It is better to use materials to seal teeth fissures. Indications and contraindications for fissure sealing

Just a few years ago, few people had heard of fissure sealing in children. Today the situation has changed: parents constantly use this service, performing fissure treatment not only for their children, but also for themselves.

What is a fissure

Fissures on the tooth surface

If you carefully examine the chewing surface of your teeth, you will find ridges protruding upward and small grooves between them. These grooves are called “fissures”; literally translated, fissure means “gap”.

Deep narrow cracks create all the conditions for the retention of small food debris, the accumulation of mucus, and the proliferation of harmful bacteria. They are extremely difficult to clean with a toothbrush or toothpick, so they often cause the development of caries.

Types of fissures

In dentistry, it is customary to divide fissures into types based on shape. Despite all their diversity, any, even the most intricate specimen can be attributed to one group or another. Main types of fissures:

• polyp-like;
• teardrop-shaped;
• funnel-shaped;
• having the shape of a cone.

The depth of any type of gap can reach 3 mm on adult teeth and 0.25–2 mm on children’s teeth.

What is fissure sealing?

Sealing is the sealing of fissures with a special compound. During application, the composition remains elastic, so the doctor can easily and accurately distribute it over the treated tooth surface.

As the substance hardens, it hardens and adheres tightly to the enamel, thereby achieving absolute sealing of dental fissures, which has already proven its effectiveness in the fight against caries.

Indications for the procedure

As a method of prevention, fissure sealing is used for treatment permanent teeth . To preserve baby teeth, experienced dentists use another effective method - applying dental varnishes with high content fluorine

Direct indications for sealing fissures of permanent teeth are:

• The incomplete process of mineralization - saturation of tooth enamel with fluoride and calcium compounds. It is observed in all children and adolescents under 16 years of age.
• Large fissure cavity size.

Today, doctors insist that dental sealing is a procedure necessary for all children at the stage of developing a permanent dentition. Since teeth tend to erupt gradually rather than all at once, you will have to make several visits to the dental clinic.

Pay attention! The sealant will be especially effective when sealing teeth that appeared no earlier than three years before the date of treatment. After teething, the enamel is especially susceptible to caries - timely protection will preserve the health of the teeth and reduce the financial costs of treatment and filling.

Contraindications to the procedure

The main contraindication to fissure sealing is the carious process that has already begun. Caries does not require a constant supply of air; this disease actively develops in a dark, confined space. Therefore, by applying a sealant, the doctor will only aggravate the situation, directing the destructive force of caries towards the dentin and root. This warning applies to both fissure sealing in adults and the treatment of baby teeth with fluoride-containing varnishes.

How it's done

Teeth sealing is a simple and completely harmless procedure, especially if the dentist chooses non-invasive technology. The choice of sealing method is made taking into account the diagnostic examination and radiographic results.

Non-invasive sealing

The non-invasive technique is designed to seal open fissures - crevices that are fully accessible for inspection. The dental technician’s algorithm of actions may vary depending on the condition. oral cavity, but the approximate order looks like this:

1. Cleaning chewing teeth that are not affected by caries.
2. Applying sealant.
3. Surface polishing.

It is impossible to make a tooth completely straight, because without cusps, it will cease to perform its main function - to chew food easily and efficiently. Therefore, doctors always try to replicate the natural shape of the chewing surface as accurately as possible, sealing only the cracks.

Invasive sealing

If the gaps are too deep or narrow, the doctor cannot guarantee the absence of caries. In addition, they cannot be completely filled with a sealing compound, so doctors have to use a drill. With its help, the doctor expands the fissure space, makes sure there is no caries and seals the gap with sealant.

Sealing materials

Modern pharmaceuticals do not stand still; the drugs themselves and the form in which they fall into the hands of doctors are improved every day. Dentistry is no exception. New to dental sealants are convenient disposable syringes already filled with sealant.

The materials used are:

• Compomers are fairly fluid substances that are tolerant of humid environments and wear out in an average of two years.
• GIC are glass ionomer cements that make it possible to do without pre-treatment of the enamel.
• Composite resins that can protect a tooth from carious destruction for 6–7 years or even more.

The composition of the materials often includes sodium fluoride, due to which the mineralization of the permanent tooth with fissure filling continues for one to one and a half years after the procedure.

Sealants can be colored, tinted with tooth enamel, or completely clear. The former are extremely rarely used to treat the enamel of adults - usually adult patients speak out against fissure staining. But children and teenagers agree with great pleasure to multi-colored fissures and fillings.

Fissure sealing in children: pros and cons

Despite the many positive properties of the procedure, the method of fissure sealing in children has opponents. Their main arguments:

• Sealing baby or permanent teeth is an intervention in the natural development of the dentofacial apparatus.
• Sealing the fissures of baby teeth with varnish, as well as applying sealant for permanent dentition, weakens the local immunity of the oral cavity and “frees” the body from the fight against bacteria.
• The doctor may not notice the onset of caries and seal the diseased tooth.

Those who advocate the procedure say that children need dental sealants to:

• Effective prevention of caries.
• Saturation of tooth enamel with useful microelements.
• Increasing the strength of teeth.

Dentists more often support the need for the procedure for children and adults. And those who are against it point to the painlessness of the treatment, positive reviews from patients who have already had their teeth treated, and the safety of the materials.

To seal or not?

Whether to treat the chewing surface with sealant or not - everyone decides for himself and his child. Official dentistry has long accepted the sealing method as one of the most effective in terms of prevention. The results of professionally performed treatment are especially clear in the photographs, which show the chewing surface of the back tooth before, during and immediately after the doctor’s manipulations.

Those who are against the procedure or fear for the quality of its implementation can be recommended to consult several specialists from different clinics at once. You can choose suitable candidates based on reviews from similar patients. By comparing the opinions of several competent specialists, it will be easier to make a decision in favor of sealing.

Fissure sealing in dentistry “All yours!” in Moscow are carried out to prevent caries. During the procedure, the indentations on the chewing surface of the lateral teeth are filled with sealant - creating a physical barrier for the accumulation of plaque and the penetration of microorganisms deep into the tooth. The method increases caries resistance (immunity to caries) of the fifth, sixth and seventh molars in a row.

In children, caries prevention is carried out in stages: at 5-7 years old, the fissures of the first molars are sealed, at 10-11 years old - premolars, and at 12-14 years old, the grooves on the second permanent molars and sevens are closed.” The condition for sealing fissures in adults is the absence of medium and deep caries.

We use fluid photocomposite Fissurit F from the German company VOCO. Fissurit F contains 3% sodium fluoride, so it not only seals grooves and microcracks, but also strengthens the enamel, forming a super-strong compound on the tooth surface - fluorapatite.

Cost of fissure sealing in children

Timing for fissure sealing

The duration of the procedure is 30-60 minutes. Before sealing the fissures, professional cleaning is carried out with electric brushes and a special paste.

Indications for fissure sealing

Fissures of teeth can have different anatomical structure. In some people they are more open, so they are easily cleaned and mineralized by oral fluid.

But more often, the grooves are so narrow that the hairs of the brush when brushing the teeth do not reach their bottom. Food debris accumulates in the depressions and microbial plaque forms. And, since the fissures are located at the enamel-dentin border, caries easily and quickly penetrates through them to the deep layers of the tooth and the pulp.

To strengthen “weak” spots on the surface of the lateral teeth, in dentistry “All Yours!” carry out fissure sealing - an effective procedure for the prevention of caries.

How to prevent caries

During the initial examination, the doctor evaluates the density, color of the enamel and the shape of the dental fissures. Then he removes plaque and dries the chewing surface with a stream of warm air, treats the teeth with gel with orthophosphoric acid to firmly fix the sealant.

The photocomposite is introduced into the grooves with a syringe, after which it is illuminated with a polymerization lamp. The sealant seals fissures and microcracks on the surface of the tooth, penetrates through the micropores of the enamel into the dentin.

The procedure is painless, does not require anesthesia and is well tolerated by children.

The average service life of a composite is 5 years. This is enough to prevent premature loss of baby teeth and ensure the correct formation of the child’s bite. After wiping off the sealant on permanent teeth the procedure is repeated.

Fissure sealing is possible even if there is superficial caries on the sixth and seventh teeth! Contact your nearest dentistry “All Yours!”, and we will provide effective caries prevention for you and your family members.

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Shastova Elena, 32 years old:

Do you know what needs to be done to keep your child’s teeth healthy? It is necessary to seal the fissures. Fissures are the depressions on chewing teeth, in which food debris usually collects, and where caries most often appears. Dentists cover the fissures with a special sealant, so that caries will not appear there for many, many years, and maybe never at all. This procedure is especially important for children, since their teeth are weak and too vulnerable. My daughter is 11 years old, her teeth are perfect! Recently I took her for another preventive examination, there was not even a hint of caries!

About dentistry at: m. Belyaevo, st. Profsoyuznaya, building 104/d

Permanent teeth emerge from the gums with insufficiently mature enamel, especially for fissures, narrow depressions located between the cusps of the teeth. Soft and thin enamel is much more susceptible to acids, and therefore to the risk of developing caries. The situation becomes more complicated if the shape of the fissures does not allow them to be thoroughly cleaned from plaque and food debris.

What types of fissures are there?

Deep and closed, drop-shaped or polyp-shaped fissures of permanent teeth cannot be thoroughly cleaned with conventional hygiene products; plaque accumulates in them and caries soon forms, and therefore their shape is an indispensable indication for sealing. At the same time, they must be intact, that is, undamaged, and there must be no carious cavities on the chewing surface of the teeth.

The hygiene of funnel-shaped and cone-shaped wide fissures is not complicated in any way, food residues do not linger in them: nothing interferes with access to them for brushes and toothpaste, as well as saliva, which contributes to additional cleaning and protection of the teeth. Therefore, they are considered caries-resistant and do not require sealing.

The presence of caries on the proximal (contact) surfaces of the teeth is a contraindication to fissure sealing; in addition, it is not carried out if oral hygiene is poor, or if more than four years have passed since tooth eruption, and the pits and fissures remain healthy.

However, even if the tooth already requires treatment, the procedure can help further strengthen the filling, prevent its rapid destruction, and prevent harmful microorganisms from reaching the tooth.

As a rule, dental fissure sealing is carried out in children starting at the age of five to six years, when the first permanent molar, the “six,” appears. The procedure must be performed in the first six months after the eruption of a permanent tooth, which is why it makes no sense for adults to seal fissures: if the teeth have not undergone caries, it means that the enamel mineralization is sufficient, as well as oral hygiene. On the other hand, if the fissures have already undergone painful changes, not sealing will be carried out, but caries treatment will be carried out, followed by restoration of the tooth surface with a composite material.

Sealing the fissures of baby teeth, as a rule, is not carried out due to the fact that in young children it is difficult to achieve long-term fixation of attention, and this interferes with the doctor’s work, and the procedure is simply not possible to carry out: the child will not sit in a chair with his mouth open for a sufficient amount of time .

Methods and types of fissure sealing: invasive and non-invasive

The fissure sealing technique is selected based on the individual characteristics of the patient and his specific clinical case. If the fissures are wide enough, their bottom is clearly visible, and the presence or absence of caries can be determined with confidence, non-invasive technology is used. It consists in the fact that the surface of the tooth is thoroughly cleaned and isolated from saliva (ideally using a rubber dam), polished, special etching compounds are applied to the fissures, then a sealant or sealant is applied to the fissures themselves, and after hardening, occlusion control is carried out. One of the stages of fissure sealing is coating the teeth with fluoride varnish. It is used before sealing if the mineralization of the teeth is low and additional measures are required to protect against caries.

Invasive sealing is required if inspection of the bottom of the fissure is difficult: it is too deep or narrow. Then, first, the fissures are expanded to make sure there is no caries and the plaque is thoroughly cleaned, then it is sealed in a manner similar to the previous method. Sealing a fissure affected by caries leads to negative consequences for the tooth: the disease will develop inside.

Fissure sealing in children: pros and cons

Most doctors recommend this procedure to almost all of their patients, but there are also those who do not perform it unless absolutely necessary. Their motives are not difficult to understand. Insufficient mineral sealing of fissures requires observation: over some time, with careful care of the oral cavity and regular visits to the dentist, the fissures mature on their own. On the other hand, if tooth preparation is required, that is, opening the fissure and subsequently sealing it, such doctors do not see the difference between the actual sealing and the treatment of superficial caries with composite materials or other drugs. In addition, the slightest violation of technology leads to the development of caries under the sealant, which can be quite difficult to detect.

Price for fissure sealing in children

In Moscow, sealing the fissures of one tooth in different clinics costs from 400 to 1,700 rubles.
Sealing does not at all negate regular (at least once every six months) observation by a specialist, but professional cleaning teeth is additional protection for immature fissures. There is also an opinion that interdental caries occurs much more often than fissure caries. Sealing does not prevent it.

It is necessary to seal fissures in the first months after eruption at the stage of immature enamel. However, there is always a fear that the sealant in this case will prevent saliva from penetrating into the fissures, which complicates the process of natural maturation of hard dental tissues in this area.

Currently, most researchers believe that partial interruption of enamel maturation does not affect mineralization as a whole.
Thus, sealants do not adversely affect the normal mineralization process of enamel.

Mineral elements from the oral fluid can diffuse freely along the edge and partially through the coating substance itself. This allows us to ensure the physiological level of metabolic processes in hard tissues tooth under the coating, while preventing the penetration of large protein molecules.

Considering the high caries resistance of hard tissues, sealing of fissures in teeth with high IUM is not recommended. General hygiene measures are sufficient.

For teeth with average IUM- immediately after eruption, it is recommended to carry out a month-long course of topical application of calcium phosphate and fluorine-containing preparations, followed by sealing with a composite sealant.

For teeth with low fissure IUM, it is not recommended to use composite sealants using them as an etching agent. 38% orthophosphoric acid. In this case, glass-polymer sealants are used, or invasive sealing with a composite sealant, or, according to indications, a preventive filling method.

The presence of pigmented fissures and natural depressions in teeth at the maturation stage, in contrast to teeth with mature enamel, indicates an actively ongoing process and requires invasive sealing methods.

Initial caries is an indication for invasive sealing with composite sealants.

Clinical signs of fissure caries:
. Softening the bottom of the depression or fissure;
. Cloudiness of the area around the depression or fissure, indicating demineralization of the tissue;
. Possibility of extracting softened enamel from a tooth with a probe.

Contraindications:
. The presence of intact wide, well-communicating fissures;
. Teeth with healthy pits and fissures, but with carious lesions on the proximal surfaces;
. Pits and fissures that have remained healthy for 4 years or more do not require sealing;
. Poor hygiene oral cavity .

With a decrease in the level of health and the presence of local risk factors for the development of caries, spontaneous fissure sealing does not occur.

Other articles

Sealing fissures of permanent teeth in children.

A feature of the course of caries in childhood is its predominant localization in fissures and natural depressions of the enamel. More than 50% of fissures are affected by caries in the first 12-18 months after tooth eruption. If in 7-year-old children fissure caries is about 70%, then in 12-year-old children it is more than 90%.

Comparison of the effects of anti-caries drugs.

According to the literature, local methods for the prevention of dental caries in children using therapeutic and prophylactic toothpastes, gels, elixirs, remineralizing solutions, rinses and varnishes led to a decrease in the increase in caries by 20-35% and slightly increased the acid resistance of tooth enamel.

Fissure sealing. Sealants

Composite sealants are traditionally considered as the main ones when carrying out sealing methods. The class of sealants includes composites with a filler content from 1 to 50% by weight. This figure is significantly less than that of traditional

Technology of using fissure sealants.

The main indication for sealing is the presence of a deep fissure, which cannot be cleaned with conventional dental hygiene products (daily brushing), since the space of the fissure is disproportionately smaller than the bristles of a toothbrush, and therefore plaque will accumulate there.

Method of sealing an open fissure.

Thorough cleaning of the walls and bottom of the fissure from soft plaque and food debris. They are carried out using brushes and products that do not contain fluoride. You can use pumice, but you should not use hygienic toothpastes and powders, as the fragrances they contain can adversely affect the sealant. Still not resolved



Caries is recognized as the most common disease on the planet. Not surprisingly, most people are eager to warn him. Fissure sealing is a preventive procedure that can help prevent the formation of caries and maintain dental health. The essence of the procedure is to smooth out the natural relief of the tooth to prevent the development of a pathological process.

Fissures and pits of teeth are relief on the chewing surface, in which the carious process most often occurs. This is due to several factors:

• Food particles easily fall into the depressions on the surface of the enamel;
• At the same time, it is quite difficult to completely clean such grooves, because they are often narrow and deep;
• At the same time, mineralization of fissures occurs later than other tooth tissues - therefore, children, for example, often develop caries in this area.

The procedure was invented in 1965 by Michael Buonocore - he smoothed the relief of chewing teeth with resin and published a report on the results. The author noted two main functions of sealing: preventing the development of caries and strengthening teeth through the use of fluoride and calcium preparations.

Modern sealing materials have the following advantages:

• High security;
• Hypoallergenic;
• Biocompatibility;
• Strength, wear resistance;
• Clinical effectiveness;
• Fluidity, ability to penetrate into pits and furrows;
• The ability to release fluoride and calcium into tooth tissue;
• Coefficient of thermal expansion close to that of natural fabrics;
• Fast hardening;
• Color stability;
• Good adhesion to enamel.

Composite and hybrid materials, glass ionomer cements, true sealants, and compomers are used for the procedure. The effectiveness of the procedure depends on many factors: the sealing method, the material, the work of the doctor, and the individual characteristics of the oral cavity. In most cases, such preventive manipulation reduces the occurrence of caries by more than 90%.

Indications for sealing

The fissure sealing procedure is indicated in the following situations:

• The presence of recently erupted teeth with intact fissures;
• The presence of deep, narrow grooves and pits on the chewing surface;
• Caries of other teeth;
• Cariogenic situation in the oral cavity – medium and high risk of developing the disease;
• Incomplete closure of the jaws;
• Fissure pigmentation;
• Manifestations of signs of mineral loss on the chewing surface of the teeth;
• Unfinished mineralization of enamel.

Sealing can be done on both baby and permanent teeth. It is especially important to carry out manipulation when changing teeth - when there is caries in baby teeth, the risk of developing caries in permanent teeth is 90%. Therefore, it is so important to resort to timely preventive measures to protect permanent teeth.

The following contraindications to treatment exist:

• Absence of pronounced fissures and grooves;
• Severe carious lesion;
• Allergy to sealing materials.

It is recommended to carry out prevention using sealing on baby teeth at the age of 3, when molars erupt and a bite is formed. Sealing of permanent teeth should be carried out after teething: 1 molar (6 tooth) at 5-7 years, 1 premolar (4 tooth) at 9-10 years, 2 premolar (5 tooth) at 10-11 years, 2 molar (7 tooth) ) at 12-13 years old.

Fissure sealing - to do or not?

Whether or not to prevent caries using fissure sealing is up to everyone to decide for themselves. Dentists recommend performing the procedure if there are indications for it.

In children, it is better to carry out sealing after teething - the earlier the prevention is carried out, the lower the risk of developing caries. It is important to combat caries, because oral diseases have an extremely negative impact not only on the teeth, but also on the entire body as a whole. The presence of infection in the mouth contributes to its spread throughout the body. Pathological microorganisms from the oral cavity enter digestive tract, cause gastrointestinal diseases, decreased local and general immunity.

Sealing is a simple dental procedure that takes only 20-30 minutes. This is a great opportunity to introduce your child to the dentist and show that dental treatment can be completely painless. As a result, children develop a healthy attitude towards treatment and an understanding of the need to care for their teeth.

Sealing is carried out as follows:

• The doctor examines the teeth, determines the presence of indications and contraindications for the procedure;
• Implemented professional hygiene teeth. The dentist removes deposits from the teeth;
• Dental tissues are treated with an antiseptic solution;
• The necessary teeth are isolated from saliva;
• The fissure enamel is treated with a special acid for 15-30 seconds (or drilled with a dental instrument);
• Fabrics are dried with a warm air stream;
• The sealant is applied in a thin layer to the chewing surface;
• The material is illuminated with a light lamp for hardening;
• If necessary, sand off excess sealant.

Fissure sealing methods

There are two main treatment methods:

• Non-invasive sealing – complete preservation of tissue without any changes in tooth anatomy;
• An invasive technique is partial excision of the enamel of pits and grooves in the presence of thin fissures and pigmentation.

Based on technology, there are several methods:

• Preventive sealing consists of smoothing healthy fissures, the anatomy of which can cause problems in the future;
• Therapeutic sealing is the sealing of fissures with the removal of tissue affected by initial caries;
• Preventive restoration includes minor tissue preparation, restoration of carious lesions, and sealing of healthy fissures.

The non-invasive technique involves coating clean, healthy enamel grooves with a sealant. Its purpose is to create a barrier and smooth the relief, so it is enough to place the material at the mouth of the fissure without filling it to the full depth.

Non-invasive sealing is a technically simple procedure and does not require high qualifications or special equipment. The big advantage of the manipulation is its low cost, painlessness and maximum effect.

Invasive fissure sealing

The invasive method involves slightly opening deep and pigmented fissures using a bur and applying a sealant. Invasive sealing is almost no different from non-invasive sealing - but in the case of invasive sealing, the burr opens the entrance to the furrow and evaluates its bottom. If the bottom is affected by a carious process, then a deeper tissue preparation is carried out - preventive filling. There are situations when hidden caries affects the tooth up to the dentin, in which case classical caries treatment is carried out.

Experts say that sealing is the most effective method prevention. When using photopolymer sealants, caries does not occur in 92% of cases if the sealant has been preserved in the tooth for at least 2 years. In 43.3% of cases, the disease is not a concern if the material is in the tooth for a year. Sealing with chemical materials is less effective and can prevent the development of the disease in 57-67% of cases.

It can be concluded that the effectiveness of sealing depends on several factors:

• Type and quality of dental material;
• Sealing techniques;
• Doctor's work;
• The period when sealing was carried out after tooth eruption. The earlier the preventive procedure is carried out, the better.