Fissure sealants DCP1 S2 Lecture 8 - part 1 By Dr A. Eldarrat

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Fissure sealants DCP1 S2 Lecture 8 - part
1By Dr A. Eldarrat A. Uni
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Objectives

• To understand the following
• Role of fissure sealants in preventive dentistry.
• Indications/contraindications advantages and
  disadvantages
• of fissure sealants.
• Different types of materials used as fissure
  sealants and their advantages and disadvantages.

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Objectives

• Acid etch technique and the mechanism of bonding
  of resin based sealants.
• To be able to apply fissure sealants (Composite
  resin sealants and Glass ionomer sealants) on
  natural teeth in the laboratory situation.
• To be able to critically evaluate the quality of
  composite resin fissure sealants after placement.
  

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FISSURE CARIES
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Early caries in fissure confined to enamel only
Incipient Caries
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Early caries in fissure Enamel spread
Incipient Caries
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Caries in fissure Spread to DEJ and involves
dentine
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Caries in fissure Dentine involvement note no
cavitation
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Why do pits and fissures decay?

• Morphology of the pits (buccal/palatal) and
  fissures

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Why do pits and fissures decay?

• Two main types of pits and fissures
• 1. Shallow, wide, V-shaped fissure

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Why do pits and fissures decay?

• 2. Deep, narrow I-shaped or bottle neck shaped
  fissures
• Plaque retention
• Mechanical plaque removal is difficult
• Depth of fissure is in close proximity to the DEJ

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Diagnosis of pit/fissure caries

• Diagnosis of pit/fissure caries - can be very
  difficult
• 3 Possibilities
• No caries
• Definite caries
• Questionable caries

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Are these fissures carious or just stained ?
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Are these fissures carious or just stained ?
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Management of Questionable pit/fissure early
caries

• Monitor tooth surface over period of time in
  conjunction with other caries preventive
  measures.
• Mechanically open up fissures with a bur/air
  abrasion and check if carious (invasive?)
• Fissure seal with fissure sealant.

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What is a Fissure sealant ?

• Definition
• A low viscosity material which is flowed into
  pretreated pit or fissure on (occlusal, buccal,
  palatal surfaces) which fills the pits/fissures.
• The Material polymerizes into a hard material.
• Acts as a physical barrier between the sealed
  area of the tooth and the bacteria in the oral
  cavity.
• Sealants are used as preventive and therapeutic
  treatment.

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How does a Fissure sealant prevent caries ?

• 1. Physical barrier in the pit/fissure of the
• tooth.
• 2. Eliminate the environment conducive to
  s.mutans.
• 3. Make pit/fissures easier to clean by tooth
  brushing and mastication

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Indications for fissure sealing for children and
adults

• Caries risk status.
• Tooth morphology.
• Age of patient.

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Contraindications to fissure sealing

• Shallow, self cleansing pits/fissures.
• Patient with low or negligible caries risk (eg.
  no new lesions or past restorations).
• Partially erupted teeth in which all
  pits/fissures not exposed to oral cavity.

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Cont.

• If can not obtain excellent moisture control (for
  composite resin FS).
• Occlusal caries has progressed into the dentine.
• Tooth has proximal caries.
• Uncooperative child/patient.

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Sealing over early occlusal caries? Advantages
and disadvantages

• Caries can be in-activated if
• use a CR sealant that is well bonded.
• use GIC Fuji 7 sealant.
• (Chemical adhesion high Fluoride release)
• Caries can progress
• If place a CR sealant which is poorly bonded or
  partially lost.
• (Use your own clinical judgement and assess each
  case carefully)

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Partially erupted teethSeal or wait until fully
erupted?

• For Composite Resin
• If seal whilst partially erupted - Risk of
  sealant failure
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  Risk of caries development
• For Glass Ionomer Fissure sealant- Fuji 7 only
• can be placed in situations where tooth can be
  partially erupted because of its ability to be
  placed in conditions where moisture control can
  not be optimally maintained.
• More appropriate material to use in this clinical
  situation.

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What type of sealant materials are available?

• 1. Composite resin (CR)
• 2. Glass ionomer (GI)

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Composite resin sealants

• BIS-GMA (Bowens resin)
• low viscosity unfilled or partially filled
  resins.
• Polymerised.

2 bottles (base and catalyst which are
mixed together)
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Composite resin sealants

• a. Self-cured sealant.
• (also known as auto-cured or chemically-cured).
• b. Light-cured sealant.
• white light (wavelength 420-490nm) equipped with
  a blue filter.

Kidd and Smith 1996
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Composite resin sealants

• Advantages/Disadvantages
• Clear/Opaque sealants

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• Composite resin fissure sealant
• - light cured opaque type

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Glass ionomer sealants

• Chemical bond to enamel.
• Fluoride release.
• New GIC material- Fuji 7
• high fluoride release (6 x more) than other
  restorative GICs.
• has good flow properties and flow well into
  pits/fissures.
• moisture tolerant.
• has a strong fused layer which is acid resistant
  continues
• to offer protection to occlusal surface even
  when it
• appears visually lost due to wear.
• Restorative GICs tend not to be suited as fissure
  sealants as
• are thicker and do not flow well into
  narrow/deep
• pits fissures

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Fuji 7 GIC
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• Restorative Glass ionomer fissure sealant

Mount Hume, 2005
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Summary

• Effective primary preventive measure against pit
  and fissure caries.
• - prevent plaque accumulation - hence prevent pit
  fissure caries.
• arrest very early pit/fissure caries.
• Can be used as part of patients overall caries
  prevention/management plan.

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Summary

• Conservative (Minimal Intervention). non
  invasive
• Relatively Painless.

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Summary

• Benefits children and adults- if at risk
  pit/fissures sealed.
• Commonly used fissure sealants are light cured
  resin sealants but the new Fuji 7 GIC material
  gives us more options
• Cost effective if careful case selection.

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Thank you