Sealing of furrows, pits and fissures
1-) Definition and principles of sealing wells and cracks “sealant”:
- It is essentially a preventive measure that aims to prevent or
stop the development of initial carious lesions.
- Early installation of seals creates a physical barrier that is impervious to cariogenic bacteria.
- To be effective, this measure must be based on a reliable diagnosis and a rigorous protocol.
1-1) Preferential locations of carious lesions:
- More than two-thirds of children with caries have damage to the occlusal surfaces.
- It is in this order of ideas that we will first observe the involvement of the anfractured occlusal grooves, then of the vestibular grooves of the mandibular molars “36, 46” followed by the palatine grooves of the maxillary molars “16, 26”
- In these regions, lesser effectiveness of other preventive measures, including fluoridation, has been observed and the effectiveness of sealing is no longer in doubt.
1-2) Particular susceptibility of immature permanent teeth
It is important to know that enamel requires 2 to 3 years of post-eruptive maturation and the non-coalescence of enamel prisms at the bottom of the grooves makes it particularly vulnerable during this period.
The shape and depth of the grooves “Tormented occlusal morphology” leads to the absence of self-cleaning of the dental surfaces during eruption and contributes to the rapid carious damage of immature permanent teeth.
The wider the groove, the easier it will be to clean; the narrower it is, the greater the risk of caries developing.
Mechanical sealing is the preventive therapy of choice for these teeth.
1-3) The different types of seals:
- Sealing can be preventive: when the groove is healthy, it will be carried out without preparation.
- The sealing will be invasive: when the furrow is colored “doubtfully” and there preparation is required “this is what is called Fissurotomy”.
2-) Indications for sealing:
The indication for the installation of a seal is based on several parameters:
- Professional cleaning of dental surfaces
- What teeth?
- At what age?
- Morphology of the furrows,
- Diagnostic rigor: cavities?
- Assessment of individual caries risk,
a-) Which teeth?:
- Immature, mature permanent molars – Occlusal grooves – Mandibular vestibular grooves – Maxillary palatal grooves
- Premolars: occlusal grooves
- Maxillary lateral incisors (palatal grooves)
- Temporary molars; indicated by some authors.
:
- First molar: eruption 6 years – Immature 6 to 8 years – and at any age “healthy tooth”.
- Second Molar: eruption 12 years to 25 years …as long as the tooth is considered healthy.
c-) Morphology of the furrows:
- Wide: do not seal • Narrow: Seal – V-shaped – Teardrop Diagnosis of grooves?: Healthy grooves • Brown grooves, caries.
d-) Assessment of caries risk and indication of sealing:
- Any permanent tooth that is not decayed if there is a high risk of decay must be sealed.
- Permanent teeth without decay but with fissures if there is a low risk of decay
- Medical, physical or intellectual disorders
- Therapeutic sealants: stop the progression of early lesions, strict monitoring.
e-) How to do the DC?
- It is based on clinical examination.
- Clean and dry the tooth.
- Preferably with magnifying optics under adequate lighting.
- Other tools can be used: “fiber optics with transillumination, fluorescence laser, intraoral camera”… etc.
3 -) Additional Indications:
- Enamel abnormalities
- Sealing prior to ODF treatment,
- Peripheral sealing of ODF rings,
- Additional sealing of accessory grooves after composites,
- Sealing the margins of an old restoration.
4-) Contraindications:
- As long as the tooth is not completely on the arch and the practitioner is unable to properly isolate the tooth, “persistence of gingival tissue on a part of the crown which has not completed its eruption”
- Decayed teeth with cavitation and dentin damage.
5-) Choice of materials:
5-1) Required qualities:
- Adhesion to enamel • Easy clinical handling • Good flowability • Fast polymerization • Resistance to occlusal abrasion • Biocompatibility • Possibility of re-evaluation
5-2) For the Preventive Sealant;
- Bis-GMA resins Bisphenol A free
- Glass ionomers “Glass ionomers: Fluoride release ++ GC Fuji VII ® Used transiently on erupting teeth Insufficient retention”
5-3) For the Invasive sealant:
- Fluid composites called “flow”, – Filled – Adhesive.
6-) Operating protocol:
- Professional cleaning of dental surfaces: in order to improve sealant retention.
- Brushing with toothpaste
- Abrasive prophylactic paste
- Sono-abrasion: ultrasound.
- Alumina oxide air abrasion.
- Fissurotomy: mechanical opening of the groove with a burr
- Absence of dentin lesions
- Widens the furrow and facilitates: – etching, – penetration of sealants
- Improves sealant retention
- Recommended by many authors (Terrié et al. 2000)
- Fissurotomy is recommended in the case of brown or questionable furrows
“Invasive Sealants”.
- Isolation ++: conditions adhesion and ensures non-saliva contamination.
- Salivary rolls,
- Operating field,
- 37% phosphoric acid mordant
- Gel or liquid, • 30s to 40s, 15s for immature teeth,
- Wide etching, cusp slopes,
- Elimination of 95% of cariogenic bacteria,
- H2O rinse and air dry
- Rinse for 20s to 30s,
- Chalky white appearance: demineralization,
- Importance of non-saliva contamination.
- Adhesive
- Invasive sealants
- polymerization;
- Installation of the sealant.
- Tip diameter,
- Slow injection, avoid excess and bubbles,
- “Shake” the sealant on the furrow (probe, brush) to ensure its penetration.
- Installation of the sealant.
- Polymerization of the sealant; wait 20 seconds before polymerization to allow it to penetrate into the grooves, pits and cracks.
RQ: There are “Photochromatic Sealants” which allow you to clearly visualize their adaptation.
- Sealant control
- Retention: by the passage of a probe.
- Checking the occlusion.
7- ) Follow-up:
The follow-up interval for people with a high individual caries risk should not exceed 12 months, but if there was any doubt during the protocol about isolation or other issues, a check-up at 6 months is required.
Favorable prognosis:
- Respect the instructions;
- Respect and rigor of the operating protocol;
- Retention rate: 67% at 5 years Periodic renewal required;
- Regular check-ups between 6 and 12 months;
- Association with topical fluoridations;
- Compliance with oral hygiene rules;
- Food risk management.
- Sealant and fluoride varnish:
According to several studies, it appears that the application of sealant combined with the concomitant application of fluoride varnish, preserved the molars free for longer, and, together with good hygiene, constituted optimal protection against carious pathology.
Conclusion :
In the contemporary medical approach to dentistry, prevention takes an important place and constitutes the main axis of Pediatric Dentistry.
Immature permanent teeth are therefore at the center of prevention strategies in order to preserve their tissue and cellular integrity. Sealing the grooves, pits, and fissures of the first and second permanent molars is a simple, quick, and effective technique in preventing occlusal caries. However, it must be carried out rigorously in terms of indications, protocol, and follow-up in order to optimize its protective effect.
In no case should this procedure neglect other means of preventing carious lesions . The practitioner must make the child and their parents aware of the need to maintain oral hygiene, food hygiene and check-ups in order to ensure the durability of the seal and dental structures.
Sealing of furrows, pits and fissures
Wisdom teeth can cause infections if not removed in time.
Dental crowns protect teeth weakened by cavities or fractures.
Inflamed gums can be a sign of gingivitis or periodontitis.
Clear aligners discreetly and comfortably correct teeth.
Modern dental fillings use biocompatible and aesthetic materials.
Interdental brushes remove food debris between teeth.
Adequate hydration helps maintain healthy saliva, which is essential for dental health.
Sealing of furrows, pits and fissuresSealing of furrows, pits and fissures
1-) Definition and principles of sealing wells and cracks “sealant”:
- It is essentially a preventive measure that aims to prevent or
stop the development of initial carious lesions.
- Early installation of seals creates a physical barrier that is impervious to cariogenic bacteria.
- To be effective, this measure must be based on a reliable diagnosis and a rigorous protocol.
1-1) Preferential locations of carious lesions:
- More than two-thirds of children with caries have damage to the occlusal surfaces.
- It is in this order of ideas that we will first observe the involvement of the anfractured occlusal grooves, then of the vestibular grooves of the mandibular molars “36, 46” followed by the palatine grooves of the maxillary molars “16, 26”
- In these regions, lesser effectiveness of other preventive measures, including fluoridation, has been observed and the effectiveness of sealing is no longer in doubt.
1-2) Particular susceptibility of immature permanent teeth
It is important to know that enamel requires 2 to 3 years of post-eruptive maturation and the non-coalescence of enamel prisms at the bottom of the grooves makes it particularly vulnerable during this period.
The shape and depth of the grooves “Tormented occlusal morphology” leads to the absence of self-cleaning of the dental surfaces during eruption and contributes to the rapid carious damage of immature permanent teeth.
The wider the groove, the easier it will be to clean; the narrower it is, the greater the risk of caries developing.
Mechanical sealing is the preventive therapy of choice for these teeth.
1-3) The different types of seals:
- Sealing can be preventive: when the groove is healthy, it will be carried out without preparation.
- The sealing will be invasive: when the furrow is colored “doubtfully” and there preparation is required “this is what is called Fissurotomy”.
2-) Indications for sealing:
The indication for the installation of a seal is based on several parameters:
- Professional cleaning of dental surfaces
- What teeth?
- At what age?
- Morphology of the furrows,
- Diagnostic rigor: cavities?
- Assessment of individual caries risk,
a-) Which teeth?:
- Immature, mature permanent molars – Occlusal grooves – Mandibular vestibular grooves – Maxillary palatal grooves
- Premolars: occlusal grooves
- Maxillary lateral incisors (palatal grooves)
- Temporary molars; indicated by some authors.
:
- First molar: eruption 6 years – Immature 6 to 8 years – and at any age “healthy tooth”.
- Second Molar: eruption 12 years to 25 years …as long as the tooth is considered healthy.
c-) Morphology of the furrows:
- Wide: do not seal • Narrow: Seal – V-shaped – Teardrop Diagnosis of grooves?: Healthy grooves • Brown grooves, caries.
d-) Assessment of caries risk and indication of sealing:
- Any permanent tooth that is not decayed if there is a high risk of decay must be sealed.
- Permanent teeth without decay but with fissures if there is a low risk of decay
- Medical, physical or intellectual disorders
- Therapeutic sealants: stop the progression of early lesions, strict monitoring.
e-) How to do the DC?
- It is based on clinical examination.
- Clean and dry the tooth.
- Preferably with magnifying optics under adequate lighting.
- Other tools can be used: “fiber optics with transillumination, fluorescence laser, intraoral camera”… etc.
3 -) Additional Indications:
- Enamel abnormalities
- Sealing prior to ODF treatment,
- Peripheral sealing of ODF rings,
- Additional sealing of accessory grooves after composites,
- Sealing the margins of an old restoration.
4-) Contraindications:
- As long as the tooth is not completely on the arch and the practitioner is unable to properly isolate the tooth, “persistence of gingival tissue on a part of the crown which has not completed its eruption”
- Decayed teeth with cavitation and dentin damage.
5-) Choice of materials:
5-1) Required qualities:
- Adhesion to enamel • Easy clinical handling • Good flowability • Fast polymerization • Resistance to occlusal abrasion • Biocompatibility • Possibility of re-evaluation
5-2) For the Preventive Sealant;
- Bis-GMA resins Bisphenol A free
- Glass ionomers “Glass ionomers: Fluoride release ++ GC Fuji VII ® Used transiently on erupting teeth Insufficient retention”
5-3) For the Invasive sealant:
- Fluid composites called “flow”, – Filled – Adhesive.
6-) Operating protocol:
- Professional cleaning of dental surfaces: in order to improve sealant retention.
- Brushing with toothpaste
- Abrasive prophylactic paste
- Sono-abrasion: ultrasound.
- Alumina oxide air abrasion.
- Fissurotomy: mechanical opening of the groove with a burr
- Absence of dentin lesions
- Widens the furrow and facilitates: – etching, – penetration of sealants
- Improves sealant retention
- Recommended by many authors (Terrié et al. 2000)
- Fissurotomy is recommended in the case of brown or questionable furrows
“Invasive Sealants”.
- Isolation ++: conditions adhesion and ensures non-saliva contamination.
- Salivary rolls,
- Operating field,
- 37% phosphoric acid mordant
- Gel or liquid, • 30s to 40s, 15s for immature teeth,
- Wide etching, cusp slopes,
- Elimination of 95% of cariogenic bacteria,
- H2O rinse and air dry
- Rinse for 20s to 30s,
- Chalky white appearance: demineralization,
- Importance of non-saliva contamination.
- Adhesive
- Invasive sealants
- polymerization;
- Installation of the sealant.
- Tip diameter,
- Slow injection, avoid excess and bubbles,
- “Shake” the sealant on the furrow (probe, brush) to ensure its penetration.
- Installation of the sealant.
- Polymerization of the sealant; wait 20 seconds before polymerization to allow it to penetrate into the grooves, pits and cracks.
RQ: There are “Photochromatic Sealants” which allow you to clearly visualize their adaptation.
- Sealant control
- Retention: by the passage of a probe.
- Checking the occlusion.
7- ) Follow-up:
The follow-up interval for people with a high individual caries risk should not exceed 12 months, but if there was any doubt during the protocol about isolation or other issues, a check-up at 6 months is required.
Favorable prognosis:
- Respect the instructions;
- Respect and rigor of the operating protocol;
- Retention rate: 67% at 5 years Periodic renewal required;
- Regular check-ups between 6 and 12 months;
- Association with topical fluoridations;
- Compliance with oral hygiene rules;
- Food risk management.
- Sealant and fluoride varnish:
According to several studies, it appears that the application of sealant combined with the concomitant application of fluoride varnish, preserved the molars free for longer, and, together with good hygiene, constituted optimal protection against carious pathology.
Conclusion :
In the contemporary medical approach to dentistry, prevention takes an important place and constitutes the main axis of Pediatric Dentistry.
Immature permanent teeth are therefore at the center of prevention strategies in order to preserve their tissue and cellular integrity. Sealing the grooves, pits, and fissures of the first and second permanent molars is a simple, quick, and effective technique in preventing occlusal caries. However, it must be carried out rigorously in terms of indications, protocol, and follow-up in order to optimize its protective effect.
In no case should this procedure neglect other means of preventing carious lesions . The practitioner must make the child and their parents aware of the need to maintain oral hygiene, food hygiene and check-ups in order to ensure the durability of the seal and dental structures.
Sealing of furrows, pits and fissures
Wisdom teeth can cause infections if not removed in time.
Dental crowns protect teeth weakened by cavities or fractures.
Inflamed gums can be a sign of gingivitis or periodontitis.
Clear aligners discreetly and comfortably correct teeth.
Modern dental fillings use biocompatible and aesthetic materials.
Interdental brushes remove food debris between teeth.
Adequate hydration helps maintain healthy saliva, which is essential for dental health.
Sealing of furrows, pits and fissures