We know that 80 percent of decay on young permanent teeth occurs in pit and fissure areas, and sealants have proven to be a very useful prevention tool. However, applying these sealants on permanent molars successfully is not always easy—especially in a young six-year-old.

The following five criteria based on a review of published research will help improve sealant success with ease and efficiency.

1. Acid etch clean enamel surface: Although use of self-etch+prime+bond agents has been suggested, acid etch with 35 percent phosphoric acid for 15 seconds gives a superior outcome (4). It is important that the enamel surface is cleaned of the plaque and salivary pellicle food debris first. A quick clean with pumice and a prophy cup helps achieve this.

2. Avoid saliva contamination: Use of Isolite or similar isolation device can help prevent saliva contamination, which is the most common cause for sealant failure (2). Isolite allows the clinician to achieve consistent results in the most efficient manner. Used correctly with skilled hands this device is a huge comfort for the patient as well. For example, once placed, #3 and #30 both can be worked on simultaneously. In less than five minutes a clinician can pumice etch, apply sealant and cure both teeth. The Isolite position is then swapped to the other side and the same process can be repeated for #14 and #19.

If there is inadvertent contact of saliva after acid etch, just dry the enamel surface again until the frosty/chalky layer is re-established and then apply the sealant to cure. Studies have shown that it still can get you very close to ideal bond strengths.

3. Pit and fissure preparation not needed: For stained or deep fissures with "catch," it has been suggested to open the grooves with fissurotomy burs. Such surface alterations are not needed and it's best to keep the procedure simple. As long as the above steps are followed and the entire sealant stays locked-bonded onto the enamel surface, even if some microscopic decay gets sealed in, the bacteria will not get the substrate to produce acid. Studies have shown that such teeth stay stable and healthy just like ideal teeth with pristine enamel surfaces. The key is complete occlusion of the pits and fissures.

4. Complete seal is important: Studies have shown that partial or incomplete seal is no benefit at all (1). The tooth is at as much or greater risk of decay as an untreated tooth. Also, most sealant failures occur in the first six months so it's important to evaluate at the follow-up hygiene visit and repair or redo if necessary.

5. Less is more: It is important to not overfill the pits and fissures. Keeping the bulk of the sealant to the minimum so that it just barely fills up the valleys and grooves is crucial. Bulky over-contoured sealants fail quickly.

1. Duangthip, Duangporn, and A. Lussi. "Variables contributing to the quality of fissure sealants used by general dental practitioners." Operative dentistry 28.6 (2003): 756.

2. Feigal, Robert J. "Sealants and preventive restorations: review of effectiveness and clinical changes for improvement." Pediatric Dentistry 20 (1998): 85-92.

3. Going, R. E., et al. "Four-year clinical evaluation of a pit and fissure sealant." The Journal of the American Dental Association 95.5 (1977): 972-981.

4. Perry, Amber O., and F. A. Rueggeberg. "The effect of acid primer or conventional acid etching on microleakage in a photoactivated sealant." Pediatric Dentistry 25.2 (2003): 127-131.

Vivek Mehta DMD, FAGD, Visiting Faculty, Spear Education. Follow him on Twitter @Mehta_DMD.

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Commenter's Profile Image Edward Aziz
March 13th, 2014
This really a noce way for young People and simple without fearing them And exhusting both the clinician and child
Commenter's Profile Image Gerald Benjamin
March 13th, 2014
The only thing that has determines sealant success is the use of rubber dam. This is 40 year old knowledge and the more we try to cut corners the lower our success. Stop the laziness.
Commenter's Profile Image Vivek Mehta
March 13th, 2014
Gerald : Thank you for reading this post and taking the time to share your opinion. Yes, you can argue that not using rubber dam could be "laziness". But I am curious if you find yourself in situations when you can't use rubber dam to place sealants on 6 yr molars. Would you like to share your treatment/procedure protocol?
Commenter's Profile Image Gerald
March 15th, 2014
Vivek; For the first 15 years of my almost 40 year career, I was a general 'family' dentist and placed all of my sealants with rubber dam using local in almost all cases. For the last 20+ years my practice has been limited to fixing teeth and restoring implants which means that I have very few children in my practice. We know the statistics on rubber dam use: 5% of dentists use rubber dam. I can honestly say that I could not remember a single case where my sealants fell off. In the biggest picture, the reason that sealants fail is the same reason that many, many posterior direct resins fail : the dentist can't see, can't isolate and is rushed for time fighting saliva and a tongue...If any one questions this then why do 95% of all second molars that I restore have retained caries from the previous restoration? Sorry for the rant but there are very few good reasons not to use a rubber dam.
Commenter's Profile Image Ronald Jarvis, DDS
March 18th, 2014
In response to Gerald... We all know that in direct resins are technique sensitive and that one of the fundemental requirements is effective isolation. There are multiple ways to achieve the goal of effective isolation. A rubber dam isn't magic - it is one of the tools available to help keep a tooth isolated from the oral environment. I trust that I'm not the only one that has seen saliva leak past a rubber dam. Using the Isolite allows me to be efficent and productive AND it provides the isolation necessary to place excellent sealants and direct resin restorations. If that makes me 'lazy', then so be it.