Fissure sealing
Prof. MUDr. Martina Kukletová
Fissure sealing
Black's extension for prevention
replaced
Sealing for prevention
 to prevent the occurrence of caries on occlusial
surfaces and pits
 Component of the preventive restoration
glass ionomer cements
sealant
composite resin
Effects of sealants
 mechanical sealing of pits and fissures
with acid resistant material
 annulling the preferred habitat of S.
mutans and other cariogenic
microorganisms
 allowing for a better cleaning of pit and
fissure areas
Types of sealants
Bis-GMA polymers
Autocured
Ligth-cured
Urethan diacrylate
 unfilled resins
 filled 20-25 inorganic fillers (glass , quartz
particles)=greater wear resistance
 colored
 uncolored (without pigments)
 transparent
Indication
1. recently erupted teeth-deep pits and
fissures
free of caries(difficult to clean)
2. teeth of physically handicapped patientsmotorical
difficulties to performe dental
hygiene
3. adults-reduction of the saliva flow
Clinical procedures
1. Isolation
 cotton rolls,
 rubber dam
 suction
2. Cleaning of pits and fissure
 3H2O2
 sodium bicarbonate(prophy set)
 depuration paste-brush
3. Rinsing
 water, 10“
4. Acid etching
 phosphoric acid,
 liquid, gel=60“
5. Rinsing
 air/water spray
 20“ (after liquid)
 60“ (after gel)
6. sealant application
 according to manufacturers
instructions
 brush
 cannula
 explorer
7. Polymerization
 light cured
 self cured
8. Removal of nonpolymerized layer
 water soaked cotton pelleet
9. Occlusion
 articulation paper
10. Fluoridation
 local (topical) application
 elmex-fluid, protect gel
Checking-on 6months intervals
Preventive restorations
Glass ionomer
Composite resin
Sealant
Removal of isolated carious sites
Conservation of healthy pits and fissures
Restoration-composite resin
All pits and fissure areas-sealant
Preventive restoration
Advantage
1. healthy tissue-preserved
2. possible reduction of
marginal leakage
3. prevention of secondary
caries in adjacent pits
and fissures
4. loss of restauration-easy
to replace
Disadvantage
1. need for total absence of
moisture
2. longer working time
3. longevity-has not yet
been determined
Preventive restoration
1. sealant filling
 caries confined to enamel of pit or fissure, only
sealant. The technique is used rather
exceptionally, D1, D2, and D3 (just below dentinoenamel
junction) are treated by prophylactic
procedures)
2. preventive filling
 caries in pits and fissures, reaching to dentine
 preventive composite filling
 preventive glassionomer filling
 indication:
 primary molars, premolars, permanent molars
 caries lesion D3 and more
 small caries lesion
 cotraindication:
 approximal caries on the treated tooth, more
extensive caries (more than 1/3 of intercuspal
distance), open approximal defects on any tooth,
DMFT/dmft >5,
Clinical procedures
1. Isolation
 cotton rolls-suction,
 rubber dam
 suction
2. Cleaning of pits and fissures
 3H2O2
 sodium bicarbonate
 paste, brush
3. Caries removal dentin reached
 round bur
4. Cleaning of the cavity
 water
 polyacrylic acid (25)
(dentine exposure)
5. Base
 glass ionomer cement
6. Enamel wall cleaning
 explorer, probe, diamond bur
(excess cement)
7. Etching
 phosphoric acid
liquid, gel=60“
8. Rinsing
 water spray
20“-after liquid
60“-after gels
9. Composit resin application
 bond(fluid resin)-air spray
whole ensemble
 composite resin, posterior type
 sealant
10. Light curing
11. Fluoridation
 local (topical) methods, elmex fluid, protect gel
12. Occlusion
Removal of excess material
 scaler, dental floss