OD in children Flashcards
Why control caries in primary teeth?
Control disease (teeth tend to fall out at 10-12, if early caries then prolly wont survive)
Preserve pulp vitality, preventing pain, sepsis and damage to permanent teeth
Restoring function, occlusion
Maintaining arch length for permanent teeth
Medical conditions that warrant delay of exo (extensive chemo causing low WBC/platelet counts etc)
Aesthetics..?
Scared of exo?
Tooth factors influencing restorability
Restorability
Extent of pulpal pathology
Arrested lesions (do they rly need to be restored in problem pts?)
Perio support (v rarely an issue)
Host factors influencing restorability
Developmental status of dentition (is the tooth gna exfoliate soon?)
Caries risk
Compliance
Space loss
How do primary teeth differ from permanent teeth?
Fewer in number
Smaller (except that primary molars > permanent premolars)
Whiter
Presence of mammelons in permanent teeth
Mesiodistal : incisocervical is 1:1 in primary teeth, permanent teeth usually incisocervical > mesiodistal dimensions
Posterior primary crowns are more bulbous with narrower occlusal tables
Crown, pulp and root morphology
Crown morphology of primary anterior teeth
Shorter clinical crown
Relatively larger MD : axial crown length ratio, looks fat esp when worn
Marked cervical constriction
Contact points v broad and flat
Morphology of primary posterior teeth
Roots more divergent
Very bulbous, constriction marked all round
General structure and morphology of primary teeth
Enamel thinner, whiter, cervical enamel rods slope occlusally and end at cervix instead of being oriented gingivally
Dentine thinner
Pulp larger wrt tooth size, mesial pulp horns closer to surface than distal pulp horns
Roots more slender, more flared, more accessory canals esp in floor
Very hard to see PA lesions as they commonly overlap with permanent tooth follicles
But easier to see furcal lesions
Restorative modalities
Amalgam
CR
GIC
SS crowns
Composite strip crowns
Minimally invasive: disking/fluoride, SDF, hall technique, interim therapeutic restorations
Considerations influencing the material to use
Number of surfaces affected
RCT?
Anterior or posterior?
Caries risk
Patient compliance, likelihood of timely recall, cooperation with treatment
Amalgam advantages
Ease of manipulation
Durability
Relatively low cost
Reduced technique sensitivity
High survival rates
Amalgam disadvantages
Poor esthetics
Environmental concerns
When to use amalgams
Class I, IIs, V for primary and permanent teeth
AR Class I cavity prep
Width 1mm
Depth 1.2-1.5mm
Narrow width following fissures
90 degree cavosurface margins
No unsupported enamel
Buccal and lingual undercuts for retention
Rounded internal line angles
AR Class II cavity prep
Occlusal-gingivally parallel to long axis of tooth
Buccal and lingual undercuts
Axial walls follow contour of tooth and long axes of cusps
Gingival floor beneath contact point, break contact but cannot pass explorer tip through
1mm MD width
Common failures for AR
Cavity prep too wide, too deep, nicking neighboring teeth
Restoration has voids, overcarved, not polished, polished off natural tooth
Fracture of isthmus of class II due to insufficient bulk, proximal box too large and isthmus too narrow, cavosurface margin too flared
Advantages of GIC
Chemical bonding to enamel and dentine
Thermal expansion similar to tooth structure
Biocompatible
Fluoride release
Decreased moisture sensitivity wrt resins
Disadvantages of GIC
Lower strength
When to use GIC
Class I, II, III, V restorations in primary teeth
Class III,V restorations in permanent teeth
Caries control for high risk px, restoration repair, temporary dressing, ART
Advantages of CR
Aesthetics, conservative tooth preps
Strong evidence that CR is successful for class I restorations in primary teeth
Disadvantages of CR
Takes longer to place
Very moisture sensitive
Technique sensitive
Polymerization shrinkage causes recurrent decay
Contraindicated for high caries risk pts
Need to bevel for esthetics and retention
Types of CR
Different filler sizes
Flowable vs packable
When to use CR
Class I, II, III, IV, V
Strip crowns
PRR
What is disking and fluoride?
Removing carious enamel/outer layer of dentine without restoration, then applying concentrated fluoride
Advantages of disking and fluoride
Simple
Inexpensive
Requires minimal cooperation
When to use disking and fluoride
Primary anterior teeth, esp lower
Teeth near exfoliation but not loose yet
Shallow wide caries in uncooperative px
Advantages of composite strip crowns
Aesthetics
Disadvantages of composite strip crowns
Cooperation needed
Expensive
Moisture isolation imperative
Not indicated for grinders
Steps for composite strip crown
LA rubber dam
Choose color and size
Cut strip crown along gum margin then create a hole on distal w explorer to allow excess composite to flow out
Caries free and prepare tooth
Vitrebond and pulp therapy as needed
Reduce incisally 2mm and clear contacts
Feather/light chamfer, suprag
Etch prime bond, fill crown w composite and fit
Remove excess
Cure facial and palatal
Score palatal surface with sickle scaler or bur, peel off strip crown
Polish
Advantages of stainless steel crowns
Biocompatibility
High strength
Moisture control not impt
Lower 5 year failure rate than class II AR restorations
Disadvantages of stainless steel crowns
Poor esthetics
Gingival inflammation
Increased chairside time
Made out of nickel-chromium: Nickel allergy?
Indications of SSC
Posterior teeth
Grossly worn down but still restorable
Previous pulp therapy, not a lot of tooth structure left
Hypoplastic molars
High caries risk
Other restorative materials will fail
Contraindications of SSC
Unresolved/severe perio/periapical pathology
Exfoliating within 6-12 months
Uncooperative child that cannot be held down
Allergy to nickel
SSC steps
LA
Caries free
Occlusal reduction 1.5mm
Proximal reduction w feather edged margin
Minimal buccal and lingual reduction for retention
Trial fit size, margin should be 1-2mm subg, seat w a click and not easily removed, no catch w explorer
Close crown margins w crimpers
Cement with GIC cement by filling crown and seating
Remove excess
Floss
Problems w SSC
Difficult to fit when there is significant space loss
May impact or obstruct adjacent permanent tooth eruption
May be swallowed/aspirated/lost during prep
Minimally invasive dentistry types
Atraumatic restorative technique (ART)
Interim therapeutic restorations (ITR)
SDF
Hall technique
What is ART
Just use spoon excavator, remove caries then fill with IRM or GIC
What is ITR
Postpone the traditional cavity prep and placement of traditional cavity restorations by placing GIC to prevent further decalcifications and caries
Used for v young, uncooperative, or special needs patients
What is hall technique
Used for class II lesions where px is not cooperative
Push crown down without prepping or removing decay, j starve the bacteria to arrest the decay
Put separators between the teeth for 2-3 days to create space
