OD In Children Flashcards
Rationale for restoring baby teeth
- Preserve pulp vitality
- Aesthetics
- Maintain arch length
- Restore occlusion
- Maintain function
- Avoid extractions –> space loss, medically compromised
- Control disease
When might you choose not to restore endodontically involved primary tooth
Root resorption (pathologic/may also mean about to exfoliate)
Uncooperative child, unrestorable
Child come back with very bad infection, facial swelling etc
Systemic medical conditions eg immunosuppressed, increased risk of infection hence choose exo over RCT
Considerations in restoring primary tooth
Tooth factors
- Extent of pulpal pathology
- Restorability
- Arrested lesions
- periodontal support
- Time foe exfoliation
Host factors
- Developmental status of dentition
- Patient cooperation, parental compliance
- CRA
- Systemic medical conditions
- Likelihood of timely recall
- Pathologic root resorption
Why is there lee way space
Deciduous molars are wider mesiodistally then permanent premolars. leeway space disappears with mesial drift of teeth
Deciduous vs permanent teeth
Deciduous teeth smaller in overall dimension
Increased md:incisocervcal
Short clinical height
Marked cervical constriction, very bulbous
OD significance of anatomy primary posterior teeth
Marked cervical constriction at neck contributed by bulge of enamel at cervical ridge –> lose floor of proximal box very quickly
Broad and flattened contact area –> harder to clear
Larger pulp in relation to tooth size, easier to pulp expose. Mesial pulp horns are closer to surface than distal pulp horns
Extraction of primary molars things to note
Roots more flares to accommodate developing tooth under
Roots are more slender so easier to fracture, even though children’s bones softer and more pliable. Slow, controlled elevation required
Advantages of amalgam
Ease of manipulation
Low cost
Durable
Reduced technique sensitivity
Limitations of amalgam
Extent of caries. Caries cannot go beyond line angle; if it goes beyond line angle, when you condense it will just fracture
Require increased preparation vs CR
Unaesthetic
Environmental concerns
Cause of fracture of AR class II isthmus
- Insufficient bulk
- Large proximal box, narrow isthmus
- Excessive flare of cavosurface margin
Advantages of GIC
- Chemical bonding to dentine and enamel
- Thermal expansion similar to that of tooth
- Biocompatibility
- Fluoride release
- Decreased moisture sensitivity vs CR
Form for class V in deciduous teeth
Contour must recreate the cervical bulge (plaque retentive)
Classification of PRR
A: suspicious pits and fissures, caries removal limited to enamel, using slow speed round bur
B: incipient lesion in dentine, prep is small and confined
C: need for greater exploratory prep
What is disking
create self cleansing surface for primary anterior teeth
remove carious enamel/outer layer of dentine without restoration using interproximal bus, then high fluoride application
indications of disking and fluoride
Primary anterior teeth (lower more common than upper)
teeth near exfoliation but not loose yet
shallow and wide caries hence filling would drop out
Indications for stainless steel crown
grossly broken down but still restorable hypoplastic high caries risk previous pulp therapy other restorative methods would fail Abutment for space maintainer
contraindications for stainless steel crown
unresolved pulpal pathology
tooth exfoliating within 6-12 months
uncooperative child
nickel allergy
how much of contact to clear for SSC vs class II
Class II: light pass through
SSC: explorer can pass through
why is there minimal buccal and lingual reduction for SSC prep
these surfaces are needed for retention’ mainly the buccal due to large cervical constriction which SSC flexes to fit
where should margins of SSC be placed
1-2mm subgingival. if you leave crown margins at the gingival margin, will get recurrent caries
problems with ssc
may be aspirated/lost/swallowed during preparation
may obstruct/impact permanent teeth eruption
difficult to fit when there is significant space loss eg mesial drift
What are the techniques for minimally invasive dentistry
Atraumatic restorative technique
interim therapeutic restoration
38% silver diammine fluoride
Hall technique
what is atraumatic restorative technique
traditionally don’t use handpiece
minimally clean the DEJ which is where occlusal caries spread along
What is IRT
Interrim therapeutic restoration
Restore and prevent further caries in very young patients, uncooperative patients
traditional cavity prep/placement of traditional restoration not possible. use GIC, to replace when child is older
Maximum removal of peripheral caries and form good seal so that can lay down tertiary dentine and caries free in the future
Potential adverse effects of SDF
Tooth cavities stained black permanently (healthy tooth structure will not be stained)
tooth coloured fillings may discolour
accidental application on skin/lips –> brown/white stain which resolves in 1-3 weeks
risk of tooth decay progression if no changes to OH habits
contraindications to use of SDF
Silver allergy
Ulcers
Considerations in restorative material for primary teeth
Number of tooth surfaces affected by active/incipient caries
RCT
Ant vs post
Caries risk
Patient ability to cooperate, will resto be good quality?
Anticipated parental compliance (regular fluoride application, meticulous care)
Likelihood of timely recall eg space maintainer
Disadvantages of gic
Long setting time
Brittle
Susceptible to erosion and wear
Adv and disadvantages of CR
Aesthetic, conserve tooth structure
Moisture and technique sensitive
Longer time to set
Recurrent decay due to polymerisation shrinkage
Contra for high caries risk, poor moisture control
