Medical c Restorative Dentistry for Primary Teeth

8/2/2019 Medical c Restorative Dentistry for Primary Teeth

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Restorative Dentistry for

Primary Teeth



What is an ideal restorative

material? Simple

Durable

Painless

Acceptable

Insensitive



Factors

Developmental state of the dentition (Age)

Caries Risk

Patient’s oral hygiene

Cooperation of child

Parental compliance and likelihood fortimely recall



Age

How long tooth will be in the mouth

9 year old (D, E, 6)

D - 1 year and exfoliate

E – 2 – 3 years and exfoliate6 – permanent



Caries Risk OH and past caries

experience

High caries risk – dmfs>age,white spots,lowsocioeconomic, highsugar diet

Fluoride GIC

Compomer

SSC



Cooperation of child and

parental compliance Amalgam less sensitive

than composite

Compomer requires lessmoisture control thancomposite



Dental factors

Extent of lesion in primary molars destructionof the marginal ridge indicates a high

probability of pulpal involvement. If several primary molars require pulp therapy,

and cooperation/motivation is poor, serious

thought should be given to extraction ratherthan restoration.



It is worth considering the occlusion.

In a particularly crowded case, restoration

of a decayed tooth may be indicated if further space loss would mean thatextraction of more than one premolar per

quadrant would be required.



compensating (same tooth in opposingarch) and balancing (contralateral tooth)

extractions, although this is still an area of an area of some controversy.

The rationale is that a symmetrical

problem is easier to deal with later, but if taken to its logical conclusion, it will resultin a clearance!,



In general, loss of C, , or D in a crowdedpatient should be balanced to

prevent a centre-line shift.



Temporization Initial step in management

of caries Open cavities hand

excavated and temporized

with GIC (ZnOE) Introduction to dental

treatment Decreases oral loading of

streptococci Decreases pain and

sensitivity



Restoration of primary posterior

teethLocation of caries

Occlusal caries in primary molars are more common thaninterproximal lesions in preschool children

When posterior contacts, prevalence of interproximal lesions will increase

Mandibular teeth more than maxillary teeth

Bitewings



Restoration of primary teethdiffers from restoration of permanent teeth, The mesiodistal diameter of a primary molar

crown is greater than the cervicoocclusaldimension.

The buccal and lingual surfaces converge toward the occlusal.

The enamel and dentin are thinner.

The cervical enamel rods slope occlusally,ending abruptly at the cervix instead of beingoriented gingivally, gradually becoming thinneras in permanent teeth.



The pulp chambers of primary teeth areproportionately larger and closer to the surface.

Primary teeth contact areas are broad andflattened rather than being a small distinct

circular contact point, as in permanent teeth.

Shorter clinical crown heights of primary teethalso affect the ability of these teeth to

adequately support and retain intracoronalrestorations.



• Tooth preparation should include the removal of caries or improperly developed tooth structure toestablish appropriate outline, resistance, retention,and convenience form compatible with therestorative material to be utilized.• Rubber-dam isolation should be utilized when

possible during the preparation and placement of restorative materials.



Diagnosis

Explorer

Good source of light

Bitewing radiograph

Dry teeth



Bitewings



Class II lesion Diagnosis

Bitewings

Gray discoloration marginal ridge -->?

pulp involved

Broken marginal ridge pulp

involvement



Class II lesions

Surface adjacent to class II lesion

Mesial surface of E – distal caries on D



Full mouth picture

If caries in one quadrant check contralateral and opposing teeth



Anterior teeth

Nursing bottle caries

Labial surfaces of

anterior teeth

Mesial of primary anteriorteeth (class III)

Class V commonly seen onlabial surface of canines



Dental Materials

Amalgam

Composite Resin

Stainless steel crowns

Resin modified glass ionomer cement

Polyacid modifed composite resin(Compomer)



Amalgam

Quick

Simple

Cheap

Insensitive

DURABLE



Disadvantages

Aesthetics

Failure if improper cavity preparation or technique

Lack of adhesion - destructive

Concerns about toxicity



Toxicity



Dimensions of cavity preparation

Minimum cavity depth – 1.5 mm (0.5 mm pulpalto ADJ) to provide sufficient bulk of amalgam

Narrowness – can be as narrow as no. 330 bur

Intercuspal distance – not > 1/3

Rounding internal line angles (axiopulpal lineangle)

No need for ‘dovetail extension’ - outdated



Failures

Fracture at isthmus

insufficient amalgam at isthmus Overcarving or shallow preparation

Sharp axiopulpal line angle

Recurrent caries



Failures

Marginal deterioration Faulty cavity design Large proximal box Unsupported enamel Faulty manipulation of materials Failure to remove caries

Failure to extend to caries susceptible areas Differences in material wear to tooth wear at

occlusal interface



Dental Materials

Amalgam


Composite Resin






Prefabricated crowns forms are adapted toindividual teeth and cemented with luting

agent




Extremely durable

< 4 yrs – SSC success rate twice as long

as amalgam

Full crown coverage



Disadvantage

Expensive

Need cooperation



Indications

High risk

Extensive decay, large lesions or multisurfacelesions

Pulpotomized teeth

GA



Dental Materials

Amalgam


Composite Resin

Glass ionomer cements





Composite resin

Advantages Aesthetic Adhesive (no need for retentive cavity form) Reasonable wear resistance

Disadvantages

Sensitive Secondary caries (shrinkage) expensive



Indications

Small fissure caries

Minimal class II caries

Class III, IV, and V

Strip crowns in anterior teeth



Dental Materials

Amalgam


Composite Resin

Glass ionomer cements





Glass ionomer Advantages Chemical bonding to enamel and dentine

Thermal expansion similar to tooth

Uptake and release of fluoride

Decreased moisture sensitivity

Disadvantage

Poor wear resistence Poor tensile strength

Long setting time



Uses

Luting cements

Bases and liners

Temporary restoration

ART – atraumatic restorative technique



Resin-modifed GIC

Convential GIC with added monomer (bis-GMA) and photoinitiator

Sets by acid base reaction and curing of monomer



Advantages

Fluoride release

Improved aesthetics

Improved tensile strength

Adhesion to enamel and dentine



Polyacid Modified Composite Resin(Compomer)

Composite resin with modest GICcharacteristics

Advantage

Adhesion

Ease of use

Better mechanical properties



Disadvantage

Less fluoride release (10% that of GIC)

Cannot be recharged with fluoride

Less wear resistance than composite



Compomers

Recommended for load-bearing areas inprimary teeth



Conclusion

Careful examination and diagnosis of caries important

New restorative materials useful in thechild patient

Stainless steel crowns show best results



Thank you

Medical c Restorative Dentistry for Primary Teeth

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