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Thorough reviews of pit and fissure sealant are available in the literature. It is the intent of this paper to focus on the clinical aspects of pit and fissure sealant application and the most recent publications that support an evidence-based clinical application technique. Pit and fissure sealants were introduced in 1971 based on the pioneering studies of Buonocore. Additional work initiated by Handelman in 1972 looked specifically at what happens to the bacteria trapped underneath a sealant. Concerns that such entrapment could lead to propagation, or continued development, of caries under a well-sealed area, were mitigated by this and many other succeeding studies. It remains clear that the application of pit and fissure sealant to newly-erupted posterior (and occasionally, anterior) teeth is the best method we have in dentistry to prevent pit and fissure caries, and ⁄ or to prevent the continued development of incipient caries into frank caries when the incipient lesion is sealed over with resin.

A retrospective clinical evaluation of 1,314 cast gold restorations in 114 patients placed by one practitioner was conducted. A very high percentage of patients contacted (114/116 [98.3%]) participated in the evaluation. Almost 90% of the restorations had been in service for over 9 years, 72% for over 20 years, and 45% from 25 to 52 years. All restorations had been cemented using zinc phosphate cement. The restorations were evaluated by independent evaluators in terms of marginal integrity, anatomic form, and surface texture, and 96% of the evaluations were excellent (Figures 1-5). Sixty restorations required removal and replacement, yielding an overall failure rate of 4.6% or a survival rate of 95.4%. The survival rates at various time periods were 97% at 9 years, 90.3% at 20 years, 94.9% at 25 years, 98% at 29 years, 96.9% at 39 years, and 94.1% for restorations in place > 40 years. It appears that properly fabricated cast gold inlays, onlays, partial veneer crowns, and full veneer crowns can provide extremely predictable, long-term restorative service. It is suggested that the use of such restorations should not be automatically precluded simply because they are gold colored. These restorations should be considered in patients who are more concerned with longevity than esthetics, and in those patients in whom placement of a conservative cast gold restoration would not result in an unesthetic display of metal.

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