257H
Fig. 6.17 A fluoride slow-release glass
device attached to the buccal surface of
the upper right first permanent molar
tooth.6.4.4 Fissure sealing
Pit and fissure sealants (sealants) have been described as materials which are applied
in order to obliterate the fissures and remove the sheltered environment in which
caries may thrive. Initially developed to prevent caries their use has been developed
further and they now have a place in the treatment of caries.
The decline in caries observed in industrialized countries over recent decades has
affected all tooth surfaces but has been greatest on smooth surfaces. Therefore the pit
and fissured surfaces, particularly of the molars have the greatest disease
susceptibility. This means that the potential benefits of effectively used sealants
continue to increase.
The technique for placement of sealants is relatively simple but is technique sensitive.
Salivary contamination of as little as half a second can affect the bond and therefore
the retention of the sealant.
Several sealant materials are available but the most effective is bis-GMA resin.
Current resin materials are either autopolymerizing or photo-initiated, and most
operators prefer the advantages of demand set offered by photo-initiation. Although
there are theoretical advantages to chemically cured materials in terms of retention, as
these materials have longer resin tags extending into the etched surface. Filled and
unfilled resins are available, the filled materials being produced to provide greater
wear resistance. However, this is not clinically relevant and clinical trials demonstrate
superior efficacy for unfilled materials. Irrespective of the presence of fillers some
materials are opaque or tinted to aid evaluation. This is an advantage but means the
clinician is unable to view the enamel surface to assist with caries detection and to
detect the presence of restorations such as sealant restorations.
Key Points
Fissure sealing technique
- Prophylaxis before etching does not enhance retention but is advisable if abundant
plaque is present. A dry brush should be used rather than paste as these are retained in
the depths of the fissures preventing penetration of the resin. - Isolate the tooth surface,