Topic 12. Prevention of fissure caries. Sealing of fissures. Indications, contraindications, effectiveness. Mastering the method of sealing fissures.

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Sealing or sealing of fissures is the main etiotropic method of preventing fissure caries.

Sealing tasks:

 • elimination (minimization) of the local risk of caries;

 • creating conditions for the death of microorganisms remaining in deep fissures;

 • elimination of potential reservoirs for cariesogenic microorganisms, which should reduce their number in the oral cavity and, accordingly, reduce the overall risk of dental caries;

 • acceleration of enamel mineralization in the area of fissures when using glass ionomer cements (GIC) and compomeric sealants;

 • better protection of the edges of restorations from microbial invasion and secondary caries during preventive filling technology (a combination of seals and sealants).

Sealing of fissures performs two main functions:

 • firstly, it creates a physical barrier on the surface of the tooth (made of filling material) for the impact of caries factors on the tooth. These factors include: food residues stuck in the fissures of teeth and cariesogenic microorganisms that feed on these residues and produce organic acids, which destroy the tooth.

 • secondly, it increases the resistance of enamel to cariesogenic factors due to the content of active fluorine ions in the sealant.

Four types of fissure structure:

 • Funnel - shaped;

 • Cone-shaped;

 • Drop - shaped;

 • Polyp-like.

Funnel–shaped fissures are more open, well mineralized, food residues are not retained in them due to free washing with oral fluid, they are caries-resistant.

Cone–shaped - mainly mineralized due to oral fluid, but there are conditions for the retention of food residues and microorganisms.

Mineralization of droplet-like and polyp-like fissures occurs mainly from the side of the tooth pulp. This process is less intensive than mineralization due to oral fluid, and fissures remain hypomineralized for a long time.

Sealing of fissures, indications:

• In adults and children: the presence of deep fissures of chewing teeth, difficult to access for oral hygiene (when using traditional hygiene products — toothbrushes and pastes)

 • Only in childhood: this is an incomplete mineralization of the chewing surface of the teeth (here it means that in children in the initial period, the enamel is still saturated with calcium and other trace elements, and before the period of full saturation, the tooth enamel is especially vulnerable). It is advisable to seal the fissures of permanent teeth in children immediately after their eruption, until caries has appeared in the fissures.

 • Additional condition: fissures should not be affected by caries.

Contraindications to sealing fissures:

• The presence of intact wide, well-communicating fissures.

• Teeth with healthy pits and fissures, but having carious lesions on the proximal (interdental) surfaces.

 • Pits and fissures that remain healthy for 4 years or more do not require sealing.

 • Poor oral hygiene.

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