Fissure Sealants Part 1 Theory PDF

Fissure sealants Part I - Theory Module: FCSP Dr Haydee Husain BDS MSc GDC Learning Outcomes 1.1.9 Describe the scientific principles underpinning the use of materials and biomaterials and discuss their limitations and selection, with emphasis on those used in dentistry 1.10....

Fissure sealants Part I - Theory Module: FCSP Dr Haydee Husain BDS MSc GDC Learning Outcomes 1.1.9 Describe the scientific principles underpinning the use of materials and biomaterials and discuss their limitations and selection, with emphasis on those used in dentistry 1.10.4 Advise on and apply a range of preventive materials and treatment as appropriate Intended learning outcomes To define fissure sealants To describe the different types of fissure sealant and the evidence for their use To explain the indications and contra-indications for the use of fissure sealants To determine both patient and tooth factors that need to be considered before placement of a fissure sealant Associated reading material Aetiology of dental caries lecture Histopathology of enamel and dentine caries lecture Tooth morphology lectures Fissure sealants Part II - Clinical Technique lecture And future biomaterials lectures where relevant to your program of study! Pits and fissures Fissures are the deep clefts between adjoining cusps. They are areas at risk from plaque retention and stagnation Pits are small pinpoint depressions located at the developmental grooves What are fissure sealants? Refer to you tooth morphology lectures Fissure sealants are protective coatings applied to caries susceptible surfaces of teeth The occlusal surfaces of posterior teeth are the most vulnerable site for dental caries They form a physical barrier to prevent the retention of food debris and biofilm thus preventing the development of caries lesions In addition to preventing caries, fissure sealants are also used in the control and management of some carious lesions Caries susceptible sites Fissures Buccal and cingulum pits Dens in dente, dens evaginatus Prominent cusp of Caribelli Which refers to each image? Background Miller 1905 – use of silver nitrate Hyatt 1923 – ‘Prophylactic odontomy’ Buonocore 1955 – observed the increased retention of acrylic resin after treating the enamel with acid-etch Bowen et al 1965 – development of Bis-GMA resin In the 1960s widespread use as part of preventative programs Types of fissure sealant Refer to your biomaterials lectures where relevant to your program of study! Ideal properties: Glass Ionomer Retention Resin modified glass Dimensionally stable ionomer Wear resistant Polyacid modified resin Low solubility (compomer) Biocompatible Composite resin Simple to apply Glass ionomers and composite resins Glass ionomers Composite resins Acid base reaction Polymerisation reaction High acid-base bonding Resin-dentine bonding Less shrinkage on setting More shrinkage on setting High fluoride release Less fluoride release Low thermal expansion Less expansion Low tensile strength Higher tensile strength Susceptible to dessication Low susceptibility to dessication Stiffer Compomers and resin modified glass ionomers Compomers Resin modified glass ionomers Polyacid modified resin sealants Modified glass ionomers with resin components Combine resin-based material with the fluoride and adhesive Release fluoride properties of glass ionomer Longer working time Poorer retention Less water sensitivity Acid etch technique Removes smear layer Creates microporosities Increases surface area Micromechanical retention of the resin sealant 35-37% phosphoric acid Liquid or Gel A = Normal B= Etched enamel enamel Resin sealants Bis GMA (Bisphenol A glycidyl methacrylate) monomer diluted with low weight dimethacrylate monomer to make the sealant fluid Fourth generation sealants now also contain fluoride Prevent caries by forming a physical barrier Unfilled Effectiveness depends on longevity of retention Filled – opaque, greater wear resistance, higher viscosity Unfilled – clear, less resistant to wear Require a dry, acid-etched enamel in which to bond Light activated Filled  Bisphenol A (BPA) Dental composites and sealants contain BisGMA derived from Bisphenol A (BPA) Low levels of BPA immediately after placement Most human exposure to BPA is from food and beverages No evidence of adverse effects Ensure light curing unit is calibrated and functioning correctly Adhere to manufacturer instructions Wash surface/polish/rinse after placement Rubber dam Glass ionomer sealants White GIC sealant Fluoroaluminosilicate powder and polyacrylic acid solution Hydrophilic No etching required Bond chemically Anticariogenic - release fluoride Less retentive Pink GIC sealant Evidence Resin based sealants applied to occlusal surfaces of permanent molars reduced caries between 11% and 51% 2 years after application, when compared to no sealant Which type of sealant to use Evidence for superiority of one material over another is weak Resin sealants offer greater retention and are the material of choice Consider tooth and patient factors Indications and contraindications Patient factors Tooth factors What do we need to know about What tooth factors might we need our patient before placing a fissure to consider before placing a fissure sealant? sealant? Break Patient selection Caries risk Level of co-operation Assess caries risk Medical history Introduction to dentistry Social history First experience of dental Dietary habits procedure? Plaque control Tell-show-do Fluoride use Child friendly language Past caries experience Co-operation Clinical presentation Tooth Selection Refer to your Tooth morphology, aetiology of dental caries and Histopathology of enamel Tooth morphology and dentine caries lectures! Highly fissured/deeply fissured molars Is isolation possible? Lateral incisors and cingulum pits Recently erupted tooth Caries status Radiographs or Repair of previously sealed molars ICDAS/ICCMS™ code ICDAS II The International Caries Detection and Assessment System II Developed for use in clinical research, clinical practice and for epidemiological purposes A clinical scoring system used to diagnose caries ICDAS allows detection of the caries process at every stage and characterisation of the carious activity of the lesion Developed due to standardise caries detection and assessment ICCMS™ International Caries Classification and Management System ™ Classifies lesions into initial, moderate or extensive Focus on prevention of new lesions, arresting existing lesions and preserving tooth structure of lesions that require operative care ICCMS™ https://www.iccms-web.com/ ICDAS score 0 Sound tooth After 5 seconds of air drying No evidence of caries ICDAS 1 – first visible change in enamel First visible change in enamel seen after air drying Opacity or discoloration (white or brown lesion) is visible that is not consistent with the clinical appearance of sound enamel Confined to entrance of pit/fissure ICDAS 2 – distinct visual change in enamel The tooth must be viewed wet When wet there is a carious opacity (white spot lesion) and/or brown carious discoloration Note: the lesion must still be visible when dry ICDAS 3 – localized enamel breakdown When wet there is a (a) carious opacity (white spot lesion) and/or (b) brown carious discoloration With localised enamel breakdown in opaque or discoloured enamel No visual signs of dentinal involvement seen when wet or after prolonged drying Summary of indications/contraindications Indications Contraindications High caries risk Low caries risk Poor oral hygiene Optimum oral hygiene Recently erupted tooth Shallow self cleansing pits and fissures Deep pits and fissures Partially erupted teeth without Fully erupted tooth (?GIC) adequate moisture control (?GIC) Enamel defects Teeth with previously restored pits/fissures (?repair) Orthodontic/other appliance wear Known allergy to methacrylate Initial carious lesions Frank cavitation/extensive carious lesions Fissure sealants in managing early caries Clean, dry, well illuminated tooth Do not probe pits or fissures Radiographic assessment? ICDAS I or 2/Initial lesions ICDAS 3/Early moderate lesion Demineralisation confined to enamel with no localised enamel breakdown Localised enamel breakdown due to caries with no visible dentine or underlying shadow Fissure sealants – review and maintenance Worn sealant Fissure sealants are only effective where exposed if all the fissures are fully covered fissure are now Monitor at each recall visit carious (Image source: SDCEP) Visual inspection Physical check with a probe Revisit caries risk Reapply – ‘top up’ Probe inserted under palatal Reassess developing dentition extension that lifts away (Image source: SDCEP) Clinical Technique This will be covered in: Fissure sealants Part II - Clinical Technique lecture References/Further reading Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Makela M, Worthington HV. Sealants for preventing dental decay in the permanent teeth (Review) The Cochrane Collaboration 2017 Issue 7 Deery C. Caries detection and diagnosis, sealants and management of the possibly carious fissure. British Dental Journal 2013; 214 (11): 551-557 Wright JT, Crall JJ, Fontana M et al. Evidence based clinical practice guideline for the use of pit-and-fissure sealants A report of the American Dental Association and the American Academy of Pediatric Dentistry. JADA 2016; 147(8): 672-682 Public Health England Delivering better oral health: An evidence based toolkit for prevention Third Edition March 2017 SIGN 138 Dental interventions to prevent caries in children A national clinical guideline March 2014 Scottish Dental Clinical Effectiveness Programme Prevention and Management of Dental Caries in Children Dental Clinical Guidance 2nd Edition May 2018 Marzouk T, Sathyanarayana S, Kim AS, Seminario AL, McKinney CM A systematic review of exposure to Bisphenol A from Dental Treatment. JDR Clinical and Translational Research 2019 Apr; 4(2): 106-115 https://www.iccms-web.com/ End Fissure sealants Part II - Clinical Technique lecture to follow Formative assessment to follow