pfs

• Application and mechanical bonding of a resin material to an acid-etched enamel surface sealing existing pits and fissures from the oral environmen

  OCCLUSAL SEALANTS
• Prevents bacteria from colonizing in the pits and fissures and nutrients from reaching the bacteria already present.

  OCCLUSAL SEALANTS
• are considered an effective caries-reducing agent when proper patient selection and application techniques are followed

  OCCLUSAL SEALANTS
• Hyatt • Prophylactic odontotomy → noncarious fissures were prepared and restored with a shallow silver alloy 


  1923
• Bodecker • Fissure eradication → fissures were removed and smoothed but not restored


  1929
• Development of topical and systemic fluorides


  1950
• • Buonocore • Introduced a method of adhering resin to an acid-etched enamel surface


  1955
• • First clinical trial was reported by Cueto and Buonocore → used cyanoacrylate as the sealant material placed over an etched occlusal surface.


  1967
• • Buonocore • Substituted and investigated a bisphenol A-glycidyl methacrylate (bisGMA) ultraviolet light-activated resin


  1971
• has been found to be more selective in its caries reducing benefits on the smooth surfaces than on the pit and fissure surfaces.

  Systemic fluoride ingestion
• The ingestion of systemic fluoride during the preeruptive development of a tooth contributes to the reduced caries susceptibility of its occlusal surface
• A single application is an effective caries-reducing agent provided that it is meticulously applied.

  occlusal sealant
• Recommended sequence of treatment: ◦

  Prophylaxis ◦ Sealant placement ◦ Topical fluoride application (flouridization)
• Challenges: ◦


  Time ◦ Cost effectiveness
• Cost of placement can be minimized by 


  ◦ Delegating treatment to auxiliary personnel where legally permitted - Selecting commercial products that have the highest proved success rates and are approved by the American Dental Association (ADA) - Applying sealants in conjunction with optimal fluoride therapy
• Composed of hydroxyapatite crystals arranged in hexagonal prisms forming rods oriented at right angles to the surface

  normal enamel
• enamel Surface is usually in a low- energy weakly reactive, hydrophobic state
• becomes a high-energy, strongly reactive, hydrophilic surface

  Acid exposure
• Etches the enamel surface, producing increased surface area and porosity → selective demineralization of the hexagonal prisms.

  acid
• Preferential removal of the prism core 


  (type I) ◦
• Preferential removal of the prism periphery

  (type II)
• Random pattern of both types

  (type III)
• ETCHING TIME • Conventional: 60-seconds
• 20 second etching time produces comparable retention rates
• Sealants placed on permanent teeth were initially reported to be higher than those for primary teeth
• To achieve the greatest possible caries reduction, a comprehensive cariespreventive program must use sealants in conjunction with other caries- preventive methods
• Patients for sealant placement must ◦ Be dependable on recall appointments ◦ Be aged 6 to 15 years ◦ Be motivated and proficient in caries control ◦ Have a low caries activity ◦ Receive systemic and topical fluorides ◦ Have eligible teeth → recently erupted (within 3 years), caries-free permanent teeth with steep cuspal inclines
• Most important factor: Risk of carious development on a particular surface

  Patient oriented
• A questionable tooth surface would be an ideal candidate for sealants

  Tooth oriented
• do not seal: 


  ◦ carious ◦ broad pits and fissures ◦ caries free for 4 yrs
• seal: 


  many occlusal lesion ◦ few proximal lesion ◦ deep pits and fissure ◦ recently erupted
• Newly erupted permanent first and second molars should receive priority over premolars and primary molars even in high-risk groups
• retention of sealants is more on

  ◦ older patient ◦ permanent ◦ mandibular ◦ premolars ◦ occlusal
• Quality of the etch and sealant coverage and polymerization are greatly influenced by the quality of the isolation
• Carious process on the occlusal surface is initiated within the fissure and not on the cuspal inclines.
• Etched enamel remineralizes completely within 48 hours because of the deposition of salivary calcium and phosphate salts
• Occlusal sites that have lost sealant coverage are not more susceptible to future caries development because of the etching
• Several commercial products are available whose opaque color is more visually detectable.
• Not recommended to place sealant over a detectable carious lesion
• the sealant's marginal integrity is maintained, the carious site may become inactive