The concept of sealing fissures of teeth: methods and materials-sealants, indications, treatment and prevention of fissure caries. Indications and contraindications for fissure sealing Pros and cons of fissure sealing

Most of the work of chewing food falls on the premolars and molars (or, as they are also called, chewing teeth). They are larger and have structural features: unlike other teeth, chewing teeth have a bumpy surface. At the base of the tubercles, grooves are formed, which are called fissures.

What is a fissure of a tooth

Translated from Latin fissure means "gap". But this is a literal translation. In fact, fissures are more like grooves or grooves located among the tubercles that make up the molar. That is, they are considered to be of natural origin. However, these grooves change throughout life. At first they are shallow and have a smooth sloping bottom. Over time, the grooves between the sides of the cusps of the tooth go down, forming a deeper angle directed inwards.

Thus, a fissure is a recess on the surface of a chewing tooth that dissects its enamel. This phenomenon can lead to caries. In such grooves, framed by the sharp edges of the tooth, food debris quickly accumulates, which can rot. Decay causes the fissures to deepen.

Brushing your teeth will not help get rid of stains. bacteria living in oral cavity, cope with plaque, but produce acid, which adversely affects the teeth and leads to the formation of caries.

Forms

Depending on the shape of the fissure, there are four types.

funnel fissure

This form is the safest in terms of caries formation. After all, the type of funnel makes the furrow more open, and this does not allow the remaining food to get stuck. That is, food residues are independently washed out of the fissure. In addition to the increased openness of the funnel-shaped form, its good mineralization can be noted as an advantage.

cone-shaped fissure

This type of tooth recess already creates conditions favorable for the accumulation of food debris. And the liquid that collects in the oral cavity directly affects the course of mineralization. However, careful quality control of brushing your teeth will help get rid of even the smallest food debris.

Teardrop-shaped or flask-shaped fissure

Its main characteristic is a very low level of cleanability. The structure of this furrow is such that the toothbrush is not able to cope with the removal of all remaining pieces of food and other microorganisms. This situation is favorable for the development of caries.

polypoid fissure

In many ways, it is similar to the drop-shaped form: the features of its structure lead to a slow process of mineralization. This increases the risk of tooth decay.

Thus, the depth of the recess, the degree of complexity of its structure increase the risk of developing caries.

When to Apply Sealing

The process of filling with a specialized tool the grooves and recesses formed on chewing teeth is called fissure sealing. The substance that is used during the procedure prevents the smallest microorganisms and pieces of food from getting into the grooves of the tooth.

In fact, the tooth is sealed and is inaccessible to the influence of harmful factors. The means by which sealing is carried out, as a rule, includes fluoride ions, and this makes the enamel resistant to the threat of caries.

The described procedure is carried out both for adults and children. Both milk and molars can be “sealed” with a special substance, since people of any age are susceptible to caries. However, in children, the process of mineralization of fissures is lower, so the possibility of an enamel defect increases.

There are several indications for this procedure:

the presence of teeth whose fissures have a complex structure and great depth, which leads to the accumulation of food debris in the furrows;
appearance of signs caries;
arising from brushing teeth difficulties;
detection pigmented fissures, that is, areas of enamel that are most susceptible to caries;
the presence of teeth that are not yet four years.

Indications for sealing are the appearance of weakly mineralized areas on the teeth, as well as the identification of areas prone to caries. A professional doctor, having checked the structure of the recesses, will immediately be able to determine the need for this procedure.

On the other hand, sealing will be contraindicated if the oral cavity is not well cared for. First, you will need to remove tartar and plaque and teach the patient how to properly care for their teeth. It is also impossible to carry out the procedure if the tooth recesses are very wide and interconnected. In this case, incorrect application of the sealing material is possible.

Sealing methods

There are two main sealing methods. The choice of one or another type of procedure is determined by the condition of the tooth surface.

Non-invasive fissure sealing

It is carried out when the patient has grooves that are not able to get rid of pieces of food and plaque with the help of saliva and brushing the teeth. The non-invasive form does not imply surgical actions. A set of actions that the doctor will perform:

cleanse tooth surface from the plaque layer;
will work on making the edge of the tooth rough, as it is necessary for a stronger fixation of the sealant;
will inflict sealant and fix it; the type of working material will determine how the operation to harden it will go; in some cases, special light is used.

It happens that the hollows on the chewing edge of the tooth are closed. This prevents them from being cleaned and then filled with airtight material. In this case, the doctor will have to open the notches by applying mechanical action.

Invasive fissure sealing

This method is used more often when the patient's tooth enamel is almost completely formed, nearing the final stage of formation. It is at this time that two circumstances converge at once: on the one hand, the enamel is not yet fully formed, on the other hand, plaque could already accumulate in deep and closed fissures. The problem of getting rid of plaque will be solved by sealing by mechanical expansion of the recesses.

The use of this method has an advantage over ordinary filling, even if we are talking about caries that has already begun. A filling that is familiar to everyone, when applied to a tooth, covers the smallest ¼ of the chewing edge of the tooth. While the use of a sealant reduces the coverage area by up to 5%.

To increase the width of the fissure and level its faces to the full depth, a diamond bur is used. Expansion and leveling are necessary to ensure that the sealed material properly fills the cavity of the furrow. In addition, this stage of sealing will help to detect those places affected by caries that were not identified during a superficial examination.

When signs of caries are found during the expansion of the fissure, the doctor must first take all measures to eliminate them. Only after removing the carious focus can you start sealing.

When resorting to any of the described sealing methods, it must be understood that this operation is temporary. If the enamel of chewing teeth is fully formed, then the presence of a sealant no longer plays a big role, since the teeth have received the stability they naturally rely on and are now able to cope with some problems on their own. But this ability will remain only if you perform all hygiene procedures and periodically visit the dentist.

Sealing materials

The sealants used to fill fissures consist of low-viscosity resins of artificial origin. Sometimes fluorides are added to enhance the strengthening effect. The sealant keeps its qualities from 2 to 5 years.

There are two types of sealants. The division is based on the color of the material:

colorless or a transparent hermetic material is more difficult to apply, but it has the advantage that it does not interfere with ascertaining the presence of caries;
opaque milky white sealant, which appears due to the addition of titanium dioxide to the sealed substance; due to the white color of the material, it is easy to apply and control the integrity of the tooth surface; control can be carried out independently without going to the dentist.

From the point of view of the preventive result, both types of sealant are equivalent.

In dental practice, the most common use of the following sealants for clogging fissures:

"Fissurite"("Fissurit"). This is a white material, the active reaction of which begins under the influence of light energy. Available in the form of vials or syringes. A distinctive feature is the rapid adhesion of the substance to the enamel, as well as the fluorine-free content.
"Fissurit F"("Fissurit F"). This sealant contains fluorine. As well as the previous drug is activated under the influence of light. It comes in the form of a syringe for ease of use.
Fissurit FX. Produced in the form of sterile syringes filled with a white substance containing fluorine. It is characterized by a high level of stability and a low probability of rapid abrasion of the preparation.
"Fissil". The sealant has no color, it is transparent. It consists of two fluids: universal and catalytic. Before the procedure, they are mixed in a 1:1 ratio and applied to the tooth. Unlike the materials described above, Fissil hardens due to a chemical reaction that its components enter into (chemical hardening). And this happens in 1-1.5 minutes after application.
"Fissil-S". Available in both transparent and opaque form. It differs from the previous material in that hardening occurs under the influence of a light wave.
"UltraSeal XT® plus". The advantages of this sealant include its resistance to wear. After all, it is 58% resin, which means it shrinks a little. Prevents even minimal infiltration of microorganisms. The undoubted advantage is the rapid curing, which occurs as a result of exposure to light energy.

Thus, fissure sealing is a preventive procedure with a high level of effectiveness in the fight against caries. It is relevant, and its implementation is possible for both adults and children.

Caries begins almost anywhere on the surface of the tooth, but the most vulnerable is chewing the surface of the tooth, which is literally dotted with intricate grooves. These natural grooves, grooves and depressions on the chewing surface of the molars are called fissures.
Fissures in translation from Latin - a gap, a crack. A feature of fissures is the presence of thinner enamel on them, the maturation process of which is much slower. They may have different anatomical structure. But more often, the grooves are so narrow that the brush hairs do not reach the bottom of the teeth when brushing. Remains of food accumulate in the recesses, microbial plaque is formed. Due to their shape and size, it is difficult to rid them completely of bacteria with every cleaning.
IMPORTANT:That is, it is an ideal place for life and reproduction of bacteria. Therefore, fissures are frequent sources of caries!

What is fissure sealing?

Sealing or sealing fissures is a preventive measure
filling of furrows and cavities with a special protective material: fluorinated sealants ordental composite. Such materials are not afraid of water, are highly durable, perfectly fixed in fissure holes. During this procedure, the dental grooves and grooves are filled with a sealant, which, under the influence of the rays of the lamp, polymerizes. The surface of the tooth is leveled, and the recesses previously inaccessible to the toothbrush disappear, which facilitates the hygienic removal of plaque and significantly reduces the risk of caries. When hearing about the need for fissure sealing for the first time, the patient asks himself: what is it?

Types of fissure sealing.

Sealing fissures of chewing teeth - preventive procedure aimed at reducing the risk of developing fissure caries. It consists in sealing the natural depressions on the chewing surface of the teeth with highly adhesive materials. Teardrop and polypoid fissures are subject to sealing as potentially dangerous. Their bottom cannot be cleaned with a brush, which means that the risk of developing caries is very high.

Sealing can be invasive or non-invasive.

non-invasive sealing is carried out when the bottom of the fissure cavity is accessible for visual
inspection and probing. The doctor must make sure that there is no carious process, the enamel is dense. The tooth and the fissure cavity are completely cleaned of plaque and dried with an air stream. The surface of the enamel is etched for better adhesion of the sealant to its surface. The fissure is sealed, the sealant is cured with the light of a polymerization lamp.

Invasive sealing is carried out in the presence of overhanging edges of fissures. In such a situation, the doctor cannot unequivocally determine whether there is a carious process. Moreover, such a structure of the fissure makes it difficult to introduce material into its cavity. Therefore, overhanging edges are removed, which takes literally a matter of seconds. Then the doctor freely probes and examines the bottom of the cavity. If there is caries, it is treated. If not available, seal.

The fissure sealing procedure includes the following steps:

Indications for fissure sealing.

Accumulation of plaque in the fissure cavity
Up to 5 years after teething (deciduous or permanent)
Unfavorable shape of fissures
Difficulty viewing the bottom of the fissures of chewing teeth

When is it applied?

The average service life of the sealant is 5 years. This is sufficient to prevent premature
loss of milk teeth and ensure the correct formation of the bite in the child. After erasing the sealant on the permanent teeth, the procedure is repeated.

Conducted clinical researches, allow us to assert that the sealing procedure allows to reduce the development of caries by 90% and such reliable protection lasts for 5-8 years. Already at 6-7 years old, the child is prescribed sealing of the first molars (sixth teeth), at 10-12 a procedure for premolars is required (fours and fives), and a year later for the second molars (sevens). In adult patients, this procedure can be performed at any age.

IMPORTANT: Fissure sealing is an important way to prevent caries. This technique can rightly be called "Vaccination against caries."

The cost of fissure sealing services.

Preventive procedures and their cost in Moscow are always cheaper than therapeutic ones, and this is no secret.
It is much more profitable to prevent the development of caries than to treat it later. That is why we recommend this procedure to all patients with indications for sealing in order to prevent the development of caries and more serious costs for its treatment.

We carry out the sealing procedure

We invite you to undergo the fissure sealing procedure at the dental clinic "Dantist". We guarantee complete safety for the enamel of your teeth and painlessness during the procedure. The earlier you carry out the sealing procedure, the lower the chance of developing caries in the future. Our dentistry adheres to an open pricing policy. We announce the full cost of all manipulations before they are carried out. In our work we use materials of exceptional quality and modern equipment.

Dental fissure sealing is a modern preventive procedure to protect the chewing surface of teeth from caries. It consists in sealing the grooves with special compounds, which creates a barrier to food debris and bacteria.

The sealing procedure is carried out in a dental office, does not cause pain and retains its effect for several years. Most relevant for children and adolescents, but in some cases it can be recommended for adult patients.

Dentistry Beskudnikovo uses modern dental sealants with a high level of protection and durability to seal fissures. The standard service life of such a coating is 5 years, and subject to the rules of hygiene and healthy eating may increase to 10 years or more.

The procedure lasts no more than an hour, does not require additional preparation and special post-procedural care.

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What is dental fissure sealing

Fissures are multidirectional grooves on the chewing surface of the tooth. Their combination forms a kind of “grater” and contributes to high-quality grinding of food in the oral cavity. However, too narrow and deep fissures are a “paradise” for a carious infection: they are inaccessible not only to mechanical cleaners, but also to chemical rinses. With complicated hygiene, stuck food particles provoke the active development of bacteria in hard-to-reach cavities, leading to the development of caries.

It is more convenient to seal all molars and premolars. This will reduce the likelihood of a carious process by 90% and create additional protection for the chewing surface. In special cases, sealing of the fissure of a single tooth can be carried out.

Sealing compounds

The main type of sealant - sealant - is a liquid fluid mass based on methacrylate and polyurethane. Its grades differ in composition, wear resistance and transparency:

Transparent sealants are almost invisible against the background of the tooth, so their wear is very difficult to control on your own. At the same time, they provide full access to the state of fissures, eliminating the slightest chance of unexpected development of caries under the sealant layer.
Opaque compositions are close in color to enamel and do not stand out against its background. Such a texture does not allow tracking the state of fissures, however, it makes it possible to assess the rate of thinning of the sealant itself.

The method of curing the material also matters. Dentistry has a large selection of light-curing and self-curing sealants.

Indications and contraindications

Fissure sealing is a preventive measure. The main indication for its implementation is the presence of completely or relatively healthy teeth. Tooth sealing is recommended in the following cases:

weak enamel of milk teeth (thin and porous children's enamel is easily exposed to the aggressive effects of food and microorganisms);
chronic unwillingness of the child to brush his teeth (the use of sealants and remineralizing compounds partially compensates for poor oral hygiene);
difficulty brushing your teeth
immature fissures;
the first signs of a carious process in the deepening of fissures;
prevention of caries before the installation of braces.

The main reason for the procedure is narrow and deep fissures of permanent teeth..

In dentistry, there are 4 main types of fissures:

funnel-shaped
conical,
drop-shaped,
polypoid.

Funnel-shaped - the safest. They provide full access to mineralizing substances and contribute to quick and easy self-cleaning of the surface, preventing food from lingering in the recesses. All that is required in this case is proper nutrition and hygiene.

Cone-shaped structures require more thorough cleaning of the tooth surface, however, with due attention, they do not create difficulties for the owner of the tooth.

Teardrop and polypoid forms are the main source of fissure caries. If appropriate measures are not taken in time, they will certainly provoke a carious process, while it will be almost impossible to notice the beginning of its development.

Fissure sealing is an optional procedure. If the patient observes the rules of hygiene, and the grooves on the chewing surface are wide enough for self-cleaning (funnel shape), sealing is not required. The procedure will be refused altogether if:

active caries (medium and deep) was diagnosed;
the general condition of the teeth and tissues of the oral cavity leaves much to be desired (periodontal disease, tartar, erosive processes should be eliminated beforehand);
the tooth has not erupted completely;
for more than 4 years from the moment of eruption, the fissures remain clean, intact and with a high level of mineralization;
the grooves are too wide and unable to hold the sealant on the enamel surface.

Before proceeding with the sealing procedure, the dentist conducts a complete examination of the oral cavity, assessing the general condition of the teeth and their structural features: age, enamel thickness, fissure depth, fissure cleft width, presence/absence/intensity of the carious process. Only then is a decision made about sealing with a choice in favor of an invasive or non-invasive method.

Invasive fissure sealing

An invasive technique can be used to clean fissures from the first signs of fissure caries (darkening of the enamel), but is most often used to change their structure. The procedure is performed only on permanent teeth.

Too narrow and thin grooves of a closed type cannot be cleaned and sealed without the risk of developing a carious process under the applied sealant. To avoid such trouble, the fissures are pre-expanded.

General sequence of actions:

the working area is isolated from saliva with special materials;
thoroughly clean fissures from bacterial plaque and food residues (with poor oral hygiene, a full cycle is required professional cleaning with the removal of tartar);
carry out micropreparation of the surface with a diamond bur to open fissures (in addition, removal of tissues affected by caries may be required);
dry the treated surface with a dental dryer;
treat the fissure recesses with phosphoric acid to increase the adhesion of the enamel to the sealant (a 32% solution is applied to the chewing surface, held for 20-30 seconds and washed off with distilled water);
re-dry the surface with a dental dryer;
sealant is applied along the fissure pattern of the tooth (the mixture has a fluid consistency and is supplied in syringes);
curing the applied mixture (if necessary using UV lamps);
check the bite and carry out a fit with stripping excess sealant.

Invasive fissure sealing can cause discomfort (especially for those with thin and sensitive enamel), so dentists pre-anaesthetize with local anesthetics.

ATTENTION! If, during the opening of the fissure, it turns out that the carious process has also affected the dentin, a filling is installed instead of the sealant (or together with it).

Non-invasive fissure sealing

The sequence of actions is similar invasive method, with the exception of the stage with micropreparation (here the fissures must be sufficiently open for full processing with adhesives and sealant).

Non-invasive fissure sealing is completely painless and does not require anesthesia.

REFERENCE! Regardless of the age of the patient and the type of sealing (invasive, non-invasive), the procedure may be accompanied by remineralization and fluoridation of the teeth. An integrated strengthening approach allows you to build reliable protection tooth from carious infection and avoid frightening and costly treatment.

Fissure sealing in permanent teeth

The tactics of actions in sealing fissures of permanent teeth is directly related to the level of their initial mineralization:

a high level of mineralization (the enamel in the fissure area is dense, shiny, the dental probe slides over the surface during examination) ensures good enamel resistance to carious infections; sealing is recommended only in the presence of complex fissures;
the average level of mineralization (chalky spots in the fissure area, the probe periodically lingers in the recesses) creates an 80% risk of developing caries over the next 2 years; sealing is carried out after a course of remineralizing drugs;
low level of mineralization (matte chalky enamel with a loosened structure) in 100% of cases leads to the development of caries already in the 1st year after tooth eruption; sealing is applied special approach(without phosphoric acid and using special formulations).

ATTENTION! Each tooth is evaluated individually. It is quite possible that the dentist will stop at selective sealing (1-2 teeth).

Fissure sealing in children

Fissure sealants are best done in childhood when enamel is most vulnerable to aggressive environments and bacterial infection. Most often, the technique is applied to permanent molars and premolars, which erupt in a child aged 7-13 years. With regard to milk teeth, the practice of sealing the chewing surface is less common. Parents justify their actions by saying that milk teeth “will fall out anyway”. However, statistics show that untreated caries of milk molars negatively affects permanent ones. Taking into account the fact that dental sealing in children is quite affordable, it is better to spend money on prevention than on expensive caries treatment.

REFERENCE! Fissure sealing of milk teeth can be carried out with colored sealants. Such a fun “inlay” is liked by kids and allows you to notice the thinning / loss of a section of the sealing compound in time.

Children's enamel contains little calcium and fluoride. It has a porous structure and is very vulnerable to infections. For milk teeth, weak mineralization persists throughout their existence. permanent teeth subsequently “ripen” - gradually accumulate a sufficient level of minerals in themselves. However, the maturation process can take years (up to 3-4 years), therefore, it is recommended to seal all fissures during this period. If there are no anomalies in shape and depth, once is enough - the sealant is quite resistant and stays on the teeth during the entire period of mineralization.

IMPORTANT! Sealing with sealant can slow down the maturation of enamel in the fissure area, but does not stop it completely. Saturation with ions continues from the inside, from the side of the pulp.

Fissure sealing in adults

Previously, it was believed that the sealing procedure makes sense only in the first days after tooth eruption, and after the final maturation of the enamel, sealing is not needed. However, modern dentistry has proven that fissure sealing in adults is no less effective, especially with weak tooth mineralization and the presence of complex fissure shapes.

In conclusion, it is worth noting that fissure sealing is completely safe for dental health. It does not affect the quality of the bite, does not delay the formation and growth of children's teeth, and fissures smoothed with sealant are much easier to hygienically clean. However, it should be remembered that only an experienced specialist with high qualifications can perform a high-quality sealing procedure. Otherwise, such prevention will result in the development of latent caries.

Fissure sealing steps

The procedure consists of several mandatory steps:

The tooth surface is put in order - it is cleaned of plaque and pieces of food, processed antiseptic preparation. Then dry with warm air.
The teeth are lined with rollers to protect against saliva. A special substance is applied to the enamel - acid, designed to create a good adhesion of the tooth surface with the polymer. After that, the acid is washed off, the dentition is dried, rinsed with distilled water and again exposed to warm air.
Sealant is applied. Liquid sealant is poured onto the fissures. The resulting layer is dried under a lamp, as a result of which it polymerizes.
The patient should tell the doctor if he experiences discomfort when closing his teeth. If this is the case, a special grinding tool is used to grind off the excess layer of sealant.

Fissure sealing takes a little time, about 40 minutes. The procedure does not cause pain and is completed fairly quickly.

How long does the sealing effect last?

The stated service life of fissure treatment is 5 years. Fissure sealed teeth do not require special care, hygiene is carried out according to standard rules. However, judging by practical cases, the effectiveness of the procedure is maintained for 10 and even 30 years. Of course, over time, the layer begins to thin and break down, so you need to visit the dentist regularly.

In our clinic, you can carry out sealing of the fissure of the teeth inexpensively and efficiently. Specialists use the most modern materials that retain durability for a long time and protect teeth from diseases.

Fissure sealing in Moscow

The procedure for sealing fissures is performed in Beskudnikovo dentistry at the address: Verkhniye Likhobory metro station, Beskudnikovsky Boulevard, 2A. To make an appointment please use the registration form.

From this article you will learn:

Fissure sealing of teeth: what is it,
what material is better to use,
non-invasive fissure sealing in children - price, reviews.

Fissure sealing is a method of prevention of posterior caries used in pediatric dentistry. The method consists in sealing the recesses (fissures) on the chewing surface of the teeth with a special filling material, for example, a composite or glass-ionomer cement. In a child, this method can be safely used from the age of 6 - to seal the fissures of permanent teeth. It should be noted that in children and adults, caries is formed primarily in three favorite areas - this is the enamel of the teeth in the region of their necks, in the interdental spaces, and also in the fissures of the chewing teeth.

All upper and lower teeth 6, 7 and 8 of permanent bite have grooves (fissures) on their chewing surface, in which food residues are very well retained after eating. These food residues are converted by oral bacteria into acid, which destroys the enamel and leads to the development. Naturally, it is better to completely prevent the appearance of such caries and avoid regular replacement of fillings - for which the method of sealing fissures was invented in dentistry, which is also much cheaper.

Fissure sealing: before and after photos

How does fissure sealing work?

Firstly– with the help of a filling material, a barrier is created on the chewing surface of the tooth, which prevents the retention of food residues and cariogenic bacteria in the fissures of the teeth,

Secondly- it can increase the resistance of tooth enamel to the acid produced by cariogenic microorganisms (if the composition of the material used for sealing fissures contains active fluoride ions) - thereby also preventing the development of caries.

Indications for use in children -

Deep fissures in permanent teeth –
in the deep fissures of the teeth, the child will definitely retain a lot of food residues, unless, of course, your child brushes his teeth after each cookie or candy. At the same time, fissures should not be affected by caries.
Teeth sealing in children is carried out only for the prevention of caries of permanent teeth, but for the prevention of caries of milk teeth in children (in addition to regular hygiene), treatment of teeth with fluoride-containing varnishes should be used. Studies have shown that additional treatment with fluoride varnishes reduces the risk of developing caries in milk teeth by about 68% (website).

Incomplete mineralization of the enamel of erupted teeth –
the fact is that in children, tooth enamel contains very little calcium and fluorine, and therefore, until the period of complete saturation with calcium (up to 16-18 years of age), tooth enamel is especially vulnerable to caries.
Therefore, dentists recommend sealing the fissures of permanent teeth in children - immediately after their eruption, while caries has not yet appeared in the fissures. Given that they are very different, it will be necessary to go to the dentist several times.

Diagram of the timing of eruption of permanent teeth in children –

For adults : The method of sealing fissures can also be successfully used in adults, and the obligatory condition is that the fissures should not already be affected by caries.

Fissure sealing in children: price 2020

In economy class clinics and the middle price category, fissure sealing in children will cost from 600 to 1200 rubles per 1 tooth. Such a difference in cost will depend on the type of fissure sealing material, as well as on the sealing technique (each of which has its own indications for use).

There are 2 methods: non-invasive sealing of fissures (without opening them with a drill) will be cheaper. But if you have narrow deep fissures that will need to be opened with a drill before applying the material, the price will be around 1200 rubles without the cost of anesthesia (the cost of anesthesia will be about 300 more rubles).

How is fissure sealing performed?

There are invasive and non-invasive fissure sealants. The choice of a particular technique is carried out by a doctor based on the results of a visual examination, fissure probing, sometimes even taking into account additional methods diagnostics, such as x-rays.

1. Non-invasive sealing technique -

This non-invasive technique is used to seal medium or deep open fissures. The open type of fissures means that they are fully accessible for visual inspection (after all, only this ensures that the doctor does not miss caries in the bottom or walls of the fissure). A drill for expanding fissures is not used here.

Non-invasive fissure sealing: before and after photos

The main steps of this technique are
(detailed description what is happening in the photo is located under the photos)

Description of non-invasive sealing –
first, a thorough cleaning of the surfaces of the teeth is carried out using a polishing brush and paste (Fig. 5). Further actions depend on the choice of material for filling the fissure. If glass ionomer cement is used, then after cleaning the tooth, this cement is immediately applied to the fissures.

If a composite material is chosen, then the surface of the fissures is first etched with phosphoric acid (Fig. 6), which is then washed off, the tooth is dried. Only after that, a composite material is introduced into the fissures, for example, light curing (Fig. 8-9), after which the material is illuminated with a polymerization lamp (Fig. 10). After the material hardens, the chewing surface of the tooth is polished.

Non-invasive sealing of teeth in children: video

2. Invasive fissure sealing -

It is used in the presence of deep and narrow fissures, the bottom and walls of which cannot be subjected to visual inspection. In this case, it becomes impossible to guarantee the absence of foci of carious lesions in the area of the bottom and walls of fissures. In addition, in the presence of deep narrow fissures, it is extremely difficult to achieve good fissure filling with filling material.

Expansion of fissures with a drill during invasive sealing -

Unlike non-invasive technique, invasive fissure sealing involves the expansion of fissures with a drill. In Fig. 11 you can see a section of the tooth, which schematically shows how the fissure is expanded with a bur (within the thickness of the enamel). In Fig. 12 you can see that deep narrow fissures were expanded with a drill (they are indicated by arrows), after which they were filled with composite material (Fig. 13).

Video of processing fissures with a drill –

Important: Fissure sealants

Fissure sealants are divided into 3 groups: composite (chemical or light curing), glass ionomer cement and compomer. What is the difference between them...

Composite materials –
these materials are made from a special composite resin, and can be either light cured or chemically cured. Materials of this class are divided into 2 subgroups: unfilled and filled sealants. The former are highly fluid, and therefore penetrate even the narrowest and deepest fissures; in addition, they adhere more closely to the surface of the enamel, but wear out faster and require replacement.
Filled sealants have a lower fluidity and penetration depth, and therefore they are more used specifically for invasive fissure sealing technology (see below). Also, their disadvantage is high sensitivity to moisture and complex application technology. Pros: high resistance to abrasion.
Important: this class of materials allows for a long time (up to 5-8 years) to protect teeth from fissure caries. The degree of preservation of the composite sealant 3 years after application is up to 90%. The best composite sealants include the following 3rd generation light-curing sealants: Fissurit, Helioseal, Estisial LC and especially those containing fluorine - Fissurit F and Admira Seal. Fluoride release from Fissurit F lasts over 190 days from application!

Glass ionomer cements (GIC) –
these materials have a pronounced cariesstatic effect due to the presence of aluminum, zinc, calcium, and especially due to the content of fluorine. These materials are chemically cured, a big plus - they do not require etching the enamel with 38% acid before application (unlike composite materials).
Compared to composite materials, GICs have low fluidity, which does not allow them to be used in deep fissures without opening them with a drill, and also have a greater degree of marginal leakage and wear out faster. There is an opinion that the use of GIC as fissure sealants is justified when it comes only to newly erupted teeth (with extremely low mineralization of fissure enamel). In the latter case, it is undesirable to etch the enamel with acid, and for the use of composites, the enamel must always be etched.
The safety of the GIC after 1, 6, 12 and 24 months after application is 90, 80, 60 and 20%, respectively, and after 3 years - only 10% (in turn, the composite sealant - 90%). However, this class of materials reduces the occurrence of caries in fissures by 80-90% in 2 years. The GIC includes the following materials: "Dyract seal", "Fuji", "Glass Ionomer", "Aqua Ionoseal" ...

Compomers –
they are classified as light-hardening composite materials, however, components have been added to their composition that give them the positive properties of glass ionomer cements. Advantages compared to traditional composites: greater tolerance for wet environments, greater fluidity and the ability to release fluorine in small amounts.
It should be noted that these pluses had to be paid for by a higher degree of abrasion (in 2 years, the compomer almost completely disappears). The materials of this class include "Dyrect Seal" (Dentsply).

Sealant Effectiveness: Conclusions

Comparative results of the study different ways prevention of caries have shown that the method of sealing fissures of teeth is the most effective. Patients with fissure seals experience a 92.5% reduction in caries growth during the first year compared to patients who do not receive fissure sealants. For example, if caries prevention is carried out only by treating teeth with fluorine-containing varnish (once a year), then this reduces the growth of caries only up to 70%.

One-time sealing of fissures of teeth is guaranteed to be effective for up to 5 years on average, but can retain its properties for up to 10 years (this also happens by increasing the resistance of fissure enamel to caries due to the release of fluorine ions by the material). Studies show that after 7 years from the date of fissure sealing with composite materials, about 49% of fissures are still sealed.

Best material : The most effective materials are undoubtedly composites, however, when it comes to sealing fissures in newly erupted teeth (whose enamel has an extremely weak mineralization), then glass ionomer cement should be preferred. Also, preference should be given to glass ionomer cements when sealing fissures for low-contact children, in whom it is difficult to achieve good isolation of the tooth surface from saliva. We hope that our article on the topic: Fissure sealing in children pros and cons turned out to be useful to you!

Sources:

1. Higher professional education of the author in dentistry,
2. Personal experience work as a dentist,
3 . The European Academy of Pediatric Dentistry (USA),
4. National Library of Medicine (USA),
5. “Pediatric therapeutic dentistry. National leadership"(Leontiev V.).

Sealing of fissures of molars is carried out in order to prevent the development of caries, for which they are treated with a special composition. A description of the process of processing and the structure of fissures is given below.

"Fissure" is a gap in translation from Latin. These are slots that are located on the chewing surface of the molars, if the concept is explained in a scientific, but more accessible language.

Important! All grooves, folds, depressions on the tooth are fissures. They accumulate particles of food and plaque, which are very problematic to deal with. In this case, neither rinsing nor a toothbrush helps.

Fissures are:

polyp-like - mineralization occurs from the side of the pulp;
funnel-shaped - they are washed with saliva due to the wide open top, the remnants of food practically do not linger;
in the form of a cone, food is often delayed, liquid from the mouth gets on the teeth, mineralization occurs;
drop-shaped - mineralization from the side of the pulp.

Fissures are grooves and grooves found on the surface of a tooth. They are particularly susceptible to these acids and therefore to caries. It is deep fissures that create favorable conditions for the reproduction of bacteria.

The recesses and grooves are constantly increasing. The chewing surface of the tooth under the influence of food and liquids gradually changes the geometry, the edges become sharper, the pits are constantly deepening. Their bottom, which was originally rounded, is sharpened. Food particles remaining in the recesses rot over time, pathogenic flora multiplies, the tooth is affected by fissure caries.

fissure caries

This type of caries is one of the most common. In fissures, food accumulates more and more often, which is an excellent basis for rapid growth, increasing the number of bacteria and microorganisms. And to clean the fissures to the end is very problematic. Symptoms of fissure caries:

the bottom in the deepening of the tooth is softened;
the enamel on the surface of the tooth near the fissures becomes cloudy.

Attention! The recesses are designed so that in the case of a closed type, the top is narrow, and deeper the gap opens wider. The brush will simply not penetrate into such a hole. It is for such fissures that sealing is required in order to protect the tooth from caries.

The causes of fissure caries can be:

individual features of the structure of fissures;
poor-quality teeth cleaning;
saliva is not enough to self-clean the surface of the tooth with grooves;
unformed to the end of the enamel;
missed the beginning of the development of caries.

Fissures are difficult to clean hygienically, so microbes often accumulate there. Bacteria in the oral cavity, processing plaque, form an acid that dissolves the tissues of the tooth, which subsequently leads to the formation of a carious defect.

Sealing process

A special composition seals the recesses in the tooth. After its hardening, fissure sealing occurs. Now nothing can get and linger in the grooves and grooves on the chewing surface. This technique is effective in preventing the development of caries.

Fissure sealing in children

Children are most often diagnosed fissure caries. And the child cannot properly observe oral hygiene. Therefore, in order to keep teeth healthy, fissure sealing is the solution.

Important! Both permanent and milk teeth can be sealed. Therefore, within three months after the appearance and final formation of the molar and premolar, it is necessary to bring the child to the procedure.

If more time passes, then there is a high probability of rapid development of pathogenic flora in fissures. It is allowed to extend this period up to six months.
The following deadlines for sealing have also been established:

from 2.5 to 3 years in the presence of 4 and 5 milk teeth;
from 5 to 6 - with the appearance of permanent premolars;
from 11 to 13 years old - during the eruption of permanent molars.

Fissure sealing provides up to 90% chance of keeping teeth healthy. While the composition is on the baby's teeth, it is possible to teach him how to brush his teeth.

Materials for the procedure

The sealing material is a liquid sealant. The main feature is good fluidity, which allows them to fill all the cracks and folds in the tooth. After hardening, no air bubbles form in it. It contains fluorine, which additionally protects the tooth from external influences. Silant is transparent and colored. Multi-colored is usually applied to children, so the process of filling fissures is more visible. Transparent on the tooth is not noticeable, but the carious focus is visible.

Attention! Dentists believe that a reflective filling holds better on the tooth than a sealant. But, thanks to its transparency, you can see the process of development of caries and take it under control in time.

The most popular of the sealants are materials:

Fissurite F - sodium fluoride content - 3%.
Grandio Seal - low shrinkage and good strength.

Liquid sealant is a material for sealing fissures, it has good fluidity, which allows it to fill all the gaps and folds in the tooth. It contains fluorine, which additionally protects the tooth from external influences.

Procedure steps

The stages of sealing are:

Preparatory - the surface of the tooth is qualitatively cleaned and treated with an antiseptic. This is followed by thorough drying of the tooth with a stream of warm air.
Tooth enamel is treated with phosphoric acid or acid-containing gels to ensure good adhesion of the sealant to the surface due to post-treatment porosity. So that saliva does not interfere with the application process, the tooth is covered with cotton rolls. After 15 seconds, the acid is washed off and the surface of the teeth is dried again. Once again wash the teeth with distilled water, dry thoroughly for the last time at this stage.
Application of liquid sealant with a special probe. The sealant is then dried using a curing lamp. The sealant can be self-hardening, it is necessary to wait for 4 - 5 minutes.
Grinding. First, the doctor evaluates the quality of the application of the liquid, removes excess. In case of discomfort in the patient in the area of sealing, the dentist grinds the surface with a special diamond tool. To check the volume and level of application, the doctor usually uses special carbon paper designed for this purpose.
The procedure lasts about 40 minutes. During the filling of fissures with sealant, the patient does not experience pain. This coating lasts about 5 years.

The main stages of fissure sealing are preparation and cleaning of the tooth, application of sealing material, grinding of the tooth and restoring the natural shape.

Sealing methods

Ways to prevent the appearance of fissure caries are:

Non-invasive. If the fissures do not have a complex structure and there is no caries, then only a sealant is applied to the surface of the tooth. The tissues are not subjected to any interference. This applies to both milk and permanent teeth.
Invasive. If the shape of the fissures is closed or the grooves have a complex geometry, then the doctor expands the fissure fossa using a drill to exclude or detect caries.

In the presence of caries, the tooth requires additional processing, cleaning of the carious cavity. In the absence of caries, fissure sealing is performed immediately.

The invasive method is used for closed fissures, the non-invasive method is used for open ones.

Pros and cons of sealing

The advantages of the technique include:

reliable protection against caries, both in adults and children;
caries can be stopped at the manifestation of its first signs;
sealant securely fixes already installed seals;
protects against secondary caries.

Important! The cons of sealing are not always confirmed, whether to believe the definition of some doctors is unknown, because they are controversial. For example, some argue that such manipulation interferes with the normal growth and formation of teeth. They believe that this substance should not be applied to a child's teeth.

The second argument is that the sealant can only be applied to a flat surface, without various recesses. If one of the voids is not filled with sealant, then caries may develop in it. And if its development cannot be traced, then the tooth can be lost.
The third argument is that applying sealant can only be entrusted to a highly qualified specialist with extensive experience due to the need to do this as accurately and accurately as possible. This argument cannot be ignored, because the professionalism and reputation of a doctor is very important in dentistry, especially when it comes to eliminating dental problems in children.

Sealing blind pits and fissures on the chewing surface of small and large molars is an effective measure to prevent dental caries.

Indications and contraindications

The procedure is indicated to be carried out if:

caries begins to develop;
narrowness and depth of the patient's fissures;
teeth appeared less than 4 years ago;
caries is already visible on the side walls of the tooth;
on fissures, demineralization in the form of pigmented spots began to be detected;
prevention is needed not in one, but in different ways.

treatment of lateral walls from carious foci is indicated;
fissures have an open type, they can be cleaned without additional effort, there is no need to seal them;
there is no caries in the fissures, and after the appearance of teeth, more than a four-year period has passed;
the tooth has not fully entered the dentition, continues to grow, has not yet reached its full height;
the structure of the patient's oral cavity and insufficient salivation do not allow protecting the tooth;
the content of fluorine in the water that the patient consumes is much less than normal;
the patient is absolutely not engaged in oral hygiene and prevention of caries.

Demineralization of teeth - leaching of mineral substances from tooth enamel: apatites of calcium, phosphorus, magnesium, potassium, sodium, fluorine, chlorine and others. Fissure sealing during demineralization is undesirable.

Sealing is carried out after the treatment of teeth with caries, and the sealant is not applied directly to it. Under a layer of sealant, it will continue its destructive action. The sealant is also not applied to the seals. The procedure in this case does not make sense, the tooth is already cured and protected by a filling.

After the procedure

Attention! Special care after sealing, apart from the usual hygiene of the oral cavity, the teeth are not required. The service life of the applied material is from 3 to 5 years.

But this is a cautious forecast. In fact, sealing lasts 10-25 years. During this time, under the influence of the environment in the oral cavity, the food taken, the composition of the sealant is gradually destroyed, it can be damaged. Therefore, it is advisable to visit the dentist twice a year for examination and conclusions about the state of sealing.

Fissure sealing cost

For sealing one tooth in different clinics, you can pay from 500 to 5000 rubles. An expensive pleasure for preventive manipulation. But given that the procedure is performed once and for many years, it is not so expensive. If you constantly treat and seal, or even remove teeth, it will be much more expensive. Fissure sealing is not such a painful procedure for a child as the installation of a filling and takes little time, so even children's patience is usually enough for it.