Pit and Fissure Sealants
Cara Miyasaki-Ching, RDHEF, MS
Legal requirements
RDA, RDAEF – DDS decision or supervision
RDH, DDS/DMD – General supervision
Sealant adjustments
Requirements - minimum
16 clock hours total Student shall:
4 hours of didactic Have current CPR
training Take a written exam
4 hours of laboratory RDA or RDA eligible
training (this includes coronal
8 hours of clinical
polish)
training
Requirements - continued
Patient requirements
18 years of age or older
Must be in good health
A minimum of four (4) virgin, non-
restored, natural teeth, sufficiently erupted
so that a dry field can be maintained.
A minimum of one tooth per quadrant
Certification Requirements
Successful completion of written exam
Successful completion of laboratory and
clinical portions of the course
Pit and fissure sealants
A thin plastic coating placed in the pit and
fissures of the teeth to act as a physical barrier
to decay
Why pit & fissure sealants needed
Bacteria produces acid
which causes decay
“demineralization”
Pit and fissure sealants
Over 85% of children (5-17 years old) in US have caries in
the pits and fissures
Fluoride is least effective on pit and fissures
Only 18% of school-aged children in US have sealants
Effectiveness of sealants
15 year study – 68%
of sealed teeth were
caries free vs 17% of
unsealed control
group
Other Preventive Programs
Community water
fluoridation
50-60% (18-40%)
School water
fluoridation 40%
Fluoridated toothpaste 15-30%
Fluoride mouthrinse 31%
In-office treatment 26%
Preventive Programs as Related to
Sealants
Tooth brushing and flossing - mechanical
plaque removal
Fluoride – chemical prevention
Dental visits – mechanical plaque removal
and chemical prevention
Preventive Programs as Related to
Sealants - continued
Diet
Minimize exposure to cariogenic foods and
liquids that have little or no nutritional
value
Minimize solid and sticky foods
Minimize slowly dissolving foods
History of Sealants
Acrylic polymers introduced to dentistry –
1937
Composites - 1960
“Occlusal Sealing” – 1965
Glass ionomers – 1972
Retention of Sealants – 4 year study
Fluoride releasing Non-fluoride
sealant releasing sealant
91% retention 95% retention
(77% complete (89% complete &
& 14% partial) 6% partial)
10% caries rate 10% caries rate
Retention of Sealants – 2 year study
Fluoride releasing sealant
>90% retention
No caries
Sealant retention
Sealant Failure
Debris and/or saliva contamination
Air inclusion during manipulation – voids
Manipulating self-cured sealants late in the
setting reaction
Loss of Sealant
A contaminated site from faulty technique
will likely result in complete or partial loss
of the sealant within 6-12 months.
Cost Factors
Dental Sealants = $25 - $49 per tooth
Amalgam = $75 to $145 per filling
Composite = $150 to $200 for a single surface
white composite filling
Medical reimbursement
Insurance reimbursement
Preventive Resin Restoration
The preparation
of fissures by use
of air abrasion,
bur or laser
followed by
filling the prep
with a flowable
composite.
Incipient Caries
Studies have shown that sealants can be
placed over incipient caries which arrests
the caries process
Most dentists choose to use air abrasion, a
bur, or a laser to remove the caries before
the sealant is placed
Tooth morphology
Pits and fissures
Tooth morphology
Tooth morphology
Tooth morphology
Why fissures are
caries susceptible
Selection of teeth
Considerations
Patient age
Oral hygiene
Caries risk
Diet
Fluoride history
Tooth type
Morphology
Selection of teeth - continued
Frequency of pit & fissure caries
Lower molars – 50%
Upper molars 35-40%
Upper and lower second premolars
Upper laterals and upper first premolars
Upper centrals and lower first premolars
Indications
Deep fissures
Incomplete or ill formed pits
Newly erupted teeth
High caries rate
Children
Molars
Contraindications
Shallow fissures
Well coalesced pits
Fluoride rich enamel
Low caries rate
Occlusal or proximal caries
Adults
Partially erupted teeth?
To seal or not
to seal?
Operculum
(gum flap) –
leaks
crevicular
fluid
Sealant Kits
Cavity Indicators
Drying and/or bonding agent (optional)
Acid etch
Sealant material
Acid Etch
Gel
Liquid
3M Innovation:
Adper™ Prompt™ L-
Pop™ Self-Etch
Adhesive
Acid etch
Phosphoric acid 35%-40%-50%
Dissolves organic portion of
enamel
“micromechanical retention”
Acid etch - continued
Creates more
surface area for
better adhesion
Also high
energy surface
Acid etch - Precautions
Avoid contact with
adjacent teeth or soft
tissues
Can use mylar strips
or matrix bands
Acid etch –Precautions cont.
Active ingredient – phosphoric acid
Avoid contact with skin, eyes, and clothing.
If skin contact – flush with water
If eye contact – flush immediately with water
and seek medical attention
If ingestion- do not induce vomiting. Give
large amounts of water or milk. Take an
antacid. Call a physician.
Acid etch – storage and handling
protocol
Protection – protective eyewear, gloves and
clothing
Toxicity – mild irritation for skin or ingestion
but damage to eye exposure if chronic
exposure.
Storage - Store at room temperature.
Handling – Use gloves, protective eyewear and
PPE.
Acid etch - continued
Will an etched tooth be
more prone to decay?
Remineralization
begins after 24 hours
Drying agent (PrimaDry)
Acid etching and
Primadry (alcohol
based) allows enamel
to be easily “wetted”
PrimaDry – precautions
Active ingredient – ethyl alcohol
If skin contact – wash with soap and water
If eye contact – flush with lots of water
Ingestion- give large amounts of water or milk.
PrimaDry – storage and handling
protocol
Protection – protective eyewear, gloves and
clothing
Toxicity – mild irritation for skin or ingestion
but severe irritation for eye exposure
Storage - Store at room temperature. Keep out
of heat and/or direct sunlight.
Handling – Use gloves and protective eyewear.
Sealant composition
A type of
specialized plastic
(resin) or glass
ionomer material
Matrix
Filler
Sealant Types
Resin Sealants Glass Ionomer Sealants
(Bis-GMA) Bisphenol Anticariogenic
A-glycidyl More viscous, less
methacrylate resins retention, more brittle
Urethane-based resin and less resistant to
occlusal wear
Sealant Types
Filled sealants
Unfilled sealants
Accepted Sealant Materials
ADA Council on Scientific Affairs
3M ESPE – Clinpro Sealant
Confi-Dental Products Company
Dental Technologies
Dentsply International - FluroShield
Ivoclar Vivadent, Inc. - Helioseal
Kuraray America Inc. – Teethmate F-1
PracticeWares Dental Supply
Pulpdent Corporation
Southern Dental Industries
Tru-Tain Prime Dental
Ultradent Products, Inc. - Ultraseal
Zenith/DMG Dental Manufacturing
Types of curing for sealants
Chemical cured – “autopolymerization”
Base and catalyst
Monomer & Initiator + Diluted monomer & 5% Organic
Amine Accelerator = Sealant
Visible light cured – “photopolymerization”
Pre-mixed
Dimethacrylate + Diluent + Activator + Light = Sealant
Chemical cure sealant materials
Advantages
No cure light or risk of eye damage
Can apply sealants to several teeth
Disadvantages
Variation in setting time (appx 2 min)
Voids from mixing material
Changes in viscosity over time
Light cured sealant materials
Advantages
Short setting time (appx 20 seconds)
No mixing required
Won’t set-up – longer working time
Does not get thick
Disadvantages
Potential eye damage due to light cure
Additional cost of cure light
Cure time increased with number of teeth sealed
Difficult to manipulate cure light for posterior teeth
Sealant Shades
Clear
Tinted
Opaque
Clinpro™ Sealant goes
on pink for easy-to-see
application, and cures to
a natural white.
low viscosity, fluoride-
releasing sealant
Sealant Material – precautions
Active ingredient – Bis-GMA
Skin contact – wash with soap and water
Eye contact – flush with lots of water & call
physician if needed
Ingestion- in large amounts induce vomiting
Sealant Material – storage and
handling protocol
Protection – protective eyewear, gloves and
clothing
Toxicity – mild irritation for skin and eye. Low
possiblility of sensitization upon prolonged
exposure for the skin.
Storage - Refrigerate when not in use.
Handling – Use gloves, protective eyewear and
PPE.
Concepts of bonding
Mechanical bonding – interlocking
Chemical bonding – use of adhesive
Physical bonding – attraction of atomic
charges
Requirements for Adhesion
Clean surface
Good wetting by adhesive
Good adaptation to the substrate
Good interface
Good curing
Strength and Viscosity
Characteristics
Viscosity
The thicker the sealant the
less likely to penetrate to
depth of fissure
Wear of Sealants
Considerations for wear –
less filler, more wear and
visa versa
Curing units
Conventional cure light with halogen bulb =
20 seconds cure for each surface
Plasma arc or laser = 5-10 seconds
Assemble armamentarium
Assemble sealant kit
Check the operation of
the syringe on gauze
Armamentarium
Curing units
CAUTION – Avoid looking directly at the
light
Give patient instructions
Verbal instructions
I will be placing a
dental sealant on your
teeth – it’s like a thin
plastic coating on top
of the tooth and will
help prevent cavities
If you have any
problems then raise
your left hand
Give patient instructions
Verbal instructions
This won’t hurt but
you will need to keep
open for a long time
and it doesn’t taste
very good.
Wear personal protective
equipment - operator
Gloves
Mask
Safety glasses/visor
Protective clothing
Closed toed shoes
Wear personal protective
equipment - patient
Safety glasses
Pt. glasses should be
tinted when using a
curing light
(operator/assistant
should have tinted
glasses on shields)
Position patient
Mandibular Maxillary
Check prescription and teeth
Occlusal surfaces
Buccal and lingual pits
on first molars
Lingual pits on upper
anterior teeth
Suspicious lesions?
Explorer – “a stick”
Caries indicator dye
DIAGNOdent
Prepare the tooth
Bristle brush or rubber
cup and plain pumice
Dentist can use bur,
air abrasion or laser
Sharp explorer to
clean out debris
Rinse
Prepare the Tooth - continued
air abrasion, bur,
prophy jet or laser
Position the patient
Check occlusion
Avoid placing
acid etch and
sealant on
marked areas
from
articulator
paper
Isolate tooth/teeth
Treat quadrants
separately
To control isolation
To prevent
contamination by
moisture
Isolate tooth/teeth
Rubber dam
Cotton rolls
Cotton roll holders
Dri-angle
Dry tooth
Test air/water syringe
before applying blast
of air
Apply acid etch
15-20 seconds
Use blue micro tip or
brush tip
Apply only in pit and
fissures
For liquid – dab but do
not rub
Re-etch 10 seconds if
saliva contamination
Apply acid etch - continued
3M Innovation:
Adper™
Prompt™ L-
Pop™ Self-Etch
Adhesive
Etch, prime and
bond
Apply acid etch
Etch pit and fissures
Extend 1-2 mm beyond
pit and fissures
Avoid cusp tips
Acid etch - continued
Etch longer
Deciduous teeth
Saliva contamination
Air abrasion or prophy
jet used
Highly mineralized
teeth
Do not use explorer
Rinse tooth/teeth
Use HVE and a/w
syringe
Proper – usually
20 seconds rinse
Avoid saliva
contamination
Re-isolate
Dry tooth/teeth
Should appear chalky
or frosty white if
etched
If not, re-etch for
another 10 seconds if
not contaminated
with saliva
Apply drying agent (PrimaDry)
Use brush tip
Apply and leave for 5
seconds
Gently blow air to dry
DON’T RINSE
Apply bond agent
A bond agent will
improve retention
Apply sealant material
Most posterior tooth first
Extend 1-2 mm beyond pit
and fissures
Gently work into pits and
fissures
Avoid lifting off tooth
Don’t overfill
“pop” bubbles in sealant
with explorer or brush tip
before curing
Light cure for 20 seconds
20 seconds each tooth
Don’t touch tip of cure
light to sealant
material
Don’t let saliva
contaminate the
field…..yet
Note: sealant will appear
shiny/wet
Light cure for 20 seconds – air
inhibition theory
Top layer of sealant
will remain uncured
sealant will appear
shiny/wet
Check sealed teeth
Use explorer
Tooth should be
smooth but not soft
Re-apply sealant, if
necessary
(Remove uncured
sealant with wet
cotton roll)
Remove isolation materials
Moisten Dri-angle
Rinse the patient’s
mouth
Check occlusion & contact(s)
Articulating paper
Dental floss
Ask patient how it
feels
Dentist can adjust with
bullet-shaped finishing
bur or polishing stone
Give patient instructions
The sealant is hard so you don’t have any
restrictions on eating
If it feels “high” after you go home – you
can come in to get it adjusted
We will keep checking the sealant at
subsequent appointments
(if using unfilled corposite sealant the bite
will self adjust in 2-3 days)
Documentation
9/1/05 Medical history updated – no changes.
Parent consented to sealants on #19 OB and
#30 OB. Cotton rolls and dri-angle
isolation. Ultraseal etch, primer and light
cured sealant used. Patient tolerated
procedure well. Informed parent that
sealant will be checked at recall
appointments.
Infection control
Disinfect unit
Disinfect sealant
syringes
Throw away brush
tips used in patient’s
mouth
Sharp tips need to be
placed with sharps
container
Common Problems
Re-etch
Improperly etched surface – doesn’t appear
frosty and chalky white
Dentin etching – need to dissolve smear
layer
Contamination of application site – saliva
Non-adherence of sealant material
Failure of sealants
Main cause – moisture
contamination
Maxillary and
mandibular 2nd molars
Early loss means less
retention of the resin
Sealing over caries
For incipient caries –
risk of progression is
very small
Risks associated with sealants
No carcinogens or toxic materials
Have xenoestrogens – concentrations too low
Potential chemical burns from phosphoric acid
Occlusal trauma
Danger from cure light
Sealant maintenance
Loss of all or part of
the sealant
Staining at edges
Discoloration
underneath sealant
Repair of sealant
Reapply if totally lost
Repair partial loss
Roughen with
diamond stone
Re-etch 20 seconds
Reapply sealant
Finished!
