Lecture 4

Pit and fissure sealants

Dr- Khaled Al-Haddad

The anatomic pits and fissures of the teeth have long been recognized as
susceptible areas for initiation of dental caries. According to multinational
studies the occlusal surfaces seemed to be the highest susceptible surfaces of
dental caries. Many clinical studies report on the success of pit and fissure
sealants with respect to caries reduction.

Selection of teeth for sealing:

Good professional judgment should be used in the Selection of teeth and
patient. Pit and fissure sealants are contraindicated in cases of rampant caries
and with interproximal lesions present. Occlusal surfaces that are already
carious require restoration. The meticulous technique requires patient
cooperation and should be postponed for uncooperative patient until the
procedure can be properly executed. Sealants are only applied to the
chewing surfaces of back teeth. Sealants are not meant for areas
between the teeth or for the front teeth. Also, teeth that have
decay or old fillings present are not sealed
Almost 9 out of every 10 cavities in children occur on the
biting surfaces of the teeth. While children have been the
primary recipient of sealants in the past, recent advances in
bonding technology and caries (decay) detection have led to
more adults having sealants bonded to certain areas of their
teeth.
Sometimes it is impossible for children to brush deep grooves
or pits on the chewing surfaces of their teeth effectively. These

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grooves are very deep and often, tinier than the bristles on a
toothbrush. A cavity will usually begin in these grooves because
they are ideal places for cavity, causing bacteria to hide.
Sealant material bonds to the chewing surface of the back teeth
forming a protective barrier covering the depressions and
groves (pits and fissures) of the chewing surface. Decay-
causing bacteria normally reside in these groves and are
difficult to remove with even the best of tooth brushing habits.
By sealing the groves, bacteria are not present and the tooth
will not decay in this susceptible area.
Sealants are composite / plastic-like material that helps shield
out decay-causing bacteria from the chewing surfaces of the
back teeth. It is bonded to the tooth surface in a procedure that
is quick and painless.
It is best to apply sealants to the permanent molars and
premolars as soon as they appear in a child's mouth - generally
between the ages of six and fourteen years of age. Adults can
also take advantage of this decay preventing treatment if their
teeth have not been treated in the past. Sealant makes the
chewing surface smooth, making it easy clear these surfaces.

Manipulation technique:
Cleaning:
First, the teeth to be treated are cleaned and polished. A slurry
of plain pumice and water (or a nonfluoride paste that is not
oil-based) may be used. A sharp explorer tip is run in the
grooves to free any entrapped pumice powder, and the tooth is

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thoroughly washed and dried. When a sealant is used in young
adults, where the primary pellicle has been lost, a pumice slurry
may not be essential. In these cases a hydrogen peroxide
mixture can be placed on the tooth, and the tooth brushed to
remove organic material from the pits and grooves with slow-
speed handpiece. After this, the hydrogen peroxide solution was
reapplied and the surface was cleaned further with pointed
bristle brush.

Isolation:
Isolate the tooth (or quadrant of teeth) to be sealed. Rubber
dam isolation is ideal but may not be feasible. Cotton rolls, Dri
Angles, and high-volume evacuation with compressed air may
also be used effectively.

Etching:
A mild acidic solution is placed on the chewing surface. This
roughens the enamel surface to effectively bond with the
sealant material. This permits a low viscosity resin to applied
that penetrates the roughened surface and produces a
mechanical lock of resin tags when cured. Generally 30% to
50% phosphoric acid solutions or gels are now recommended.
The etchant in solution should be placed on the enamel with
either a brush, small sponge, cotton pellet, or applicator
provided by the manufacturer. A 20- second etching time is
recommended. Enamel that has been exposed to fluoride
(topical and systemic) may be resistant to etching and may need

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to be exposed for longer periods of time. Primary teeth may
also be resistant to etching and require a longer etching time
(120 seconds to produce suitable etch patterns).

Washing:
Most manufactures instructions advocate a thorough washing
and drying of the etched tooth surface without specifying a time
interval. Meixler suggest washing for 60 seconds if an etchant
in solution is used, and 90 seconds when a gel etchant has been
applied. The etched enamel is dried thoroughly by use of a
compressed air steam that is free of oil contaminants.

Application of sealant:
1- Chemically cured sealant:
Follow of manufacturer ’s instructions. Precise mixing
without vigorous agitation can help to prevent the formation of
air bubbles. Avoid contamination. Working time is limited
2- Visible light-cured sealant:
The working time is longer. The method of placement varies
with the different applicators. The sealant is applied to the
prepared surface in moderation and then gently teased with a
brush into the pits and grooves. Careful application will avoid
incorporation of air bubbles. The intensity of the light should
be considered. Before removing the rubber dam, remove the
unpolymerized surface layer by washing and drying the surface
to avoid an unpleasant taste.

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Check occlusal interferences:
Check for occlusal interferences with articulating paper and
adjust the occlusion if necessary. All centric stops should be on
enamel. Also remove other excess sealant that may have flowed
over the marginal ridge or toward the cervical area. A small
round bur at slow speed will remove the excess effectively.

Reevaluation:
It is important to recognize that sealed teeth should be
observed clinically at periodic recall visits to determine the
effectiveness of the sealant. If a sealant is partially or
completely lost, any discolored or defective old sealant should
be removed and the tooth reevaluated.

Sealed composite resin restoration:

The Sealed composite resin restoration is an alternative
procedure for restoring young permanent teeth required only
minimal tooth preparation for caries removal but also having
adjacent susceptible fissures. Caries is identified by careful
visual examination of a dry occlusal surface using a sharp
explorer. The tooth is anesthetized, isolated. A pear-shaped high
speed bur can be used to gain access to the depth of the lesion.
Remove any remaining caries with a round slow-speed bur,
wash, dry, and examine the preparation, which should not
extend to the occlusal contact marks. Place a calcium
hydroxide, glass-ionomer cement used and offers better bonding
to dentine. The enamel margins of the cavity, susceptible

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grooves, and lingual and buccal grooves are etched. A thin layer
of bonding agent is applied to the cavity. A gentle steam of air
can help prevent bonding agent pooling in the cavity. The
cavities are filled with a light-curing composite, and cured. A
light- curing sealant is placed over the susceptible areas and
brushed into the pits and grooves and polymerized with light in
accord with the manufacturer ’s instructions. A small- particle
diamond rotary instrument can be used to remove excess sealant
and ensure centric stops on enamel.
Do Sealants take the place of Fluoride?
Sealants and fluoride are both designed to prevent decay to
prolong the life of your natural teeth. Sealants are applied
topically to only certain susceptible areas of the back teeth.
Fluoride is used to prevent or reduce dental decay on all
surfaces of all teeth. It is absorbed by the teeth most effectively
during developmental years and is retained in tooth enamel
permanently.

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The following drawing is probably the best way to describe why teeth with
deep pit and fissures decay so easily and why sealants are so effective in

cavity prevention.