[Fissure sealing. A review]. / Barázdazárás. Osszefoglaló referátum.

The aim of this review is to give an overview of 50 years experience of fissure sealing and draw conclusions about the applicability and effectiveness of the method. Another purpose is to provide a summary of the relevant scientific evidence that will assist clinicians with their decision-making process. A fissure sealant is a material that is placed in the pits and fissures of teeth in order to prevent the development and/or to arrest of initial caries progression. Sealants, by providing a physical barrier, inhibit microorganisms and food particles from collecting in pits and fissures. Sealants are highly effective in preventing dental caries in pits and fissures of teeth when applied by trained operators. Sealant should be placed on pits and fissures of children's and adolescents' permanent teeth when it is determined that the tooth or the patient is at risk of developing caries. Fissure sealing can be recommended as a caries preventive measure. Whilst there is a good evidence to support the inclusion of fissure sealants as part of a preventive programme from the dental team, a number of related issues need to be considered. In areas of high caries prevalence it has been shown that treatment costs can actually be reduced by sealing susceptible surfaces, usually the occlusal surfaces of first permanent molars. Fissure sealing was introduced and first investigated in the years 1960-1970. During the past decades, evidence-based approaches have developed concerning the effectiveness of this primary and secondary preventive measure. It is generally accepted that the effectiveness of sealants for caries prevention depends on long-term retention. Resin-based sealants are the first choice of material for dental sealants. Glass-ionomer cement may be used as an interim preventive agent. Whilst cost-effectiveness is an important consideration, from an ethical standpoint the protection of oral health should not be viewed purely in economic terms. The oral health care professional should monitor and reapply sealants as needed to maximize effectiveness.

Retention of three fissure sealants and a dentin bonding system used as fissure sealant in caries prevention: 12-month follow-up results.

BACKGROUND: Bonding agents could be used as fissure sealants. This study compares the retention three fissure sealants (Delton, Delton Plus and Concise) and a filled dentin bonding system (Optibond Solo). METHODS. Fifty-six children aged 7-8 years received fissure sealants either in the four permanent first molars, in the four deciduous second molars, or in all eight of these teeth. Every child received a different sealing material in each quadrant on a random basis. Clinical evaluation at 12 months was performed by a single blind examiner, and the retention was classified as either a success (total retention) or a failure (partial retention or not present). RESULTS: There were no statistically significant differences among the four materials in permanent maxillary molars or deciduous molars. In permanent mandibular molars, Optibond Solo showed a lower percentage of retention (40.9%), significantly different (p=0.002) to that of Delton (89.5%), Delton Plus (87.5%) and Concise (76.5%). CONCLUSION: One bottle dentin bonding system used as a sealant does not improve the retention of conventional fissure sealants. CLINICAL IMPLICATION: Because of the scarcity of studies on the use of dental adhesives as sealants, further studies are warranted for the final support of that conclusion.

Synergistic effect of Nd:YAG laser combined with fluoride varnish on inhibition of caries formation in dental pits and fissures in vitro.

BACKGROUND AND PURPOSE: Although the effectiveness of neodymium yttrium aluminum garnet (Nd:YAG) laser and fluoride anticaries treatment has been established, most previous studies focused on smooth tooth surfaces. We evaluated the anticaries effects of Nd:YAG laser combined with fluoride varnish (Duraphat) on caries-susceptible pit and fissure areas. METHODS: A total of 36 noncarious molars were treated with either a Nd:YAG laser (2.5 W, 6 sec) followed by fluoride varnish, Nd:YAG laser only, fluoride varnish only, or no treatment (control). Artificial carious lesions were created to assess the acid resistance of enamel after treatment. Undecalcified successive tooth slices were made. Percentage lesion formation, lesion length, and lesion depth were evaluated using polarized light microscopy. RESULTS: The Nd:YAG laser enhanced the resistance of dental enamel to acid challenge. However, Nd:YAG laser alone was not as effective as the Nd:YAG laser combined with fluoride varnish, especially for the treatment of pits and fissures. Nd:YAG laser treatment combined with fluoride varnish inhibited 43% of lesions at pits and fissures and 80% of lesions on smooth surfaces compared to no treatment. Carious lesions had shallower depth and shorter length. No carious lesion extended beyond the dentinoenamel junction in either laser-treatment group. CONCLUSIONS: A synergistic effect on dental caries prevention in pit and fissure areas and on the smooth surfaces of the tooth can be achieved by applying Nd:YAG laser followed by fluoride varnish.

Identification of caries risk children and prevention of caries in pre-school children.

A special model for dental care in pre-school children was used in a small clinic in the county of Blekinge in southern Sweden. The model is based on screening of caries risk performed by a dental assistant before the caries attack. Any single risk factor or risk behavior in pre-school children was considered. The aim was to 1) evaluate the dental assistant's selection of caries risk children up to the age of three years, 2) compare dental health variables in 4 yr olds in the test clinic with those for the whole county in 1994 and 3) compare time spent by the dentist and the dental assistant in the test clinic and in the whole county per child up to the age of four. 102 children participated. One specially trained dental assistant screened all children using background factors combined with clinical examinations at ages 1, 2 and 3. Eighty-two children participated each year from one year. A systematized form for questioning the parents was used. Individual caries prevention was given including fluoride and antimicrobial treatments as well as fissure sealants in primary molars at caries risk. The proportion of children with caries lesions at four years and a caries risk assessment up to the age of two was 1.0 (sensitivity). The proportion of children with no caries lesions at four years and no caries risk assessment at year two was 0.7 (specificity). The most frequent risk factors found at 2 yrs were frequency order: lack of oral hygiene (visible plaque), deep fissures in molars and frequent intakes of sweet drinks. The proportion of children with no caries lesions at 4 yrs of age in the test clinic was 92.9% compared to a county mean of 76.4%. In the group of children where a risk assessment was made each year from one year the proportion of caries free children was 96.3%. The total time spent per child in the test clinic was 22 minutes more than the county mean. However, dentist's time, excluding assistance, was 28 minutes less in the test clinic. The results suggest that the model used for caries prevention in pre-school children is cost-effective, and that dental health can be remarkably improved.

The role of pit-and-fissure discoloration in caries assessment.

Occlusal dental caries often is not apparent using traditional diagnostic techniques. The clinical significance of pit-and-fissure discoloration in the absence of dietary and habit substances was examined. The study included 462 extracted teeth (216 with obvious pit-and-fissure discoloration, 216 with subtle discoloration, and 30 with no discoloration); 130 clinical teeth with varying degrees of pit-and-fissure discoloration; and 159 teeth in young adults, which had sealants placed > or = 10 years. All teeth studied were excavated very conservatively using air abrasion and/or the uniquely small H1 004 carbide bur. Presence of caries and its depth and extent were recorded, photographed, and measured with a custom made calibrated probe. Of the 721 teeth with discolored pits and fissures studied (432 extracted teeth and 289 clinical teeth), 660 (92%) had two or more of the four clinical criteria used to define dental caries in this study. Sixty-four percent of the lesions were > 2 mm in depth and 27% were > 3 mm in depth. Of the 159 teeth sealed for > or = 10 years, 47 (92%) were carious, and 26% had large, deep carious lesions penetrating > 3 mm. These data indicate: more effective methods are needed to diagnose pit-and-fissure caries and presence of pit-and-fissure discoloration in the absence of substances causing extrinsic staining should be a strong warning for clinicians to examine carefully for dental caries.

[Will discolored molar fissures within 4 years become carious more frequently than nondiscolored ones? Observations from 1975 to 1988]. / Werden verfärbte Molarenfissuren innerhalb von vier Jahren häufiger kariös als nichtverfärbte? Beobachtungen aus den Jahren 1975 bis 1988.

Caries progression was studied in 5242 first molar fissures of children in the Canton of Zurich, Switzerland, in two observation periods, extending from 1975/76 to 1979/80 and from 1983/84 to 1987/88, respectively. DFT averages at age 12 in the children studied were fairly low, being 3.60 in 1975/76 and 2.21 in 1983/84. Fissures of first molars were classified as completely sound (Grade 0), discolored (Grades 1 and 2) or DF. An exploratory cross-sectional analysis revealed that there is a slow and linear increase of the percentage of DF fissures with increasing age. During the period 1975/76 to 1979/80, Grade 0 fissures became DF with a probability of 14 to 22% while 42 to 54% of the dark brown or black discolored fissures (Grade 2) were DF after four years. In the period 1983/84 to 1987/88, these percentages were lower. It was concluded that in this population with low caries activity there is little reason to apply preventive measures to fissures immediately after their eruption or later to those free from any discoloration.

[The characteristics of the development of caries in human dental fissures based on microhardness data. Its diagnosis, treatment and prevention]. / Osobennosti razvitiia kariesa v fissurakh zubov cheloveka po dannym mikrotverdosti. Diagnostika, lechenie, profilaktika.

Hygienic status of the teeth was assessed after Fyodorov-Volodkina and Green-Vermillion in 500 patients aged 26 to 68 consulted for caries, chronic and acute periodontitis. A good hygienic status of the teeth was observed in 70 subjects: the Fyodorov-Volodkina hygienic index was 1, the Green-Vermillion index O. The Fyodorov-Volodkina index from 1,7 to 5 in 430 patients, depending on the hygienic habits. Patients whose hygienic index was still unsatisfactory despite special training, were subjected to hygienic treatment of teeth with a drill fitted with a modified toothbrush, using water suspension of tooth powder, zink oxide, phosphate cement powder, or tooth paste. Hygienic treatment of teeth by this method proved to be highly effective. The duration of the procedure is 3 to 5 min.

Tuberous sclerosis with portal vein thrombosis, protein C and S deficiency.

A 29-year-old lady with a bad obstetric history and portal vein thrombosis, presented to the Skin OPD for facial lesions. On examination, angiofibromas on face, shagreen patch and periungual fibromas were observed. She also had dental pits and a retinal hamartoma. Investigations revealed hamartomas in the brain and kidney. Hematological work-up showed protein C and S deficiency with Factor V Leiden positivity. Except for the cutaneous symptoms, the patient did not have any clinical manifestations in other organs affected by tuberous sclerosis. A similar association of tuberous sclerosis with protein C deficiency has been reported in only one case in literature.

[Detection of early fissure caries with clinical, radiologic, and laser fluorescence methods]. / Skutecznosc diagnostyczna badania klinicznego, radiologicznego i refleksometrii fluorescencyjnej w wykrywaniu poczatkowych stadiów próchnicy bruzd.

PURPOSE: The aim of study was to compare the diagnostic efficacy of the newly introduced DIAGNOdent laser fluorescence with traditional methods for detection of molar caries, namely visual inspection and bitewing radiographs. MATERIAL AND METHODS: Discolored fissures of 134 permanent molars were studied in 103 patients aged 12-18 years. RESULTS: The results indicate that visual examination and bitewing radiographs showed very high or high sensitivity and specificity for the detection of early fissure caries. Combination of these two methods decreased the number of false positive and negative results. Diagnostic accuracy of DIAGNOdent was significantly inferior to that of clinical examination or bitewing radiographs. CONCLUSION: However, the diagnostic accuracy of DIAGNOdent was increased by combining it with one of the two traditional methods studied.

Prediction of the extent of caries in pit and fissure lesions in a field trial in the west of Scotland.

A field trial is in progress in which 14 community clinical dental officers and 19 general dental practitioners were asked to record the actual extent of fissure lesions and how this compared with the cavity size they expected. Participating operators worked under their normal conditions of daily practice. Forty-eight to fifty-seven percent of 644 prepared cavities were of the expected size upon investigation, depending on the diagnostic technique used. Greater accuracy was achieved among the smaller cavities (58-75% as expected) than with the larger (52-69% larger than expected). More difficulty with cavity size prediction occurred with the lower right first molar than with the other first molar teeth and with both mandibular second molars compared to the maxillary molars. Comparisons between the accuracy of cavity size prediction achieved using a visual inspection in combination with the probe and a visual inspection alone showed no significant difference. Under the conditions of this field trial, considerable difficulties were experienced in predicting cavity size accurately.