A comparison of enameloplasty sealant technique and conventional sealant technique: An in-vivo study.

AIM: THE AIM OF THE STUDY IS TO COMPARE TWO DIFFERENT METHODS: Enameloplasty sealant technique (EST) and conventional sealant technique (CST) in terms of the presence or loss of sealant and the presence or absence of caries after 6, 12, and 18 months.
MATERIALS AND METHODS: A total of 15 children in the age group of 7-9 years participated in the study. After taking consent, status of occlusal surface was evaluated under standardized conditions. Only mandibular molars were used in the study. On each patient, one side molar was sealed using EST and other side molar was sealed using CST. All children were recalled and examined after 6 months, 12 months and 18 months.
RESULTS: At the end of 18 months, no teeth were found carious in EST and CST group. At the end of 6, 12, 18 months there was no loss of sealants in both EST and CST group. There was no difference between EST and CST success rates.
CONCLUSION: In our study both EST sand CST showed good results. So we can do EST in deep I-Type and K-Type pit and fissures.

Ripa (1973)[1] observed that although occlusal surfaces represent only 12.5% of the total surface area of tooth, they accounted for almost 50% of caries in school children.

A pit and fissure sealant is a resin material which is applied and mechanically bonded to an acid etched enamel surface thereby sealing existing pit and fissure from oral environment.[2]

Nagano (1960)[3] described 4 types of fissures.

U-Type: Self cleansing, somewhat caries resistant.

V-Type: Deep V shaped fissure.

I-Type: Narrow slit like opening with a large base.

K-Type: Narrow short opening with broad base.

For V type fissure non-invasive conventional pit and fissure sealant Application is enough. Application of sealant without air entrapment in I and K type fissure is difficult. So for I and K type fissures, invasive enameloplasty sealant technique (EST) is advisable.[4]

Godoy (1994)[5] used a specially designed bur for enlarging deep pit and fissures, always maintaining the preparation in enamel and then applying the sealant. This technique is called as the EST.

Aim of the present study is to compare two different methods: EST and conventional sealant technique (CST) in terms of the presence or loss of sealant and the presence or absence of caries after 6, 12, and 18 months.

Materials and Methods

A total of 15 children in the age group of 7-9 years participated in the study.

All the children and their parents were informed before sealing and they gave their consent.

At the baseline, status of occlusal surface was evaluated under standardized conditions by a trained examiner using a flat mirror and a blunt explorer probe. First permanent molars with deep pit and fissures and which were fully erupted into the oral cavity were included. Previously sealed first permanent molars or those with detectable caries or restorations were excluded from the study.

Only mandibular molars were used in the study. On each patient, one side molar was sealed using EST and other side molar was sealed using CST. The procedure was done on all patients by same operator under standardized conditions.

EST

The occlusal surface[6] was cleaned and polished with pumice slurry using a Prophy brush.

Then the surface was thoroughly rinsed with water and dried with air.

Using a specially designed bur [Figure 1], (Fissurotomy NF bur, S.S.White Corp.), the deep pit and fissures on the occlusal surface of the first molars were enlarged slightly with care to keep the preparation in enamel [Figure 2].

Figure 1

Bur and heliosealf

Figure 2

Enameloplasty on 36

Dry surface is paramount to successful retention of sealant. To avoid salivary contamination and to provide a dry surface, the tooth was isolated with cotton rolls and saliva was ejected with a high volume suction device.[7]

The enamel surface was acid etched with 37% phosphoric acid gel [Figure 3] (SS White Corp.) for 20 s.[8] The tooth surface was then washed with water for 40 s and dried for 15 s using oil free compressed air. Dry enamel surface had a dull, frosty white opaque appearance.

Figure 3

Etching on 36

Helioseal sealant (Ivoclar vivadent) was applied to the prepared tooth surface with a fine haired brush. To avoid incorporation of air bubbles, the sealant was gently teased through the fissure. It was light cured for 40 s. Occlusion was checked for high points and adjusted [Figure 4].

Figure 4

Enameloplasty sealant technique on 36

CST

The same procedure (without enlarging the pit and fissure with bur) was done on the other side first permanent molar [Figures 5] and [6].

Figure 5

Etching on 46

Figure 6

Conventional sealant technique on 46

All standard preventive measures were performed in addition to sealant application in all 15 children. They included: diet advice, oral hygiene instructions, and topical fluoride application.

All children were recalled and examined after 6 months, 12 months and 18 months.

The recall examinations were done by the same operator under standardized conditions.

Results

Evaluation was carried out as follows: A tooth was decided to be registered as sound without caries or carious (including cavitated, non-cavitated, restored.)

Sealants were decided to be recorded as present or lost (including partial or totally).

At the end of 18 months, no teeth were found carious in EST and CST group.

At the end of 6, 12, 18 months there was no loss of sealants in both EST and CST group.

So there was no difference between EST and CST success rates.

Discussion

Occlusal surface decay is seen commonly because of inaccessibility of the area to routine hygiene measures. So American Dental Association (ADA) in 1983 recommended that pit and fissure sealant should be used as a part of total caries preventive program that also includes among others optimum fluoride treatment and restricted frequency of refined carbohydrate intake.

In case of a deep pit and fissures which are slightly discolored EST is better than CST. If we follow EST, If carious lesion is detected on enlarging the fissure, we can modify our treatment plan[9] accordingly.

EST allowed a deeper sealant penetration and superior sealant[10] adaptation.

The tapered shape and small size of fissurotomy bur are designed specifically to enlarge deep pit and fissures. It shows minimal heat build-up and minimal vibration during enameloplasty procedure. This has the advantage of decreased patient discomfort and there is no need of local anesthetic. Traditional cutting burs remove far more enamel at any depth of cut and are more invasive.[11]

Following enameloplasty, tooth surface should be acid etched to create microporosities for the sealant to enter and form resin tags. McDonald suggested that 20 s acid etching is enough to create microporosities. Helioseal F (Ivoclar vivadent) is a light curing, white shaded, fissure sealant featuring fluoride release. It′s monomer matrix consists of Bisphenol A Glycidyl MethAcrylate (BISGMA), Urethane di methacrylate, Tetra Ethylene Glycol Di MethAcrylate (TEGDMA). Fillers include silicon di oxide and fluoro silicate glass. Helioseal F shows good retention.[12]

Conclusion

In our study both EST and CST showed good results. So we can do EST in deep I-Type and K-Type pit and fissures.

However, we should conduct more studies on a larger sample size with longer recall period before reaching a definitive conclusion.