2 Objectives Students should be able to Explain concept of pit fissure sealant and Preventive resin restoration (PRR)Discuss advantages, disadvantages and indications for pit and fissure sealantDiscuss advantages, disadvantages and indications for Preventive resin restorationDescribe the procedures of Pit and fissure sealant and Preventive resin restoration
3 CariologyDental caries is an infectious microbiological disease of teeth that results in localized dissolution and destruction of the calcified tissues.S. Mutans have been demonstrated to have significant potential to cause caries
5 Pit & fissure: highest prevalence of all dental caries narrow opening, almost impossible to cleanPlaque accumulation (bacteria harbor)Fluoride is less effective to prevent pit & fissure caries
6 Pit & fissure: highest prevalence of all dental caries narrow opening, almost impossible to cleanPlaque accumulation (bacteria harbor)Fluoride is less effective to prevent pit & fissure caries
7 Management of deep fissure Prophylactic odontomyFissure eradicationEnameloplastyFluorideSealant
8 Management of deep fissure Prophylactic odontomy (Hyatt 1923)Eliminating all susceptible fissures by cutting a shallow, minimal width class I cavity in enamel. Then the cavity is filled with amalgamDestructive, committed toa restoration
9 Management of deep fissure Fissure eradication (Bodecker 1929)Fissures reshaped by reducing the steep cuspal inclines so that the occlusal surface is more readily cleansed by the patientDestructive
10 Management of deep fissure EnameloplastyGrinding away enamel on developmental deep pit and fissure to create a smooth, saucer-shaped surface which is self cleansing or easily cleaned
11 Management of deep fissure FluorideSystemic/topical F¯ most effective in preventing smooth surface caries but least effective in occlusal surfaceIt is speculated that neither stannous nor acidulated fluoride is able to impregnate the enamel at the depths of the fissures
13 Management of deep fissure Pit fissure sealingThe idea is to form a barrier that protects pits and fissures against bacteria and fermentable foods like sugars and starches, and thereby helps to prevent decay from starting deep within these fissures
14 Pit & fissure sealants were first introduced in 1967 by Cueto & Buonocore Enamel is etched and bonded with resinFissure is sealed and protected from the ingress of plaque, microflora, and oral fluid.
15 Bacteria remaining in sealed fissures? Studies have shown a decrease in numbers of microorganisms in lesions under intact sealants, and caries progression appeared negligibleJenson & Handelman 1980, Handelman & Leverett 1985, Martz-Hfairhurst et al 1986
16 Advantages & Disadvantages Caries is prevented as long as fissures remain completely sealedIf there is lost or leakage of the sealants, the tooth is once again at risk to cariesNeeds periodic evaluation
17 Indications Newly erupted posterior teeth with complicated fissures High caries risk patient with deep pits & fissuresIncipient caries where caries is limited to enamelBite wing radiographs should be taken to ensure that caries does not extend to the DEJ and proximal surfaces
18 Contraindications When adequate isolation cannot be achieved Where definite occlusal decay is presentWhen proximal decay is presentOn hypoplastic teethIn uncooperative patients
19 Ideal Properties of fissure sealant Should seal the pits and fissures against every penetration by oral floraAdhere to enamel (high retention rate)Should have a cariostatic action (F release)Resistant to oral fluid and diet (acid, alcohol, etc)Low viscosity
20 Ideal Properties of fissure sealant Adequate mechanical properties on setting (strength, abrasive resistance)Simple to useNon toxicShould be detectableHave short setting/polymerization time
23 Choice of materials (resin-based sealant) Light cured or Chemical curedChemical cured is no longer availableUnfilled or slightly filled resinfiller particles are added to improve abrasive resistance
24 Choice of materials (resin-based sealant) Translucent or opaque (or coloured)
25 Compomer sealant Composition Polymerisable Strontium-alumino-fluoro-silicate glassModified carboxylic acidPhosphate-modified monomersNo laboratory or clinical date available
26 Glass ionomer sealant Powder-liquid form Chemical cured Finer filler particles
27 Effectiveness Retention rate & caries reduction Researches showed that sealant efficacy is directly related to sealant retentionSealant placement also leads to a reduced prevalence of restorations having to be placed later on.
28 Dennison & others JADA 2000 A retrospective study of 5,203 children 6.5%6.6%6.2%Graph shows Incidence of restoration placement on 1st molars with and without sealants.
29 Dennison & others JADA 2000 A retrospective study of 5,203 children Restoration Incidence (%)10.4%10.1%8.7%Graph shows Incidence of restoration placement on 2st molars with and without sealants.
30 EffectivenessGoing et al 1977 reported caries prevention effectiveness (10 years)premolar: 84%molar : 30%Mertz-Fairhurst et al 1984 (7 years)caries reduction effectiveness 55%Romcke et al 1990 (10 years)3% of the sealant had been replaced with restorations due to decayWendt &others 2001 reported65% complete retention of sealant on 1st molar after 20 years with 13% of caries/restorations placed65% complete retention on 2nd molar with 5% caries/restorations placed
31 Effectiveness of GIC sealant Retention rate & effectiveness comparable to resin sealant?
38 ProceduresAdjust occlusion using white stone or finishing bur
39 Sealant failure Usually occurs at enamel-resin interface Mostly caused by saliva or moisture contamination during application
40 Preventive Resin Restoration Treatment of small carious lesions where caries is removed and restored with composite resin.Fissure sealant is then applied to the surrounding pits and fissures
41 Preventive Resin Restoration Introduced by Simonsen and Stallard in 1977Minimally invasiveG.V. Black “extension for prevention” is no longer practisedSmall carious lesions within pits and fissures were removed and restored with composite resin while the remaining healthy fissures were sealed with a pit and fissure sealant
42 Advantages Conservative approach Minimum intervention -conserve more tooth structureMore aesthetic compared to amalgam
43 Disadvantages Needs absolute moisture control Bonding procedures are very technique sensitiveMore time consumingFailure to proper bonding will lead to leakage and recurrent caries
44 Indications Small occlusal caries with a deep pit and fissure An opaque, chalky or brown/black lesions along the pits and fissure, suggestive of caries
45 Type I Caries is very minimal and limited in enamel Remove caries with 1/4 round burSealant is then appliedPit & fissure Sealant
46 Type IIAfter caries removal with ¼ or ½ round bur, the preparation is limited in enamel but is greater than 1 mm in cross sectionPosterior composite placement in the preparationSealant applied over composite restoration and fissures
47 Type III Caries extends into dentin Remove caries with suitable size round burGlass ionomer base placed over dentin. CaOH2 may be required if the cavity is deepRestore the cavity with Posterior composite resinSeal the entire surface with sealant