Dental Problems

Pit and Fissure Sealants

Fissure sealants are defined whereby pits and fissure that occur principally on the occlusal surfaces of the molar and premolar teeth are occluded by application of fluid materials, which are then polymerized. In this article, there is a brief discussion on the pit and fissure sealants. Read on to know more.

Pit-and-FissurePit and Fissure Sealants

The sealants are applied on the pits and fissures using current methods. Currently used methods are based on the principle that the adhesion of acrylic and composite resin to enamel is greatly increased if surfaces are first etched with an acid. The acids used are of two main types:

  1. Those that polymerize after mixing two components and
  2. Those that polymerize only after exposure to an appropriate light source.

Effectiveness of Sealants:

For the sealants to be very effective, first of all it must be retained. Whether or not a sealant is retained is dependent upon the following:

  • Technique of application.
  • The type of sealant material.
  • The morphology of the tooth surface to which it is applied.

Classification of Pit and Fissure Sealants:

Mitchell and Gordon

(1990) stated that the sealants can be differentiated in the following ways.

  1. Polymerization methods:

    • A. Self activation (mixing two components)
    • B. Light activation:
      First generation: Ultraviolet light
      Second generation: Self cure
      Third generation: Visible light
      Fourth generation: Fluoride releasing
  2. Resin systems:

    • A. BIS-GMA
    • B. Urethane acrylate
  3. Filled and Unfilled

  4. Clear or tinted:

    • A. Clear sealants have been shown to have better flow characteristics than tinted or opaque, but this can be an advantage or disadvantage depending on the position of the tooth to be sealed. Although the retention rates of the two types are similar, colored sealants are more easily appreciated by the patient and monitored by the dentist at subsequent recalls.
    • B. The sealant is applied in a viscous liquid state enters the micro-pores, which have been enlarged through acid condition. Then the resin hardens because of either a self-hardening catalyst or application of a light source. The extensions of the hardened resin that have penetrated and filled the pores are called tags.

Requisites of an Efficient Sealant:

Need of an efficient sealant as according to Brauer (1978) is as follows:

  • A viscosity allowing penetration into deep and narrow fissures even in the maxillary teeth.
  • Adequate working time.
  • Rapid cure.
  • Good and prolonged adhesion to the enamel.
  • Low sorption and solubility.
  • Resistance to wear.
  • Minimum irritation to tissues.
  • Cariostatic action.

Eligibility for sealant application:

The age ranges for the application of sealants is discussed below:

  • Three to four years of age for the primary molar sealant application.
  • Six to seven years of age for the first permanent molar.
  • Eleven to thirteen years of age for the second permanent molars and the premolars.
  • The approach that considers only selected patients for sealants has been discussed by Simonsen in 1983. He recommended triaging patients into three groups.
    Group 1: Caries-free patients judged at no risk to decay.
    Group 2: Patients judged to be at moderate risk to decay.
    Group 3: Patients with rampant caries at a high risk to decay.
    Sealing of teeth in group 2 patients is done, but not in group 1 and 3.
  • Most realistic approach for deciding which criteria should be used in selecting patients for sealant application is to judge clinically. Clinical judgement is done to select the teeth that are most likely to decay based on the following:
    1. Age
    2. Oral hygiene
    3. Familial and individual history of dental caries
    4. Fluoride environment and history
    5. Dietary habits
    6. Tooth type and morphology

Indications:

Clinical judgement is the deciding factor in the placement of sealants.

  • Newly erupted both primary molars and permanent bicuspids and molars with complete recession of pericoronal operculum and with open and/or sticky grooves and fissures.
  • Stained pits and fissures with minimum decalcification or opacification and no softness at the base of fissures.
  • The tooth in question should have erupted less than 4 years ago.

The above article discusses briefly about the pit and fissure sealants.

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