Operative Dentistry - Best Practices

Caries Management: Pit and Fissure Caries Non-cavitated & Cavitated

(last modified August 10, 2017)
 

We follow the ADA Council of Scientific Affairs, Use of Pit and Fissure Sealants: Evidence-based clinical recommendations. JADA 2008, for the management of pits and fissures at risk for caries lesion development and pits and fissures that have non-cavitated lesions. See chair side guide shown below.

levels of evidence and strength of recommendations

 

non-cavitated lesions

 

Overall management of pit and fissure caries is summarized in the figure below which was adapted from our pre-doctoral teaching textbook, Summitt’s Fundamentals of Operative Dentistry 4th Edition, Figure 5-24.

management of pit and fissure caries summarized

A recent systematic review supports arresting initial pit and fissure lesions, that is, ICDAS 1 and 2, with therapeutic sealants. See http://www.ncbi.nlm.nih.gov/pubmed/27470525

Another recent systematic review and meta analysis supports the use of using dental adhesives before sealant placement and favors an etch & rinse over self-etch adhesives. See https://www.sciencedirect.com/science/article/pii/S0002817716000696?via%3Dihub