FPM Flashcards
what percentage of 11 year olds have caries affecting the FPM?
50%
Caries in the occlusal surface of 6’s accounts for how much caries in children?
90%
Why are FPM so prone to caries?
they erupt at a young age and they often go un noticed and enamel defects are common
What do you need to take before deciding treatment options for FPM?
clinical exam
radiographic exam
What are the three main treatment options for FPM of poor prognosis?
Extract
retain
Keep until ideal time
What factors would influence treatment choice for FPM?
Patient
Dental
Orthodontic
What patient factors must you consider?
Medical symptommatic behavioura motivation OH Cost pt prefernce
What dental factors would influence your treatment choice for FPM?
extent of lesion
presence and condition of remaining dentition eg are 8’s presnt and position of 5
is the enamel prone to furrther breakdown
vitality
stage of develpment/dental age
Which orthodontic factors would influcence your decsion re FPM?
malocclusion: this will influence timing of xla
hypodontia
make sure you have an orthodontic input
What is the ideal situation if the 6’s are extracted?
mesial migration of 7’s to replace 6’s and then if 8’s are present they will complete the dental arch
What are the advantages of XLA FPM?
immediate resolution of symptoms
once off procedure
space created could be used to alleviate crowding in buccal segments, reduce overjet and create space for 8’s to come through
What are the disadvanatges to xla FPM?
loss of permanent tooth
may need GA or RA
need to deal with the consequences of late or early extrcations
pt may need ortho after which prolongs treatment time and complexity
When is the ideal time to xla FPM?
When the root bifurcation of the 7’s are forming which is usallt around 9 yrs
WHat happens if you extract the FPM too early?
the 5 will escape distally
What happens if you xtarct the FOM too late?
the 7 tips rather then moving mesially
under which circumstance would could you maintain the FPM?
it must be restorable
What factors must you take into account of you were going to restore the FPM?
extent of lesion qulaity of enamel moisture control pateint co operation symptoms caries risk
What are the options for FPM with deep caries?
Indirect pulp cap
direct pulp cap
partial pulpotomy
pulpectomy
WHen would you do an indirect pulp cap and what would you use?
deep caries with no pain
removal caries from periphery and leave some over the centre t avoid pulpal exposure
place CaOH or GIC over the pulpal area and then go back into the tooth after 6 months once some repative dentine has been laid down
When would you do a direct pulp cap?
this is not advised
Why are partial pulpotomies succesful in young perm teeth and how would you perform one?
because they have increased vascularisation
LA and Rubber dam
remove all caries and inflamed pulp usually about 2mm until healthy pulp is found
What is the most likely treatment that will be carried out on a FPM that is still vital and has deep caries?
indrict pulp cap
How effective are RCT’s/pulpectomy in YPD?
not very
this is because apices immature
long term success is 36% Peretz et al 1997
committing child to life long maintenance
What is the best treatment option for non vital FPM?
EXTRACT
What would be the purpose of maintain a FPM?
This is to maintain when futrue loss is planned
How can you maintain FPM?
SSC
GIC, RMGIC
What are the advantages of using SSC to maintain?
prevents further breakdown since full coverage relieves sensitivity longevity quick and inexpensive single visit
What are the disadvantages of using SSC to temporise FPM?
Expensive
LA may be required
occlusion affcted
need to monitor eription of 7
WHat are the advantages of mainting the FPM with GIC?
fluoride release
easy to place
tolerant to moisture contamination
What are the disadvantages to mantaing the FPM with GIC?
poor physical properties
no full coverge so wont help with further breakdown
