Pit & Fissure Sealants

Pit and Fissure Sealants

Cara Miyasaki-Ching, RDHEF, MS

Legal requirements   

RDA, RDAEF ± DDS decision or supervision RDH, DDS/DMD ± General supervision Sealant adjustments

Requirements - minimum 16 





clock hours total

hours of didactic training 4

hours of laboratory training 4

8 hours of clinical training

Student shall: 

Have current CPR 



Take a written exam



RDA or RDA eligible (this includes coronal polish)

Requirements - continued  Patient requirements 

18



Must be in good health





years of age or older 

A minimum of four (4) virgin, nonrestored, natural teeth, sufficiently erupted so that a dry field can be maintained. A minimum of one tooth per quadrant

C ertification ertification Requirements 



Successful completion of written exam Successful completion of laboratory and clinical portions of the course

Pit and fissure sealants 

A thin plastic coating placed in the pit and fissures of the teeth to act as a physical barrier  to decay

Why pit & fissure sealants needed  

Bacteria produces acid



which causes decay ³demineralization´

Pit and fissure sealants 

 

Over

85% of children (5- 17 years old) in US have caries in the pits and fissures Fluoride is least effective on pit and fissures Only 18% of school-aged children in US have sealants

E ffectiveness ffectiveness 

15

of sealants

year study ± 68% of sealed teeth were caries free vs 17% of  unsealed control group

Ot her 



Preventive Programs

Community water  fluoridation School water  fluoridation



50-60% (18-40%)



40%



Fluoridated toothpaste



15-30%



Fluoride mouthrinse



31%



In-office treatment



26%

Preventive Programs as Related to Sealants 

 

Tooth brushing and flossing - mechanical plaque removal Fluoride ± chemical prevention Dental visits ± mechanical plaque removal and chemical prevention

Preventive Programs as Related to Sealants - continued  Diet 

Minimize exposure to cariogenic foods and liquids that have little or no nutritional value



Minimize solid and sticky foods



Minimize slowly dissolving foods

H istor  istor y 

of Sealants

Acrylic polymers introduced to dentistry ±  1937



Composites - 1960



³Occlusal Sealing´ ± 1965



Glass ionomers ± 1972

Retention of Sealants ± 4 year stud y Fluoride releasing sealant 

91%

retention (77% complete & 14% partial)



10%

caries rate

Non-fluoride releasing sealant 



95%

retention (89% complete & 6% partial) 10%

caries rate

Retention of Sealants ± 2 year stud y Fluoride releasing sealant 

>90%

retention



No caries

Sealant retention

Sealant Failure 

Debris and/or saliva contamination



Air inclusion during manipulation ± voids



Manipulating self-cured sealants late in the setting reaction

Loss of Sealant  

A contaminated site from faulty technique will likely result in complete or partial loss of the sealant within 6-12 months.

C ost ost Factors 

Dental Sealants = $25 - $ 49 per tooth



Amalgam = $75 to $145 per filling



Composite = $150 to $200 for a single surface white composite filling



Medical reimbursement



Insurance reimbursement

Preventive Resin Restoration 

The preparation of fissures by use of air abrasion, bur or laser  followed by filling the prep with a flowable composite.

I ncipient C  ncipient C aries aries 



Studies have shown that sealants can be placed over incipient caries which arrests the caries process Most dentists choose to use air abrasion, a bur, or a laser to remove the caries before the sealant is placed

T oot  oot h 

morph morp holog y

Pits and fissures

T oot  oot h

morph morp holog y

T oot  oot h

morph morp holog y

T oot  oot h 

Why

morph morp holog y

fissures are caries susceptible

Selection of teet h Considerations 

Patient age



Oral



Caries risk 



Diet



Fluoride history



Tooth type



Morphology

hygiene

Selection of teet h - continued  

Frequency of pit & fissure caries



Lower molars ± 50%



Upper molars 35-40%



Upper and lower second premolars



Upper laterals and upper first premolars



Upper centrals and lower first premolars

I ndications ndications 

Deep fissures



Incomplete or ill formed pits



Newly erupted teeth



High caries rate



Children



Molars

C ontraindications ontraindications 

Shallow fissures



Well



Fluoride rich enamel



Low caries rate



Occlusal



Adults

coalesced pits

or proximal caries

Partiall y erupted teet h? h? 



To seal or not to seal? Operculum

(gum flap) ±  leaks crevicular  fluid

Sealant Kits 

Cavity Indicators



Drying and/or bonding agent (optional)



Acid etch



Sealant material

Acid E tch tch   

Gel Liquid 3M Innovation: Adper Prompt LPop Self-Etch Adhesive

Acid  



etch etch

Phosphoric acid 35%- 40%-50% Dissolves organic portion of  enamel ³micromechanical retention´

Acid 



etch - continued  etch

Creates more surface area for  better adhesion Also high energy surface

Acid 



etch - Precautions etch

Avoid contact with adjacent teeth or soft tissues Can use mylar strips or matrix bands

Acid

etch ±Precautions cont. etch



Active ingredient ± phosphoric phosph oric acid



Avoid contact with skin, eyes, and clothing.



If skin contact ± flush with water 





If eye contact ± flush immediately with water  and seek medical attention If ingestion- do not induce vomiting. Give large amounts of water or milk. milk. Take an antacid. Call a physician.

Acid

etch etc h ± storage and h and handling  protocol  







Protection ± protective eyewear, gloves and clothing Toxicity ± mild irritation for for skin or ingestion ing estion but damage to eye exposure if chronic exposure. Storage - Store at room temperature. Handling ± Use gloves, protective eyewear and PPE.

Acid

etch - continued  etch

Will

an etched tooth be more prone to decay?



Remineralization begins after 24 hours

Dr ying 

agent (PrimaDr y) y)

Acid etching and Primadry (alcohol based) allows enamel to be easily ³wetted´

PrimaDr y ± precautions 

Active ingredient ± ethyl alcohol



If skin contact ± wash with soap and water 



If eye contact ± flush with lots of water  Ingestion- give large amounts of water or milk.

PrimaDr y ± storage and h and handling  protocol  







Protection ± protective eyewear, gloves and clothing Toxicity ± mild irritation for for skin or ingestion ing estion but severe irritation for for eye exposure expos ure Storage - Store at room temperature. Keep out of heat and/or direct sunlight. Handling ± Use gloves and protective eyewear.

Sealant compositi composition on 

A type of  specialized plastic (resin) or glass ionomer material



Matrix



Filler 

Sealant T ypes Resin Sealants 



(Bis-GMA) Bisphenol A-glycidyl methacrylate resins Urethane-based resin

Glass Ionomer Sealants  

Anticariogenic More viscous, less retention, more brittle and less resistant to occlusal wear 

Sealant T ypes 

Filled sealants



Unfilled sealants

Accepted

Sealant Materials ADA C ouncil ouncil on Scientific Affairs            

3M ESPE ± Clinpro Sealant Confi-Dental Products Company Dental Technologies Dentsply International - FluroShield Ivoclar Vivadent, Inc. - Helioseal Kuraray America Inc. ± Teethmate F-1 PracticeWares Dental Supply Pulpdent Corporation Southern Dental Industries Tru-Tain Prime Dental Ultradent Products, Inc. - Ultraseal Zenith/DMG Dental Manufacturing

T ypes

of curing for sealants

Chemical cured ± ³autopolymerization´ Base and catalyst 

Monomer & Initiator + Diluted monomer & 5% Amine Accelerator = Sealant

Organic

Visible light cured ± ³photopolymerization´ Pre-mixed 

Dimethacrylate + Diluent + Activator + Light = Sealant

Chemical Ch emical cure sealant materials Advantages 

No cure light or risk of eye damage



Can apply sealants to several sev eral teeth

Disadvantages 

Variation in setting time (appx 2 min)



Voids from mixing material



Changes in viscosity over time

Lig ht cured sealant materials Advantages Short setting time (appx 20 seconds) No mixing required Won¶t set-up ± longer working time Does not get thick     

Disadvantages Potential eye damage due to light cure Additional cost of cure light Cure time increased with number of teeth sealed Difficult to manipulate cure light for posterior po sterior teeth    

Sealant S hades 

Clear 



Tinted



Opaque





Clinpro Sealant goes on pink for easy-to-see application, and cures to a natural white. low viscosity, fluoridereleasing sealant

Sealant Material ± precautions 

Active ingredient ± Bis-GMA



Skin contact ± wash with soap and an d water 





Eye contact ± flush with lots of water & call physician if needed Ingestion- in large amounts induce vomiting vo miting

Sealant Material ± storage and  handling protocol  







Protection ± protective eyewear, gloves and clothing Toxicity ± mild irritation for skin and eye. Low possiblility of sensitization upon prolonged exposure for the skin. Storage - Refrigerate when not in use. Handling ± Use gloves, protective eyewear and PPE.

C oncepts oncepts of bonding  

Mechanical bonding ± interlocking



Chemical bonding ± use of adhesive



Physical bonding ± attraction of atomic charges

Requirements for Ad hesion 

Clean surface



Good wetting by adhesive



Good adaptation to the substrate



Good interface



Good curing

Strengt h and Viscosit y Characteristics Ch aracteristics Viscosity 

The thicker the sealant the less likely to penetrate to depth of fissure

Wear 

of Sealants

Considerations for wear ±  less filler, more wear and visa versa

C uring uring units 



Conventional cure light with halogen bulb = 20 seconds cure for each surface Plasma arc or laser = 5-10 seconds

Assemble

armamentarium

Assemble 

sealant kit 

Check the operation of  the syringe on gauze

Armamentarium

C uring uring units



CAUTION ± Avoid looking directly at the light

Give

patient instructions

Verbal instructions I will be placing placin g a dental sealant on your  teeth ± it¶s like a thin plastic coating on top of the tooth and will help prevent cavities If you have any problems then raise your left hand 



Give

patient instructions Verbal instructions 

This won¶t hurt but you will need to keep open for a long time and it doesn¶t taste very good.

W ear ear personal protective equipment - operator  

Gloves



Mask 



Safety glasses/visor 



Protective clothing



Closed toed shoes

W ear ear personal protective equipment - patient  



Safety glasses Pt. glasses should be tinted when using a curing light (operator/assistant should have tinted glasses on shields)

Position patient  Mandibular

Maxillary

Check Ch eck prescription and teet h 

Occlusal surfaces



Buccal



and lingual pits on first molars Lingual pits on upper  anterior teeth

Suspicious lesions? lesions? 

Explorer ± ³a stick´



Caries indicator dye



DIAGNOdent

Prepare t he toot h 







Bristle

brush or rubber  cup and plain pumice Dentist can use bur, air abrasion or laser  Sharp explorer to clean out debris Rinse

Prepare t he T oot  oot h - continued  

air abrasion, bur, prophy jet or laser 

Position t he patient 

Check Ch eck occlusion 

Avoid placing acid etch and sealant on marked areas from articulator  paper 

I solate solate

toot h/  h/ teet  teet h

Treat quadrants separately  

To control isolation To prevent contamination by moisture

I solate solate

toot h/  h/ teet  teet h



Rubber dam



Cotton rolls



Cotton roll holders



Dri-angle

Dr y

toot h

Test air/water syringe before applying blast of air 

Appl y  







15-20

acid etch etch

seconds Use blue micro tip or  brush tip Apply only in pit and fissures For liquid ± dab but do not rub Re-etch 10 seconds if  saliva contamination

Appl y 



acid etch etch - continued 

3M Innovation: Adper Prompt LPop Self-Etch Adhesive Etch, prime and bond

Appl y 





acid etch etch

Etch pit and fissures Extend 1-2 mm beyond pit and fissures Avoid cusp tips

Acid

etch - continued  etch

Etch longer  

Deciduous teeth



Saliva contamination





Air abrasion or prophy jet used Highly mineralized teeth

Do not use explorer 

Rinse toot h/  h/ teet  teet h 







Use HVE and a/w syringe Proper ± usually 20 seconds rinse Avoid saliva contamination Re-isolate

Dr y 



toot h/  h/ teet  teet h

Should appear chalky or frosty white if  etched If not, re-etch for  another 10 seconds if  not contaminated with saliva

Appl y 



dr ying agent (PrimaDr y) y)

Use brush tip Apply and leave for 5 seconds



Gently blow air to dry



DON¶T RINSE

Appl y 

bond agent 

A bond agent will improve retention

Appl y  



sealant material 

Most posterior tooth first Extend 1-2 mm beyond pit and fissures Gently work into pits and fissures



Avoid lifting off tooth



Don¶t overfill



³pop´ bubbles in sealant with explorer or brush tip before curing

Lig ht cure for 20 seconds  



20 seconds each tooth Don¶t touch tip of cure light to sealant material Don¶t let saliva contaminate the field«..yet

Note: sealant will appear  shiny/wet

Lig ht cure for 20 seconds ± air  inh in hibition t heor y 



Top layer of sealant will remain uncured sealant will appear  shiny/wet

Check Ch eck sealed teet h 





Use explorer  Tooth should be smooth but not soft Re-apply sealant, if  necessary (Remove uncured sealant with wet cotton roll)

Remove isolation materials 



Moisten Dri-angle Rinse the patient¶s mouth

Check Ch eck occlusion & contact(s) contact(s) 

Articulating paper 



Dental floss





Ask patient how it feels Dentist can adjust with bullet-shaped finishing bur or polishing stone

Give 





patient instructions

The sealant is hard so you don¶t have any restrictions on eating If it feels ³high´ after you go home ± you can come in to get it adjusted We will keep checking the sealant at subsequent appointments (if using unfilled corposite sealant the bite will self adjust in 2-3 days)

Documentation 9/1/05

Medical history updated ± no changes. Parent consented to sealants on #19 OB and #30 OB. Cotton rolls and dri-angle isolation. Ultraseal etch, primer and light cured sealant used. Patient tolerated procedure well. Informed parent that sealant will be checked at recall appointments.

I nfection nfection 







control 

Disinfect unit Disinfect sealant syringes Throw away brush tips used in patient¶s mouth Sharp tips need to be placed with sharps container 

C ommon ommon Problems Re-etch 



Improperly etched surface ± doesn¶t appear  frosty and chalky white Dentin etching ± need to dissolve smear  layer 



Contamination of application site ± saliva



Non-adherence of sealant material

Failure of sealants 





Main cause ± moisture contamination Maxillary and mandibular 2nd molars Early loss means less retention of the resin

Sealing over caries 

For incipient caries ±  risk of progression progres sion is very small

Risks associated wit h sealants     

No carcinogens or toxic materials Have xenoestrogens ± concentrations too low Potential chemical burns from phosphoric acid Occlusal trauma Danger from cure light

Sealant maintenance 





Loss of all or part of  the sealant Staining at edges Discoloration underneath sealant

Repair of sealant  Reapply if totally lost Repair partial loss 

Roughen with diamond stone



Re-etch 20 seconds



Reapply sealant

Finish Finis hed!