8.1 restorative dentistry for the pediatric patient

what three things should restorative treatment be based on?

Restorative treatment should be based upon the results of an appropriate clinical and radiographic examination, ideally be a part of a documented comprehensive treatment plan and must be prepared in conjunction with an individually-tailored preventive program

tx plan should take into account what five things?

developmental status of the tooth n stage of root resorption n caries risk assessment n caries experience of the patient n the patient's ability to cooperate for

treatment

how do primary teeth differ in anatomy compared to permanent teeth?

(size, enamel and dentin layer thickness, pulp chamber size, pulp horn location and shape, enamel rod direction)

• Primary teeth are smaller in all proportions

• Enamel and dentin layers are thinner

• Pulp chambers are larger

• Pulp horns are higher and more pointed

• Enamel rods in gingival third extend in occlusal direction from dentin-enamel junction

large pulp chambers

primary teeth

higher pulp chambers with higher and more pointed pulp horns

primary teeth

enamel rods in gingival third extend in occlusal direction from DEJ

primary teeth

enamel rods in gingival third extend in gingival direction from DEJ

permanent teeth

teeth A&J and K&T: which type of primary teeth? turn into which permanent teeth?

second primary molars max and mand; turn into permanent second premolars

teeth B&I and S&L: which type of primary teeth? turn into which permanent teeth?

first primary molars max and mand; turn into permanent first molars (look like them too just very small)

contact areas are flat, broad, and wide

primary teeth

since contact areas are flat, broad, and wide you cannot detect what for primary teeth just by looking, you need a bw

interproximal caries

greater constriction of crown at CEJ, more prominent cervical contour

primary teeth

pros and cons of primary teeth greater constriction at the crown and more prominent cervical contour

advantage: stainless steel crown built in retention

disavd: class II prep with the box drop leads to overextension and you may lose gingival floor and expose the pulp

deeper pits and fissures

permanent teeth

roots are more flared and ribbon like due to permanent successor

primary teeth

advantages of rubber dam isolation

• Better access and visualization

• Moisture control n Safety of child is improved

• Results in decreased operating time

• Aids in the management of the children

• Child becomes primarily nasal breather - good for NO

contraindications for rubber dam isolation (3)

• Presence of some fixed orthodontic appliances

• Recently erupted molars will not retain a clamp

• Child with upper respiratory infection, congested nasal passage, or other nasal obstruction

(BLANK) must always be attached to the clamp

floss

only the tooth being restored must be isolated

Class I and V

at least one anterior and one tooth posterior to tooth being restored should be isolated

Class II

options for restoration of primary molars

amalgam, adhesive materials, stainless steel crown restorations

options for restoration of primary incisors and canines

adhesive materials, interim therapeutic restorations (ITR)

which restoration option for primary molars: Class I and II

amalgam

which restoration option for primary molars: CAR (conservative adhesive restorations), Class I, Class II

adhesive materials

which restoration option for primary incisors and canines: Class III, V

adhesive materials

Objectives: To restore form and function in primary and permanent teeth

Indications: They are indicated for the restorations of carious lesions and/or developmental defects in primary and permanent teeth

amalgam

ideal pulpal floor depth is (?)mm into dentin for class I amalgam primary molars

0.5

all internal angles should be (?) for class I amalgam primary molars

rounded

retention is given by (?) shape of 330 bur for class I amalgam primary molars

pear

leave (?) with enough dental support (do not cross bc it is is a strong tooth structure)

oblique ridges

some common mistakes with amalgam restorations

• Failure to include all susceptible pits and fissures

• Pulpal wall too deep

• Undercutting the marginal ridges

• Carving the anatomy of the amalgam too deep

• Not removing the amalgam flash from the cavosurface margins

• Under-carving which leads to subsequent fracture of the amalgam from hyperocclusion

isthmus width should be 1/3rd the (?) distance ± 0.5mm for Class II Cavity Preparations for Amalgam Restorations for Primary Teeth

intercuspal

break buccal and lingual contacts with adjacent tooth Class II Cavity Preparations for Amalgam Restorations for Primary Teeth

true

break gingival wall contacts and do not bevel and stay at the gingival crest for Class II Cavity Preparations for Amalgam Restorations for Primary Teeth

true

axial wall is past the dentin for Class II Cavity Preparations for Amalgam Restorations for Primary Teeth

false, just into the dentin

for Class II Cavity Preparations for Amalgam Restorations for Primary Teeth the proximal box should be (?) at the cervical portion

broader

for Class II Cavity Preparations for Amalgam Restorations for Primary Teeth, retentive grooves should be placed

false, no retentive grooves

for Class II Cavity Preparations for Amalgam Restorations for Primary Teeth all internal angles should

rounded

common errors with class II amalgam restorations

• Failure to extend occlusal outline into all susceptible pits and fissures

• Failure to follow outline of cusps

• Isthmus cut too wide - restoration will break

• Flare of proximal wall too great

• Angle formed by the axial, buccal, and lingual walls too great

• Gingival contact with adjacent tooth not broken

• Axial wall not conforming to the proximal contour of the tooth, and the mesiodistal width of the gingival floor is greater than 1mm

describe T-band matrix application

• It is formed into circle

• The extension wings are folded down to secure the band

• The T- band is adapted to fit the tooth tightly, it is trimmed with scissors and the free end is bent back

• Less need for contouring matrix bands

These materials do not require extensive removal of non-carious tooth structure to establish appropriate retention form and are more esthetic for anterior tooth restorations

Objectives: To restore form, function and esthetics

adhesive material

Indications:

• All surfaces of anterior teeth, including those with developmental or acquired defects

• Up to two surfaces of posterior primary or permanent teeth

Contraindications:

• Where tooth cannot be isolated to obtain moisture control

• In patients needing large multiple surface restorations in the posterior primary dentition n In high caries risk patients

adhesive materials

Advantages:

• Excellent esthetic qualities - especially resin based

• More conservation of tooth structure in cavity preparation

• Restorative material bonds to the tooth

• Elimination of mercury

• Low thermal conductivity

Disadvantages:

• Technique sensitive

• Increased operator time

• Potential marginal leakage

• Possible postoperative sensitivity

adhesive materials

Technique sensitive, good occlusal wear resistance, good color stability and more esthetic

resin-based composites

Very limited life span. Chemically bond to both enamel and dentin, uptake and release fluoride, decreased moisture sensitivity

glass ionomers

More color change and occlusal wear than resin-based composites, chemically bond to both enamel and dentin, release fluoride, lower polymerization shrinkage

resin-modified glass ionomers

• combines the preventive approach of sealing susceptible pits and fissures with conservative Class I cavity preparation of caries occurring on the same occlusal surface

• limits cavity preparation to the discrete areas of caries

• Bonding agent and an adhesive material are placed in the preparation and then a sealant is applied over the remaining susceptible pits and fissures

CAR (conservative adhesive restoration)

what can you use to ensure all caries are removed for class I and class II cavity preparations for resin-based composite restorations?

caries detecting dye

non carious pits and fissures can simply be sealed

true

retention for class I and class II cavity preparations for resin-based composite restorations is obtained micromechanically with what technique and what item?

with acid etching technique and with the use of bonding agents

for class I and class II cavity preparations for resin-based composite restorations break which three contacts

buccal, lingual, and gingival

for class I and class II cavity preparations for resin-based composite restorations

for class I and class II cavity preparations for resin-based composite restorations at least an equal amount of dentin that is found on the gingival floor of the box should be prepared on the (?) surface; 50-50 rule

occlusal surface

for class I and class II cavity preparations for resin-based composite restorations what materials are used?

T-band and wooden wedge

which is the amalgam surface? composite?

gray outline amalgam and green-blue is composite

prefabricated crown forms that are adapted to individual teeth and cemented with a biocompatible luting agent

stainless steel crowns

Objectives: To restore form and function in primary and permanent teeth

Advantages:

• Extremely durable

• Relatively inexpensive

• Offer the advantage of full coronal coverage

• Subject to minimal technique sensitivity during placement

stainless steel crowns

Indications:

• Restoration of primary or young permanent teeth with extensive carious lesions - open apex

• Restoration of primary teeth following pulpotomy or pulpectomy procedures n In patients with increased caries risk whose cooperation is affected by age, behavior, medical history or require general anesthesia for treatment

• Intermediate restoration of fractured permanent posterior teeth

• Restoration of primary teeth to be used as an abutment for a space maintainer

• Restoration of hypoplastic or hypocalcified primary or permanent teeth n Restoration of teeth with hereditary anomalies (dentinogenesis imperfecta or amelogenesis imperfecta)

• Failure of other available restorative materials

• others: don’t need a completely dry field

stainless steel crowns

stainless steel crowns come in 2-7 sizes with (?) as the most common

4 (and 5)

stainless steel crowns are usually places 1mm below gingival margin, take them out and tighten with cotton pliers, tighten some more and cement

true

• Very challenging restorations

• Caries often extend subgingivally

• Extra retention is often required - due to size

• Preparations must be kept small because of the large size of the pulps

• Slot preparation with a dove tail is used for both incisors and canines

• Retention can be gained by beveling the cavosurface margin

class III adhesive restorations

• An atraumatic minimally invasive procedure that involves removal of caries using hand or slow speed rotary instrument with caution not to expose the pulp.

• The tooth is restored with an adhesive restorative material such as glass ionomer or resin-modified glass ionomer cement

ITR (interim therapeutic restorations)

ADVANTAGES

• Prevention of further decalcification and caries in young patients, uncooperative patients, or patients with special health care needs

• Protection of the tooth in cases that traditional cavity preparation and/or placement of traditional dental restorations are not feasible and need to be postponed.

• Reduction of the levels of cariogenic oral bacteria

• The need of local anesthesia is eliminated.

• Glass ionomer (fluoride releasing material) helps prevent further caries.

ITR (interim therapeutic restorations)