|Year : 2020 | Volume
| Issue : 2 | Page : 247-251
|Comparative evaluation of occlusal pits and fissures morphology modification techniques before application of sealants: An In vitro study
Anju Singh1, Konark2, Vishwas Patil3, Meena Juyal4, Rachna Raj5, Priyadershini Rangari6
1 Department of Dentistry, Nalanda Medical College and Hospital, Patna, Bihar, India
2 Department of Conservative Dentistry and Endodontics, Patna Dental College and Hospital, Patna, Bihar, India
3 Department of Pediatric and Preventive Dentistry, Dr. D.Y. Patil University (DPU)), Pune, Maharashtra, India
4 MDS, (Paediatric and Preventive Dentistry), Consultant, Cloud 32 Dental Clinic, Pune, Maharashtra, India
5 Department of Public Health Dentistry, Patna Dental College and Hospital, Patna, Bihar, India
6 Department of Dentistry, Sri Shankaracharya Institute of Medical Sciences, Bhilai, Durg, Chhattisgarh, India
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|Date of Submission||25-Dec-2019|
|Date of Decision||13-Jan-2020|
|Date of Acceptance||30-Jan-2020|
|Date of Web Publication||19-May-2020|
| Abstract|| |
Background: Pits and Fissures are recognized as being highly susceptible to caries. Pit and fissure sealants are one of the best methods of preventing caries as it occludes the fissures and pits from the accumulation of plaque and cariogenic microflora. There are different methods of cleaning and preparing occlusal pits and fissures for preventing caries which helps in alleviating oral health status of paediatric population. Aim: The aim of the present study was to evaluate and compare the microleakage of pit and fissure sealants after using five different preparation techniques, namely: A) Conventional technique using pumice prophylaxis, B) enameloplasty with round carbide bur, C) enameloplasty with fissurotomy bur, D) air polisher, and E) air abrasion. Materials and Methods: The study was conducted on 50 caries-free premolars extracted for orthodontic purpose. These teeth were randomly assigned to five groups, 10 teeth in each for receiving fissure sealant after different surface preparation; thermocycling and sectioning of samples were performed and microleakage was assessed under a stereomicroscope after methylene blue dye immersion. Results: The results of air abrasion groups were significantly superior with “0” microleakage when compared to all other groups followed by round bur, fissurotomy bur, air polisher and pumice prophylaxis. Conclusion: To improve the marginal adaptation of the sealants, minimally invasive methods are the most favoured methods of occlusal preparation. This study promises to show positive results for fissure sealants which are likely to play an important role in caries prevention and techniques that are intended to protect caries susceptible surfaces.
Keywords: Microleakage, stereomicroscope, surface preparation techniques
|How to cite this article:|
Singh A, Konark, Patil V, Juyal M, Raj R, Rangari P. Comparative evaluation of occlusal pits and fissures morphology modification techniques before application of sealants: An In vitro study. Indian J Dent Res 2020;31:247-51
|How to cite this URL:|
Singh A, Konark, Patil V, Juyal M, Raj R, Rangari P. Comparative evaluation of occlusal pits and fissures morphology modification techniques before application of sealants: An In vitro study. Indian J Dent Res [serial online] 2020 [cited 2020 Sep 24];31:247-51. Available from: http://www.ijdr.in/text.asp?2020/31/2/247/284593
| Introduction|| |
Caries is mainly a disease of pits and fissures. Manton and Messer (1995) reported in their study that pit and fissure caries represents a greater proportion of coronal lesions than interproximal lesions. This can be explained by the fact that enamel in the area of pits and fissures do not receive the same level of caries protection from fluoride as smooth surface enamel. Sealing pits and fissures with a resin material in caries-susceptible teeth forms a micromechanically retained, physically protective layer that acts to prevent the demineralization of enamel by blocking the interaction of cariogenic bacteria and their nutrient substrates, thus eliminating the harmful acidic by-products, and this is regarded as a definitive mode of treatment in the prevention of dental caries.
The success of sealant can be judged by its ability to act as a physical barrier between oral fluids and bacteria and the pits/fissures of occlusal surfaces. This is based on an ideal regimen for the placement of sealants to maximize retention and prevent microleakage, as the seepage of bacteria beneath a sealant may support caries initiation and progression. Factors affecting the degree of microleakage include material shrinkage, salivary and debris components in the fissures, air entrapment and fissure geometry which contribute to limiting the sealant penetration, making it necessary to have a good clinical technique.
Preparation of tooth surface prior to etching may vary from the conventional methods like use of dry pointed bristle brush, rubber cup and pumice slurry and invasive methods such as opening up of fissures using dental bur to more recent advances such as abrading the surface enamel with a slurry of sodium bicarbonate or alumina oxide particles under pressure or even prolonging the etching time.
Since there is no clear consensus relative to the best method of cleaning pits and fissures and the search continues for the most effective enamel surface preparation to enhance sealant integrity, the present study has been taken up to investigate and compare the effectiveness of different conventional and new techniques for cleaning and preparing of occlusal fissures before sealant placement to prevent microleakage.
| Materials and Methods|| |
The present study was conducted in the Department of Pedodontics and Preventive Dentistry and Department of Conservative and Endodontic, in the time period of four months, i.e. September 2018 to December 2018. As the study was performed on extracted teeth, no ethical clearance was required. However, consent forms were taken from the patients for using the extracted teeth for study purpose.
Fifty non-carious human premolars—free of macroscopic fractures or other defects, fissure sealants, and/or restorations—were included for the study. These teeth were randomly assigned to five groups, 10 teeth in each for receiving fissure sealant after different surface preparation; thermocycling and sectioning of samples were performed and microleakage was assessed under a stereomicroscope after methylene blue dye immersion.
The absence of caries was determined according to the clinical parameters using sharp explorer and visual examination. The study teeth were cleaned of any periodontal tissue debris with periodontal scalers and then refrigerated and stored in 0.1% thymol until further use.
The teeth were then randomly assigned to five groups of ten teeth each for receiving fissure sealant. The groups were as follows:
Group I (Conventional pumice prophylaxis)
All fissures were cleaned with an aqueous slurry of fine flour of pumice in water (5 mg/4 ml) using a disposable prophylaxis cup with bristle brush inserted in a slow speed hand piece for 10 s. The teeth were then rinsed with air-water spray and dried.
Group II (Enameloplasty with tungsten carbide round bur)
Enameloplasty or saucerization of the pits and fissures was carried out using 1/4 round tungsten carbide bur (S.S. White) in a low speed hand piece. The fissures were opened to approximately the width and depth of the bur diameter (0.5 mm). The teeth were then dried by gently blowing the area with moisture-free and oil-free air.
Group III (Enameloplasty with fissurotomy technique)
The pits and fissures were prepared with the Fissurotomy Bur (S.S. White, Lakewood, NJ, USA) in a high speed hand piece using a light “sweeping” motion for 10 s according to manufacturer's directions to minimally open pits and fissures. The pits and fissures were prepared to the size of the bur head followed by rinsing and drying of the teeth.
Group IV (Air polisher)
Air polishing unit (Air Prophy Unit) was used to prepare fissures by delivering air-powered slurry of warmed water and sodium bicarbonate with the nozzle at 90°, pressure of 3.5–4.5 bar and at the rate of 18–80 ml/min as per manufacturer's instruction. The nozzle was kept close to the tooth surface directing the slurry over the fissure surface.
Group V (Air abrasion)
Air sonic Mini Airblaster (Microjato Standard) with 50-μm alumina particle size and 80 psi pressure was kept at a distance of about 2 mm from the tooth surface with the nozzle at 120° to the tooth surface using irregular movements and rapid trajectories as per manufacturer's instruction. A quick, steady, sweeping motion along the surface was used to achieve a uniform, frosty appearance. The occlusal surfaces were then rinsed and dried.
Subsequent to fissure preparation with etchant by the different techniques, pit and fissure sealant (3M™ Clinpro™ Sealant, St. Paul, MN, USA) was applied according to manufacturer's instructions. Polymerization of the sealant was done using visible light cure (Dentsply) for 20 s, with the tip of the curing light held vertical to the resin surface and about 1 mm away. The margins of the sealant were checked for proper intactness and retention with an explorer.
Study samples were then placed in distilled water at 37°C for 24 h. The specimens were thermocycled (Eppenday Themostatplus) for 1000 cycles in separate distilled water baths of 5°C and 55°C with a dwell time of 60 s in each bath and a transfer time of 3 s. The teeth were then dried and the apices were sealed with sticky wax. Two coats of acid-resistant varnish were applied to all teeth surfaces except for 1 mm diameter surrounding the sealant. The teeth were immersed in 1% methylene blue solution for 24 h at 37°C to allow dye penetration into possible gaps in the tooth sealant interface. After immersion in methylene blue, the teeth were rinsed thoroughly with tap water for 5 min to remove excess dye. The specimens were embedded in acrylic blocks up to the cemento-enamel junction. Approximately, 1.5 mm thick sections were made longitudinally with a double-sided diamond disc in bucco-lingual direction producing two parallel cuts of the specimen block (sectioned transversely, from buccal to lingual surface) yielding a surface per tooth available for scoring. The sections were then kept dry and observed for microleakage.
The sections were observed for microleakage on both sides of each section; first, a total of 10 sites were scored in each group (n = 10) using a stereomicroscope (Lucia) with magnification at 10×. The extent of dye penetration was measured linearly along with the tooth-restoration interface. All measurements were taken from the junction of the tooth-sealant interface to the first point of termination. The degree of microleakage was scored by taking the mean of three readings by a single observer according to the scoring criteria described by Overbo and Raadal (1990). The scoring criteria were as follows [Figure 1]:
- Score 0 = no dye penetration
- Score 1 = dye penetration restricted to outer half of the sealant
- Score 2 = dye penetration restricted to inner half of the sealant
- Score 3 = dye penetration into underlying fissure.
The sections were photographed to show microleakage with score 0, 1, 2, 3 and data was statistically analysed. Each surface was determined by the greatest dye penetration detected on the buccal occlusal and/or lingual occlusal fissure wall.
Representative microscopic photographs [Figure 2] were revealed for each group showing sealant microleakage and penetrability.
|Figure 2: Microscopic photographs showing sealant microleakage and penetrability|
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| Results|| |
The present study was carried out with an objective to evaluate the microleakage of different pit and fissure preparation techniques. All statistical analysis was performed using SPSS version 15.0 Statistical Analysis Software and the data were presented in tabular, pie diagram, bar diagram, and normal Q-Q plot form. The Kruskal–Wallis “H” test, Mann–Whitney “U” test, Kolmogorov-Smirnov test and Friedman test were performed to know the effect of variables and to reveal the statistical significance.
[Table 1] and [Graph 1] show the comparison of overall dye penetration scores among the different study groups. Results showed that Group I (conventional pumice prophylaxis) had maximum dye penetration [2.00 ± 0.82] followed in descending order by Group IV (air polisher) [mean score 1.30 ± 0.68], Group III (enameloplasty with fissurotomy bur) [mean score 1.20 ± 0.42], Group II (enameloplasty with tungsten carbide bur) [mean score 0.90 ± 0.57] and Group V (air abrasion) [mean score 0.70 ± 0.68], respectively. Except Group I (Conventional pumice prophylaxis) which had a median value of 2, all the groups had median value 1.
|Table 1: Overall dye penetration scores among the different study groups|
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The maximum number of sections with the highest microleakage score of “3” was with Group I- Conventional pumice prophylaxis.
[Table 2] and [Graph 2] intergroup comparison showed Group I (conventional pumice prophylaxis) with highest dye penetration while Group V (air abrasion) showed lowest; whereas, Groups II (enameloplasty with tungsten carbide bur), Group III (enameloplasty with fissurotomy bur) and Group IV (air polisher) had mean ranks in between these two extremes. Statistically, the intergroup difference was found to be statistically significant (P = 0.004).
|Table 2: Intergroup comparison using non-parametric ANOVA (Kruskal-Wallis H test)|
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[Table 3] shows comparison between study groups using Mann–Whitney U test, revealed that Group I (conventional pumice prophylaxis) had significantly higher dye penetration scores as compared to Group II (enameloplasty with tungsten carbide round bur), Group III (enameloplasty with fissurotomy bur) and Group V (air abrasion). However, none of the other differences were significant statistically.
Hence, on the basis of the above assessment, the following order of dye penetration scores was observed in different groups:
Group IV ~ Group I > Group II ~ Group III ~ Group V [Figure 1] and [Figure 2].
| Discussion|| |
Pits and fissures are the imperfections in cuspal odontogenesis allowing the accumulation and stagnation of microorganism, fermentable substrates and oral debris that cannot be readily cleaned leading to the development of occlusal caries. Robertson (1835) reported that the caries potential in pits and fissures was directly related to the shape and depth of these pits, fissures and caries which seldom began on smooth, easily cleaned surfaces as cited by Chaitra et al.
In these situations, sealing pits and fissures of teeth is a widely advocated preventive technique where sealants are placed to prevent caries initiation and to arrest caries progression by providing a physical barrier that inhibits microorganisms and food particles from collecting in pits and fissures.
Microleakage is defined as the ingress of fluids and/or microorganisms into the space between tooth structure and restorative material. If microleakage occurs at the sealant-enamel interface, there is potential for failure due to recurrent caries, postoperative sensitivity, adverse pulpal response and/or loss of the restoration.
In the present study, the maximum microleakage was found with the non-invasive method of pit and fissure preparation technique, i.e. the pumice prophylaxis technique as compared to air polisher, fissurotomy, enameloplasty and air abrasion, respectively.
Our results were in accordance with the studies conducted by Hatibovic-Kofman et al. (1998), Chaitra et al. (2010), Agrawal and Shigli (2012) and Chaturvedy et al. (2013), but pumice slurry preparation methods are not very effective means of surface preparation. This could be attributed to greater leakage in conventional pumice preparations and it does not completely and consistently remove debris from pits and fissures even after acid etching and rinsing, thus prevents enamel conditioning and decreases resin penetration.
It also revealed that preparation with air abrasion showed least microleakage when compared to other groups. This is in accordance with the study of Setien et al. (2001), Knobloch et al. (2005), Brown and Barkmeier (1996), Ellis et al. (1999), Lupi-pegurier et al. (2004) andYazici et al. (2006). The reason for the minimum microleakage with air abrasion can be attributed to the fact that air abrasion may induce a more retentive etching pattern and enhance etchant penetration to deep fissures, as this system widens and deepens the pits and fissures, eliminates organic material and exposes a more reactive tooth enamel.
It is apparent that microleakage around sealants is a series of phenomena and not a single entity. The physical and chemical nature of sealants and the clinical skills of the operator play equally important roles. It must be recognized that application of the fissure sealantsin vivo is more difficult than their applicationin vitro on extracted teeth. Inin vitro studies, as ours, the teeth were not subjected to mechanical stress, occlusal wear and other biological factors. Hence, long-term stability of the fissure sealantin vivo and marginal sealing ability of such sealants via different techniques should be investigated in order to have a better option.
| Conclusion|| |
Air abrasion was the most successful cleaning and preparing technique. Enameloplasty with round bur and fissurotomy bur showed better results than air polisher and conventional pumice prophylaxis.
Fissure sealants are likely to play an important role in caries prevention and techniques that are intended to protect caries susceptible surfaces. To improve the marginal adaptation of the sealants, minimally invasive methods are the most favoured methods of occlusal preparation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Department of Conservative Dentistry and Endodontics, Patna Dental College and Hospital, Patna, Bihar
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]
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