Podcast
Questions and Answers
What is the primary purpose of applying fissure sealants?
What is the primary purpose of applying fissure sealants?
Which of the following factors should be considered before placing a fissure sealant?
Which of the following factors should be considered before placing a fissure sealant?
Fissures in teeth are primarily at risk for what issue?
Fissures in teeth are primarily at risk for what issue?
Which of these is NOT a common site susceptible to caries?
Which of these is NOT a common site susceptible to caries?
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Fissure sealants can also be used in the management of:
Fissure sealants can also be used in the management of:
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What is a key advantage of using resin sealants over glass ionomer sealants?
What is a key advantage of using resin sealants over glass ionomer sealants?
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Which component is essential for the bonding process of resin sealants?
Which component is essential for the bonding process of resin sealants?
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What characteristic differentiates compomers from traditional glass ionomer sealants?
What characteristic differentiates compomers from traditional glass ionomer sealants?
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How do filled resin sealants differ from unfilled resin sealants?
How do filled resin sealants differ from unfilled resin sealants?
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Which of the following is true concerning the acid etch technique in bonding?
Which of the following is true concerning the acid etch technique in bonding?
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What is a primary indication for using fissure sealants?
What is a primary indication for using fissure sealants?
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Which ICDAS score indicates a sound tooth with no evidence of caries?
Which ICDAS score indicates a sound tooth with no evidence of caries?
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What is a key feature of the International Caries Classification and Management System (ICCMS™)?
What is a key feature of the International Caries Classification and Management System (ICCMS™)?
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Which scenario would be considered a contraindication for applying fissure sealants?
Which scenario would be considered a contraindication for applying fissure sealants?
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What describes an ICDAS score of 2?
What describes an ICDAS score of 2?
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Study Notes
Fissure Sealants Part 1 - Theory
- Fissure sealants are protective coatings applied to susceptible tooth surfaces.
- Posterior teeth's occlusal surfaces are highly vulnerable to dental caries.
- Sealants create a physical barrier preventing food debris and biofilm from accumulating, preventing future caries.
- Sealants are also used to manage some carious lesions.
- Fissures are deep clefts between adjoining cusps; prone to plaque accumulation.
- Pits are small depressions at developmental grooves.
- Learning outcomes include defining fissure sealants, describing types and evidence for use, explaining indications/contraindications, and determining patient/tooth factors before placement.
- GDC learning outcomes include describing scientific principles underpinning material use and discussing limitations/selection, emphasizing those used in dentistry.
Associated Reading Material
- Aetiology of dental caries lecture is necessary.
- Histopathology of enamel and dentine caries lecture is crucial.
- Tooth morphology lectures provide essential background.
- Fissure sealants Part II - Clinical Technique lecture is linked.
- Future biomaterials lectures (which are relevant to the program) will add additional knowledge.
Types of Fissure Sealant
- Glass ionomer
- Resin modified glass ionomer
- Polyacid modified resin (compomer)
- Composite resin
- Ideal properties include retention, dimensional stability, wear resistance, low solubility, biocompatibility, and ease of application.
Glass Ionomers and Composite Resins
- Glass ionomers: Acid-base reaction, high acid-base bonding, less shrinkage on setting, high fluoride release, low thermal expansion, low tensile strength, susceptible to desiccation, and stiff.
- Composite resins: Polymerisation reaction, resin-dentine bonding, more shrinkage on setting, less fluoride release, less expansion, higher tensile strength, and low susceptibility to desiccation.
Compomers and Resin Modified Glass Ionomers
- Compomers (Polyacid modified resin sealants): Combine resin-based material with glass ionomer properties (fluoride and adhesive). They have a poorer retention rate, but a longer working time and are less sensitive to water.
- Resin modified glass ionomers: Modified glass ionomers with resin components. They release fluoride, and have a longer working time and are less sensitive to water.
Acid Etch Technique
- Removes the smear layer
- Increases the surface area to improve the micromechanical retention.
- Uses 35-37% Phosphoric acid (liquid or gel form)
- Required for resin sealants to bond efficiently.
Resin Sealants
- Bis-GMA (Bisphenol A glycidyl methacrylate) monomer diluted with low-weight dimethacrylate monomers.
- Fourth-generation sealants often contain fluoride.
- Sealants are effective by forming a physical barrier
- Filled sealants tend to have greater wear resistance and higher viscosity.
- Unfilled sealants are clear, and less resistant to wear.
- Sealants are light-activated.
Bisphenol A (BPA)
- Dental composites and sealants contain BisGMA.
- Commonly found in food and beverages.
- There is no evidence of adverse effects.
- Ensure the light-curing unit is calibrated and functioning properly.
- Adhere to the manufacturer's instructions.
Glass Ionomer Sealants
- Fluoroaluminosilicate powder and polyacrylic acid solution.
- Hydrophilic.
- No etching is required.
- Bond chemically, and release fluoride.
- Less retentive compared to resin-based sealants.
Evidence
- Resin based sealants reduce caries in permanent molars by 11-51% after two years.
Which Type of Sealant to Use
- Evidence for one material's superiority over another is weak.
- Resin sealants are often the material of choice, due to higher retention.
- Consider tooth and patient factors when making the final decision.
Indications and Contraindications
- Indications: High caries risk, poor oral hygiene, recently erupted teeth, deep pits and fissures, fully erupted teeth, enamel defects, Orthodontic, early caries.
- Contraindications: Low caries risk, optimum oral hygiene, shallow self-cleansing pits and fissures, partially erupted teeth without adequate moisture control, teeth with previously restored pits/fissures, known methacrylate allergy, extensive carious lesions.
Patient Selection
- Caries risk and level of cooperation are considered.
- Assess medical history, social history, dietary habits, plaque control, fluoride use, past caries experience, and clinical presentation.
Tooth Selection
- Tooth morphology, highly fissured or deeply fissured molars, lateral incisors and cingulum pits, recently erupted teeth, and repair of previously sealed molars are considered.
- Isolation ability, caries status, and radiographic/code information is crucial.
ICDAS II
- International Caries Detection and Assessment System II, for clinical research and epidemiological purposes.
- Clinical scoring system for diagnosing caries at each stage, and characterization of carious activity.
- Standardized caries detection and assessment.
ICCMS™
- International Caries Classification and Management System™
- Classifies lesions into initial, moderate, or extensive.
- Focuses on prevention of new lesions, arresting existing ones, and preserving tooth structure.
ICCMS™ (cont.)
- Describes initial moderate and extensive caries and signs of active and inactive lesions
ICDAS Score 0
- Healthy tooth after 5 seconds of air-drying, no evidence of caries
ICDAS 1
- First visible change in enamel after air-drying, opacity or discolouration that is not consistent with sound enamel, confined to pit/fissure
ICDAS 2
- Distinctive visual change in enamel when wet, showing carious opacity (white spot) or brown discolouration, visible after drying.
ICDAS 3
- Local enamel breakdown when wet. Showing opacity(white spot lesion) or brown discolouration, with no visible dentinal signs.
Summary of Indications/Contraindications (repeated for ease of access)
- Indications: High caries risk, poor oral hygiene, recently erupted teeth, deep pits and fissures, fully erupted teeth, enamel defects, Orthodontic, early caries.
- Contraindications: Low caries risk, optimum oral hygiene, shallow self-cleansing pits and fissures, partially erupted teeth without adequate moisture control, teeth with previously restored pits/fissures, known methacrylate allergy, extensive carious lesions.
Fissure Sealants in Managing Early Caries
- Cleaning, drying, well-lit tooth.
- Avoid probing pits or fissures.
- Radiographic assessment is crucial
- Treatment with ICDAS I or 2/initial lesions.
- Treatment needed for ICDAS 3/early moderate lesions, demineralization confined to enamel and localized enamel breakdown with no visible dentin.
Fissure Sealants - Review and Maintenance
- Sealants effectiveness is dependent on covering all fissures.
- Monitor at each recall visit, inspect visually, assess with probe, evaluate caries risk, reapply (top-up) where appropriate, and reassess developing dentition.
Clinical Technique
- Fissure sealant Part II - Clinical Technique lecture will cover full details.
References/Further Reading
- Contains various studies related to dental fissure sealants and other relevant sources.
End
- Fissure sealants Part II - Clinical Technique lecture follows, along with further formative assessment.
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Description
This quiz covers the theory of fissure sealants, protective coatings applied to teeth to prevent caries. It addresses their function, types, indications, and contraindications, as well as the underlying scientific principles. Understanding these concepts is crucial for effectively managing dental health.
