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Pit and Fissures are highly susceptible to caries. Since they occur on occlusal surface,they account 50% of the caries,hence it is required to seal the Pit and Fissures.

CARIES OF PIT AND FISSURE

Black in 1897 noted that pit and fissures provide a sanctuary to those agents which cause caries.
In caries susceptible person,when carbohydrates in food comes in contact with the plaque,acidogenic bacteria in the plaque create acid.This acid damages the enamel walls of pit and fissures and caries results.

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PIT

It is defined as a small pin point depression located at the junction of developmental grooves or at terminals of those grooves.

FISSURE

It is defined as deep clefts between adjoining cusps.

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NANGO(1960) described four principle types of fissures, based on alphabetical description of shape namely

V-type

U-type

I-type

K-type

These are self cleansing

Since they are constricted,more prone to caries

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DEFINITION:

Pit and fissure sealants are thin plastic coatings placed on the occlusal surface of posterior teeth which forms a mechanical barrier between tooth structure and oral environment

: HISTORICAL DEVELOPMENT

1923:(Hyatt) introduced prophylactic odontomy in which non-carious fissures were prepared and restored with silver amalgam.

1929:(Bodecker )Fissures were smoothened but not restored.

1950:Topical and systemic flourides were used.

1955:Buonocore introduced the acid etching technique.

1967:First clinical trial conducted using cyanoacrylate as a sealant.

1971:Bisphenol A glycidyl methacrylate (Bis-GMA)

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1.DEPENDING ON THE TYPE OF CURING AGENT

First generation(UV light)
Second generation(Self cure)
Third generation(Visible light)
Fourth generation(Fluoride releasing)

2.ACCORDING TO COLOR

Transparent-clear,pink,amber
Opaque-Tooth coloured,white
Tinted

3.ACCORDING TO FLOURIDE CONTENT

Flouridated
Non flouridated

4.ACCORDING TO FILLER CONTENT

Unfilled
Filled
Semi-filled

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FOOD AND PLAQUE GAIN ACCESS DEEP INTO THE GROOVE WHERE A TOOTHBRUSH BRISTLE CANNOT REACH AND A CAVITY DEVELOPS EASILY

TOOTHBRUSH BRISTLE

GROOVE IN TOOTH

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The pit and fissure sealant essentially “plugs up” the groove and prevents cavitation.

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BIS-GMA	Polymerizes to Yield highly cross linked polymer
TEG-DMA	Decreases the viscosity of BISGMA.
Titanium dioxide	Opaquer
Yitterbium flouride	Flouride release

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3-4 Years 6-7 years 11-13 years	Primary molar sealant application First permanent molar Second permanent molar and the premolars

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This high energy state helps the retention of sealant to the enamel surface
Mechanical retention of sealants is due to the direct result of penetration into the porus etched

surface forming resin tags.

BEFORE ACID ETCHING LOW ENERGY WEAKLY REACTIVE HYDROPHOBIC	AFTER ACID ETCHING HIGH ENERGY HIGHLY REACTIVE HYDROPHILIC

HYDROXYAPETITE CRYSTALS ARE

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PORES CREATED AFTER ACID ETCHING

TAGS FORMED BY THE SEALANT INTO THE PORES-MECHANICAL RETENTION

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Q] Why is acid etching done for a longer time(40-60sec) in primary teeth as compared to 15 sec in permanent teeth?

Prismless enamel

Organic content of primary enamel is high

Increased internal prism volume

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REQUIREMENTS OF A SEALANT(Brauer 1978)

1.A viscosity allowing penetration into deep and narrow fissures even in the maxillary teeth

2.Adequate working time

3.Rapid cure

4.Good and prolonged adhesion to the enamel

5.Low sorption and solubility

6.Resistance to wear

7.Minimum irritation to tissues

8.Cariostatic action

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Newly erupted primary molars and permanent bicuspids
Molars with complete recession of pericoronal operculum and with sticky grooves and fissures
Stained pits and fissures
less than four years after eruption

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no previous caries
well coalesced pit and fissures.
proximal caries
Wide and self cleansable pits and fissures
Tooth that cannot be isolated or partially erupted tooth
Caries free tooth four years after eruption

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	Criteria	Seal	Do not seal
1	Tooth age	Recently erupted	Teeth remains caries free for 4 or more than 4years
2	Tooth type	Molar	Premolar except when caries risk high
3	Occlusal morphology	Deep narrow self cleansing pit and fissure	Narrow wide self cleansing pit and fissure
4	Status of proximal surface	Sound	Carious
5	General caries activity	Many occlusal lesions few proximal lesions	Many proximal lesions
6	Other preventive measure	Patient receiving appropriate systemic or flouride therapy and still caries active	Patient is not co-operating in child preventive program then restoration of pit and fissure are preferred.Water supply is fluoride defficient

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ADVANTAGES Non-invasive technique Long term Fluoride release Can be used at the community level for prevention of caries.	DISADVANTAGES Technique sensitivity. Lack of universal usage. Caries susceptibility of etched enamel. Economic unfeasibility

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1.SCALING AND POLISHING

The surface of the tooth is cleaned with

slurry of pumice and water.

Prophy paste and paste containing

fluoricle cannot be used as they

will compromise the acid etching

procedure

2.WASHING AND DRYING

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3.ACID ETCHING

Occlusal surface is then etched

with a 30-50% solution of Orthophosphoric

acid is used for 60 sec in primary teeth

and 15 sec in permanent teeth.

4.WASHING AND DRYING

Following etching the tooth surface

is washed with water for 30 seconds

to remove etchent and then air dried

properly etched tooth surface has a

dull frosted appearance

5.APPLICATION OF MATERIAL

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6.CURING

7.RECALL

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FLUORIDE RELEASING PIT AND FISSURE SEALANT

LONG TIME FLOURIDE RELEASE

LAZER

INCREASES BOND STRENGTH

COALESCES DEEP PIT AND FISSURES

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PREVENTIVE RESIN RESTORATIONS

Preventive resin restoration,prevents sound tooth structure by incorporating a conservative composite resin restoration with sealant application.
There are three types of preventive resin restoration based on extent & depth of carious lesions-A,B&C.
TYPE A-suspicious pit & fissures where caries removal is limited to enamel.
TYPE B-incipient lesion in dentin that is small & confined
TYPE C-for greater exploratory preparation in dentin & requires administration of LA & liner placement over exposed dentin.

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PLACEMENT TECHNIQUE

TYPE-A RESTORATION

CLEAN THE SURFACE
ISOLATE WITH COTTON ROLLS
REMOVE DECALCIFIED PIT &FISSURE
PLACE ACID ETCHING GEL OVER THE ENTIRE OCCLUSAL SURFACE FOR 20-60 SEC
WASH(20SEC)&DRY(10SEC)THE SURFACE
APPLY SEALANT CAREFULLY
POLYMERIZE VISIBLE LIGHT FOR 20SEC
ADJUST THE OCCLUSION

SEALANT

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TYPE-B RESTORATION

REMOVAL OF CARIES WITH HIGH SPEED NO330 BUR FOLLOWED BY SLOW SPEED NO1/2 ROUND BUR.
PLACE CALCIUM HYDROXIDE LINER OVER EXPOSED DENTIN
ACID ETCHING GEL APPLIED OVER ENTIRE OCCLUSAL SURFACE FOR 20-60 SECONDS AND THEN WASHED(20 SEC) AND DRIED(10 SEC)
WALLS ARE COATED WITH BONDING AGENT
FILLED COMPOSITE RESIN IS THEN INJECTED INTO THE PREPARATION
IT IS CONDENSED AND SMOOTHENED WITH PLASTIC OINSTRUMENT
FILLED SEALANT MATERIAL APPLIED
POLIMERIZED WITH VISIBLE LIGHT
OCCLUSION ADJUSTED

BONDING AGENT

COMPOSITE RESIN