pits and fissure
DESCRIPTION
sealantsTRANSCRIPT
PITS AND FISSURE SEALANTS
MUJTABA NADEEM
BDS 2nd year Roll number 124
Annuit coeptisNovus Ordo Seclorum
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.
WHY PIT & FISSURE ARE SEALANTS NEEDED?
TOOTH MORPHOLOGY Why fissures are
caries susceptible
CLASSIFICATION OF SEALANTS
GENERATIONS OF PITS AND FISSURE SEALANTS
First Generation Ultraviolet Light cured
Second Generation Chemically cured (auto polymerized),
Third Generation Visible Light cure
Fourth Generation Those containing Fluorides
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
B. TYPES OF FISSURE SEALANTS
Filled and Unfilled Light cured and Chemically cured Clear and Tinted
A. TYPE CLASSIFICATION SEALANTS
Plastic Sealants
(Bis-GMA) Bisphenol A-glycidyl methacrylate resins
Urethane-based resin
Sealant of choice
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.
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.
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
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
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
CURING UNITS
Conventional cure light with halogen bulb = 20 seconds cure for each surface
Plasma arc or laser = 5-10 seconds
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.
REQUISITES FOR SEALANTS RETENTION
The tooth surface must have Maximum surface area
Surface area can be increased by tooth conditioners or etchants(30-50%phosphoric acid).
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
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.
APPLICATION PROCEDURE
INDICATIONS
Deep fissures Incomplete or ill formed pits Newly erupted teeth High caries rate Children Molars
CONTRAINDICATIONS
Shallow fissures Well coalesced pits Fluoride rich enamel Low caries rate Occlusal or proximal caries Adults
ACID ETCH Phosphoric acid 35%-40%-
50% Dissolves organic portion of
enamel “micromechanical
retention”
ACID ETCH - CONTINUED Creates more
surface area for better adhesion
ACID ETCH - PRECAUTIONS
Avoid contact with adjacent teeth or soft tissues
Can use mylar strips or matrix bands
DRYING AGENT
Acid etching and Primadry (alcohol based) allows enamel to be easily “wetted”
ACCEPTED SEALANT MATERIALSADA 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
ISOLATE TOOTH/TEETH Rubber dam Cotton rolls Cotton roll holders
DRY TOOTHTest air/water
syringe before applying blast of air
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
APPLY ACID ETCH Etch pit and fissures Extend 1-2 mm
beyond pit and fissures
Avoid cusp tips
ACID ETCH - CONTINUED
Etch longer Deciduous teeth Saliva
contamination Air abrasion or
prophy jet used Highly mineralized
teethDo not use explorer
RINSE TOOTH/TEETH
Use HVE and a/w syringe
Proper – usually 20 seconds rinse
Avoid saliva contamination
Re-isolate
DRY TOOTH/TEETH
Should appear chalky or frosty white if etched
If not, re-etch for another 10 seconds if not contaminated
with saliva
APPLY DRYING AGENT
Use brush tip Apply and leave
for 5 seconds Gently blow air to
dry DON’T RINSE
APPLY BOND AGENT
A bond agent will improve retention
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
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
LIGHT CURE FOR 20 SECONDS – AIR INHIBITION THEORY
Sealant will appear shiny/wet
CHECK SEALED TEETH
Use explorer Tooth should be
smooth but not soft
Re-apply sealant, if necessary(Remove uncured sealant with wet cotton roll)
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)
FAILURE OF SEALANTS
Main cause – moisture contamination
Maxillary and mandibular 2nd molars
Early loss means less retention of the resin