Pit and fissure sealant and Preventive Resin Restorations

Prepared by: Velasco, Philipp rey Pagulayan, Sheena May Pua, Mar Kristine U.

 Sealants are the effective caries protective agents to the extent they remain bond safe & their effectiveness should justify their routine use as a preventive measure Caries potential is directly related to shape & depth of the pit and fissures The cariostatic properties of sealants are attributed to the physical obstruction of the pit and grooves.

History
1905: application of silver nitrate by miller 1923: Hyatt reported a technique namedprophylactic odontomy. 1929: Bodecker introduced fissure eradication. 1955: Buanocare introduced a method ofadhering resin to an acid etched enamel surface. 1965: Bowen & associates developed BIS- GMAresin. 1970 & EARLY 1980S: UV light with awavelength of 365 nm was used to initiate thesetting reaction.

DIAGNOSIS OF PIT AND FISSURE CARIES

When the explorer catches or resists removalafter insertion into a pit and fissure withmoderate to firm pressure softens at the base of area Opacity adjacent to the pit & fissure asevidence of demineralization. Softened enamel adjacent to the pit & fissurethat can be scraped away with the explorer. By xeroradiographic & digital radiography, dyepreparation,fiberoptictransillumination,ultrasonic

CLEAN THE TOOTH SURFACE

Remove plaque & debris from enamel and pits &fissures of the tooth. Debris interfere with proper etching process Simply use a toothbrush prophylaxis withtoothpaste or pumice followed by copious waterrinsing. If sodium bicarbonate slurry has been used, it isnecessary to neutralize the retained slurry withphosphoric acid for 5-10 sec.

ISOLATE & DRY THE TOOTH SURFACE

Rubber dam provides best isolation Cotton roll isolation with adequate suctioning isalso preferred method of isolation for manypractioners.

ETCH THE TOOTH SURFACE

Etch with 37% conc. Of orthophosphoric acid for15-30 sec. for primary teeth and 15 sec. forpermanent teeth. additional time is required for fluorosed teeth. Gently rub etchant applicator over a tooth surfaceincluding 2-3 mm of the cuspal inclines. Periodically add fresh etching agent. Donot allow the etchant to come into contact withthe soft tissue.

APPLY BONDING AGENT

Apply a hydrophilic bonding agent , prior tosealant application may improve retention withteeth that cannot be isolated properly Then cure it.

MATERIAL APPLICATION
Sealant material is then applied to the toothaccording to manufacturer direction. Be careful not to corporate air bubbles in thematerial. with mandibular teeth apply the sealant at thedistal aspect and allow it to flow mesially and withmaxillary teeth vice versa. After the sealant has set, the operator shouldwipe the sealant surface with a wet cotton pellet. With autopolymerising sealants working timevaries from 12 min & with photoactive sealants,10-20 sec. for complete setting.

EVALUATE THE SEALANT

Sealant should be evaluated visually andtactically. Take the explorer & attempt to dislodge it. Any deficiences in the material, more sealantmaterial should be applied. Remove the rubber dam and cotton rolls.

RINSE AND DRY ETCHED TOOTH SURFACE

Rinse the etched tooth surface with an air sprayfor 30 sec. Dry the tooth surface for atleast 15 sec. withuncontaminated compressed air. Dried etched enamel should have frosted whiteappearance. Repeat the etching step if necessary. Moisture contamination- most common cause ofsealant failure.

AGE RANGES FOR SEALANT APPLICATION

3-4 YEARS- PRIMARY MOLARS 6-7 YEARS- 1ST PERMANENT MOLAR 11-13 YEARS- 2ND PERMANENT MOLAR ANDPREMOLARS.

Indication
Susceptible pits and fissures (deep). Soon after eruption. High risk patients. Have caries or extraction of deciduous teeth. Requires restoration in one molar the others should be fissure sealed. Poor oral hygiene.

Contra-indication

Well-coalesced , self cleansing pit and fissures Radiographic/clinical evidence of proximal caries Tooth not fully erupted Isolation not possible Life expectancy of tooth is limited Dental caries

 Mentally or physically disabled patients. Medically compromised patients. Tooth which can be isolated with a rubber dam.

Materials
Composite. GIC.

PREVENTIVE RESIN RESTORATION

Restores the pit and fissure decay which is confined to one area in the fissure system and seals rest of the fissures. Combination of preventive measure of sealant therapy for caries susceptible pits and fissures with the therapeutic restoration of incipient caries

Technique
Clean the surface. Cavity preparation. Isolation using rubber dam / cotton rolls Lining and etching. Washing and drying. application of bonding agent. Filling the cavity. Sealing the fissures. Finishing.

Indication
Young permanent teeth requiring only minimal tooth preparation for isolated caries removal but also having adjacent susceptible fissures

Contraindications
Teeth with interproximal caries Extensive caries