Fissure sealants DCP1 S2 Lecture 8 - part 1 By Dr A. Eldarrat & A. Uni

Objectives To understand the following: Role of fissure sealants in preventive dentistry. Indications/contraindications; advantages and disadvantages of fissure sealants. Different types of materials used as fissure sealants and their advantages and disadvantages.

Objectives Acid etch technique and the mechanism of bonding of resin based sealants. To be able to apply fissure sealants (Composite resin sealants and Glass ionomer sealants) on natural teeth in the laboratory situation. To be able to critically evaluate the quality of composite resin fissure sealants after placement.

FISSURE CARIES

Early caries in fissure confined to enamel only [Incipient Caries] Fluoride prevents smooth surface caries – but limited in preventing pit/fissure caries Pit and fissure caries is major problem for many children

Early caries in fissure Enamel spread [Incipient Caries]

Spread to DEJ and involves dentine Caries in fissure Spread to DEJ and involves dentine

Dentine involvement – note: no cavitation Caries in fissure Dentine involvement – note: no cavitation

Why do pits and fissures decay? Morphology of the pits (buccal/palatal) and fissures

Why do pits and fissures decay? Two main types of pits and fissures: 1. Shallow, wide, V-shaped fissure

Why do pits and fissures decay? 2. Deep, narrow I-shaped or bottle neck shaped fissures Plaque retention Mechanical plaque removal is difficult Depth of fissure is in close proximity to the DEJ

Diagnosis of pit/fissure caries Diagnosis of pit/fissure caries - can be very difficult 3 Possibilities No caries Definite caries Questionable caries

Are these fissures carious or just stained ?

Are these fissures carious or just stained ?

Management of Questionable pit/fissure early caries Monitor tooth surface over period of time in conjunction with other caries preventive measures. Mechanically open up fissures with a bur/air abrasion and check if carious (invasive?) Fissure seal with fissure sealant.

What is a Fissure sealant ? Definition: A low viscosity material which is flowed into pretreated pit or fissure on (occlusal, buccal, palatal surfaces) which fills the pits/fissures. The Material polymerizes into a hard material. Acts as a physical barrier between the sealed area of the tooth and the bacteria in the oral cavity. Sealants are used as preventive and therapeutic treatment. Sealing decay out

How does a Fissure sealant prevent caries ? 1. Physical barrier in the pit/fissure of the tooth. 2. Eliminate the environment conducive to s.mutans. 3. Make pit/fissures easier to clean by tooth brushing and mastication Provide a barrier bt pits and fissures – areas which are inaccessible to toothbrush bristles and fermentable CHOs and s mutans.

Indications for fissure sealing for children and adults Caries risk status. Tooth morphology. Age of patient.

Contraindications to fissure sealing Shallow, self cleansing pits/fissures. Patient with low or negligible caries risk (eg. no new lesions or past restorations). Partially erupted teeth in which all pits/fissures not exposed to oral cavity.

Cont. If can not obtain excellent moisture control (for composite resin FS). Occlusal caries has progressed into the dentine. Tooth has proximal caries. Uncooperative child/patient.

Sealing over early occlusal caries? [Advantages and disadvantages] Caries can be in-activated if use a CR sealant that is well bonded. use GIC Fuji 7 sealant. (Chemical adhesion & high Fluoride release) Caries can progress If place a CR sealant which is poorly bonded or partially lost. (Use your own clinical judgement and assess each case carefully)

Partially erupted teeth Seal or wait until fully erupted? For Composite Resin If seal whilst partially erupted - Risk of sealant failure Risk of caries development For Glass Ionomer Fissure sealant- Fuji 7 only can be placed in situations where tooth can be partially erupted because of its ability to be placed in conditions where moisture control can not be optimally maintained. More appropriate material to use in this clinical situation.

What type of sealant materials are available? 1. Composite resin (CR) 2. Glass ionomer (GI)

Composite resin sealants BIS-GMA (Bowen’s resin) low viscosity unfilled or partially filled resins. Polymerised. 2 bottles (base and catalyst which are mixed together)

Composite resin sealants a. Self-cured sealant. (also known as auto-cured or chemically-cured). b. Light-cured sealant. [white light (wavelength 420-490nm) equipped with a blue filter]. Kidd and Smith 1996

Composite resin sealants Advantages/Disadvantages Clear/Opaque sealants

Composite resin fissure sealant - light cured opaque type

Glass ionomer sealants Chemical bond to enamel. Fluoride release. New GIC material- Fuji 7 high fluoride release (6 x more) than other restorative GICs. has good flow properties and flow well into pits/fissures. moisture tolerant. has a strong fused layer which is acid resistant & continues to offer protection to occlusal surface even when it appears “visually” lost due to wear. Restorative GICs tend not to be suited as fissure sealants as are thicker and do not flow well into narrow/deep pits & fissures

Fuji 7 GIC

Restorative Glass ionomer fissure sealant Mount & Hume, 2005

Summary Effective primary preventive measure against pit and fissure caries. - prevent plaque accumulation - hence prevent pit & fissure caries. arrest very early pit/fissure caries. Can be used as part of patients’ overall caries prevention/management plan.

Summary Conservative (Minimal Intervention). – non invasive Relatively Painless.

Summary Benefits children and adults- if at risk pit/fissures sealed. Commonly used fissure sealants are light cured resin sealants but the new Fuji 7 GIC material gives us more options Cost effective – if careful case selection.

Thank you