Pit and fissure sealants: review of literature and application technique

Molars and premolars are the most vulnerable teeth to caries attack. The high susceptibility of these teeth to caries is directly related to morphology of their occlusal surface that prevents both chemical cleaning by saliva and mechanical cleaning by toothbrush. Pit and fissures are therefore the most prone areas to caries and need special protection to prevent carious lesions. Fluoride is the only chemical element used for caries prevention. In fact, it favors the remineralisation of initial lesions, prevents the production of polysaccharides essential for the development and sustainment of bacterial plaque, and the absorption of salivary glycoprotein. Fluoride also reinforces enamel, making it less susceptible to caries. Two methods of fluoroprophylaxis have been proposed: the first is the systemic fluoroprophylaxis which is particularly efficient in preventing interproximal caries, but it does not form an adequate protective barrier on the occlusal surfaces; the other is the topical application of a fluoride gel to the tooth surface, although this second method does not significantly reduce the incidence of caries. The efficacy of the sealing procedures depends on the correct application technique. Observing an operative protocol will ensure a longer lasting retention of the sealant on the occlusal surface and subsequently prolongs the protection against caries.

The use of pit and fissure sealants

This paper reviews key issues of sealant use and methodology and poses recommendations to inform the discussion toward a consensus statement by participants. A comprehensive review of sealant literature, including policy recommendations from previous conferences that reviewed best practices for sealant use, was completed. Building on previous review papers and on previous policy statements by dental and public health groups, this paper discusses key questions about sealant use in light of contemporary caries data and cost-benefit analyses. In addition, newest material advancements are reviewed to establish the next step in sealant improvement for young patients.

Microleakage of three sealants following conventional, bur, and air-abrasion preparation of pits and fissures

OBJECTIVES

The aim of this study was to compare the microleakage of a filled sealant with a drying agent (UltraSeal XT plus), a filled sealant (Prismashield) and an unfilled sealant (Delton), after conventional, bur, and air-abrasion tooth preparation techniques.

SETTING

The study was completed in a clinical setting at the Simulated Practice Environment Clinic, School of Dentistry, University of Western Ontario, London, Ontario, Canada.

SAMPLE AND METHODS

One hundred and eighty extracted teeth were cleaned and divided randomly into three groups. Group 1 was prepared using acid etch only. Group 2 was prepared with a 1/4 round bur in a low-speed handpiece followed by acid etching. Group 3 was prepared with high speed (120PSI) microabrasion using 27 microm alpha-alumina particles in a Midwest Airtouch unit. The teeth in each group were randomly assigned to one of the three subgroups according to the sealant applied. Subgroup A was sealed with a filled sealant with drying agent, B with a filled sealant only, and C with an unfilled sealant. All teeth were stored in artificial saliva for 7 days at 37 degrees C. After this, the teeth were coated with nail varnish 1 mm from the sealant and immersed in 1% methylene blue dye for 48 h at 37 degrees C. Each tooth was sectioned at four locations buccolingually and a total of 665 sections were ranked (0-3) for microleakage. Statistical analysis was completed using the Chi-squared test and Fisher's exact test.

RESULTS

UltraSeal XT plus, the filled sealant with drying agent, showed significantly less microleakage than the other two sealants (P < 0.05). Delton, the unfilled sealant, showed significantly less microleakage than Prismashield, the filled sealant (P < 0.05). Air abrasion with acid etch showed significantly less microleakage than either bur with acid etch or acid etch alone. There was however, no significant difference between the bur and acid etch tooth preparations (P < 0.05).

CONCLUSIONS

UltraSeal XT plus was the most effective sealant for preventing microleakage in this study. The most successful method of preparation was air abrasion with acid etch.