissures
26

Two upper first molars showing variations
in the number of cusps, fissure patterns
27

Two lower first molars showing variations in the
number of cusps, fissure patterns
28

• The first knowledge of pit and fissure morphology was based on
examinations of serial ground sections of human teeth
Nagano T. Relation between the form of pit and
fissure and the primary lesion of caries. Shikwa
Gakuho. 1960;60:80.
Gillings B, Buonocore M. Thickness of enamel at the
base of pits and fissures in human molars and
bicuspids. J Dent Res. 1961;40:119–33.
• Nagano classified the shapes of occlusal fissures into five types on the
basis of the anatomical form
29

• V-type, wide at the top and
gradually narrowing
toward the bottom.
• V-type occurred in 34%
1.
30

• U-type, almost the same
with from top to bottom.
• In Nagano’s study, U-type
occurred in 14%
2.
31

• I-type, an extremely
narrow slit
• In Nagano’s study, I-type
occurred in 1%
3.
32

• IK-type, an extremely
narrow slit associated with
a large space at the bottom.
• In Nagano’s study, IK-type
occurred in 26%
4.
33

Cvikl B. et al. Pit and Fissure Sealants—A Comprehensive Review Dent. J. 2018, 6, 18
34

5. OTHERS
Morphological variants not classifiable after system of Nagano
In Nagano’s study other types occurred in 7%.
35

• A micro-CT scan of a
mandibular wisdom tooth.
• The course and the depth of
the pits and fissure are
marked blue.
• A lesion can be seen localized
in the lower part of one
fissure
The high-resolution microcomputed tomography technique has proven to be useful as a non-destructive
method to precisely visualize the external and internal anatomy of teeth, showing the finest details.
36

Nagano classification
made visible by
microcomputed
tomography
37

The Morphology of Pits and
Fissures and Sealant Success
38

Selecman JB, Owens BM, Johnson WW. Effect of preparation technique, fissure morphology, and material characteristics
on the in vitro margin permeability and penetrability of pit and fissure sealants. Pediatr Dent. 2007;29(4):308–14
According to Selecman et al.
• Fissure morphology was not a significant factor regarding microleakage,
whereas morphology did have a significant impact on sealant
penetrability with U-type fissures displaying the greatest values.
39

Iyer RR, Gopalakrishnapillai AC, Kalantharakath T. Comparisons of in vitro penetration and
adaptation of moisture tolerant resin sealant and conventional resin sealant in different fissure types.
Chin J Dent Res. 2013;16(2):127–36.
According to Iyer RR et al.
• Fissure morphology significantly affected adaptation of sealant than it’s
penetration
• U-shaped fissures showed the highest mean percentage of adaptation
and penetration
• The narrower the fissure, the poorer the penetration
40

Contents of Pits and Fissures
41

According to Galil and Gwinnett
• Histology of fissures in human unerupted teeth
• Three-dimensional replicas of pits and fissures in human teeth: scanning electron
microscopy study
• The contents of fissures consist mainly of ameloblasts lining the wall of the
fissures, remnants of cells constituting the enamel organs, and red blood
cells.
• In the middle regions, bacteria are more abundant, while in deeper parts at
the bottom of the fissures, amorphous masses of material predominate, and
stronger mineralization has taken place.
• Bacteria appear to become calcified deeper down in the fissure
42

• organic mass : colored blue
An organic mineralization spots are visible in middle and
bottom portions, colored in light pink.
43

Such contents of pits and fissures
significantly influence the effectiveness of
certain caries prevention procedures.
Pit and fissure sealants : most effective method
44

Willoughby Miller, 1905
The first attempt to prevent occlusal caries by applying silver nitrate on tooth surfaces
chemically treating the biofilm with its antibacterial functions against the caries pathogens.
Hyatt, 1921
• Prophylactic odontotomy of pits and fissures
by creating Class 1 cavity preparations of
teeth that were considered at risk of
developing occlusal caries.
• This technique made pit and fissures wider
which were filled, later by amalgam, in order
to prevent occlusal caries.
Prophylactic
Odontomy
Zero DT. How the introduction of the acid-etch technique
revolutionized dental practice. J Am Dent Assoc.
2013;144(9):990–4.
Avinash J, Marya CM, Dhingra S, Gupta P, Kataria S,
Meenu Bhatia HP. Pit and fissure sealants: an unused caries
prevention tool. J Oral Health Commun Dent. 2010;4:1–6.
46

• Other chemical substances were also used to prevent occlusal caries such as
zinc chloride, but without success.
• Less than 10 years later, Large Round Bur was used to smooth out the
fissures without any filling material since it was believed that this mechanical
procedure would be capable to prevent the bacterial colonization in these areas.
• Then these fissures were filled up with dental cement, such as oxyphosphate
cement.
• Gore, 1939 : use of polymers
• All these techniques and products, which have been used until then, were not
successful in the caries prevention.
Zero DT. How the introduction of the acid-etch technique
revolutionized dental practice. J Am Dent Assoc.
2013;144(9):990–4.
Avinash J, Marya CM, Dhingra S, Gupta P, Kataria S,
Meenu Bhatia HP. Pit and fissure sealants: an unused caries
prevention tool. J Oral Health Commun Dent. 2010;4:1–6.
47

Buonocore, 1955
• Acid-etch technique, after treatment of enamel with
concentrated phosphoric acid solutions, attachment of
acrylic resin to tooth was greatly increased.
Cueto and Buonocore, 1965
• Used 50% phosphoric acid with 7% zinc oxide, mixture of methyl
cyanoacrylate with silicone cement, as sealant material.
• The results showed that the retention was 71% after 1 year, while the reduction
of caries reached 87%
Cueto EI, Buonocore MG. Sealing of pits and fissures with an adhesive
resin: its use in caries prevention. J Am Dent Assoc. 1967;75(1):121–8.
48

Methyl cyanoacrylate viscous resin bis-GMA
(Methyl methacrylate)
susceptible to bacterial breakdown The new material had smaller thermal
expansion coefficient, produced less heat
during polymerization, and was harder
than the methyl cyanoacrylate
bisGMA : formed the basis for the development of several resin-based sealants
and composites available today.
Chemical
cure UV cureRodyhouse, 1968
Buonocore 1970
Buonocore M. Adhesive sealing of pits and fissures for
caries prevention, with use of ultraviolet light. J Am Dent
Assoc. 1970;80(2):324–30
49

First pit and fissure sealant developed and
commercially introduced by LD CAULK Company.
In 1971,
In 1974, Glass ionomer PFS were introduced by McLean and Wilson
50

CLASSIFICATION
Pit and Fissure sealants
51

• Pit and Fissure sealants are classified as follow :
1) According to the chemical structures of monomers used.
2) Based on generations.
3) Based on filler content.
4) Based on colour.
5) Based on curing.
52

1) According to the chemical structures of monomers used:
• Methyl Methacrylate (MMA).
• Triethylene glycol dimethacrylate (TEGDM).
• Bis phenol dimethacrylate (BPD).
• Bis-GMA
• Propyl methacrylate urethane (PMA).
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2) Based on Generations :
1ST GENERATION 2ND GENERATION 3RD GENERATION 4TH GENERATION
Polymerized with UV
Light with wavelength
of 356 μm.
Self cure or chemical cure
resins
Light cured with
visible (blue) light of
430-490 μm.
Fluoride releasing
sealants.
Had incomplete
polymerization of
sealant at its depth.
Based on accelerator catalyst
system
Nuva-lite
(Caulk/Dentsply)
Concise White (3M) Helioseal Seal right (Pulpdent)
5TH generation:
• GIC as pit and fissure sealants
• Sealants with bonding agents
6TH generation:
• Self-etching light cured sealants
Norman O.Harris. Primary preventive dentistry, 2014; 8th edition;, pg:273-283
54

3) Based on filler content:
• Unfilled: Better flow and more retention but, abrade rapidly.
• Filled : Resistance to wear but, may need occlusal adjustments
4) Based on appearance or colour:
Transparent Opaque
• Clear, pink or Amber coloured
• Colour changes during or after polymerisation
• Tooth coloured or white
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Types of sealants:
1. Glass ionomer cement sealants
2. Sealants with bonding agents
3. Self-etching light cured sealants
4. Fluoride releasing sealants
5. Moisture-resistant sealants
6. Colored versus clear sealants
Norman O.Harris. Primary preventive dentistry, 2014; 8th edition;, pg:273-283
56

58
According to Priscilla S. et al(2016)
conducted a study Pit and Fissure Sealants with Different Materials: Resin
Based vs Glass Ionomer Cement.
Both the sealants, Fluroshield (Dentsply) and Clinpro TM Varnish®
XT(GIC) were effective in preventing caries lesion within 6 months,
although Fluroshield sealant showed better clinical retention.
Priscilla Santana Pinto Goncalves et al. Pit and Fissure Sealants with Different Materials: Resin Based x
Glass Ionomer Cement – Results after Six Months .Brazilian Research in Pediatric Dentistry and
Integrated Clinic 2016, 16(1):15-23

IDEAL REQUISITES OF AN EFFICIENT SEALANT
According to Brauer et al.
1. Viscosity allowing penetration into deep and narrow fissures
2. Adequate working time
3. Rapid cure
4. Good and prolonged adhesion to the enamel
5. Low solubility
6. Resistance to wear
7. Minimum irritation to tissues
8. Cariostatic action
60

Occlusal surfaces of posterior teeth are the most vulnerable
sites due to their anatomy favouring plaque retention
Pits and fissures, permit the entrance of microorganisms and food into this
sheltered warm moist richly provided incubator.
The dental plaque can be expected to form and to be retained here.
Pits and fissures instead provide a sanctuary to those agents, which cause caries
When carbohydrates in food come in contact with the plaque,
acidogenic bacteria in the plaque create acid.
This acid damages the enamel walls of the pits and fissures and caries results
L. Paglia et al. The Role of Pit and Fissure Sealants in the Prevention of Dental Caries
Springer International Publishing Switzerland 2018 K. Bekes (ed.), Pit and Fissure Sealants
61

First evidence of lesion formation occurs at the orifice of the fissure
and is represented by bilateral lesions in enamel on opposite
cuspal inclines
Lesion progresses and depth of fissure wall becomes involved
Two lesions coalesce into one at the base of fissure
The enamel at the base is affected and lesion spreads laterally along
the enamel adjacent to the depth of fissure towards DEJ
Cavitation occurs due to lose of mineral and structural support
from affected enamel and dentin resulting in a clinically detectable lesion
15
62

Sealants were developed to help manage these sites of dental stagnation
forming a hard shield that keeps food and bacteria from getting into the
tiny grooves in the teeth and causing caries.
Fluorides and other caries preventive approaches (e.g., mechanical plaque
control) seem to be less effective for preventing carious lesions in pit and
fissure surfaces compared with smooth surfaces.
Beauchamp J, Caufield PW, Crall JJ, et al. Evidence-based clinical recommendations for the use of
pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs.
JADA. 2008;139(3):257–68
Dental sealants
Primary prevention
Secondary prevention: arrest or inhibit the
progression of carious lesions.
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Splieth C, Förster M, Meyer G. Additional caries protection by sealing permanent first molars compared to
fluoride varnish applications in children with low caries prevalence: a 2-year results. Eur J Paediatr Dent.
;2(3):133–7
According to Splieth C. et al.
Additional caries protection by sealing permanent first molars compared to fluoride
varnish applications in children.
Conclusion :
Fissure sealants yield a significant caries preventive benefit over fluoride varnish
treatment in children with low caries prevalence.
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Hiiri A, Ahovuo-Saloranta A, Nordblad A, Makela M. Pit and fissure sealants versus fluoride
varnishes for preventing dental decay in children and adolescents. Cochrane Database Syst Rev.
2010;3:CD003067. https://doi.org/10.1002/14651858.CD003067.pub3.
According to Hiiri A. et al.
Pit and fissure sealants versus fluoride varnishes for preventing dental decay in children and
adolescents: Cochrane Database Systematic Review
Conclusion :
There was some evidence on the superiority of pit and fissure sealants over fluoride varnish
application in the prevention of occlusal decays.
According to Levy SM. et al.
Pit-and-fissure sealants are more effective than fluoride varnish in caries prevention on occlusal
surfaces.
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Griffin SO, Oong E, Kohn W, Vidakovic B, Gooch BF, CDC Dental Sealant Systematic Review Work
Group, et al. The effectiveness of sealants in managing carious lesions. J Dent Res. 2008;87(2):169–74.
According to Griffin SO. et al.
The effectiveness of sealants in managing carious lesions (Dental Sealant
Systematic Review Work)
Conclusion :
Placement of pit and fissure sealants significantly reduces the percentage of non-
cavitated carious lesions that progress in children, adolescents, and young adults
for as long as 5 years after sealant placement, compared with unsealed.
To Seal vs not to seal ??
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Evidence-based clinical practice guideline (ADA-AAPD)
Recommends the use of sealants, compared with non-use, in primary and
permanent molars with both sound occlusal surfaces and non-cavitated
occlusal carious lesions in children and adolescents.
children and adolescents who receive sealants in sound occlusal surfaces or non-cavitated pit and
fissure carious lesions in their primary or permanent molars (compared with a control without
sealants) experienced a 76% reduction in the risk of developing new carious lesions after 2
years of follow-up.
Even after 7 or more years of follow-up, children and adolescents with sealants had a caries
incidence of 29%, whereas those without sealants had a caries incidence of 74%.
Wright JT, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, Donly K, Hewlett ER, Quinonez RB, Chaffin J,
Crespin M, Iafolla T, Siegal MD, Tampi MP, Graham L, Estrich C, Carrasco-Labra A. Evidence-based clinical
practice guideline for the use of pit-and-fissure sealants. A report of the American Dental Association and
the American Academy of Pediatric Dentistry. J Am Dent Assoc. 2016;147(8):672–682.e12
67

68
Longevity of restorations: the ‘death spiral’. In: Fejerskov O,
EAM K, editors. Dental caries: the disease and its clinical
management. 2nd ed. Oxford: Blackwell Munksgaard; 2008.
p. 444–55.
DEATH SPIRAL
(RESTORATIVE CYCLE

Who Should Get Sealant?
Children : prime target
• Inadequate tooth brushing
• Inadequate oral hygiene practices
• tend to ignore the problem areas in posterior teeth
According to ADA, if adults have certain problem areas that could be cured with
sealants, this could be an option for them too.
The American Dental Association recommends that kids receive dental sealants as
soon as their adult teeth erupt. (According to Disease susceptibility Criteria)
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Age period for sealant placement
The Disease susceptibility of the tooth should be considered when
selecting teeth for sealants not the age of the individual.
IMPORTANCE
• Ages 3 and 4 years most important times for sealing the
eligible deciduous teeth
• Ages 6-7 years most important times for sealing the
first permanent molars
• Ages 11-13 years most important times for sealing the
second permanent molars and
premolars(if need).
American Dental Association
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AAPD GUIDELINES (REVISED 2008)
1. Sealants should be placed into pits and fissures of teeth based upon the patient’s caries
risk, not the patient’s age or time lapsed since tooth eruption.
2. Sealants should be placed on surfaces judged to be at high risk or surfaces that already
exhibit incipient carious lesions to inhibit lesion progression. Follow up care, as with all
dental treatment, is recommended.
3. 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.
4. A low-viscosity hydrophilic material bonding layer, as part of or under the actual sealant, is
recommended for long-term retention and effectiveness.
5. Glass ionomer materials could be used as transitional sealants.
71

First molars to be sealed in a 7-year-old child
73

When: As Soon As Possible?
• The best medical procedure that a health worker can do is prevent a disease, so
that his patients remain healthy.
• Occlusal surfaces of first permanent molars are the most susceptible sites for
the caries in the developing of permanent dentition. In fact, the decay of the pits
and fissures is the fastest and most prevalent, representing over 80% of caries
in permanent teeth in young patients.
• The application of sealants should be recommended to prevent or control caries,
especially at the first stage of eruption.
74

According to National guidelines for oral health promotion and oral
disease control in children:
claim that the sealants are shown to prevent tooth decay with a most
effective when used in the 2 years following the eruption of the tooth, with
the recommendation to control its integrity every 6–12 months
L. Paglia et al. The Role of Pit and Fissure Sealants in the
Prevention of Dental Caries Springer International Publishing
Switzerland 2018 K. Bekes (ed.), Pit and Fissure Sealants
First molars sealed at the early stage of complete eruption
75

• On the contrary, some longer follow-ups report a reduction of the preventive
effect of early sealants application.
• Patient’s age and compliance are important factors.
• Although should be fundamental a proper isolation (using the rubber dam) of the
tooth to be sealed, in many cases it is too difficult, depending on the compliance
of the patient or on his periodontal anatomy that, in the early stage, reveals only
the occlusal surface of the molar, making often impossible to isolate the field as a
standard procedure.
IMPORTANT FACTORS :
Evaluate the effectiveness of sealants
must consider their efficiency
in the different contexts in which they are applied
Tikhonova S. Sealing pits and fissures of permanent molars in children and adolescents is effective in controlling
dental caries. J Am Dent Assoc. 2015;146(6):409–11. https://doi. org/10.1016/j.adaj.2015.01.023.
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Perform an early application of fluoride varnishes,
as a preliminary surface treatment, waiting for
better conditions to seal pits and fissures
First molar during first stage of
eruption to be treated
In other cases glass ionomer cements can be used as
transitional sealant materials on the surfaces of
teeth considered at high risk of caries development
Use of ozone (O3) seems to be effective to reduce or eliminate bacterial contamination
not only of the occlusal surface but also of the deepest part of the fissures, either waiting
better conditions to do sealings, in association with fluoride varnishes, or just before the
application of sealants.
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• Incipient caries: In cases of incipient caries, ozone can kill bacteria in the demineralized
part and this demineralized tooth structure then can be remineralized.
• Huth et al. conclude that a single 40-second application of ozone gas on non-cavitated
ssure caries in permanent molars showed reduced caries progression when compared to
the untreated control lesions.
• Pit and fissure caries: Deep pits and ssures which are not self cleansable are likely to
cause food lodgement resulting in bacterial growth. Ozone application in such cases has
been found to be highly effective. After the ozone treatment, application of
remineralizing agent and sealing of the clean ssures is encouraged.
Manoharan V. Et al. Dental ozone - a revolution in pediatric dentistry, International journal of scientific
research Volume-7 | Issue-2 | february-2018 | ISSN no 2277 - 8179 | IF : 4.176 | IC value : 93.98
According to Manoharan V. et al.
Dental ozone - a revolution in pediatric dentistry
78

Which: Resin-Based or Glass Ionomer Cement?
• Fissure sealing with a resin-based sealant is considered effective to arrest the progression
of non-cavitated occlusal dentinal caries.
• Resin-based sealants have the disadvantage in that they require an optimal level of
moisture control during placement.
• In children glass ionomer ART (atraumatic restorative treatment) sealants, which are
more moisture tolerant, can offer a viable alternative.
• In fact, during the eruptive phase of the permanent molars, in addition to a proper oral
hygiene and professional fluoride applications, glass ionomer sealants can be applied,
because it could be difficult in this stage to use resin-based sealants,
79

• GIC sealants, although less retentive than those resin-
based, they provide a slow release of fluoride when
cured and not only on the molar surface but also when
much of the sealant is lost and remain only residual parts
at the bottom of the fissures, offering an obstacle to the
possible formation of secondary caries.
• Differently, a partial loss of the resin-based sealant
material leads to the occurrence of marginal leakage and,
hence, to caries development underneath the sealant
• Act as a reservoir of fluoride, as they can absorb it from
toothpastes, mouthwashes, gels, and varnishes.
Partial loss of the
resin-based sealant material
with underlying caries
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• Glass ionomer sealants may also be employed in very young child, with difficult
cooperation and poor control of saliva at the time of their application.(excellent
transitional sealant )
Particular attention must be given to the use of resin-modified glass ionomer
cement, especially those light curing, that consents ease and speed of application, as for
the conservative procedures in the primary teeth.
• better mechanical properties and reduce the solubility after mixing
• create a hybrid layer with the dental tissues and a lower solubility in the mouth
environment
81

Caries diagnosis : An Important
aspect of sealant application
82

• The detection of occlusal lesions is difficult because of the morphology of
molars and premolars.
• Deep fissures are often plugged with organic material that can be stained
over time or that can promote the beginning of the caries process.
• Deep fissures also often hamper direct sight of an existing incipient caries
lesion that might therefore be detected at a relatively advanced stage (beyond the
stage of sealing it. )
• visual-tactile caries detection is the first and most important method to detect
and diagnose occlusal caries lesions
Caries diagnosis
83

• It should be noted that using a sharp-ended explorer to test a fissure in
its resistance to withdrawal (“stickiness”) must be discouraged.
• First, it does not provide any benefit over meticulous visual examination
of a dry tooth and does not increase sensitivity or specificity.
• Second, probing has been shown to irreversibly damage the tooth
surface, to potentially turn a remineralizable subsurface lesion into a
frankly cavitated lesion, and to thus promote lesion progression.
• Both the WHO and ICDAS recommend using a round-ended periodontal
probe for caries detection.
NO : sharp-ended explorer
Topping GV, Pitts NB, International Caries D, Assessment System C. Clinical
visual caries detection. Monogr Oral Sci. 2009;21:15–41.
84

A fissure with enamel caries is brittle and should not be probed
forcefully because the surface can be irreversibly damaged
85

Nyvad criteria
Clinical visual caries detection systems
ICDAS system
UniViSS system
CAST (Caries Assessment Spectrum
and Treatment) index
ICDAS system ------------ sealant application
preventive as well as non-invasive treatment
of non-cavitated pit and fissure caries.
86

CODE
0 Sound
1 First visual change in enamel (seen only
after prolonged air drying or restricted to
Within the confines of a pit or fissure)
2 Distinct visual change in enamel
3 Localized enamel breakdown (without
clinical visual signs of dentinal
involvement
4 Underlying dark shadow from dentin
5 Distinct cavity with visible dentin
6 Extensive distinct cavity with visible
dentin
87

ICDAS codes and criteria for treatment of fissures with example photographs
88

89
Barbara Cvikl et al. Pit and Fissure Sealants—A Comprehensive Review

• The idea of this noninvasive intervention is to arrest caries progression which will
result in the maintenance of a maximum amount of tooth structure since operative
procedures are delayed and minimized.
• This procedure seems to be highly advantageous in pediatric dentistry
• It may replace the conventional restorative approach and can be performed with a
shorter chair time and without the need for anesthesia.
Noninvasive Treatment of Non-cavitated Pit and Fissure Caries
MECHANISM : Since the biofilm is starved of its nutritional supply, the
progression and growth of the carious lesion is inhibited
90

Permanent Versus Primary Teeth
Noninvasive Treatment of Non-cavitated Pit and Fissure Caries
According to Borges et al.,
compared the efficacy of sealing the pits and fissures using a resin-based material to that
of traditional tooth restorations when treating non-cavitated dentin caries lesions in
primary molars.
• Analysis of the clinical and radiographic efficacy of the treatment showed no difference
between the groups.
• Fissure sealing and tooth restoration were equally effective.
• The authors concluded that invasive procedures can be replaced with the noninvasive
approach with no adverse consequences for pediatric patients.
fissure sealing seems to be effective not only in prevention of caries but also in the
arresting of pre-existing occlusal carious lesions as long as no cavitations exist
91

Procedure of pit and fissure
sealant placement
92

• A Cochrane review found that sealants placed on the occlusal surfaces of permanent molars in
children and adolescents reduced caries up to 48 months when compared to the no sealant
control.
• According to a meta-analysis of 24 studies, the overall effectiveness of auto polymerized fissure
sealants in preventing dental decay was 71%
Llodra JC, Bravo M, Delgado-Rodriguez M, Baca P, Galvez R.
Factors influencing the effectiveness of sealants: a meta-
analysis. Community Dent Oral Epidemiol.;21(5):261–8.
Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A,
Makela M, et al. Sealants for preventing dental decay in the
permanent teeth. Cochrane Database Syst Rev.2013;(3):CD001830
The protection afforded by this layer is reduced or lost when the marginal seal between the
tooth and the sealant is compromised.
Success with dental sealants is very dependent on the correct application protocol.
The application, while inherently simple, is very technique-sensitive,
requiring attention to detail at all stages
93

Cleaning of the Tooth Surface
• The tooth surface must be thoroughly
cleaned in order to remove adherent
plaque and debris as much as possible
prior to the placement of the sealant.
• Cleaning can be accomplished in different
ways.
• Traditionally, it has been suggested to
clean the tooth with pumice and a
prophylaxis cup or bristle brush
Wells M. Pit and fissure sealants: scientific and clinical rationale. In:
Casamassimo PS, Fields Jr HW, McTigue DJ, Nowak A, editors. Pediatric
dentistry: infancy through adolescence. Oxford: Elsevier; 2012. p. 638
94

Gray SK, Griffin SO, Malvitz DM, Gooch BF. A comparison of the effects of tooth brushing and handpiece prophylaxis on
retention of sealants. J Am Dent Assoc. 2009;140(1):38–46.
Toothbrush prophylaxis
Handpiece prophylaxis
Air abrasion (NEW : Bio-glass air abrasion )
Enameloplasty
Different techniques of
surface preparation
Lack of “deep cleaning” of narrow fissures when using brushes
95

According to MAZZOLENI S. et al.
Comparative evaluation of different techniques of
surface preparation for occlusal sealing.
• mechanical brushing,
• air abrasion and
• Intensive bur FG 40D4
No microleakage in samples treated with air abrasion,
followed by the samples treated with mechanical
brushing. The teeth prepared by bur treatment before
sealant application show a significant number and
degree of marginal infiltration.
It can be concluded that air abrasion technique is able
to guarantee a reliable seal of occlusal surfaces
Air abrasion, showing NO microleakage
Note the absence of dye penetration at
the sealant/tooth interface (arrow)
Treated with bur, showing microleakage
Note the dye penetration at the
sealant/tooth interface (arrow)
96

While air polishing resulted in reduced micro-leakage in in vitro experiments, a clinical
study showed no improvement in the retention rate using this procedure
Bevilacqua L, Cadenaro M, Sossi A, Biasotto M, Di Lenarda R. Influence of air abrasion and
etching on enamel and adaptation of a dental sealant. Eur J Paediatr Dent. 2007;8(1):25–30.
Bagheri M et al. 2017
An in vitro investigation of pre-treatment effects before fissure sealing.
Bioglass air-abrasion improved enamel etchability and reduced microleakage irrespective
of the adhesive use but neither pre-treatment affected the microtensile bond strength.
In summary, the best method of cleaning cannot be defined from the literature. From current
point of view, the cleaning of the teeth with a bristle brush with or without the use of a
prophylaxis paste can be seen as the routine procedure since it has been used in a large number
of available clinical studies because of its simple, fast, and child-friendly practicability.
Bagheri M, Pilecki P, Sauro S, Sherriff M, Watson TF, Hosey MT. An in vitro investigation of pre-
treatment effects before fissure sealing. Int J Paediatr Dent. 2017
97

• It is important that the pumice mixture contain no oil or fluoride
• Fluoride renders the outer layer of enamel more resistant to demineralization or
acid etching, fluoride treatment if indicated should be accomplished after the
sealant is placed, not before.
• After the surfaces to be sealed have been cleaned thoroughly, they are
washed well for 10-15 seconds and dried well for 10-15 seconds.
98

Isolation
• Most critical issue in the proper placement of sealants.
• If the enamel porosity created by the etching procedure is filled by any kind
of liquid other than the adhesive primer, the formation of resin tags in the
enamel will be blocked or reduced, and the resin will be poorly retained.
• Salivary contamination, during and after acid etching, also allows the
precipitation of glycoproteins onto the enamel surface, greatly decreasing
bond strength to the fissure sealant.
• Sealant loss and immediate failure of retention are most often linked to
moisture or salivary contamination.
Silverstone LM. State of the art on sealant research and priorities for
further research. J Dent Educ. 1984;48(2 Suppl):107–18.
99

Basic methods:
(1) Rubber dam
(2) Cotton roll holders, cotton rolls.
(3) Dry field pads, dry field kits.
Eidelman E, Fuks AB, Chosack A. The retention of fissure sealants: rubber dam
or cotton rolls in a private practice. ASDC J Dent Child.;50(4):259–61.
Straffon LH, Dennison JB, More FG. Three-year evaluation of sealant: effect of
isolation on efficacy. J Am Dent Assoc.;110(5):714–7.
The results indicated no difference in retention was found between the two methods of
isolation for autopolymerized sealants after 24 months when performed appropriately.
100

AAPD — May 22, 2015 : Isolite devices
101

102
Acid Etching
Buonocore, 1955
• First to reveal the adhesion of acrylic resin to acid etched enamel.
• used 85 percent phosphoric acid for 60 seconds for enamel etching
Silverstone revealed that the optimum concentration of phosphoric acid
should range between 30 to 40 percent to get a satisfactory adhesion to
the enamel.

103
• If the concentration is greater than 50 percent:
Monocalcium phosphate monohydrate may get
precipitated
• If the Concentrations lower than 30 percent:
Dicalcium phosphate monohydrate may get
precipitated
Interferes with adhesion
Can be easily rinsed off
Silverstone et al found that the application of 30-40% phosphoric
acid resulted in retentive enamel surfaces.
Presently a 37% concentration of phosphoric acid is preferred

104
• An etching time of 60 seconds originally was recommended for
permanent enamel using 30-40% phosphoric acid.
• Currently, an etching time of 15 seconds is used.
• However , studies show that a 15 second etch resulted in a similar
surface roughness as that provided by a 60 second etch.
ETCH TIME

Tandon S et al have proposed an etching time of 15 sec to be sufficient for primary
teeth.
Duggal et al. have used different etching timing of 15, 30, 45, 60 secs and concluded
that there is no difference in retention of sealant using different etching time.
But the most accepted times and the currently applicable times were given in IADR
Sealant Symposium.
STEP PRIMARY TOOTH PERMANENT
TOOTH
Acid Etch 30 seconds 20 seconds
Wash 30 seconds 30 seconds
Dry 15 seconds 15 seconds
105

106
• In the early 1970s, it was believed that, due to the “prismless” nature of
primary enamel, it would require double the etching time of permanent
enamel, and this became the standard clinical procedure.
• Primary enamel has been described as “prismless” by Gwinnett, 1973 .
• However, there is no evidence of prismless enamel (which would require
a longer etching time) on occlusal surfaces (it is mostly found in cervical
regions.
• Despite this, early recommendations for etching primary enamel were
twice then accepted time for permanent enamel (120 seconds vs 60
seconds).(Silverstone and Dogon 1976).
Primary teeth consideration

107
Increased etching time for deciduous teeth is attributed to various
reasons like:
• Deciduous teeth have more organic material in the enamel
• The prism rods in deciduous teeth approach the surface at a greater
angle and thus are more difficult to etch
Kodaka T, Kuroiwa H, Higashi S. Structural and distribution patterns of surface
prismless enamel in human permanent teeth. Caries Research

108
• Simonsen et al. ,The first report comparing the retention on primary
molars of the 120-second etching time vs 60 seconds showed no difference
in sealant retention.
• “Decreasing the etch time for primary molars has been found to decrease
the chance of contamination, during etching. Additionally , the shorter etch
time was far more acceptable to 3- and 4-year-old children.”
The most accepted times were given in IADR sealant symposium in 1991:
Primary teeth 30 secs.
Permanent teeth 20 secs.
Kodaka T, Kuroiwa H, Higashi S. Structural and distribution patterns of surface

110
Effect of acid on enamel surface
1. A shallow layer of enamel approx.. 10 um deep is removed by etching thus
plaque and surface as well as subsurface pellicle are removed effectively from
the site. In addition, chemically inert crystals in enamel surface are also
removed favouring attempts at chemical union between hard tissue and resin.
2. After removal of surface layer by etching the remaining surface is rendered
porous by acid solution.
3. It is into this porous region the resin is penetrated and micromechanical-
chemical bond occurs.

Types of etching pattern
• Silverstone identified 3 basic patterns of etching:
Type 1: (prism centers/core)
• Generalised roughening of enamel
surface, but with distinct hollowing of
prism centers and relatively intact
peripheral regions
• Average diameter of hollowed region is
3 um
• Most common pattern.
111

Type 2: Prism peripheries
• Prism peripheries appear
to be removed or heavily
damaged.
• Prism cores are left
projecting towards original
enamel surface.
Type I etching pattern, (b)Type II etching pattern, JOS
112

113
Type 3:
• Show neither type 1 or 2 etching pattern but
appear as generalised surface roughening.
• Surface topography can’t be related to prism
pattern.

116
• Clinically a uniform dull appearance (frosty) is an indication that the
tooth surface has been adequately etched.
• Silverstone in 1974 showed that etched enamel surface under polarized
light resulted in 3 zones.
• 1. Etched Zone
• 2. Qualitative Zone
• 3. Quantitative Zone

118
Rinsing and Drying
• After etching, the surface needs to be rinsed with air-water spray and high-volume
suction.
• The aim of rinsing is to remove all of the etchant from the tooth surface. Most
manufacturers recommend a rinsing time of 20–30 s
• 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.
•
• Afterward, the tooth must be thoroughly dried, and a chalky white surface should
become visible.
• From this point, it is extremely important to avoid salivary contamination. If the tooth
surface is contaminated by saliva, it will be necessary to repeat the etching process.

119
Sealant Placement
• All the susceptible pits and fissures should be sealed for maximum caries protection.
This includes lingual grooves of maxillary molars and the buccal pits of mandibular
molars.
• The sealant may be applied with a variety of instruments:
1. An explorer tip,
2. A placement instrument,
3. A small brush,
4. The dispenser system offered by various manufacturers, which may consist of a
preloaded syringe with a small tip.
• A minimum amount of sealant to adequately
cover the pit and fissure
• No overfilling.
• No air bubble entrapment

120
For Autopolymerized Resin
• This sealant system requires mixing a catalyst and base to form an unfilled BIS-
GMA resin.
Base Catalyst
mixed
15 seconds mixing time
working time for placement is 45 seconds
The polymerization or setting time starts in 60 seconds.
It is critical that the sealant be applied within 60 seconds; otherwise, the polymerization process
will be disturbed and resin bond to enamel may be compromised. Another 60 seconds are
necessary for complete polymerization.
Thus, a total time of 120 seconds is required from start to finish.

121
Light-polymerization System
• If the material has been satisfactory placed on all susceptible surfaces, the
curing light tip should be placed as close as possible to the surface, and
each sealed surface should be polymerized as long as recommended by
the manufacture
Nalcaci A, Ulusoy N, Kucukesmen C. Effect of LED curing modes on the microleakage of a pit and
fissure sealant. Am J Dent. 2007;20(4):255–8.
Nalcaci A. et al. Conventional and LED units, with
sufficient wavelength and intensity, are regarded
equivalent and can both be used.

122
Evaluation and Monitoring
• After polymerization, the operator should visually and tactilely examine the sealant
before removing the isolation materials.
• If bubbles, voids, or areas of deficient material are observed, sealant material can be
directly added at this time because the oxygen-inhibited layer has not been disturbed.
• Sealant retention should be checked with a probe after polymerization to ensure that
all fissures are completely sealed.
• If any material is dislodged, the sealant should be reapplied after recleaning (if
necessary) and re-etching of the exposed fissure.
• If any sealant material is misplaced into some areas, it should be removed and
reapplied.
Wells M. Pit and fissure sealants: scientific and clinical rationale. In: Casamassimo PS, Fields Jr HW, McTigue
DJ, Nowak A, editors. Pediatric dentistry: infancy through adolescence. Oxford: Elsevier; 2012. p. 638.

123
• Finally, occlusion control should be performed using articulating
paper. If necessary, adjustments with composite finishing burs are
possible.
• Besides this, a removal of the superficial non-polymerized oxygen
inhibition layer with a polishing bur is necessary.
• The remineralization of etched, but not sealed, enamel areas is
supported by the local application of a fluoride compound.
• Once applied, sealants need to be monitored.
Griffin SO, Jones K, Gray SK, Malvitz DM, Gooch BF. Exploring four-handed delivery and
retention of resin-based sealants. J Am Dent Assoc. 2008;139(3):281–9. quiz 358

124
Sealed lower molar 1 year after
placement of the fissure sealant
colored with a plaque dye liquid.
Bubbles can be seen within the
sealant

125
Lower left first molar of an 8-year-old girl
with deep pits and fissures
Application of 37% phosphoric acid for etching the
enamel surface with rubber dam isolation

126
Application of a fissure sealant with smart color-
change technology to see placement
Polymerization of the fissure sealant

127
Sealed lower first molar immediately after placement
before and after the removal of the rubber dam
Control of occlusion

129
One approach to increase the retention of sealant, application of an adhesive
system as an enamel bonding layer beneath the sealant is suggested.
Adhesive system??
Since control of moisture in the oral cavity is difficult to achieve, a
modification of the classic sealant application technique was first proposed
by Hitt and Feigal in 1992 with the use of a bonding layer between the
etched enamel and the sealant.
• An improved bond strength of etched enamel to sealant in the presence
of moisture or salivary contamination was observed.

130
• An intermediate bonding layer is applied between enamel and sealant
showing increased bond strength, reduced microleakage, and
enhanced flow of resins into fissures.
Fritz UB, Finger WJ, Stean H. Salivary contamination during bonding procedures
with a one-bottle adhesive system. Quintessence Int. ;29(9):567–72
Symons AL, Chu CY, Meyers IA. The effect of fissure morphology and pretreatment
of the enamel surface on penetration and adhesion of fissure sealants. J Oral Rehabil.
;23(12):791–8

131
ETCH-AND-RINSE
ADHESIVES
conditioner
conditioner
primer
primer
adhesive resin
adhesive resin
THREESTEPTWOSTEP
SELF-ETCHADHESIVES
ONESTEPTWOSTEP
self-etching primer adhesive resin
self-etching adhesive
2 components
or
1 component
Bagherian A. et al. Adhesive systems under
fissure sealants: yes or no?: a systematic review
and meta-analysis. J Am Dent Assoc.
2016;147(6):446–56.
Bagherian A, Sarraf Shirazi A, Sadeghi R. Adhesive systems
under fissure sealants: yes or no?: a systematic review and
meta-analysis. J Am Dent Assoc. 2016;147(6):446–56.
• An enamel bonding interface below fissure
sealants have a significant positive effect
on retention rates and consequently are
beneficial in preventing caries, which is
the ultimate goal of fissure sealant therapy
• when adhesive systems are used with
fissure sealants, etch-and-rinse systems
appear to be preferable. Self etch adhesives
are not beneficial.

132
Laser : In pit and fissure sealant Technique
• Replace mechanical drilling
• As a tool for ENAMEL pre-treatment
• Surface conditioning in pit and fissure sealing
Pires PT, Ferreira JC, Oliveira SA, Azevedo AF, Dias WR, Melo PR. Shear bond strength and SEM morphology evaluation of
different dental adhesives to enamel prepared with ER:YAG laser. Contemp Clin Dent. 2013;4(1):20–6
• enamel surfaces prepared by erbium lasers
demonstrated a similar etching pattern to those of
acid etching.

133
Now a days lasers are used for curing due to the following advantages :
• Reduction in setting time.
• Control of specific radiation energy wavelengths.
• Control of area of exposure.
• Decrease in percentage of unpolymerized resin

ALTERNATIVE Procedure of pit
and fissure sealant placement
134

135
PREVENTIVE RESIN RESTORATION (PRR)
• A PRR is a conservative treatment that involves limited excavation to
remove the carious tissue , restoration of the excavated area with a
composite resin , and application of a sealant over the surface of the
restoration and remaining, sound, contiguous pits and fissures. (Ripa et al
1992)
• Also called as sealed composite resin restoration (CRR)
• First reported by Simonsen and Stallard (1978)
• Therapeutic Fissure Sealing (NEW)

139
Diagnostic criteria for PRR/CRR/ THERAPEUTIC SEALALING

140
ADVANTAGES :
• Conservation of Tooth Structure
• Aesthetics
• Ease and speed of placement
According to Thylstrup and Fejerskov
• PRR are an extension of the sealant technique that allow for caries control with minimal
loss of tooth structure.
• This method is indicated where caries within a fissure has just reached the dentine.
• Under ideal circumstances the fissure sealants can successfully prevent progression of
caries

141
According to walker et al.
• PRR placed in children of 6 to 18 yrs age group and observed for up to
6.5 years showed that out of 5185 PRR 83% teeth did not require
further intervention and caries progression was successfully controlled
by PRR.
• PROVEN LONG TERM EFFECTIVENESS.

143
Therapeutic fissure sealing

Recent advances in pit and
fissure sealant PRODUCTS
144

145
Recent advances in pit and fissure sealant PRODUCTS
• Pit and Fissure Sealant with ACP. (Amorphous calcium phosphate
sealant )
Eg: Bosworth Aegis pit and fissure sealants
Releases calcium and phosphate ions
when the pH drops to 5.9
Neutralize the acid and buffer the pH
ACP acts as reinforcement to the tooth’s natural
defence system only when it is needed.

146
According to Feda I. et al (2016)
Conducted an in-vitro study on 75
extracted non-carious third molars
sealaed with resin-based sealant
(Concise™), ACP-containing sealant
(Aegis®) or fluoride-containing sealant
(Conseal- F™).
The results showed that, The ACP-
containing pit and fissure sealant has the
potential to inhibit enamel
demineralization.
Feda I. et al. Ability of pit and fissure sealant-
containing amorphous calcium phosphate to inhibit
enamel demineralization. Int J Clin Pediatr Dent
2016;9(1):10-14.

Clear Pit and Fissure Sealant
• This type of sealant is esthetic.
• Difficult to detect in recall visits.
Helicoseal
(changes from green to white)
Colored Pit and Fissure Sealant
Clinpro ( Changes to pink after setting)
147

Fluorescing Pit and Fissure Sealant
• This sealant eliminates the guesswork involved with placing sealants and
confirming placement during recall appointments.
Eg- Delton Seal-N-Glo (Dentsply)
• The fluorescent glow provides clinicians
with a visual verification of the sealant
margins at the time of placement and
offers the easiest way to verify retention
and inspect margins during patient
recall appointments.
Through the use of a UV pen light,
this sealant fluoresces blue/white colour.
148

149
Moisture tolerant pit & fissure sealants
Eg: Pulpdent Embarce wet bond
Traditional sealents
• Hydrophobic
• They repel water and cannot
be applied where there is
Moisture.
• Bis-GMA is present.
(hydrophobic monomer)
• Filled or un-filled sealants)
Embrace wet bond
• Hydrophilc.
• Embrace is activated by moisture.
• Embrace WetBond contains no bis-GMA and no
bisphenol A.
• It contains fillers (aluminium powder, carbon
fiber, graphite, calcium carbonate, silica)

150
Comparative Evaluation of the Viscosity and Length of Resin Tags of
Conventional and Hydrophilic Pit and Fissure Sealants on Permanent
Molars: An In vitro Study.
• Hydrophilic sealant (UltraSeal XT Hydro) exhibited lower viscosity
and formed resin tag of sufficient length than that of Conventional
sealant which ultimately aided in better retention of the sealant.
• Further, with the newly developed hydrophilic sealant Ultraseal XT
Hydro, it is now possible to go ahead and seal the newly erupted teeth
that were previously left unprotected due to moisture control problems
Prabhakar J. et al Contemp Clin Dent. 2018 Jul-Sep; 9(3): 388–394

151
• Etch- free light cured sealants.
Eg: Beauti Fill sealant
• Pen type handling of sealants.
Eg: Ecuseal (Ecu-PEN is
autoclavable up to 130 °C. It will
withstand 100 autoclave cycles

152
BIOACTIVE PIT AND FISSURE SEALANTS

153
Esterogenicity
• Bisphenol-A (BPA) is the precursor chemical component of bisphenol-a
dimethacrylate (Bis-DMA) and bisphenol-a glycidyl dimethacrylate (Bis-
GMA), which are the most common monomers used in resin composite
restorations and resin-based sealants.
• It is known for its estrogenic property with potential reproductive and
developmental human toxicity.
• It has been reported in a systematic review that high levels of BPA were
found in saliva samples that had been collected immediately or one hour
after resin-based sealant placement. High levels of BPA were also detected in
urine samples.
Kloukos, D.; Pandis, N.; Eliades, T. In vivo bisphenol-a release from dental pit and fissure
sealants: A systematic review. J. Dent. 2013, 41, 659–667.

154
• ADA seal of BPA free sealant in thus important to know by every dental
practitioner.
• Some studies have reported techniques, such as the immediate cleaning of
the sealed surface, or the removal of the oxygen inhibition layer of the
unreacted monomer, which is present on the outer layer of the sealant
surface to reduce the amount of unreacted monomer. This can be done using
a pumice or a rotating rubber cup, to reduce the potential BPA exposure.
Fleisch, A.F.; Sheffield, P.E.; Chinn, C.; Edelstein, B.L.; Landrigan, P.J. Bisphenol
A and related compounds in dental materials. Pediatrics 2010, 126, 760–768.

155
• The use of fissure sealants as a key primary prevention method is well
documented and it is scientifically proved to have good results.
• Sealants act to prevent the growth of bacteria that can lead to dental
caries.
• Although the application of a pit and fissure sealant is a non-invasive and
less time-intensive procedure compared to restorative therapies, it is very
technique sensitive, requiring quality assurance.
• The dental practitioner should be familiar with the application methods of
the pit and fissure sealant. With proper placement and maintenance,
sealants can last for many years.
CONCLUSION

156
REFERENCES
• Mcdonald and Avery, Dentistry for the Child and Adolescent, Elsevier Mosby,
10th Edition.
• Stephen H.Y. Wei, Pediatric Dentistry : Total Patient Care, Lea & Febiger,
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• Casamassimo, Pediatric Dentistry : Infancy Through Adolescence, Elsevier, 5th
Edition; p297-299.
• Soben Peter, Public health dentistry.

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• Rugg-Gunn, A. Dental caries: Strategies to control this preventable disease.
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• Petersen, P.E. The world oral health report 2003: Continuous improvement of
oral health in the 21st century—The approach of the who global oral health
programme. Community Dent. Oral Epidemiol. 2003, 31, 3–23
• Bagramian, R.A.; Garcia-Godoy, F.; Volpe, A.R. The global increase in dental
caries. A pending public health crisis. Am. J. Dent. 2009, 22, 3–8
• Carvalho, J.C. Caries process on occlusal surfaces: Evolving evidence and
understanding. Caries Res. 2014, 48, 339–346

158
• American Dental Association. Center for Evidence-Based Dentistry. ADA
clinical practice guidelines handbook: 2013 update. Chicago: Ill; 2013.
http://ebd.ada.org/~/media/EBD/Files/Α_Clinical_Practice_Guidelines_Handboo
k-2013.ash. Accessed 20 May 2017
• Ahovuo-Saloranta, A.; Forss, H.; Hiiri, A.; Nordblad, A.; Makela, M. Pit and
fissure sealants versus fluoride varnishes for preventing dental decay in the
permanent teeth of children and adolescents. Cochrane Database Syst. Rev. 2016
• Tucker AS. Molecular genetics of tooth morphogenesis and patterning: the right
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