Pit-and-fissure sealants are recognized as one of dentistry’s more effective techniques of preventing occlusal surface decay.There are, however, a few complicating issues to be considered. Ease of application is the most clinically relevant of these. Sealants may be underused by some dental practices because of the difficulty in maintaining isolation in application. Salivary contamination remains a problem with a resultant decrease in retention and, therefore, less effectiveness.Second, concerns exist regarding contamination within the grooves and pits before application.The grooves and pits cannot always be totally debrided without using mechanical cleansing devices. It sometimes requires using a fissurotomy bur in a high-speed handpiece to completely remove the debris from within the pits and grooves, or some type of air/water abrasion.
Moisture itself, however, often remains; Fiegal demonstrated in his research that the bottom sac within the groove remains filled with plaque and moisture. The average penetration of the sealant is, on average, only 17% of the depth of the groove.To successfully place a hydrophobic sealant, an additional placement step may be necessary, such as the use of a priming and drying agent. Otherwise, hydrophobic sealants do a very nice job of protecting the grooves and pits because they tend to repel any moisture or plaque build-up. Unfortunately, they do not deeply penetrate into the grooves.In addition, high-viscosity sealants may not be able to fully penetrate even the area of the enamel that has been properly acid-etched. Therefore, some highly filled sealants do not sufficiently infiltrate the etched enamel.Because of this limitation, some researchers have recommended using fourth- and fifth-generation dental adhesive products to improve the adhesion and adaptation of sealants to the morphology of molars.
Another issue would be the occasional failure of the marginal integrity of the pit-and-fissure sealant. This would result in demineralization and finally decay under the leaking sealant. Although this has not been a common problem, when the leakage occurs the result can be very damaging to the sealed tooth. When the failed sealant is removed the tooth structure underneath is quite de-calcified with severe surface breakdown. Therefore, it would be very helpful to have the ability to diagnose sealant leakage before extensive demineralization.
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