Zahnaerzte-hh: Fissure sealing

The occlusal surfaces of the teeth are not flat, but are interspersed with notches and depressions. Depending on the shape, a distinction is made between crevice-like depressions (fissures) and round depressions (dimples). Fissures and dimples are often so small that they cannot be cleaned with a toothbrush (picture microscope). Food residues can accumulate unhindered and plaque can form. This is where bacteria find optimal growth conditions, including so-called caries bacteria. These bacteria produce acidic excrements that etch the tooth and eventually destroy it (caries).

Fissure sealing*

In order to prevent so-called fissure caries, fissures and dimples can be sealed as a precaution with a plastic material. This smoothes out fissured tooth reliefs, reduces the surface area exposed to caries and creates a tooth surface that is easy to clean with a toothbrush.

*The sealing of fissures and dimples is summarized under the term fissure sealing.

Effective caries protection for young people

Fissure sealing is particularly useful for children and adolescents. Their teeth are more susceptible to caries. According to various studies, 60 to over 90% of the caries infestation in adolescents up to the age of 13 or 14 concentrates on the fissures and dimples of the molars. The permanent molars are the teeth with the highest caries risk in adolescence.

The effectiveness of fissure sealing has now been proven by many studies. The Fourth German Oral Health Study (DMS IV), for example, attributes the drastic decline in caries in adolescents between 1997 and 2006 to the increasing prevalence of fissure sealing.

Fissure of a dental crown in a micropscope

The picture shows a thin disc of dental material that has been cut out of a molar tooth and prepared for viewing under the microscope. The deep notches (fissures) are clearly visible in the center of the image, almost reaching the soft dentin.

Poor to clean: The bristle of a toothbrush can be seen above the right fissure. It is much too large to clean the fissures. Accordingly, the fissures are filled with plaque. The dark areas at the edge of the fissure indicate the beginning destruction of the dental material.

Fissure sealing for children, adolescents and adults. When is the seal applied?

Despite the indisputable benefit of fissure sealing – not all teeth need to be sealed immediately. For patients without caries and with tooth surfaces that are easy to clean, sealing is not necessary. The question of when to seal depends on the individual caries risk (caries experience, tooth surfaces, oral hygiene, salivation, etc.). If fissures and dimples that are difficult to clean are present, sealing is recommended regardless of the other caries risk.

For children and adolescents, the best time for sealing is immediately after the complete breakthrough of the permanent teeth.

Fissure sealing for milk teeth

Milk teeth are placeholders for permanent teeth. If a milk tooth is lost prematurely, permanent teeth can break through incorrectly and tooth misalignments can occur. A caries-free milk tooth dentition is also a good prerequisite for the health of the permanent teeth. That is why the protection of the milk teeth makes sense. A fissure seal is particularly recommended if there is a caries risk and the teeth have deep fissures.

Fissure sealing in adults

Fissure sealing is particularly useful for younger adults with fissured tooth surfaces. The creation of smooth tooth surfaces that are easy to clean is advantageous for oral hygiene. With increasing age, on the other hand, the risk of tooth decay tends to decrease, so that teeth that have so far remained caries-free no longer have to be sealed.

When shouldn’t they be sealed?

In many cases, the tooth to be sealed must be dried during the treatment. If it is not possible to dry the tooth properly (lack of cooperation with children), the sealant must not be used. Incompletely broken teeth should not be sealed.

The treatment process

Fissure sealing usually takes only a few minutes and is usually painless. However, the preliminary examination can be more time-consuming.

1. the investigation

At the beginning there is always an examination of the teeth for a possible caries. If the tooth is caries-free or only superficially affected by caries, it can be sealed. A filling is necessary for deeper caries infestation. It is often difficult to determine whether and to what extent caries is present, which may require additional examinations such as X-rays.

2. cleaning and preparation

The occlusal surfaces must be cleaned before treatment. Rotating brushes and powder jet devices are used for this purpose. After cleaning, the tooth is dried and then etched with acid gel. This creates a rough surface to which the sealing material can adhere well. When drying the tooth, good cooperation of the patients is required (children!): If saliva comes to the tooth during this time, the sealing material cannot adhere properly.

3. sealing and fluoridation

Once the tooth has been prepared, the sealing material is applied and cured by exposure with special lamps. A short polish is applied to remove uncured material residues. Then the bite together is checked and the tooth is fluoridated.

Important: Follow-up check!

Despite careful processing, it can happen that parts of the sealings are lost. This is why it is important to check them regularly – preferably during routine checks.

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Christina Cherry
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