Pit & Fissure Sealing Techniques

1. Pit & Fissure Sealing Techniques Preclinical Operative Dentistry Practical Dr Jamal N Naim

2. 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 suitedas fissure sealants as are thicker and do not flow well into narrow/deep pits & fissures

3. Glass ionomer sealants

4. 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: • 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.

5. Diagnosis of pit/fissure caries Diagnosis of pit/fissure caries - can be very difficult! 3 Possibilities: • No caries • Definite caries • Questionable caries

6. Is there caries or is this only stain?

7. 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 sealwith fissure sealant.

8. Moisture control • Rubber dam • single or multiple isolation • Relative isolation with cotton roll

9. Fissure exploration Bur tip should be as fine as possible. L 10 L 20

10. Fissure exploration Place bur in central fossa of occlusal fissure.

11. Upright bur so that it is in the long axis of the tooth; however, bur can be leant towards the ‘direction of travel’ movement, away from the tip. Depth is determined by: • depth of staining present • what is required to alter the anatomy of the fissure so that the sealant can flow to its full depth (approx 0.5mm). • Avoid cuspal inclines. • Note that the depth may therefore vary.

12. Demonstrates initial investigation to distal part of occlusal fissure system

13. Initial investigation into complete fissure system

14. Completed fissure investigation 1.Wash (5 seconds) 2.Dry (10 seconds)

15. Completed fissure investigation (cont.) Visually check the prepared fissure system: • Any staining? • Is it clean? (Note that the depth may vary.)

16. Fissure sealant materials • Select appropriate material to complete the fissure sealant. You can use: • resin system • Glass Ionomer Cement (G.I.C) system, • Resin Modified Glass Ionomer Cement (RMGIC)

17. Application of etchant Apply etchant to fissure system for 15 seconds.

18. Wash thoroughly for minimum 20 seconds to remove etchant.

19. Dry thoroughly. Note that natural tooth should have a frosty appearance.

20. Applying sealantStep 1 • Spread sealant evenly. • One can use applicator or micro-brush, • or sealant can be applied directly to surface. • Avoid porosity (bubbles). (DO NOT blow air to spread the sealant.)

21. Applying sealantStep 2 • Note that the occlusal fissure system is completely covered with resin material but does not extend up to the cusps.

22. Light cure resin material for 20 seconds.

23. Checking the sealant • Using explorer: • ensure material is completely cured • check margins • ensure material is bonded to enamel.

24. Composite resin finishing point