The effect of fissure morphology and pretreatment of the enamel surface on penetration and adhesion of fissure sealants.

Fissure sealants have been used successfully as a means of preventing fissure caries. This effectiveness is directly related to sealant retention and retention is dependent upon a meticulous method of application. The aims of this study were to determine if sealant adhesion and penetration were affected by the variation in preparation of the enamel surface, or by pretreatment of the enamel surface with dentine adhesive systems, in fissures of varying morphology. Non-carious posterior teeth were visually examined and sorted according to fissure type, classified as shallow, deep or intermediate. Occlusal fissures were sealed using one of six methods, thermocycled for 200 cycles between 5 and 55 degrees C, in artificial saliva, then placed in a 1.5% procion orange dye for 3 min. Teeth were sectioned bucco-lingually and examined with a light microscope for (i) penetration of the sealant into the fissure pattern and (ii) adhesion of the sealant. All sealant techniques employed in this study adapted well to the enamel surface as the 1.5% procion Reactive orange dye failed to penetrate any of the sealed tooth sections. Shallow fissures were well obturated in both lateral and vertical dimensions. Sealants adapted well to the vertical walls at the orifice of deep fissures but generally failed to penetrate into the deeper aspects. Reducing the etching period with 37% phosphoric acid resulted in increased voids between the sealant and enamel surface and poorer adaptation to the vertical walls. The addition of dentine adhesive systems, Scotchbond Multi-Purpose and All-Bond 2, enhanced the vertical penetration of the sealant, particularly in deep fissures. It is proposed that the dentine adhesive systems may improve the retention rate of sealants in deep fissures particularly if the fissure is not completely dry prior to resin placement.