Resin Based Fissure Seals

Resin-Based Fissure Sealants — Clinical Procedure (Summary)

Indications (when to consider)

• High caries risk patients; deep/narrow fissures; deep pits of permanent molars; deep palatal/buccal pits; special health care needs; limited manual dexterity.
• Can be used to prevent caries on sound teeth or arrest non-cavitated lesions (ICDAS 1–4) only if an excellent seal is achieved and maintained.

Pre-op assessment

• Visual (ICDAS) is gold standard.
• Avoid sharp explorer for diagnosis (iatrogenic damage; no diagnostic benefit).
• Radiographs: occlusal lesions often not visible until DEJ/outer dentine.

Step-by-step technique (resin)

1. Isolation (critical)
   • Primary reason for sealant loss is inadequate moisture control.
   • Rubber dam preferred; cotton rolls possible if excellent control.
2. Surface cleaning
   • Remove obvious soft debris if present (bristle brush + water if needed).
   • Routine pumice/prophy paste is described as unnecessary/contraindicated in the notes; concern that pumice remnants can impair penetration.
3. Etch enamel
   • 37% phosphoric acid.
   • 15–30 seconds (no benefit to over-etching).
4. Wash + dry
   • Rinse thoroughly; dry to a distinct chalky/frosted enamel.
   • Purge air line away from patient first (good practice).
5. (Optional) bonding agent—material dependent
   • Unfilled resin sealant (e.g., Conceal F): bonding agent not required (etch → wash/dry → sealant).
   • Filled/flowable resin (e.g., Filtek Supreme Flow): a single-bottle bonding agent can be beneficial (stress-breaking layer; improved longevity per Feigal studies referenced in notes).
   • Avoid using an incompatible adhesive system; follow manufacturer instructions.
6. Apply sealant
   • Use fine tip; start at one end and “drag” along fissure to reduce air bubbles.
   • Gently adapt with ball burnisher along grooves/cuspal inclines.
7. Light cure (per product instructions).
8. Evaluate & adjust
   • Confirm coverage confined to grooves (avoid overfill onto cusp slopes/marginal ridges).
   • Check occlusion; minimal finishing if well adapted.

Follow-up / maintenance

• Review sealed surfaces regularly; repair if defective/lost provided surface is caries-free.
• Expect a proportion of annual failures even with good technique; reseal as needed.

Notes on sealing carious fissures (arrest)

• Can arrest non-cavitated lesions by isolating from biofilm/nutrients.
• Perfect seal is non-negotiable; leaking seal over active lesion is harmful.
• Document underlying staining/caries (ideally photos) to prevent future misdiagnosis.