Fissure Sealants Revision PDF

Fissure sealants  Fissures = deep clefts between adjoining cusps. Caries susceptible surfaces of teeth: Pits = small pinpoint depressions Occlusal sur...

Fissure sealants  Fissures = deep clefts between adjoining cusps. Caries susceptible surfaces of teeth: Pits = small pinpoint depressions Occlusal surfaces located at developmental grooves. Fissures Buccal and cingulum pits Prominent cusp of Caribelli FISSURE SEALANTS = Form a hard physical Dens in dente barrier to prevent Other areas with variation in anatomy protective coatings food and biofilm applied to caries retention, preventing susceptible surfaces of development of caries. teeth. Ideal properties: Types of fissure sealants Retention Dimensionally stable Wear resistant Glass Ionomer - Acid based reaction Low solubility (doesn’t dissolve) High acid-base bonding Biocompatilable (not toxic/harmful) Less shrinkage on setting Simple to apply High fluoride release Low thermal expansion Low tensile strength Stiffer Susceptible to drying out Resin modified glass ionomer - (combination of reactions) Release fluoride Longer working time Composite resin - Polymerization reaction Less water sensitivity Resin-dentine bonding More shrinkage on setting Polyacid modified resin (compomer) - (combination of Less fluoride release reactions) Less expansion Poorer retention Higher tensile strength Combine resin based material with fluoride and Low susceptibility to drying out adhesive properties of glass ionomer  Surface appears chalky Removes smear layer white or frosted Creates microporosities & acquired pellicle Increases surface area Acid etch technique Liquid or gel Micro-mechanical retention of Gel is easier to apply and 35–37% phosphoric acid the resin sealant doesn’t run as much Resin sealants Require dry, acid-etched enamel to bond to. Light activated. Resin — Filled Filled — opaque, greater wear resistance, high viscosity (thicker). Unfilled — clear, less resistant to wear. Contain; Bis GMA and BPA. Fourth generation - contain fluoride. Resin — Unfilled White GIC sealant Glass ionomer sealants No etching required. Acid based reaction — fluoroaluminosilicate powder and polyacrylic acid solution Hydrophilic — can mix and interact with water. Bond chemically. Release fluoride. Pink GIC sealant Less retentive. Current guidance is that resin based sealants are first choice to use due to greater retention.  Assess caries risk: Medical/social/diet history Level of co-operation: Plaque control First dental experience? Patient factors Fluoride use Tell-show-do Previous caries Child friendly language Clinical presentation Co-operation Caries status Recent radiographs IDCAS score 0/1/2/3 Tooth morphology: Deep fissured molars Isolation Pronounced buccal/cingulum pits Saliva and water Tooth factors Further eruption may be required Recently erupted tooth Evidence shows placing fissures Existing sealant soon after eruption is key Previous sealant require regular review and maintenance Indications: Contraindications: High caries risk Low caries risk Poor oral hygiene Optimum oral hygiene Recently erupted tooth Shallow and self cleansing pits or fissures Deep pits or fissures Partially erupted teeth without moisture control Fully erupted tooth Known allergy to methacrylate Enamel defects Cavitation or extensive carious lesion/s Orthodontic/appliance wear Initial carious lesions Review and maintenance DO NOT probe pits or Only effective is all fissures fully covered fissures to aid diagnosis, Monitor at each visit to ensure integrity can cause irreversible Visual and physical check with probe traumatic defects in Revisit caries risk demineralised areas Reapply is necessary Reassess developing dentition