For the past several decades, a significant decline in the prevalence of dental caries in children in the developed countries has been well-documented. Among all tooth surfaces 12.5% are occlusal, but these account for two-thirds of total caries in children. Caries tends to occur more in deep and narrow pits and fissures. Pits and fissures are eight times as vulnerable as the smooth surface to caries. Caries occurring in the pits and fissures account for 80% to 90% of the total caries status in permanent teeth and primary teeth they account for 44% of the whole.
Pits and fissures are more prone to caries development than smooth surfaces of the tooth which can be due to the morphological complexity of these surfaces, which in turn can lead to increased plaque accumulation and decreased levels of caries protection on pits and fissures. Plaque accumulation and susceptibility of caries are greater during the eruption of the molar teeth. Caries susceptibility in individuals is greater for early initiation and progression of caries among these sites.
Occlusal fissures are deep invaginations of enamel, they can be extremely diverse in shape and have been described as broad or narrow funnels, constricted hourglasses and multiple invaginations with inverted ‘Y’ shaped divisions and irregularly shaped.
Nagano (1960) gave a classification for fissures:
However, because of morphological variations, it is not always possible to categorize a tooth as having one particular type of fissure.
Indication for sealant use includes:
Uncooperative behavior limits the use of sealants due to hampering of adequate field or isolation techniques throughout the procedure. Other contraindications include:
Equipment typically includes:
Tray set-up: the tray should be set up before the procedure, and set up to the practitioner's preferences.
Tooth selection should include those with deep pits and fissures, interproximal caries with no occlusal involvement, and high caries susceptibility.
Preparation of tooth:
The techniques deployed varies depending on the procedure.
Isolation of the tooth:
Sealant placement and curing:
Chemically cured sealant:
Visible light cured sealant:
Evaluate the sealant:
Evaluate the occlusion of scaled tooth surfaces
Complications can be due to various causes including:
According to few studies the release of major sealant components, like Bisphenol A (BPA), impairs the development, health and reproductive system in animals.
However, the American Association of Pediatric Dentistry Guidelines reiterates that the US Drug and Food Administration (FDA) and the American Dental Association (ADA) have concluded that the low-level of BPA exposure from dental sealants poses no known health risks.
Sealants can be used as a preventive measure for total caries prevention program along with the optimum use of fluoride, reduced frequency of sucrose intake and maintenance of good oral hygiene. Pit and fissure sealants provide 100% caries prevention on the occlusal surface as long as the sealant is retained on the tooth surface. Complete retention rate up to one year is approximately 85% to 100%. Subsequently, retention rate comes down to around 50% in five years time. Once the retention rate comes down to 50%, it requires total replacement of the sealant.
Use of sealants which are non-transparent helps to identify the presence or absence of the sealant during their recall. It can be noted that retention of fissure sealants on permanent teeth is greater than primary teeth. On account of difficulties of sealant retention on primary teeth due to enamel structure differences. Caries reduction effectiveness of sealant is equally good in primary and permanent teeth.
Sealant as a therapeutic measure
It is seen that during initial caries if the teeth are sealed the number of viable bacteria decreases leading to inhibition of caries progression. This led to the concept by Bodecker "When in doubt, seal" rather than when in doubt fill.
Public Health applications
Use of sealants on a public health basis is very limited due to the professional time and cost involved. The cost-benefit ratio in the case of sealants is 0.88 dollar, which is more than the benefit when compared with water fluoridation (5.5). The average time for sealant application is 9 minutes 24 seconds per child. It is worthy to say that use of sealants must be related more to the preventive philosophy and conservation of the tooth structure than to the cost benefit ratio.
|Performance of pit and fissure sealants according to tooth characteristics: A systematic review and meta-analysis., Papageorgiou SN,Dimitraki D,Kotsanos N,Bekes K,van Waes H,, Journal of dentistry, 2017 Aug 8 [PubMed PMID: 28797916]|
|Pit and fissure sealants for preventing dental decay in permanent teeth., Ahovuo-Saloranta A,Forss H,Walsh T,Nordblad A,Mäkelä M,Worthington HV,, The Cochrane database of systematic reviews, 2017 Jul 31 [PubMed PMID: 28759120]|
|Estimating the cost of school sealant programs with minimal data., Griffin SO,Jones K,Naavaal S,O'Connell JM,Demopoulos C,Arlotta D,, Journal of public health dentistry, 2017 Jul 4 [PubMed PMID: 28675452]|
|A randomized clinical trial on the sealing of occlusal carious lesions: 3-4-year results., Alves LS,Giongo FCMS,Mua B,Martins VB,Barbachan E Silva B,Qvist V,Maltz M,, Brazilian oral research, 2017 Jun 5 [PubMed PMID: 28591240]|
|Long-term release of fluoride from fissure sealants-In vitro study., Kosior P,Dobrzyński M,Korczyński M,Herman K,Czajczyńska-Waszkiewicz A,Kowalczyk-Zając M,Piesiak-Pańczyszyn D,Fita K,Janeczek M,, Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements (GMS), 2017 May [PubMed PMID: 28347456]|
|Rubber dam may increase the survival time of dental restorations., Keys W,Carson SJ,, Evidence-based dentistry, 2017 Mar [PubMed PMID: 28338026]|
|Penetration of Filled and Unfilled Resin Sealants on Different Enamel Substrates., Kantovitz KR,Moreira KM,Pascon FM,Nociti FH Jr,Machado Tabchoury CP,Puppin-Rontani RM,, Pediatric dentistry, 2016 Nov 15 [PubMed PMID: 28281950]|
|Clinical Practice Guidelines Proposed the Use of Pit and Fissure Sealants to Prevent and Arrest Noncavitated Carious Lesions., Deery C,, The journal of evidence-based dental practice, 2017 Mar [PubMed PMID: 28259315]|
|Evidence-based Clinical Practice Guideline for the Use of Pit-and-Fissure Sealants.,, Pediatric dentistry, 2016 Oct 15 [PubMed PMID: 28206888]|
|[A qualitative research on impact factors for the effectiveness of pit and fissure sealing in Xi'an city]., Li J,Wang L,Shen Y,Wang YB,Zhang SJ,Li G,Gao JM,, Shanghai kou qiang yi xue = Shanghai journal of stomatology, 2016 Oct [PubMed PMID: 28116428]|
|Evaluation of pit-and-fissure sealants placed with four different bonding protocols: a randomized clinical trial., Khare M,Suprabha BS,Shenoy R,Rao A,, International journal of paediatric dentistry, 2016 Dec 26 [PubMed PMID: 28024165]|
|Evidence-based Clinical Practice Guideline for the Use of Pit-and-Fissure Sealants.,, Pediatric dentistry, 2016 Oct [PubMed PMID: 27931466]|
|An experimental in vivo procedure for the standardised assessment of sealants retention over time., Ferrazzano GF,Orlando S,Cantile T,Sangianantoni G,Alcidi B,Coda M,Caruso S,Ingenito A,, European journal of paediatric dentistry : official journal of European Academy of Paediatric Dentistry, 2016 Sep [PubMed PMID: 27759404]|
|Preparation before acid etching in fissure sealant therapy: yes or no?: A systematic review and meta-analysis., Bagherian A,Sarraf Shirazi A,, Journal of the American Dental Association (1939), 2016 Dec [PubMed PMID: 27666005]|
|Fissure sealant materials: Wear resistance of flowable composite resins., Asefi S,Eskandarion S,Hamidiaval S,, Journal of dental research, dental clinics, dental prospects, 2016 [PubMed PMID: 27651887]|
|Sealants for Preventing and Arresting Pit-and-fissure Occlusal Caries in Primary and Permanent Molars., Wright JT,Tampi MP,Graham L,Estrich C,Crall JJ,Fontana M,Gillette EJ,Nový BB,Dhar V,Donly K,Hewlett ER,Quinonez RB,Chaffin J,Crespin M,Iafolla T,Siegal MD,Carrasco-Labra A,, Pediatric dentistry, 2016 [PubMed PMID: 27557916]|
|Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials-a report of the American Dental Association and the American Academy of Pediatric Dentistry., Wright JT,Tampi MP,Graham L,Estrich C,Crall JJ,Fontana M,Gillette EJ,Nový BB,Dhar V,Donly K,Hewlett ER,Quinonez RB,Chaffin J,Crespin M,Iafolla T,Siegal MD,Carrasco-Labra A,, Journal of the American Dental Association (1939), 2016 Aug [PubMed PMID: 27470524]|
|Effect of Adhesive Application on Sealant Success: A Clinical Study of Fifth and Seventh Generation Adhesive Systems., Tandon V,Lingesha RT,Tangade PS,Tirth A,Pal SK,Lingesha CT,Arora V,Yadav V,, Journal of dentistry (Tehran, Iran), 2015 Oct [PubMed PMID: 27252754]|