Modern approaches to fissure sealing. What is a tooth fissure? Indications for invasive techniques

A child’s teeth are quite susceptible to the activity of pathogenic microflora, which is a source of caries development. The enamel on baby teeth after eruption and for several years is very thin. Poor hygiene oral cavity may complicate the situation. In 40% of children, caries appears and develops in natural depressions on the chewing surfaces of the teeth - fissures.

What are fissures, and why do they need to be sealed?

Fissures are natural relief patterns on teeth in the form of depressions and cavities. In addition to canines and incisors, these natural grooves are present on the chewing surface of all lateral teeth. The depth of the fissures is 0.25-3 millimeters.

Food particles accumulate in the depressions and create excellent conditions for the development of bacteria. The grooves are difficult to thoroughly clean when cleaning the oral cavity, and therefore microbial plaque and carious microflora form at the bottom of the fissures. Microorganisms produce acids that destroy weak tooth enamel. The child develops primary or secondary fissure caries.

Grooves in teeth are divided into open and closed. The first ones can be easily examined, the cavities are perfectly cleaned and are resistant to caries. The latter have the shape of a “bottle” with a narrow depression on the surface and a gradual expansion of the fissure inward. According to their structure, fissure cavities are divided into:

The deeper the groove, the higher the risk of developing caries. Initially, fissures are small pits with a rounded, smooth bottom. Water and food wash out and sharpen their corners, helping to increase depth. Over time, the recesses increasingly trap food, the remains of which begin to rot inside the gap. The cavity gradually deepens.

To prevent the development of fissure caries, doctors carry out a procedure for sealing the fissures of chewing teeth. This is a quick and safe way to protect teeth by sealing cracks with a special polymer sealant.

Features of fissure caries

Cavities on the surface of teeth are an excellent place for caries to develop. Fissures provide a favorable environment for the growth of bacteria, since a child cannot clean deep crevices on his own. The following typical signs indicate fissure caries:

The latter symptoms occur with moderate and deep caries. The discomfort is short-term and disappears after the irritant is eliminated.

Fissure caries mainly affects the surface of the chewing lateral teeth. Most often it affects “sixes” - permanent molars that erupt first. The situation is aggravated by their gradual appearance - the lower ones grow first, the upper ones form a little later. Lack of contact with each other interferes with self-cleaning. Improper hygiene increases the risk of caries, as organic acids wash away the mineral salts of the enamel and cause tissue demineralization.

Sealant materials

To seal fissures, compositions of 3 groups are used. Different materials have individual characteristics.

Materials can be transparent or opaque. The first type of sealant simplifies monitoring the condition of the tooth, but is practically indistinguishable on the tooth surface, so it is impossible to diagnose sealant wear. Fissure dental sealants with titanium dioxide are milky white in color, making signs of wear easy to see. Regardless of the type of material used, sealants do not cause allergies and do not destroy enamel.

Invasive and non-invasive methods of fissure sealing

The choice of prevention method depends on the quality of the enamel, the stage of caries development and the characteristics of the cavities. To prevent fissure caries, based on the results of diagnosing the condition of the oral cavity and teeth, the patient is prescribed sealing of the grooves using one of two methods:

Both methods are safe for children and adults. The non-invasive sealing procedure is painless and does not require anesthesia. Sealing gaps using an invasive method involves minor discomfort during the preparation of the surface tissues of the tooth. Doctors use local anesthesia based on the patient's age.

Indications for procedures

Cavity expansion sealing is used to seal cavities in permanent teeth. The procedure is contraindicated if you have:

• superficial or initial form of the lesion;
• wide fissures;
• uncertain intactness of the notches;
• violations of oral hygiene;
• somatic pathologies.

A non-invasive method of fissure sealing is intended for the prevention of caries in adults and children. It is performed on the child before installing braces.

Another indication for fissure sealing is the risk of carious lesions on erupting teeth (with high and medium levels of mineralization).

Stages of sealing fissures of both types

Dentists often use a non-invasive fissure sealing method. To do this you need to do the following:

During invasive sealing, the fissure is first opened with a diamond bur and checked for tissue damage by caries. Then, following the sealing method described above, the drilled fissure cavity is filled with a layer of sealant, condensing tightly. Depending on the required number of layers, the doctor repeats drying and insulating from moisture or immediately processes and coats with fluoride varnish.

Advantages and disadvantages

The sealing procedure not only prevents caries, but also treats it in early stages when the lesion looks like a white spot. Fissure sealing provides a double effect:

1. The filling material creates a protective barrier on the chewing surface. Once sealed, food particles do not penetrate or remain in the recesses.
2. As a result of covering the tooth with a material based on active fluorine ions, the enamel becomes resistant to the effects of acids produced by pathogenic microflora. This prevents the formation of plaque and the development of fissure caries, which requires serious treatment.

According to statistics, sealing reduces the risk of fissure primary and secondary caries by at least 90%. This is a reliable method of disease prevention and possible complications(from pulpitis to periodontitis).

A definite plus - prolonged discharge fluoride ions from composites (within 10-12 months after application). In addition, sealing costs less than dental silvering and provides significant treatment results.

Some dentists are against fissure sealing, believing that sealing teeth interferes with their normal development. To solve the problem, it is enough to ensure the supply of calcium, other vitamins and minerals in children's body or limit yourself to fluoride varnish coating.

Non-invasive fissure sealing requires perfect alignment of the tooth surface. The presence of depressions under the sealant will become a source of bacterial development and complicate the diagnosis of the disease. An inexperienced doctor will not be able to perform the procedure correctly.

Contraindications for sealing

Fissure sealing is not suitable for all patients. There are absolute and relative contraindications to sealing. The absolute ones include:

• The presence of foci of caries in fissures. Covering with a sealant will not stop further spread; the disease will develop without treatment, remaining hidden from the doctor.
• Incomplete eruption of the chewing part. An immature tooth cannot be properly examined and treated.

Sealing of wide fissures is prescribed individually. This structure allows you to remove plaque yourself while maintaining hygiene. In conditions of high mineralization, sealing of dental fissures is not carried out.

Improper oral hygiene is a relative contraindication. At the stage of wear of the sealant, teeth require full care, otherwise the chips accumulate food particles and become covered with plaque.

Measures to prevent fissure caries

It is not difficult to prevent the development of fissure caries if you follow the recommendations for caring for the oral cavity:

• brush and floss your teeth regularly;
• limit the consumption of foods that destroy tooth enamel;
• undergo an examination at least 2 times a year;
• carry out the remineralization procedure every six months.

At the stage of tooth formation and growth, it is necessary to use treatment with vitamins, calcium and fluoride. The dosage and type of drug should be selected according to individual indications in consultation with a doctor.

Depending on the condition of the tooth surface, dentists use various methods fissure sealing.

The essence of this procedure is to prevent the development of caries in the natural recesses of the teeth on the chewing surface - teeth fissures.

The chewing surface of the teeth is not completely smooth; it has indentations and protrusions that facilitate better chewing of food. It is in the grooves on the surface of the teeth (fissures) that plaque accumulates, which serves as the root cause of caries. If the grooves are wide and shallow, then sealing is not required; the teeth can be easily cleaned with a toothbrush.

Non-invasive fissure sealing

If there are fissures that cannot be cleared of plaque and food debris with saliva and a toothbrush alone, non-invasive fissure sealing is required. In this case, no operational measures are provided; only standard manipulations are carried out:

• Cleaning the tooth surface from plaque.
• Creation of roughness for better fixation of the sealant.
• Applying sealant and fixing it. Depending on the type of sealant material, the hardening process is carried out using a special light.

If the grooves on the surface of the tooth are closed, it is difficult to access them for cleaning and subsequent filling with sealant, the dentist is forced to use mechanical means to open them.

Invasive fissure sealing

Most often, invasive fissure sealing is performed on teeth where the enamel formation process is close to completion. It is then that two factors coincide: the enamel itself has not yet fully strengthened, and deep and closed fissures contribute to the accumulation of plaque. Mechanical expansion of the furrows and their subsequent sealing are designed to solve this problem.

Application invasive method much preferable to conventional filling even for initial stages caries. A traditional filling covers at least a quarter of the chewing surface, while the use of sealants can reduce this area by up to 5%.

The expansion of fissures and the alignment of their walls is carried out with a diamond bur to their full depth. This is necessary in order to properly fill the cavities with a sealing gel, as well as to identify hidden foci of carious lesions that might have been missed during a routine examination.

If, during the opening of the fissure, a center of caries is identified, then it is necessary to first carry out all the necessary manipulations to remove it and only then do sealing.

Whatever sealing method is used, it should be remembered that this procedure is temporary. After the enamel of the chewing surfaces is fully formed, the presence of sealant is no longer so important; the teeth have acquired natural stability and can take care of themselves. Naturally, problems will not arise only if hygiene methods are followed normally and periodic examinations by a dentist at MSC.

Everyone knows that many problems are easier to prevent than to successfully deal with them later. Fissure sealing is the most striking and visual dental example of this approach to caries prevention.

Each tooth has its own weak points, which caries especially loves. One of these affected areas are fissures - natural folds on the chewing surface.

The fissures are slit-shaped and flask-shaped (or teardrop-shaped), they are where most food debris gets stuck and are very difficult to clean with a toothbrush. But in addition to the fact that a nutrient medium for caries-causing microbes remains in the fissures for a long time, one more anatomical feature should be noted.

The fact is that the enamel is formed by bundles of microtubules. It is on the walls and bottom of the fissures that there are the greatest number of end sections of these microtubules, making the enamel most susceptible to destruction.

And that's not all. A newly erupted tooth is not yet fully formed; its hard tissues continue to accumulate calcium for some time, and at this time they are most vulnerable.

Fissure sealing is a practical method that consists of physically isolating the grooves on the chewing surface of the tooth from contact with the external environment, and, consequently, with food and microbes.

The insulating material prevents damage to the enamel for a period sufficient for its maturation.

Video: sealing for caries prevention

Indications

In principle, this procedure is indicated for absolutely everyone at the time of complete teething (with the exception of objective contraindications), but is especially recommended for:

• Temporary teeth- sealing the fissures of primary teeth is indicated for weak mineralization and a high tendency to rapid caries damage;
• Permanent teeth- with deep fissures that are difficult to reach for self-cleaning.

Contraindications

There are several contraindications, they can be both absolute and relative.

The absolute ones include:

• The presence of foci of carious destruction in the fissures. Caries after covering with sealant does not stop, but continues to develop for a long time, remaining inaccessible to detection and treatment.
• Incomplete eruption of the chewing surface of the tooth, which does not allow for a full examination and necessary manipulations.

Relative contraindications include:

• Wide and accessible fissures. It is generally accepted that this enamel structure is a guarantee that the tooth will be sufficiently cleaned of plaque during routine hygienic cleaning. However, with weak mineralization of teeth during their maturation, additional protection may not be superfluous.
• Low level of oral hygiene. It is especially important to properly and fully care for your teeth at the stage when the sealant has already worn out and begins to gradually chip. At this time, the activity of their fluoride release is significantly reduced, and the resulting chips serve as places for additional retention of food debris and dental plaque.

Preventive effect

In addition to their insulating effect during the period of enamel maturation, sealants strengthen the tooth surface due to the fluoride they contain.

Fluoride penetrates from the filling material slowly, but over a long period, which is much more effective than one-time remineralization therapy procedures.

Materials

Today, a dentist has a large selection of specialized sealants (sealants) in his or her arsenal. This can be fluorine-containing cement, or a special composite material, both chemical and light curing.

Recently, preference has been given to flowing photopolymers, as they are easy to use and give excellent results.

Popular sealants:

• UltraSeal XT Plus
• Grandio Seal
• Fissurit F
• Fissulight, etc.

Techniques

It is necessary to distinguish between methods and technologies. Techniques are fundamental directions in the treatment of a disease that have significant differences among themselves, and technologies are the sequence of manipulations performed to implement a separate technique.

Non-invasive

The essence of this approach is that the doctor does not make significant changes (disturbances) to the existing structure of the tooth, he only complements, adds something to what already exists.

The silvering method is not a strict sealing technology, since it does not provide insulation of the surface of enamel folds from food, plaque and microflora.

However, amorphous metallic silver deposited on the surface of the tooth has a long-term anti-caries effect and can be successfully used, especially to protect temporary teeth.

To do this, the fissures should be thoroughly cleaned of plaque and ensure that there is no fissure caries (this preliminary step is also necessary for any method of fissure sealing).

Then the surface of the enamel folds is sequentially treated with a 30% solution of silver nitrate and any of the available “developers”, for example, a 4% solution of hydroquinone or ascorbic acid.

In this case, silver is reduced from the nitrate solution and acquires a characteristic black color, the intensity of which indirectly indicates the permeability (degree of mineralization) of the treated tooth surface.

The classic non-invasive technique for sealing the fissures of primary teeth is to fill them with sealant.

Healthy fissures, cleared of plaque, are treated with etching gel using standard technology, after which they are filled with sealant from a convenient syringe. After polymerization and mechanical treatment, it is advisable to cover the chewing surface of the tooth with any fluoride varnish.

Video: stages of non-invasive sealing

Invasive

The invasive technique is used in the case of “closed”, hard-to-reach fissures, the walls of which seem to hang over the bottom, forming a flask-shaped space.

For a full examination and sealing of such folds after their preliminary cleaning, it is necessary to use a diamond tool to level the curvature of the walls to the very bottom of the fissure, providing free access to the fold throughout its entire depth. And only after making sure that there is no caries, sealing should be carried out using the technology adopted with the non-invasive method.

Photo: Stages of invasive fissure sealing

Sequence of invasive sealing:

1. Cleaning and opening of fissures;
2. Treatment with etching gel, creating a rough surface for better adhesion to the sealant;
3. Thorough washing of enamel from acid;
4. The actual filling with sealant;
5. Light polymerization of the introduced material.

If there is already a carious lesion in fissures of any type, then it must first be treated according to the most optimal scheme for a particular case, and only then the fissures must be sealed.

Frequently Asked Questions

Does sealing permanent teeth prevent tooth decay forever?

No, because sealing is only the first step in protecting the tooth from decay.

During the isolation of the most vulnerable areas, the enamel will mature and be able to independently resist the formation of carious defects.

To maintain healthy teeth, proper hygiene care and regular dental checkups will be enough.

Prices

The price of sealing for children and adults depends on the region of residence and the method and materials used.

Average cost of fissure sealing using a non-invasive method in Moscow dentistry

If an invasive method is used, the price will be slightly higher.

Sealing fissures of temporary and permanent teeth- this is not a panacea that allows a person to forever forget about the existence of caries and no longer remember about toothbrush. But with proper daily hygiene care, it will ensure the safety of everyone’s teeth for a long time.

To get the maximum effect, fissure sealing should be carried out several months after teething, but no later than 6 months. Why is this particular period so important? The bottom line is that the fissure is filled with microbes and if you miss the moment, this will lead to caries under the sealant.

Sealing fissures of baby teeth in children

It is usually carried out when the child is 2.5-3 years old, since it is at this time that the milk teeth are completely freed from the “hood” and completely erupted.

If sealing is done in time, the risk of caries is reduced by 90%. However, it is worth noting that this is only possible if the child takes proper care of his teeth.

Fissure sealing of permanent teeth

When a child turns 5-6 years old, permanent chewing teeth will begin to appear. Microbes begin to collect in the fissures. It is extremely difficult to remove them with regular tooth brushing, so there is a danger of developing fissure caries. This is why adults quite often have to remove the “six”.

At 5-7 years old, the first permanent molars appear, at 12-14 years old, the second ones. Since enamel mineralization takes place over the next 3 years after eruption, it is recommended to protect teeth from damage by the carious process during this period. In this way, you will stop the destruction of the enamel that has not yet fully formed, and food debris will not be able to get into the tooth.

If you do the procedure on time, you can protect your child’s teeth for three or more years. This will be enough to form healthy and strong tooth enamel.

Fissure sealing procedure

Stages:

• Removing plaque from teeth to make them dry and clean. Electric brushes and pastes are used, without fluoride.

• Next, the teeth are washed and covered with cotton wool to protect them from saliva. The teeth are covered with a special glue - the enamel becomes a little rough. Next, the teeth are dried and a sealant is applied.

• Using a special probe, the recess is evenly coated and the residue is removed.

• Using a polymerization lamp, the filling of fissures is checked. The material hardens. A check is made to ensure that the jaws are closing correctly.

• Removing excess sealant.

The duration of the procedure is 15-20 minutes.

Recently, a dental procedure such as fissure sealing has become increasingly popular. For baby teeth, dentists recommend sealing fissures as a preventive measure for the development of caries. Physiological depressions on the tooth (fissures) can allow harmful microorganisms into the milk teeth. For this reason, children have the surface of their teeth sealed for a certain period of time. Before deciding to undergo the procedure for a child, parents should weigh the pros and cons.

Fissures - what are they?

Fissures are anatomical grooves, grooves, cavities on the chewing surface of the teeth. Their depth varies - from 0.3 mm to 0.25 cm. During eating, these grooves become clogged with food debris, which creates favorable conditions for the development of pathogenic microflora. The consequence of this is early development caries and tooth decay. This occurs due to the peculiarities of the natural structure of the cavities, as well as due to the fact that the enamel in the depths of the cavities is thinner and has less strength. Toxic waste from the proliferation of microorganisms quickly destroys weakened enamel, which contributes to the development of superficial or deep caries fissure

In dentistry, there are main types of fissure structure:

• cone-shaped;
• drop-shaped;
• funnel-shaped;
• polyp-like.

On permanent teeth that have recently erupted, the grooves are deeper than on adult and mature molars and premolars. When brushing your teeth, such grooves are much more difficult to clean with a regular brush. The enamel on young teeth is not as strong as on adult teeth. As a result, during the first 4-5 years, new permanent teeth are at increased risk of developing fissure caries. This is why dentists recommend sealing the chewing surfaces of children’s teeth.

The question often arises - what is the difference between teeth sealing and silvering or remineralization? When fissures are sealed, irregularities are smoothed out and the resulting cavities are filled.

As a result of silvering, the enamel surface is temporarily protected from pathogenic microflora. However, due to the application of a special composition, the enamel acquires an unaesthetic black color for 2-3 years.

The use of remineralization makes it possible to correct natural enamel defects, strengthen and compact its structure, but even in this case, the physiological grooves on the fissures remain unchanged, so the risk of developing caries still remains. Remineralization gives good effect in adulthood, when the surface of the teeth has changed and become more even.

Why is sealing carried out?

Due to the accumulation of bacteria in deep grooves, the enamel is destroyed, resulting in the appearance of carious cavities, since it is not always possible to efficiently clean narrow irregular grooves from food debris. To prevent the problem, fissure sealing is used.

The procedure gives a long-term effect and is aimed at a comprehensive solution to the problem:

Sealing is carried out only if there are indications for the procedure:

• deep, too often located fissures;
• thin layer of enamel;
• the onset of caries (at the white spot stage) on the chewing or lateral surface;
• small degree of enamel mineralization;
• poor oral hygiene;
• grooves that are too narrow or have a non-standard shape.

Types of sealants

There are two types of fissure sealants used in dentistry - chemical and light-curing. To seal fissures in children, only light-curing agents are used due to their high hardening speed and composition that is safe for health.

Materials vary in appearance- transparent and white sealants are used:

• Transparent compounds are used if the enamel is thin, poor quality, a high risk of caries is predicted. Full transparency allows you to monitor the development of pathological processes and, if necessary, begin treatment on time.
• White sealants are used to seal teeth with normal and high enamel mineralization. The most commonly used compounds for sealing fissures in children are Fissurit F and Grandio Seal. These materials have a high level of strength and exhibit little shrinkage. Solutions are produced in small syringes with special narrow tips, which allows the composition to be applied to the desired area as accurately as possible.

Stages of the procedure

More recently, such procedures were performed only on those children whose baby teeth were replaced by permanent ones. According to the observations of specialists, the age period in which caries begins has decreased significantly. This indicates that preschool age is considered the most suitable period for fissure sealing. The application of sealants prevents damage to primary crowns and serves as a preventive measure for caries infection of the rudiments of permanent teeth.

Teeth can be sealed six months after complete teething. Due to their uneven growth, you may need to visit your dentist several times. To ensure good dental condition in the future, it is necessary to repeat the procedure after 7-10 years.

The procedure itself is carried out in two in different ways- invasive and non-invasive. The choice of method is influenced by the depth and location of the fissures. If wide open cavities and grooves are observed during inspection, use the second method. Its use is based on slight grinding of the surface of the teeth. If the fissures have a complex shape or their bottom is affected by caries, invasive sealing is prescribed. To increase the width of the fissures, spot turning is used.

Technology for performing a non-invasive sealing method:

Invasive sealing is carried out slightly differently:

Pros and cons of sealing

A large number of positive reviews make it possible to form an opinion about this procedure.

Using this method allows you to protect your teeth from caries for a long time. After the procedure is completed, the dentist gives advice on how to care for your teeth, what rules need to be followed so that the protective shell retains its qualities for as long as possible.

If you follow the doctor's advice and recommendations, the protective layer retains its qualities for a long time. In children preschool age it loses its integrity after about four years. The maximum duration of protection for one layer of sealant is about eight years. This means that you don’t have to worry about the appearance of caries during the entire period while your teeth are covered with a special fissure composition. The disadvantages of the method include the development of caries under the sealant layer in case of poor preparation for the procedure.