08 August 2012
PIT AND FISSURE SEALANTS | pedodontic dentistry
Pit and fissure sealants are marketed in variety of formats; they can be filled, unfilled, tinted, clear or opaque. They may be polymerized in variety of ways.
The first generation of fissure sealants is ultraviolet light cure, the second generation is chemically cured (autopolymerised) and third generation is visible light cure. The fourth generation fissure sealants are those containing fluorides.
TYPE OF FISSURE SEALANTS
A)
1. Three different kinds of plastics have been used as occlusal sealants:
a) Polyurethanes
b) Cyanoacrylates
c) Bisphenol a glycidyl methacrylate (BIS-GMA)
2. Resin based sealants
3. Glass ionomer sealants
4. Fluoride containing sealants
B)
1. Filled and unfilled
2. Light cured and chemically (self) cured
3. Clear and tinted.
INDICATION
- Presence of deep occlusal pit and fissures of newly erupted teeth (molars and premolars).
- Presence of lingual pits or palatal pits in relation to upper lateral incisors and molars.
- Presence of incipient lesion in the pit and fissure system.
- Children and young people with medical, physical or intellectual impairment with high caries risk.
- Children and young people with signs of higher caries activity and coming from non fluoride area.
CONTRAINDICATION
- Presence of shallow pit and fissure of molars and premolars.
- An open occlusal caries lesion with exetension into dentin.
- Presence of large occlusal restoration.
- Presence of proximal caries extending on to occlusal surface.
- Partially erupted tooth where in isolation is a problem.
- Unco-operative children
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TECHNIQUE FOR SEALANT APPLICATION
STEP 1: Prepare the teeth
-Clean the pit and fissure surfaces
-Utilize a dry toothbrush, properly cup with pumice or properly paste or air abrasion
-Use an explorer to remove any debris in the pit of fissure
-Rinse for 20-30 seconds
-Reevaluate surface for residual or loose debris
STEP 2: Isolate the teeth
-Use cotton rolls, dry angles and rubber dam.
STEP 3: Dry the surfaces
-Dry teeth with air for 20-30 seconds
-Check to make sure there is no moisture coming out of air syringe tip
STEP 4: Etch the surface
-Apply etchant as directed by manufacturer
-Usually between 30-60 seconds
-If using gel or semi-gel apply gel and let stand for allotted amount of time
-If using a liquid continue to apply etchant throughout the etchant time
STEP 5: Rinsing and drying the teeth
-Rinse surfaces for 60 seconds
-Check for effectiveness of etchant by drying with air, surface should appear “chalky white “
-If not, repeat etching procedure
-Placement of new cotton rolls and dry angles
-Dry teeth with air for 20-30 seconds
STEP 6: Application of sealant material
-Self curing: Mix equal parts of the two components
-Will polymerize in 60-90 seconds
-Light curing: Apply with syringe provided by manufacturer
-Apply curing light to material
-Will polymerize in 20-30 seconds
-Evaluate sealants for any voids, marginal discrepancies, or retention problems
-If noted return to step 2
STEP 7: Occlusal evaluation
-Check occlusion with articulating paper
-Adjustments must be made with filled resins
STEP 8: Setting re-evaluation sequence educating patient of the importance in having the sealants evaluated on six month basis
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