Objectives

• Review pediatric restorative techniques from sophomore lab.

• Provide knowledge for restorative procedures during Junior Pediatric experience.

• Discuss restorative dentistry in the context of pediatric dental care.

• Formulate pediatric treatment plans.

Historically management of dental caries in children has involved clinical and radiographic identification of carious lesions followed by surgical intervention to remove and restore affected enamel and dentin

Current evidence regarding caries process and risk assessment allows clinician to go beyond traditional surgical management

• Therapy should focus on patient-specific approaches that include disease monitoring and preventive therapies supplemented when necessary with restorative care.

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Restorative Tx-objectives

• Repair or limit damage from caries

• Protect & preserve tooth structure

• Reestablish adequate function

• Restore esthetics (where applicable)

• Provide ease in maintaining good OH

• Provide child with a good experience

Dental Disability

• Dental caries, periodontal disease and other oral conditions left untreated can substantially limit a child’s participation in life activities

• A child is considered to have a dental disability if pain, infection or lack of functional dentition

  • Restricts nutritional intake for growth and energy needs

  • Delays or otherwise alters growth &development

  • Inhibits participation in life activities

Isovac

• Children may struggle with the isovac for long durations.

• Sizes available: Pedo, XS, S, M, L.

• Size selection based on finger fit between front teeth for appropriate sizing.

  • If I can barely fit my 3 fingers in between their front teeth– Pedo

  • 3 fingers fit comfortably – S

The Raincoat

• Improves access and visualization = saves time

• Superior moisture control

• Prevents aspiration or swallowing of foreign bodies

• Protects soft tissues

• Aids behavior management

• Child becomes nasal breather

• Helps dentist educate parents

  • Option when child cannot tolerate the isovac system.

Clamp Selection

Technique Tips

• Visualize a 1 inch square in the middle of the 5 x 5 dam with each corner indicating the punch hole for the clamp bearing tooth

• Holes too far apart will make it difficult to fit interproximally and may cause problems in Cl II preps

• holes too close will result in leakage

• Do not include more holes than necessary to isolate area

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Considerations in Primary Dentition Restoration

• Material

• Patient’s age

  • Influences ability to co-op

  • Durability of restoration

• Caries risk

• Cooperation

  • Behavior may not be conducive to perfect, textbook cavity preparation & restoration

• Morphology of primary teeth

• Parental wishes

Nickel Allergy

• ALLERGIC CONTACT DERMATITIS OCCURRED ONE WEEK AFTER PLACEMENT

• IN PEDIATRIC DENTISTRY, IT IS COMMON TO USESTAINLESS STEEL CROWNS, WHICH CONTAIN 8 -13% NICKEL. THEIR USE IS CONTRAINDICATED INPATIENTS WITH KNOWN NICKEL ALLERGIES.SYMPTOMS DISAPPEARED AFTER CROWNREMOVED.ALLERGIC CONTACT DERMATITIS OCCURRED ONE WEEK AFTER
  

Morphologic Differences of Primary Teeth

• Mesiodistal diameter of primary molar crown > cervico oclusal dimension

• Buccal & lingual surfaces converge toward occlusal

• Enamel & dentin are thinner

• Cervical enamel rods slope occlusally

• Pulp chambers are proportionately larger & closer to surface

• Contacts are broad & flat

• Shorter clinical crown heights

• Greater cervical constriction

  • Outline form review

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Bur Selection

• efficiency & convenience

• Single bur in most situations

• Round-end, pear shape329, 330, 245 and 256

Incipient Class I Cavity - Very Young Child

• Child under 2 years of age

• Small cavity preparation made without the aid of the rubber dam or local anesthetic

• Objective is to restore the tooth with amalgam to arrest decay and to prevent further tooth destruction without a lengthily or involved dental appointment

Anatomy of pit and fissure Caries

• Enamel undermined by caries but strengthened by fluorides also makes detection of diseased dentin more difficult

• The explorer is often of limited use in detection of pit and fissure caries, since fissures are often narrower than the explorer tip.

Preventive Resin Restoration

• AKA Sealed Composite Resin Restoration

• Young permanent teeth with small Class I caries

• Contraindications

  • BWX revealing Class II caries

  • extensive caries

  • Inability to adequately isolate

• Downside

  • Success is dependent on keeping sealant intact

Class II Cavity Preparations

• 1.5 mm (check DL of axiopulpal line angle)

• Translates to .5mm into dentin

• 1/3 intercuspal distance

• Gingival seat and proximal walls break contact

• > B-L extension at cervical

• No reverse curves, no bevels

  • No MO’s on first primary molars !

Amalgam vs. Composite Resins

• Amalgam:

  • Amalgam use was common and supported by the evidence from clinical trials

  • Success rate for Class II amalgams is reported to be between 70-80%

  • Indications

    • Children who are at moderate caries risk, or who are not totally co-op (i.e. moisture control is a problem)

• Composite Resins:

  • Clinical studies would suggest that class II composites in primary molars are only moderately durable (40% after 6 years)Recent advances are showing improved success with resin-based composites

  • Biggest problem is integrity of the bond at the depth of the proximal box

  • Isolation is a must

  • Incremental condensation

  • Esthetic advantages of resin-based restorations are outweighing the increased expense in time and materials

  • Contraindications

    • Where a tooth cannot be isolated to obtain moisture and or hemorrhage control

    • Where large, multisurface restorations are required in the primary dentition

    • High-risk patients

Gerd

Small Conventional Class III

• Mandibular Incisors: retention of Class III is questionable. “Disking” of proximal surface, opening up contact and removing the cavitation, followed by topical Fl.

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Class III Cavity-Incisors

Guidelines for Treatment Planning

• Initial appointment should be short and manageable.

• Last restorative appointment requires minimal effort.

• Use quadrant dentistry when possible.

• Avoid bilateral mandibular blocks.

Parent Education on SDF (Silver Diamine Fluoride)

• Used to halt tooth decay and alleviate sensitivity.

• Application procedure:

  1. Dry the area.

  2. Apply SDF.

  3. Allow to dry for one minute, then rinse.

• Limitations to SDF:

  • Darkens affected areas permanently.

  • Requires continuation of dental fillings or crowns for functional restoration.

Molar Incisor Hypomineralization (MIH)

Etiology

• Factors include prenatal illness, low birth weight, and exposure to certain toxins.

• Permanent molars and incisors uniquely affected during development.

Treatment Strategies by Severity

• Mild:

  • Maintain function and preserve tooth structure.

• Moderate:

  • Aesthetic treatments and resin restorations may be needed.

• Severe:

  • Use of stainless steel crowns preferred; possible extraction of severely impacted molars.

Radiography Guidelines

• Prescribe radiographs judiciously to minimize radiation exposure.

• Consider the child's dental development stage and caries risk in decision-making.