2Objectives 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
3CariologyDental 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
5Pit & 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
6Pit & 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
7Management of deep fissure Prophylactic odontomyFissure eradicationEnameloplastyFluorideSealant
8Management 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
9Management 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
10Management 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
11Management 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
13Management 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
14Pit & 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.
15Bacteria 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
16Advantages & 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
17Indications 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
18Contraindications When adequate isolation cannot be achieved Where definite occlusal decay is presentWhen proximal decay is presentOn hypoplastic teethIn uncooperative patients
19Ideal 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
20Ideal Properties of fissure sealant Adequate mechanical properties on setting (strength, abrasive resistance)Simple to useNon toxicShould be detectableHave short setting/polymerization time
23Choice 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
24Choice of materials (resin-based sealant) Translucent or opaque (or coloured)
25Compomer sealant Composition Polymerisable Strontium-alumino-fluoro-silicate glassModified carboxylic acidPhosphate-modified monomersNo laboratory or clinical date available
26Glass ionomer sealant Powder-liquid form Chemical cured Finer filler particles
27Effectiveness 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.
28Dennison & 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.
29Dennison & 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.
30EffectivenessGoing 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
31Effectiveness of GIC sealant Retention rate & effectiveness comparable to resin sealant?
38ProceduresAdjust occlusion using white stone or finishing bur
39Sealant failure Usually occurs at enamel-resin interface Mostly caused by saliva or moisture contamination during application
40Preventive 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
41Preventive 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
42Advantages Conservative approach Minimum intervention -conserve more tooth structureMore aesthetic compared to amalgam
43Disadvantages Needs absolute moisture control Bonding procedures are very technique sensitiveMore time consumingFailure to proper bonding will lead to leakage and recurrent caries
44Indications Small occlusal caries with a deep pit and fissure An opaque, chalky or brown/black lesions along the pits and fissure, suggestive of caries
45Type I Caries is very minimal and limited in enamel Remove caries with 1/4 round burSealant is then appliedPit & fissure Sealant
46Type 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
47Type 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