Pits and fissure sealants are materials applied to tooth surfaces to prevent decay by filling pits and grooves where plaque can accumulate. They are needed because the morphology of teeth makes fissures prone to decay, acting as natural food traps. There are several generations of sealants from chemically cured to light cured varieties containing fluoride. Application involves isolating the tooth, etching with acid to increase surface area, rinsing and drying before applying the sealant and curing it with light for 20 seconds. Sealants must be checked periodically as moisture contamination can cause early failure.
4. WHAT ARE PITS AND FISSURE SEALANTS?
Defined as
A material applied to occlusal surfaces of the teeth in
order to obliterate the occlusal fissures and remove
the sheltered environment in which caries may thrive.
9. GENERATIONS OF PITS AND FISSURE
SEALANTS
First Generation
Second Generation
Chemically cured (auto polymerized),
Third Generation
Ultraviolet Light cured
Visible Light cure
Fourth Generation
Those containing Fluorides
10. A. TYPES OF FISSURE SEALANTS
Plastics based Sealants
Polyurethanes
Cyanoacrylates
Bisphenol a glycidyl methacrylae (BIS-GMA)
Resin based Sealants
Glass Ionomer Sealants
Fluoride containing Sealants
11. B. TYPES OF FISSURE SEALANTS
Filled and Unfilled
Light cured and Chemically cured
Clear and Tinted
12. A. TYPE CLASSIFICATION SEALANTS
Plastic Sealants
(Bis-GMA) Bisphenol
A-glycidyl methacrylate
resins
Urethane-based resin
Sealant of choice
13. A. TYPE CLASSIFICATION SEALANTS
Glass Ionomer Cement
Clinical advantage of chemically bonding to
dentine and enamel without the acid-etch
technique.
Less vulnerable to moisture
Fluoride release
Active fissure system
Not for long term.
Exerts a cariostatic effect even after removal of
GIC.
14. B. TYPE CLASSIFICATION SEALANTS
Filled and Unfilled
Addition of fillers make the sealants more resistant
to abrasion.
Fillers are coated with products such as silane, to
facilitate combination with the BIS-GMA plastic.
15. TYPES OF CURING FOR SEALANTS
Chemical cured – “Autopolymerization”
Base and catalyst
Monomer & Initiator + Diluted monomer & 5%
Organic Amine Accelerator = Sealant
Visible light cured – “photopolymerization”
Pre-mixed
Dimethacrylate + Diluent + Activator + Light =
Sealant
16. CHEMICAL CURE SEALANT MATERIALS
Advantages
No cure light or risk of eye damage
Can apply sealants to several teeth
Disadvantages
Variation in setting time (appx 2 min)
Voids from mixing material
Changes in viscosity over time
17. LIGHT CURED SEALANT MATERIALS
Advantages
Short setting time (appx 20 seconds)
No mixing required
Won’t set-up – longer working time
Does not get thick
Disadvantages
Potential eye damage due to light cure
Additional cost of cure light
Cure time increased with number of teeth sealed
Difficult to manipulate cure light for posterior teeth
18. CURING UNITS
Conventional cure light with halogen bulb = 20
seconds cure for each surface
Plasma arc or laser = 5-10 seconds
19. Clear and tinted
Depends on induvidual preferences.
Vary form translucent to white,pink and yellow.
Coloured pemits a more precise placement of the
sealant.
On the other hand clear may be considered more
aesthetically acceptable.
22. The tooth surface must have
Maximum surface area
Pits and fissure depth
Deep irregular pits and fissure offer a much more
favorable surface contour for sealant retention.
Deep fissures protect the plastic sealant from shear
forces as a result of mastication.
Surface cleanliness
Surface area can be increased by tooth conditioners or
etchants(30-50%phosphoric acid).
Thorough prophylaxis paste should be applied.
All heavy strains, debris and deposits be removed
before application.
Dryness
Saliva interposes between the tooth and sealant.
Air stream be checked for moisture contamination.
Directing the air stream onto a cool mouth mirror.
34. APPLY ACID ETCH
15-20
seconds
Use blue micro tip or
brush tip
Apply only in pit and
fissures
For liquid – dab but
do not rub
Re-etch 10 seconds
if saliva
contamination
35. APPLY ACID ETCH
Etch
pit and fissures
Extend 1-2 mm beyond
pit and fissures
Avoid cusp tips
36. ACID ETCH - CONTINUED
Etch longer
Deciduous teeth
Saliva contamination
Air abrasion or
prophy jet used
Highly mineralized
teeth
Do not use explorer
37. RINSE TOOTH/TEETH
Use
HVE and
a/w syringe
Proper – usually
20 seconds rinse
Avoid saliva
contamination
Re-isolate
41. APPLY SEALANT MATERIAL
Most posterior tooth first
Extend 1-2 mm beyond pit
and fissures
Gently work into pits and
fissures
Avoid lifting off tooth
Don’t overfill
“pop” bubbles in sealant
with explorer or brush tip
before curing
42. LIGHT CURE FOR 20 SECONDS
20
seconds each
tooth
Don’t touch tip of
cure light to sealant
material
Don’t let saliva
contaminate the
field…..yet
43. LIGHT CURE FOR 20 SECONDS – AIR
INHIBITION THEORY
Sealant will appear
shiny/wet
44. CHECK SEALED TEETH
Use
explorer
Tooth should be
smooth but not soft
Re-apply sealant, if
necessary
(Remove uncured
sealant with wet
cotton roll)
45. GIVE PATIENT INSTRUCTIONS
The sealant is hard so you don’t have any
restrictions on eating
If it feels “high” after you go home – you can come
in to get it adjusted
We will keep checking the sealant at subsequent
appointments
(if using unfilled corposite sealant the bite will self
adjust in 2-3 days)
46. FAILURE OF SEALANTS
cause –
moisture
contamination
Maxillary and
mandibular 2nd
molars
Early loss means
less retention of the
resin
Main
