- Administer local analgesia, after application of topical anaesthetic paste at the
injection site. - Place rubber dam.
- Explore the suspect area of the fissure system with a high speed small bur,
removing only enough enamel to gain access to the caries. The access must by wide
enough to ensure that the operator can remove caries from the peripheral tissue. If the
radiographs show dentinal caries, even if the enamel seems intact, access must
progress into dentine. Undermined enamel can be left in situ as the bis-GMA resin
restoration virtually restores the original strength of the tooth. - Line the cavity with calcium hydroxide. There is some debate as to whether it is
necessary to line these cavities. Some studies report no pulpal problems in teeth where
the operator has directly etched and bonded the dentine. - Etch. Precise details are dependent on the chosen 'restorative' system for steps (5)-
(8) and the manufacturers instructions must be followed. - Wash.
- Dry.
- Bond.
- Place the chosen composite in the cavity. In smaller cavities glass ionomer cement
is an alternative. - Seal all the remaining fissure system with fissure sealant.
- Check the occlusion.
- Review the integrity of the sealant at the routine recall appointments. If the visual
appearance is inconclusive, re-etch the surface to identify sealant retention.
The technique is shown in 431HFigs. 9.11, 432H9.12, 433H9.13, 434H9.14, 435H9.15, 436H9.16, 437H9.17, 438H9.18, 439H9.19,
and 440H9.20.
Where the diagnostic methods are inconclusive, the clinician should explore the
fissure to validate caries free status or eradicate occult caries. Depending on the extent
of any lesion, restoration by fissure sealing or composite completes the procedure.