CHAPTER

17
Pit and Fissure Sealants and Preventive
Resin Restorations
▲ Brian J. Sanders, Robert J. Feigal, and David R. Avery

CHAPTER OUTLINE

CLINICAL TRIALS Isolation Reevaluation

RATIONALE FOR USE OF SEALANTS Etching PREVENTIVE RESIN RESTORATION
SELECTION OF TEETH FOR SEALING Washing (SEALED COMPOSITE RESIN
SEALANT TECHNIQUE Application of Sealant RESTORATION)
Cleaning Check of Occlusal Interferences

I
n 1955, Buonocore described the technique of acid agents that allow for color change during and/or after
etching as a simple method of increasing the adhe- polymerization. These compositional changes do not
sion of self-curing methyl methacrylate resin materi- affect the sealant, but only offer some arguable benefi t
als to dental enamel.1 He used 85% phosphoric acid to in the recognition of sealed surfaces.
etch enamel for 30 seconds. This produces a roughened The cariostatic properties of sealants are attributed to
surface at a microscopic level, which allows mechanical the physical obstruction of the pits and grooves. This
bonding of low-viscosity resin materials. prevents colonization of the pits and fissures with new
The first materials used experimentally as sealants bacteria and also prevents the penetration of fermentable
were based on cyanoacrylates but were not marketed. By carbohydrates to any bacteria remaining in the pits and
1965, Bowen had developed the bis-GMA resin, which is fissures, so that the remaining bacteria cannot produce
the chemical reaction product of bisphenol A and glyc- acid in cariogenic concentration.
idyl methacrylate.2 This is the base resin to most of the
current commercial sealants. Urethane dimethacrylate
and other dimethacrylates are alternative resins used in
CLINICAL TRIALS
sealant materials. Many clinical studies have reported on the success of pit
For the chemically cured sealants, a tertiary amine and fissure sealants with respect to caries reduction. As
(activator) in one component is mixed with another com- the longevity of the sealant increases, the retention rate
ponent containing benzoyl peroxide, and their reaction becomes a determinant of its effectiveness as a caries-
produces free radicals, which initiates polymerization of preventive measure.
the sealant material. In 1983, a National Institutes of Health Consensus
The other sealant materials are activated by an exter- Panel considered the available information on pit and
nal energy source. The early light-activated sealants were fissure sealants and concluded that “the placement of
polymerized by the action of ultraviolet rays (which are sealants is a highly effective means of preventing pit and
no longer used) on a benzoin methyl ether or higher- fissure caries.… Expanding the use of sealants would sub-
alkyl benzoin ethers to activate the peroxide curing sys- stantially reduce the occurrence of dental caries in the
tem. The visible light–curing sealants have diketones and population beyond that already achieved by fluorides
aromatic ketones, which are sensitive to visible light in and other preventive resources.”3
the wavelength region of 470 nm (blue region). Some In 1991, Simonsen reported on a random sample of
sealants contain filler, usually silicon dioxide microfill or participants in a sealant study recalled after 15 years.4
even quartz. He reported that, in the group with sealant, 69% of the
Sealant materials may be transparent or opaque. surfaces were sound 15 years after a single sealant applica-
Opaque materials are available in tooth color or white. tion, whereas 31% were carious or restored. In the group
Transparent sealants are clear, pink, or amber. The clear without sealant, matched by age, gender, and residence,
and tooth-colored sealants are esthetic but are difficult 17% of the surfaces were sound, whereas 83% were cari-
to detect at recall examinations. Recent advances in ous or restored. He also estimated that a pit and fissure
sealant technology include light-activated coloring surface on a permanent first molar is 7.5 times more likely

313
314 Chapter 17 ■
Pit and Fissure Sealants and Preventive Resin Restorations

to be carious or restored after 15 years if it is not sealed Going declared that, given the results of many well-
with a single application of pit and fissure sealant. documented studies, practitioners’ fear of sealing pits and
The use of glass ionomer as a sealant material has the fissures with incipient caries is not warranted.10 He
advantage of continuous fluoride release, and its preven- pointed out that sufficient studies of scientific merit re-
tive effect may continue with the visible loss of the mate- ported negative or low bacterial concentrations after seal-
rial. Glass ionomer may be useful as a sealant material ant had been in place for several years.
in deeply fissured primary molars that are difficult to Wendt and Koch annually followed 758 sealed occlu-
isolate due to the child’s precooperative behavior and in sal surfaces in first permanent molars for 1 to 10 years.11
partially erupted permanent molars that the clinician At the end of their study, evaluation of the surfaces that
believes are at risk for developing decay. In such cases, had been sealed 10 years previously revealed that only
glass ionomer materials must be considered a provisional 6% showed caries or restorations. Romcke and associates
sealant to be reevaluated and probably replaced with annually monitored 8340 sealants placed on high-risk
resin-based sealants when better isolation is possible. (for caries) first permanent molars during a 10-year
Because questions exist regarding the strength and reten- period.12 Maintenance resealing was performed as indi-
tion of glass ionomer, further long-term research is neces- cated during the annual evaluations. One year after the
sary before it is recommended as a routine pit and fissure sealants were placed, 6% required resealing; thereafter 2%
sealant material. to 4% required resealing annually. After 8 to 10 years,
A 1996 survey of Indiana dentists5 found that 91% of 85% of the sealed surfaces remained caries free.
them were placing sealants on permanent teeth, whereas Retrospective studies based on billing data from large
in 1985 a similar study6 had found that only 73.5% were third-party databases reveal that sealant use is still sur-
placing sealants on permanent teeth. This increased use prisingly low, even in populations for which sealants are
of sealants may be related to increased practitioner com- a covered benefit.13,14 In addition, these studies show
fort with the materials, because a direct correlation was that the effectiveness of sealants in preventing the need
found between sealant use and year of graduation from for future restorative care on the sealed surfaces declines
dental school. The increase may also be related to a after the first 3 years following sealant treatment. These
decreased concern over the possibility of caries develop- data argue again for the importance of vigilant recall and
ing under the sealant. upkeep of sealants after placement.
Several studies have reported decreased viable bacterial Another concern is the placement of sealants immedi-
counts in occlusal fissures that have been sealed. Handle- ately after topical fluoride application. Clinical and in vitro
man and colleagues placed an ultraviolet-radiation– studies have shown that topical fluoride does not interfere
polymerized sealant on pits and fissures of teeth with with the bonding between sealant and enamel.15,16
incipient caries.7 They reported a 2000-fold decrease in
the number of cultivable microorganisms in the carious
dentin samples of the sealed teeth compared with un-
RATIONALE FOR USE OF SEALANTS
sealed control teeth at the end of 2 years. The 2008, Evidence Based Clinical Recommendations for
Going and colleagues obtained bacteriologic samples the Use of Pit and Fissure Sealants report by the American
from teeth that had been sealed with an ultraviolet- Dental Association on Scientific Affairs concluded that
radiation–polymerized sealant for 5 years.8 They found sealants are effective in caries prevention and can prevent
an apparent 89% reversal from a caries-active to a caries- the progression of early noncavitated carious lesions.17
free state in the sealed teeth. The American Academy of Pediatric Dentistry’s Pediat-
Jeronimus and associates placed three different pit and ric Restorative Dentistry Consensus Conference18 con-
fissure sealants on molars with incipient, moderate, and firmed support for sealant use and published these
deep carious lesions.9 Samples of carious dentin were re- recommendations:
moved immediately after and 2, 3, and 4 weeks after 1. Bonded resin sealants, placed by appropriately trained
placement of the sealants and bacteriologic cultures were dental personnel, are safe, effective, and underused in
made. They reported usually positive culture results in preventing pit and fissure caries on at-risk surfaces. Ef-
teeth where the sealant was lost. Although their short- fectiveness is increased with good technique and ap-
term study indicated that incipient carious lesions may propriate follow-up and resealing as necessary.
not be of prime concern when sealants are applied, they 2. Sealant benefit is increased by placement on surfaces
cautioned against the use of sealants over deeper lesions judged to be at high risk or surfaces that already
because of the potential for advancement of caries when exhibit incipient carious lesions. Placing sealant over
sealants over these lesions are lost. One must keep in minimal-enamel caries has been shown to be effec-
mind that their deep-lesion group consisted of teeth with tive at inhibiting lesion progression. As with all
caries that had advanced pulpally greater than half the dental treatment, appropriate follow-up care is
distance from the dentinoenamel junction. recommended.
Studies have shown definitively that deficient sealants 3. The best evaluation of risk is made by an experienced
are not effective in caries prevention and that loss of seal- clinician using indicators of tooth morphology, clini-
ants leads to immediate risk of caries attack from under- cal diagnostics, past caries history, past fluoride his-
cover surfaces. Sealants require regular maintenance and tory, and present oral hygiene.
repair or replacement to assure success in caries preven- 4. Caries risk, and therefore potential sealant benefit,
tion over the long term. may exist in any tooth with a pit or fissure, at any age,
 Chapter 17 ■
Pit and Fissure Sealants and Preventive Resin Restorations 315

including primary teeth of children and permanent Pope and colleagues found that the use of a quarter
teeth of children and adults. round bur produced the greatest penetration of the seal-
5. Sealant placement methods should include careful ant into etched enamel in laboratory studies.19 The use of
cleaning of the pits and fissures without removal of an aluminum oxide air abrasion system allows sealant
any appreciable enamel. Some circumstances may in- penetration greater than that achievable by use of pumice
dicate use of a minimal-enameloplasty technique. or a dry bristle brush alone. It is not known if the in-
6. Placement of a low-viscosity, hydrophilic material- creased depth of sealant penetration will result in greater
bonding layer as part of or under the actual sealant has sealant retention. When pumice or aluminum oxide is
been shown to enhance the long-term retention and used, particulate matter is left in the deep recesses of the
effectiveness. pits, the impact of which has not been determined.
7. Glass ionomer materials have been shown to be inef- Hatibovic-Kofman and colleagues measured the micro-
fective as pit and fissure sealants but can be used as leakage of sealants placed in three groups of extracted
transitional sealants. teeth.20 The teeth received conventional (etch), quarter
8. The profession must be alert to new preventive meth- round bur, or air abrasion surface preparation. Teeth pre-
ods effective against pit and fissure caries. These may pared with the bur exhibited the least microleakage. The
include changes in dental materials or technology. amount of microleakage in the conventional and air abra-
sion groups was about equal. No clinical studies exist to
substantiate the value of using a bur to clean fissure
SELECTION OF TEETH FOR SEALING surfaces before sealant placement.
To gain the greatest benefit, the clinician should determine The routine procedure of fissure eradication is proba-
the caries risk; thus, the term risk-based sealant treatment bly not necessary. In fact, inappropriate or aggressive use
has come into use. In risk-based sealant treatment, the of fissure opening or enameloplasty often removes the
practitioner takes into account prior caries experience, last of the enamel overlying dentin at the bottoms of fis-
fluoride history, oral hygiene, and fissure anatomy in de- sures, which leaves the tooth more susceptible to future
termining when sealant should be applied. caries in case of sealant loss. Good sealant methodology
Good professional judgment should be used in the and proper sealant volume is probably more beneficial
selection of teeth and patients. The use of pit and fissure than enameloplasty.
sealants is contraindicated when rampant caries or in-
terproximal lesions are present. Occlusal surfaces that
ISOLATION
are already carious with involvement of dentin require The tooth (or quadrant of teeth) to be sealed is first
restoration. isolated. Rubber dam isolation is ideal but may not be
All caries-susceptible surfaces should be carefully eval- feasible in certain circumstances. Cotton rolls, absorbent
uated, because caries is unlikely in well-coalesced pits and shields, and high-volume evacuation with compressed air
fissures. In this case, sealants might be unnecessary or, at may also be used effectively.
least, not cost effective. Finally, although sealant applica- Eidelman and associates reported comparable retention
tion is relatively simple, the meticulous technique re- results with the use of rubber dam and the use of cotton
quires patient cooperation and should be postponed rolls for the isolation of teeth to be sealed.21 Matis reported
for uncooperative patients until the procedures can be 96% retention of sealants with rubber dam isolation and
properly executed. 91% retention with cotton roll isolation at 12 months in
young adults.22 These values are not statistically different,
however, which indicates that retention rates are probably
SEALANT TECHNIQUE not related to isolation technique, as long as the insertion
After selection, the tooth is washed and dried and the technique is sound.
deep pits and fissures are reevaluated (Fig. 17-1A). If caries
is present, restoration or a combination of restoration
ETCHING
and sealing may be indicated (see later). Microporosities in the enamel surface are created by the
Marking centric stops with articulating paper provides acid-etching technique. This permits a low-viscosity resin
information so that excess sealant does not interfere to be applied that penetrates the roughened surface and
with the occlusion. This is not necessary when the produces a mechanical lock of resin tags when cured.
tooth has just erupted but is helpful in a well-established Various phosphoric acid solutions have been evaluated
occlusion. for the etching procedure. Zidan and Hill tested the
amount of surface loss of enamel after 60 seconds of etch-
CLEANING ing with different phosphoric acid concentrations ranging
Adequate retention of the sealant requires that the from 0.5% to 80%.23 They reported that the maximum
pit and fissures be clean and free of excess moisture loss of enamel was produced by the 35% concentrations,
(see Fig. 17-1B, C). Acid etching completely removes whereas the bond strengths were not significantly differ-
the enamel pellicle, and a dental prophylaxis (even ent after etching with 2%, 5%, and 35% concentrations.
with a dental explorer) does not increase the retention Generally, 30% to 50% acid solutions or gels are recom-
of sealants. From a practical standpoint, in cases of poor mended.
oral hygiene, fi ssure cleansing with a rotating dry bristle The etchant in solution should be placed on the
brush may be beneficial. enamel with either a brush, small sponge, cotton pellet,
316 Chapter 17 ■
Pit and Fissure Sealants and Preventive Resin Restorations

A B

C D

E F

G H
Figure 17-1. A, An occlusal view of a molar with susceptible pits and fissures. B, The tooth is cleaned with a rotary brush.
C, The tooth is etched. D, The tooth appears frosty after etching, washing, and drying. E, The bonding agent is placed on
the tooth. F, The sealant is applied to the tooth. G, The sealant is checked for polymerization voids and excess. H, The
occlusion is adjusted as necessary.
 Chapter 17 ■
Pit and Fissure Sealants and Preventive Resin Restorations 317

or applicator provided by the manufacturer. The etchant APPLICATION OF SEALANT

should be placed widely across the surface to be sealed so
that there is no chance that resin placement and polym- Chemically Cured Sealant
erization will occur over an unetched enamel area. If a The manufacturer’s instructions should be followed. Pre-
solution is used, one should gently agitate and replenish cise mixing without vigorous agitation can help prevent
it, making an effort to avoid rubbing and breaking the the formation of air bubbles.
enamel rods. The addition of the catalyst to the base immediately
Occasionally a viscous gel etchant may show a “skip- begins the polymerization of the material, and this
ping” effect, which occurs when the etchant does not should be kept in mind so that no time is lost in carrying
completely and uniformly wet the entire enamel surface, the material to the etched and dried tooth. Working time
and unetched areas are evident after washing and drying. is limited with a chemically cured sealant.
If this occurs, retching is necessary.
Generally, a 20-second etching time is recommended. Visible Light–Cured Sealant
Enamel rich with fluorhydroxyapatite may be resistant The curing of a light-polymerized sealant is not com-
to etching and may need to be exposed for longer peri- pleted without the exposure of the material to the curing
ods. Primary teeth may also sometimes be resistant to light, but the operating light and ambient light can also
etching and may require a longer etching time. Redford affect the material over a period of time, and so material
and colleagues reported no increase in bond strength should be dispensed only when it is time to place it on
with 120-second etching on primary teeth compared the tooth. The working time is longer than with chemi-
with 15-, 30-, or 60-second etching times.24 Their in vitro cally cured sealant. The method of placement varies with
study showed that the etch depth increased between the different applicators provided by the manufacturers.
60 and 120 seconds, but there was no corresponding in- The sealant is applied to the prepared surface in modera-
crease in bond strength. tion and then gently teased with a brush or probe into
Some advocate preparing enamel for sealant applica- the pits and grooves (see Fig. 17-1F, G). With careful ap-
tion with an aluminum oxide air abrasion system or a plication, incorporation of air bubbles is avoided. Care
laser system approved for hard-tissue procedures. To date, should also be taken to avoid applying large amounts of
studies indicate that additional acid etching is needed the sealant material.
after each of these techniques to allow adequate resin If a light-curing material is used, the intensity of the
bonding to enamel. light should be considered. If a large surface area requires
polymerization, place the light directly over each area of
WASHING the occlusal surface for the recommended time.
Most manufacturers’ instructions advocate a thorough With light-cured sealants there is less chance of incor-
washing and drying of the etched tooth surface but do not porating air bubbles, because no mixing of materials is
specify a time interval. Phillips advocated a 40-second required. After the material has been cured and while the
washing time.25 Norling has advocated 20 seconds.26 treated teeth are still isolated, the unpolymerized surface
The etched enamel is dried using a compressed air layer should be removed by washing and drying the sur-
stream that is free of oil contaminants. The dry etched face to avoid an unpleasant taste.
enamel should exhibit the characteristic frosty appear-
ance (see Fig. 17-1D).
CHECK OF OCCLUSAL INTERFERENCES
Feigal and colleagues found that the use of a dentin- Articulating paper should be used to check for occlusal
bonding agent increased sealant retention in teeth even interferences and the occlusion adjusted if necessary (see
when salivary contamination occurred.27 Choi and col- Fig. 17-1H). All centric stops should be on enamel.
leagues have reported corresponding findings in vitro on If a filled sealant has been used, it is essential to adjust
moisture-contaminated bovine enamel.28 In a later exten- the occlusion before the patient is dismissed.
sive review article, Feigal recommended routine place- Other excess sealant that may have flowed over the
ment of bonding agents before all sealant applications.29 marginal ridge or toward the cervical area should also be
Although the recommendation is still to avoid mois- removed. If the tooth is isolated with a rubber dam, the
ture contamination whenever possible during sealant excess should be removed before detaching the rubber
application, the use of a dentin-bonding agent as part of dam. A small round bur at slow speed will remove the
the technique appears to be warranted (see Fig. 17-1E). excess effectively. If etchant has been well localized, ex-
Furthermore, the use of a dentin-bonding agent is defi- cess sealant may be removed with a sharp instrument
nitely recommended in clinical situations that do not from unetched tooth enamel without removing sealant
lend themselves to strict isolation, for example, when from the etched groove areas.
newly erupted teeth are sealed or when patient coopera-
tion is not ideal. The use of a dentin-bonding agent is
REEVALUATION
also advantageous on the buccal surfaces of molars, It is important to recognize that sealed teeth should be
which traditionally have shown a lower retention rate observed clinically at periodic recall visits to determine
than the occlusal surfaces of teeth.30 When used, the the effectiveness of the sealant. Periodic recall and reap-
bonding agent must be thoroughly air-dried across the plication of sealants is necessary, because it is estimated
surface to be sealed to avoid a thick layer of adhesive that between 5% and 10% of sealants need to be repaired
residue. or replaced yearly. If a sealant is partially or completely
318 Chapter 17 ■
Pit and Fissure Sealants and Preventive Resin Restorations

lost, any discolored or defective old sealant should be

removed and the tooth reevaluated. A new sealant can be
applied using the method previously described.

PREVENTIVE RESIN RESTORATION

(SEALED COMPOSITE RESIN
RESTORATION)
The preventive resin restoration is an alternative proce-
dure for restoring young permanent teeth that require
only minimal tooth preparation for caries removal but
also have adjacent susceptible fissures.
A
Simonsen and Stallard described the technique of re-
moving only the carious tooth structure in small class I
cavities.31 A resin restoration was then placed, and the Sealant
adjacent pits and fissures were sealed at the same time.
Henderson and Setcos described the sequence of the
preventive resin restoration that is particularly applicable Composite or
for young patients with recently erupted teeth and mini- glass ionomer-
resin hybrid
mally carious pits and fissures.32 They pointed out that
this preparation requires a meticulous technique that in-
volves more time than the traditional occlusal amalgam
restoration. This type of restoration was advocated for
carefully selected non–stress-bearing areas to minimize
anatomic wear.
Occlusal surfaces often have small carious pits. For
minimal caries, restorations are not likely to be subjected B
to substantial stresses that might lead to wear of resin
materials. Figure 17-2 shows diagrams illustrating the
principles of the sealant-composite combination. In this
case a small carious lesion has penetrated to the dentin.
In general, bite-wing radiographs should indicate no in-
terproximal caries.
A clinical series showing the sequence for this conserva-
tive preparation and restoration is portrayed in Figure 17-3.
Caries is identified by careful visual examination of a dry Sealant
occlusal tooth surface using a sharp explorer, a mirror, and
a light (see Fig. 17-3A). Articulating paper marks on the Composite
tooth would indicate the points of occlusal contact.
The tooth is anesthetized if necessary, isolated, and
reexamined to determine the extent of the caries process.
A No. 329 bur, aluminum oxide air abrasion, or a laser
C
system approved for hard tissue can be used to gain
Figure 17-2. Diagrams illustrating the sealed composite
access to the depth of the lesion and to complete caries
resin restoration. A, A cross section showing caries extend-
removal (see Fig. 17-3B). The preparation, which should ing to the dentin. B, A cross section through a preparation
not extend to the occlusal contact marks, is washed, with a glass ionomer or composite restoration and a seal-
dried, and examined. ant. C, An occlusal view of the outline of a small restoration
The cavity and the enamel beside the susceptible where a pit and fissure sealant provides the extension-
grooves are etched (see Fig. 17-3C). A gel or liquid form of for-prevention principle of cavity preparation.
37% phosphoric acid is commonly used for 20 seconds.
Surface preparation with aluminum oxide air abrasion or bonding agent and to prevent pooling of bonding agent
a laser system approved for hard tissue may not substitute in the cavity.
for acid etching. If these cleaning methods are used, The cavities are filled with a light-curing composite or
etchant must still be applied to provide adequate resin- resin-modified glass ionomer, which may be cured at this
bonding enamel. The lingual groove of maxillary molars time (see Fig. 17-3E). A light-curing sealant is placed over
and the buccal groove of mandibular molars are also the remaining susceptible areas and brushed into the pits
commonly etched and sealed. The tooth is thoroughly and grooves (see Fig. 17-3F). The materials are polymer-
washed for approximately 30 to 40 seconds and com- ized with visible light in accordance with the manufac-
pletely dried. turer’s instructions.
A thin layer of bonding agent is applied to the cavity The rubber dam is removed, and the occlusal contacts
(see Fig. 17-3D). A stream of air must be used to thin the are checked. A small-particle diamond rotary instrument
 Chapter 17 ■
Pit and Fissure Sealants and Preventive Resin Restorations 319

A B

C D

E F

G H
Figure 17-3. A, An occlusal caries identified with susceptible pits and grooves. B, Caries is removed into dentin. C, The tooth
is etched. D, The bonding agent is placed. E, Composite resin is placed. F, Sealant is placed over resin. G, Polymerized pre-
ventive resin restoration. H, The occlusion is adjusted.
320 Chapter 17 ■
Pit and Fissure Sealants and Preventive Resin Restorations

can be used to remove excess sealant and ensure centric 10. Going RE. Sealant effect on incipient caries, enamel
stops on enamel (see Fig. 17-3G, H). maturation and future caries susceptibility, J Dent Educ
A meticulous technique is used in the selection, prepa- 48(Suppl 2):35-41, 1984.
ration, and restoration of small pit and fissure caries us- 11. Wendt L, Koch G. Fissure sealant in permanent first molars
after 10 years, Swed Dent J 12:181-185, 1988.
ing the preventive resin restoration.
12. Romcke RG, et al. Retention and maintenance of fissure
The bonded restoration with sealant overlay has sealants over 10 years, J Can Dent Assoc 56:235-237, 1990.
proven long-term effectiveness. The restorations have 13. Dennison JB, et al. Effectiveness of sealant treatment over
equivalent or better success than amalgam restorations. five years in an insured population, J Am Dent Assoc
Once again, however, success is dependent upon keeping 131:597-605, 2000.
the sealant intact. 14. Robison VA, et al. A longitudinal study of school children’s
The use of flowable composite systems is also gaining experience in the North Carolina dental Medicaid program,
in popularity because they are easy to apply and because 1984 through 1992, Am J Public Health 88:1669-1673,
evidence shows that less microleakage occurs with these 1998.
systems than when teeth are restored with condensable 15. Koh SH, et al. Effects of topical fluoride treatment on
tensile bond strength of pit and fissure sealants, Gen Dent
composite resins, such as sealant materials that have
46:278-280, 1998.
slightly more filler than filled sealants. Therefore the 16. Warren DP, et al. Effect of topical fluoride on retention of
practical results of sealing with a flowable or a filled seal- pit and fissure sealants, J Dent Hyg 75:21-24, 2001.
ant should not differ. 17. Beauchamp J, et al. Evidence based clinical recommenda-
There is no single perfect conservative restoration. tions for the use of pit and fissure sealants, J Am Dent
Each dentist must decide, on an individual basis, the ap- Assoc 139:257-268, 2008.
propriate type of procedure. The restoration described 18. Papers from the Pediatric Restorative Dentistry Consensus
can be very effective in carefully selected cases. Conference. San Antonio, Texas, April 15-16, 2002, Pediatr
Walker and associates reported on preventive resin Dent 24(5):374-516, 2002.
restorations placed in patients 6 to 18 years of age and 19. Pope BD, et al. Effectiveness of occlusal fissure cleansing
methods and sealant micromorphology, J Dent Child
observed for up to 6.5 years.33 Of the 5185 restorations,
63:175-180, 1996.
83% did not require further intervention. Those requiring 20. Hatibovic-Kofman S, et al. Microleakage of sealants after
intervention included 37% that needed sealant alone and conventional, bur, and air-abrasion preparation of pits and
21% that required treatment because of the development fissures, Pediatr Dent 20:173-176, 1998.
of an interproximal lesion. Houpt and associates reported 21. Eidelman E, et al. The retention of fissure sealants: rubber
complete retention of 54% of their preventive resin resto- dam or cotton rolls in a private practice, J Dent Child
rations, partial loss of sealant in 25%, and complete loss 50:259-261, 1983.
of sealant in 20% after 9 years.34 Caries occurred in 25% 22. Matis BA. Pit and fissure sealants in young adults: an evalu-
of the teeth that had sealant loss, and 88% of the restored ation of placement time and retention rate using two
surfaces remained caries-free 9 years after treatment. isolation techniques. Master’s thesis. Indianapolis, Indiana
University School of Dentistry, 1983.
These researchers concluded that preventive restorations
23. Zidan O, Hill G. Phosphoric acid concentration: enamel
produce excellent long-term results. Conservative cavity surface loss and bonding strength, J Prosthet Dent, 55:
preparation with sealing for prevention is a successful 388-391, 1986.
approach for treating selected decayed teeth. 24. Redford DA, et al. The effect of different etching times on
the sealant bond strength, etch depth, and pattern in
primary teeth, Pediatr Dent 8:111-115, 1986.
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4. Simonsen RJ. Retention and effectiveness of dental sealant 30. Feigal RJ, et al. Improved sealant retention with bonding
after 15 years, J Am Dent Assoc 122:34-42, 1991. agents: a clinical study of two-bottle and single-bottle
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 Chapter 17 ■
Pit and Fissure Sealants and Preventive Resin Restorations 321

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Brown LJ et al. Dental caries and sealant usage in US children Walker J, Floyd K, Jakobsen J. The effectiveness of sealants in
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