The Pit & Fissure Sealant Procedure
It is highly recommended that sealant application be performed as a two-person procedure. Even when the patient is an adult, isolation and application are difficult with just one dental clinician.
Prior to the application of a tooth conditioner, the tooth surface should be cleaned by air polishing, polishing with non-fluoridated pumice paste, hydrogen peroxide, or enameloplasty. All heavy stains, deposits, debris and plaque should be removed. After cleaning the occlusal surface, dry the area thoroughly.
Increasing the surface area requires a phosphoric acid tooth conditioner/etchant. Since sealants do not directly bond to the teeth, the adhesive force must be improved by tooth conditioner. If any of the tooth surfaces do not receive the tooth conditioner, the sealant will not be retained. Isolation of the teeth includes cotton rolls, dry-angles, or ideally with a dental dam. Follow manufacturer recommendations for the required time for the conditioner to remain on the enamel, as well as rinsing times. There are one-step systems that limit the number of steps. No matter which system you use, the enamel should appear as white, dull, and chalky after the product is used. If the enamel does not appear white and chalky, the tooth conditioner should be reapplied according to manufacturer instructions. Dry thoroughly before sealant application.
The application of the sealant material requires the pits and fissures to be filled and the material placed approximately halfway-up the inclined plane of the cusp ridge (Figure 22). Any bubbles must be broken before polymerization to prevent a defect. Polymerize with a curing light. Follow manufacturer directions for time.
Check the sealant with an explorer for proper placement and polymerization. Check occlusion with articulating paper or silk and check interproximal contacts with floss. If sealant material is present interproximal, use a scaler to remove excess. If occlusion is high, use a rotary bur, e.g., no. 4 or 8 round bur. Recheck the occlusion again. Give the patient post-op instructions, according to the manufacturer’s instructions. Sealant retention should be checked at each dental examination.
Figure 22. Occlusal Sealants.