Step-by-Step Guide to Applying Pit and Fissure Sealants

Pit And Fissure Sealants

“What is a step-by-step guide to applying pit and fissure sealants? A detailed question and answers guide”

Pit and fissure sealants are used to seal pit and fissure

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Ideal Requirements:

Pit and fissure sealants should fulfill the following requirements:

• Pit and fissure sealants should achieve sustained bonding to the enamel surface.
• Pit and fissure sealants should be biocompatible to oral tissues.
• Pit and fissure sealants offer a simple application procedure by a dentist and/ or dental hygienist.
• Pit and fissure sealants should be free flowing, low-viscosity material which is capable of entering narrow fissures.
• Pit and fissure sealants should exhibit low solubility in an oral environment.
• Pit and fissure sealants should be easily distinguishable from natural tooth structures during periodic checkups.

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Classification of Pit and Fissure Sealants

Pit and fissure sealants are broadly classified into the following categories:

1. Based on the material used:

• Polyurethanes
• Cyanoacrylates
• Bisphenol A glyceryl methacrylate
• Glass ionomer sealants
• Fluoride containing sealants

2. Based on the curing method:

• Self-cured or autopolymerized or chemically polymerized resin sealants
• Visible light-cure or photopolymerized resin sealants

3. Based on filer content:

1. Filled sealants
2. Unfiled sealants

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4. Based on the color:

• Clear
• Tinted
• Opaque
• Color changing

5. Another classification of sealant’s based on the evolution of First generation sealants:

• Polymerized by using ultraviolet light at wavelength of 350 nm
• Second-generation sealants: Polymerized by using chemical polymerization
• Third-generation sealants: Polymerized when exposed to visible light 430 to 470 nm
• Fourth-generation sealants: Fluoride was added to existing sealants for added benefits of anti carcinogenicity.

Mode of Action:

As pit and fisure sealants are placed as thin film covers and obliterate technological niches, thereby removing the sheltered environment in which caries can develop.

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Indications of Pit and Fissure Sealants

• In newly erupted posterior teeth with deep pits and fissures should be sealed soon after eruption.
• An incipient caries lesion on pit and fisure area.
• In deep lingual pits
• In mentally or physically challenged individuals.
• In children living in non-fluoridated area.
• Patients with xerostomia Margin of Class I amalgam or composite can be sealed with sealant to improve marginal integrity.
• In cases where the contralateral tooth surface becomes carious or previously restored.

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Contraindications of Pit and Fissure Sealants

• In well-coalesced and self-cleansing pits and fissures in molars and premolars.
• When there is radiographic evidence of proximal dental caries in the tooth which has to seal.
• Pit and fissure caries extending in dentin.
• In partially erupted tooth where isolation is not possible.
• In large occlusal restoration.
• In patients with behavioral problems.
• When caries or restoration existing in adjacent fossa extend in a selected area of fissure sealing.
• If pit and fissure remained caries-free for 4 years or more.

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The technique of Placement of Pit And Fissure Sealant

• Polish tooth surface with pumice and prophylactic cup
• Wash pit and fissures with water for 10 seconds
• Isolate operative fild with a rubber dam
• Compressed air should dry the operating field
• Etch pit and fissure with 30 to 50% orthophosphoric acid for 15 seconds.
• The etched surface is rinsed with water for 15–20 seconds.
• Air dry the teeth.

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Flow liquid sealant gently in pit and fissures

• Polymerize sealant in visible light curing unit for 20–40 seconds or as recommended by the manufacturer.
• Examine the sealed surface carefully before removing the isolation.
• If pit and fissures are incompletely covered, or air bubbles are seen re-etch for 10 seconds, dry and apply additional sealant material.
• With articulating paper check the occlusion and remove premature contacts.
• Interproximally pass the dental floss on either side of the sealed tooth.
• Optionally topical fluoride can be applied over the sealed tooth