Direct from the Operatory: Embrace Pit & Fissure Sealant

by Dr. Josh Wren 

A 7-year-old male patient came to my clinic for a 6-month recall examination and cleaning. We had placed two occlusal-lingual resin restorations one year earlier to repair carious lesions on teeth # A and J. There was organic debris present in all pit and fissures of the fully erupted 6-year molars (Figure 1), but not in the primary teeth. When questioned, the caregiver stated that the patient brushes his teeth with no parental supervision and had brushed just before coming to this exam. 

Figure 1. Organic or food debris is often found on examination of first permanent molars despite good hygiene for other teeth.

All first permanent molars were free of decay, and after consent was obtained, the patient was prepared for sealants on all the permanent molars. The Isolite device was chosen for its ability to treat opposing molars simultaneously. A thorough air-water blast was used to assess if a fissurotomy was indicated or if we should proceed with a non-abraded sealant procedure. 

Thorough cleaning and air-water blast were not sufficient to remove the organic debris from the permanent molars, so I chose a 330 bur to lightly prepare each groove (Figure 2).

Figure 2. Shows preparation of all grooves in a lower left first permanent molar after gentle removal of debris using a 330 bur.

This technique requires only a gentle approach to round the deep grooves, not the normal preparation for a cavity. After preparation, 37% phosphoric acid was applied to the enamel for 20 seconds, rinsed, and lightly dried, removing all surface water, but not desiccating the tooth. Embrace WetBond Pit and Fissure Sealant was applied to the grooves and cured for 20 seconds (Figure 3).

Figure 3. 37% phosphoric acid was applied for 20 seconds, rinsed and lightly dried, and then Embrace WetBond Pit and Fissure Sealant was applied and cured.

An explorer examination was performed to check the margins and attempt to remove the sealant from the tooth-sealant interface. No detectable margin was present (Figure 4). 

Figure 4. Final result. Smooth margins of Embrace sealant are undetectable with an explorer.

About Dr. Josh Wren
Dr. Josh Wren is a board-certified pediatric dentist who founded Wren Pediatric Dentistry in 2007 in Brandon, Mississippi. He is an online and live speaker for Dentaltown where he also serves as the moderator of the pediatric dental forum. Dr. Wren is the Mississippi Representative to the Southeastern Society of Pediatric Dentistry. He founded Pediatric Dental Seminars to educate dentists on all topics related to pediatric dentistry.