The Sealing of Fissures and Pits in Dentistry

Watch Dental Video about Sealing of Fissures and Pits

The sealing of fissures and pits is the preventive/therapeutic closing of the chewing surface (that is particularly vulnerable to caries) with a highly fluid synthetic compound.

Studies have shown that up to 90% of all sealed molars can be protected from carious stains. Since the mid-90s, the sealing of fissures and pits has been carried out more frequently. The indication for fissure and pit sealing should only be made after a diagnostic examination for caries.

Patients with a high risk for caries, as well as with healthy teeth with a fissure relief vulnerable to caries, should have a sealing of the fissures and pits done early. The objective is the transformation of the chewing surface of the tooth into a plaque-retentive relief and thus into a surface suitable for prophylaxis.

Contraindications to fissure and pit sealing are broad dentin lesions, incompletely erupted teeth, and milk molars, whose second dentition is imminent.

Today, sealing materials are available for clinical use, which harden chemically and are curable with visible light. Fluoride-releasing sealing systems yielded similar results compared to materials polymerizing automatically or through light; however, there is still a lack of long-term results for this type of materials. Since light polymers are quicker and easier to apply as one component materials compared to chemically hardening fissure and pit sealants, they should be given priority in daily clinical routine.

Fissure Caries

Fissure Caries

Glass ionomer cements are hardly suitable for fissure and pit sealing due to high retention losses. Although comparative clinical studies between the absolute drying with a cofferdam and a relative one with cotton rolls showed partially higher retention rates for seals applied while under a cofferdam, the majority of all comparative surveys could not prove any significant differences. Therefore, the relative drying can be viewed as sufficient; a prerequisite for the success of a treatment using relative drying is that the work is executed by four hands – i.e., good assistance!

For cleaning fissures before the use of the acid-etching technique, small rotating brushes or an abrasive particle apparatus are recommended. Afterwards, the surface of the unprepared dental enamel surface is conditioned with approx. 35% phosphoric acid gels for about 60 seconds on a permanent tooth and for about 120 seconds on a milk tooth. After the thorough spraying of the etching gel for at least 10 seconds and a forced drying, a chalk-like white enamel surface must be visible. The sealing material is then delicately applied in the fissure relief.

For the light polymerization, halogen lamps with a sufficient intensity are used; the polymerization time of 20 to 40 seconds (depending on the product) must be observed. Besides their intensity, the spectrum (wavelength range) must be considered with newer plasma and LED lamps. After the application of the sealant, a check of the occlusion is necessary; interfering protrusions must be corrected. The re-mineralization of etched, but non-sealed enamel areas is facilitated by the local application of a fluoride preparation.

A first follow-up check of the fluoride sealing should be done within 6 months. Further checks should be oriented along recall intervals that depend on the caries risk.

Click here to see the video: Fissure Sealing


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