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 clinician.

  1. 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 for 10 seconds.
  2. 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 to remain on the enamel, as well as rinsing times. The appearance of the enamel by the tooth conditioner/etchant should appear as white, dull, and chalky. If the enamel does not appear white and chalky, tooth conditioner is reapplied according to manufacturer instructions. Dry thoroughly before sealant application.
  3. The application of the sealant material requires the pits and fissures to be filled and the material brought to a knife-edge 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.
  4. Check the sealant with an explorer for proper placement and polymerization. Check occlusion with articulating paper and check interproximal contacts with floss. If sealant material is present interproximal, use a scaler to remove excess. If occlusion is high, use a slow-speed rotary bur such as a no. 4 or 8 round bur. Recheck the occlusion again. Sealants should be checked at each dental examination for retention.
Figure 22. Occlusal Sealants.
image showing occlusal sealants