{"id":436087,"date":"2016-02-24T18:37:00","date_gmt":"2016-02-24T21:37:00","guid":{"rendered":"https:\/\/fgmdentalgroup.com\/blog\/posts\/clinical-protocol-for-application-of-pit-and-fissure-sealant\/"},"modified":"2024-09-30T15:07:22","modified_gmt":"2024-09-30T18:07:22","slug":"clinical-protocol-for-application-of-pit-and-fissure-sealant","status":"publish","type":"post","link":"https:\/\/fgmdentalgroup.com\/intl\/blog\/posts\/clinical-protocol-for-application-of-pit-and-fissure-sealant\/","title":{"rendered":"Clinical Protocol for Application of Pit and Fissure Sealant"},"content":{"rendered":"

INTRODUCTION<\/h3>\n

Dental caries, defined as localized destruction caused by bacterial action, still affects a significant portion of the population, especially children and young adults.1,2 Being considered an infectious disease with a multifactorial nature, strongly influenced by fermentable carbohydrates (e.g. sucrose, starch) in the diet, its control to prevent damage to dental structures can be challenging in certain situations.1-7 The occlusal surface represents a highly susceptible region for lesion initiation, where its grooves, pits, and fissures create an environment conducive to its development. This clinical condition is exacerbated by the difficulty of maintaining hygiene in this area (Fig. 1).5 In line with these findings, dental caries lesions can begin in pits and fissures shortly after tooth eruption, and if not prevented or treated, can lead to tooth loss over time.1,2<\/p>\n

One form of prevention involves the mechanical sealing of structural enamel defects through the proper application of a resin-based, glass ionomer, or resin-modified glass ionomer pit and fissure sealant. According to various longitudinal clinical studies, these sealants have proven to be excellent, safe, durable, and effective preventive alternatives for inhibiting the onset and progression of the disease, thereby significantly controlling cariogenic activity in this region.1-4,6,7,8,9 Therefore, the aim of this work is to present a scientifically supported clinical protocol for the application technique of a resin-based pit and fissure sealant.<\/p>\n

\"Fig.
Fig. 1 – Common Optical Microscope Image Axiophot (Zeiss) 20X, illustrating carious lesions in pits and fissures. (E) enamel, (D) dentin. (Sundfield in 2001 – Free Teaching Thesis)<\/figcaption><\/figure>\n

<\/h3>\n

CLINICAL PROTOCOL<\/h3>\n

The sealing technique begins with absolute isolation of the operative field (Fig. 2), when possible; followed by dental prophylaxis using pumice and water. We must emphasize the need for minimally invasive technique application for grooves and fissures with localized chromatic changes, by using a carbide \u00bc spherical bur (KG Sorensen Ind\u00fastria e Com\u00e9rcio Ltda, Barueri, S\u00e3o Paulo, Brazil) only on the grooves and fissures with chromatic changes prior to occlusal sealing (Fig. 3 and 4).<\/p>\n

\"Fig.
Fig. 2 – Absolute isolation of the teeth to be sealed with Prevent sealant (FGM).<\/figcaption><\/figure>\n

 <\/p>\n

\"Fig.
Fig. 3 – Minimally invasive technique for grooves and fissures with localized chromatic changes in the molar; application of a smooth carbide \u00bc spherical bur (KG Sorensen Ind\u00fastria e Com\u00e9rcio Ltda, Barueri, S\u00e3o Paulo, Brazil) only on the grooves and fissures with chromatic changes.<\/figcaption><\/figure>\n

 <\/p>\n

\"Fig.
Fig. 4 – After removal of the chromatic changes.<\/figcaption><\/figure>\n

 <\/p>\n

Next, after prophylaxis (Fig. 5), enamel conditioning is performed on the entire occlusal surface using 37% phosphoric acid (Condac 37, FGM) in gel form, with vibration, employing an explorer probe for a duration of 30 seconds (Fig. 6). After thorough rinsing with water and air drying (Fig. 7), the sealing material (Prevent, FGM) should be applied in all grooves and pits using an explorer probe with vibration assistance (Fig. 8).<\/p>\n

\"Fig.
Fig. 5 – Prophylaxis with pumice and water.<\/figcaption><\/figure>\n

 <\/p>\n

\"Fig.
Fig. 6 – Complete acid etching of enamel for 30 seconds with 37% phosphoric acid (Condac 37, FGM)<\/figcaption><\/figure>\n

 <\/p>\n

\"Fig.
Fig. 7 – After acid etching, the enamel should appear opaque and whitish, free from any contamination by fluids.<\/figcaption><\/figure>\n

 <\/p>\n

\"Fig.
Fig. 8 – Application of Prevent Sealant \u2013 FGM, using an explorer probe, in all grooves and fissures, avoiding regions of occlusal interference.<\/figcaption><\/figure>\n

 <\/p>\n

Photopolymerization will be carried out for 20 seconds, using a halogen or LED light source with appropriate light intensity, at a power of over 400 mW\/cm\u00b2 (Fig. 9). When necessary, occlusal adjustment should be performed in maximum habitual intercuspation, with the patient seated and the occlusal plane parallel to the ground, using a carbon strip. Premature contacts, if present, should be removed with a diamond bur numbered 1014 (K.G. Sorensen), mounted on a high-speed handpiece, with water and air cooling, followed by the action of an abrasive rubber point.<\/p>\n

\"Fig.
Fig. 9 – After photopolymerization, the sealant should be examined for its adaptation, and occlusion should be analyzed. When necessary, adjustments with abrasive points should be performed.<\/figcaption><\/figure>\n

<\/h3>\n

DISCUSSION<\/h3>\n

According to clinical studies by Sundfeld et al. in 1990, 1992, 1993, 2001, 2004, 2006, 2007, and 2010, in order to achieve proven clinical success in sealing grooves and fissures with a sealing material, whether resin-based or resin-modified glass ionomer, a thorough clinical examination of the occlusal surface and interproximal radiographs should be performed initially. Teeth considered suitable for fissure sealing should have clinically and radiographically intact proximal surfaces, accompanied by clinically and radiographically intact grooves and fissures, meaning clear grooves and fissures without chromatic changes. However, those presenting small localized chromatic changes,10 as in the present clinical protocol report, suggestive or not of incipient carious lesions, could receive sealant application only after the removal of these changes, using a carbide \u00bd or \u00bc spherical bur (K.G. SORENSEN) mounted on a high-speed handpiece. It is worth noting that teeth exhibiting extensive carious lesions that affect the entire occlusal groove and\/or dentin tissue and involve all pits and fissures are not suitable for the pit and fissure sealant technique.<\/p>\n

Kramer et al. in 1991 and 1997 consider newly erupted teeth as ideal candidates for pit and fissure sealant application. Moreover, the concept that teeth that have not developed carious lesions within 2 years after eruption are not suitable for sealing is considered debatable. This perspective only considers post-eruptive maturation; however, an individual is not exempt from developing fissure and pit caries during the subsequent years, considering factors like oral hygiene, occlusal anatomy, diet, and other secondary and modifying factors that influence disease development. It’s important to emphasize that these factors can reverse a stabilized state of oral health, potentially transitioning a low-risk patient from caries-free to clinically active caries.13<\/p>\n

It’s worth noting that the incorrect application of the principles underlying the sealing technique has been identified as the main and decisive factor in the failure of sealants. Therefore, if you choose to perform it, do it correctly; otherwise, refrain from doing so!1-4, 6-9<\/p>\n

In 2001, Sundfeld highlighted that the excellent clinical performance presented by the occlusal sealants evaluated in his 11-year longitudinal clinical study is primarily grounded in the extremely precise technique to which they were subjected. He emphasized with great vigor that the material was applied to conditioned enamel that was thoroughly dry and uncontaminated. This fact certainly contributed to the substantial retention of the sealing materials used, as enamel conditioning was performed on the entire occlusal surface, preventing the application of the sealant to unconditioned enamel. This, undoubtedly, would lead to marginal infiltration around the sealant. He also noted the absence of total loss of the sealing material and of carious lesions around the sealants in this longitudinal clinical study, regardless of the type of sealing material used, whether it was resin-based alone or with fluoride in its composition.<\/p>\n

However, it is advisable to conduct periodic interproximal radiographic examinations, as well as to emphasize oral hygiene control. It’s important to provide guidance on intelligent consumption of sucrose and fermentable carbohydrates to prevent lesion development on proximal surfaces. This clearly demonstrates that dental caries is a multifactorial condition, where each factor has its specific role, requiring their interaction for the carious process to initiate.1,2<\/p>\n

In this context, occlusal sealing indeed represents a significantly substantial advancement in eradicating dental caries and enamel structural defects. It offers numerous benefits, such as painless application, good clinical acceptance, and being considered a conservative adhesive procedure.<\/p>\n

<\/h3>\n

CONCLUSION<\/h3>\n

In conclusion, the application of pit and fissure sealants through an appropriate technique undeniably constitutes an effective and safe resource in the prevention of pit and fissure caries lesions.<\/p>\n

GALLERY<\/h3>\n

\"Sequ\u00eancia<\/p>\n

Laboratory Sequence for Observation of Resin Tags Under Common Optical Microscopy with Polarized Light. A – Grooves, pits, and fissures of an extracted molar; B – Prophylaxis with pumice and water; C – Conditioning with 37% phosphoric acid (Condac 37, FGM); D – Complete conditioning for 30 seconds; E – Opaque whitish appearance of enamel after conditioning; F – Application of sealant (Prevent, FGM); G – Applying over the entire area of pits and fissures; H – Photopolymerization for 20 seconds; I – After fissure sealing, the tooth was sectioned using a high-precision cutter, and the slices were polished to observe the adaptation of the sealant and resin tags under common optical microscopy with polarized light.<\/em><\/p>\n

\"Corte<\/p>\n

Sectioning by wear of the posterior tooth sealed with Prevent pit and fissure sealant (FGM).<\/em><\/p>\n

\"Sequ\u00eancia<\/p>\n

Sequence observing the adaptation of Prevent sealant (FGM) in the groove and the resinous extensions (tags) responsible for the mechanical bonding of the pit and fissure sealant to the enamel. (E) enamel (D) dentin (S) Prevent pit and fissure sealant (FGM) and (T) tags. Photos (a) at 25x magnification, (b) at 50x magnification, and (c) after enamel decalcification at 100x magnification.<\/em><\/p>\n

\"Ap\u00f3s<\/p>\n

After observing the sealant adaptation, the tooth was decalcified to observe the resinous extensions formed by Prevent sealant (FGM) on the enamel. (T) – resinous extensions (tags) responsible for the mechanical bonding of the pit and fissure sealant to the enamel.<\/em><\/p>\n

<\/h3>\n

REFERENCES<\/h3>\n
    \n
  1. Sundfeld, R.H. An\u00e1lise microsc\u00f3pica da penetra\u00e7\u00e3o \u2015in vivo\u2016 de selantes de f\u00f3ssulas e fissuras; efeitos de tratamentos superficiais e materiais. Araraquara, 1990. 1 46p. Tese (Doutorado) \u2014 Faculdade de Odontologia de Ara\u00e7atuba, Universidade Estadual Paulista.<\/li>\n
  2. Sundfeld, R.H. A efici\u00eancia da aplica\u00e7\u00e3o de selantes na preven\u00e7\u00e3o das les\u00f5es de f\u00f3ssulas e fissuras: an\u00e1lise cl\u00ednico-fotogr\u00e1fica e cl\u00ednico-computadorizada. Ara\u00e7atuba, 2001. 277p. (Tese Livre Doc\u00eancia) \u2014 Faculdade de Odontologia de Ara\u00e7atuba, Universidade Estadual Paulista.<\/li>\n
  3. Sundfeld RH, Mauro SJ, Komatsu J, Rahal S. Reten\u00e7\u00e3o dos selantes: avalia\u00e7\u00e3o cl\u00ednica fotogr\u00e1fica: 18 meses de an\u00e1lise. RGO, v.40, n.6, p.424-6, 1992.<\/li>\n
  4. Sundfeld RH, Mauro SJ, Komatsu J, Rahal S. An\u00e1lise cl\u00ednica fotogr\u00e1fica da reten\u00e7\u00e3o de selantes de f\u00f3ssulas e fissuras: 36 meses de an\u00e1lise. \u00c2mbito Odontol, v.3, n.14, p.334-9, 1993.<\/li>\n
  5. Serra MC, Pimenta LAF, Paulillo LAMS. Dent\u00edstica e manuten\u00e7\u00e3o de sa\u00fade bucal. IN: KRIEGER, L. ABOPREV. Promo\u00e7\u00e3o de sa\u00fade bucal. 2.ed. S\u00e3o Paulo: Artes M\u00e9dicas, 1999. 475p.<\/li>\n
  6. Sundfeld RH, Mauro SJ, Briso ALF, Sundefeld MLMM. Clinical\/photographic evaluation of a single application of two sealants after eleven years. Bull Tokyo Dent Coll, v.45, n.2, p. 67-75, 2004.<\/li>\n
  7. Sundfeld RH, Croll TP, Mauro SJ, Briso ALF, de Alexandre RS, Sundefeld MLMM. Longitudinal photographic observation of the occurrence of bubbles in pit and fissure sealants. J Appl Oral Sci, v.14, n.1, p.27-32, 2006.<\/li>\n
  8. Sundfeld RH, Mauro SJ, Dezan E Jr, Sundefeld MLMM. Measurement of sealant surface area by clinical\/computerized analysis: 11-year results. Quintessence Int, v.38, n.7, p.384-392, 2007.<\/li>\n
  9. Sundfeld RH, Briso ALF, Mauro SJ, de Alexandre RS, Sundfeld Neto D, Oliveira FG, Machado LS. Twenty Years Experience with Pit and Fissure Sealants. Int J Clin Dent, v.2, n.4, p1-12, 2010.<\/li>\n
  10. Eklund SA, Ismail AI. Time of development of occlusal and proximal lesions: implications for fissure sealants. J Public Health Dent, v.46, n.2, p.114-21, 1986.<\/li>\n
  11. Kramer PF, Fernandes Neto PG, Fernandes RM, Corr\u00eaa MSNP, Fazzi R. Selantes oclusais: revis\u00e3o da literatura: os selantes oclusais, seus aspectos cl\u00ednicos e a import\u00e2ncia de um programa de preven\u00e7\u00e3o. Rev Assoc Paul Cir Dent, v.45, n.3, p.473-7, 1991.<\/li>\n
  12. Kramer PF, Feldens CA, Romano AR. Promo\u00e7\u00e3o de sa\u00fade bucal em odontopediatria: diagn\u00f3stico, preven\u00e7\u00e3o e tratamento da c\u00e1rie oclusal. 2.ed. S\u00e3o Paulo: ArtesM\u00e9dicas, 1997. 144p<\/li>\n
  13. Croll TP & Sundfeld RH. Resin-based composite reinforced sealant. J Dent ChiId, v.66, n.4, p.233-8, 1999.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    INTRODUCTION Dental caries, defined as localized destruction caused by bacterial action, still affects a significant portion of the population, especially children and young adults.1,2 Being considered an infectious disease with a multifactorial nature, strongly influenced by fermentable carbohydrates (e.g. sucrose, starch) in the diet, its control to prevent damage to dental structures can be challenging […]<\/p>\n","protected":false},"author":16,"featured_media":426362,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[1514],"produto-relacionado":[],"categoria-post":[1024],"linha-de-atuacao":[1478],"class_list":["post-436087","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","tag-clinical-case","categoria-post-clinical-case","linha-de-atuacao-esthetics-intl"],"_links":{"self":[{"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/posts\/436087"}],"collection":[{"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/comments?post=436087"}],"version-history":[{"count":0,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/posts\/436087\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/media\/426362"}],"wp:attachment":[{"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/media?parent=436087"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/categories?post=436087"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/tags?post=436087"},{"taxonomy":"produto-relacionado","embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/produto-relacionado?post=436087"},{"taxonomy":"categoria-post","embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/categoria-post?post=436087"},{"taxonomy":"linha-de-atuacao","embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/intl\/wp-json\/wp\/v2\/linha-de-atuacao?post=436087"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}