Sealing purpose:
- Against carious lesion
- Acid removal from difficult cleaning areas
Definition: To close the fissures of molars and premolars and the foramina of second incisiors
Fissures: from developmental lobes, fussing site
Non-invasive, effective prevention
Benefits: 1) Easy, 2) Safe, 3) Effective, 4) Not expensive
Aim: 1) counteract the carious lesion, 2) to prevent acidic/cariogen attacks
Fissure cross-section forms: shapes; U, V, Y, X.
Bottom of the fissure: no maturated enamel, not available for F, no self-cleansing, difficult to brush
History:
- 1960s: basics of fissure sealing (Buonocore); PMMA, bis-GMA, UDMA, TEGDMA
- 1972: first FS in the market (Nuva-Seal)
Types (Generations)
- UV light
- Autopolymerizing/chemical binding
- Blue light polymerization
Filling materials: against abrasion, control of occlusion needed
Application method (brush on and/or syringe)
Curing method (light-cure and/or chemical cure)
Filler and Fluoride content
No preparation / with preparation
Sealing: a part of total preventive package
F containing FS: last 20 years; anticariogen effect and antibacterial properties; 10-20 ㎛ depth: higher F c.c.
Application: 1) fluid F before polymerization, 2) organic binding F
Indication of FS (absolute)
- Deep occlusal fissure, fossae
- 3 – 4 years: primary teeth
- 6 – 7 years: first molars
- 8 – 9 years: premolars
- 11 – 13 years: second molars
- Adult: high caries risk, from side effect of medication, xerostomia caused by radiotherapy
Indications of FS (relative)
- Isolated fossa from another restoration
- Distal fossa in case of inadequate eruption
- Incipient lesion (caries incipiens)
- Class I. filling: to complete the marginal integrity
Contraindications
- Patient trembling (vibrating); impossible to dry, isolate the tooth
- Carious lesion already in the fissure
- Carious lesion in different part of the tooth, but a restoration is partially on the fissure
- Great occlusal restoration
Optimal appointment of FS: NO CARIOUS, freshly erupted tooth, max. 6 month after eruption
FS materials:
- nontoxic (local, systemic)
- flow properties,
- strong bind to enamel,
- physical properties similar to enamel
- easy to applicate
- resistance against attacks in oral cavity,
- fast binding, dimensional stability (shrinkage)
Sealing step-by-step
- First examination
- Polishing with non-fluoride paste and washing
- First isolation, drying
- Etching (preparation with orhto-phosphoric acid)
- Washing (remove the acid), remove isolation
- Second isolation, drying
- Application of flow material
- Polimerisation
- Control the occlusion assessment
- Last finishing if necessary
Extended (complicated) FS if necessary: discoloring in the fissure, worse fissure shape, contraindication in case of caries
- Open the fissure with cilindric diamond
- Minimal removal – only brown areas
- Best filling material – if necessary, with prophylactic sealing
- Control the occlusion assessment
Is it safe to use Fissure Sealing?