OD in kids Flashcards
why we restore baby teeth? c p f o a e
control of disease preserve pulp vitality- prevent pain/sepsis/damage to perm restore function restore occlusion/arch length aesthetics avoid extractions
what to consider when restoring baby teeth
tooth factors/host factors
tooth factors: restorability, pulpal pathology, arrested lesions, periodontal support, periapical condition
host factors: developmental status of dentition, caries risk, anticipated compliance, space loss
whats different bout deciduous teeth appearance
fewer in number
smaller in size but decisuous molars are wider mesiodistally than premolars
anterior teeth roots long and narrow, fat, no mamelons
shorter clinical crown, mesio-distal diameter is greater than cervico-occlusal dimension, marked cervical constriction, contact areas broad and flat,
whats different about the enamel, dentine, pulp, roots
enamel: thinner, whiter, cervical enamel rods slope occlusaly, ends abruptly at cervix (be careful when you doing class 2)
dentine: thinner
pulp: larger, mesial pulp horn closer to surface than distal
roots: flared to accomodate tooth under, roots more slender (careful exoing), more accessory canals
amalgam adv
ease of manipulation, durability, low cost, reduce technique sen class 1 sucess rate 85-96% in 7 years class2 minimal survival rate 3.5 year
amalgam disadvantage
poor esthetics, environmental concerns *no health risk
cavity prep amalgam
width: 1mm
floor: 1-1.5mm
narrow occlusal outline 1/3 of occlusal table, follows fissure pattern
90 degree cavosurface margin and remove unsupported enamel
undercut for retention
rounded internal line angles
proximal box 1mm mesio-distal width, should extend beyond contact point, break contact but not pass explorer through, dont go to the embrasures
why do amalgams fail?
operator error
fracture of isthmus from insufficient bulk, large proximal box with narrow intercuspal isthmus, excessive flare of cavosurface margin
GIC adv
chemical bonding to both enamel and dentine, thermal expansion similar to tooth, biocompatible, fluoride release and uptake
when to use amalgam
class I, II, V for primary and perm
when to use GIC
class I, II, III, V in primary, class III, V in perm
caries high risk patient
fuji ix: susceptible to erosion and wear (prefered material)
fuji ii: class v use fuji ii
CR adv
esthetics, conservative
CR disadvantage
longer time, moisture sensitive, technique sensitive, recurrent decay from polymerisation shrinkage
CR contraindications
poor moisture isolation, high caries risk
when to use CR
class I/II/III/IV/V plus bevel
minimum depth required for compactable CR is 1.5mm
strip crowns
anterior teeth crown options
composite strip crowns
veneered stainless steel crowns
posterior teeth crowns
stainless steel
what is disking and fluoride
create self cleansing surfaces for primary anterior teeth
removing carious enamel/dentine without restoration, followed by high fluoride application
indication and adv for disking and fluoride
simple, inexpensive, minimal cooperation required
for: primary anterior teeth (lower>upper), tooth 1-2 years near exfoliation but not loose yet, shallow and wide caries in uncooperative patients
composite strip crowns adv and disadvantage
adv: esthetics
disadvantage: cooperation needed, expensive, moisture control imperative, cannot grind
how to do composite strip crowns
LA & Rubber dam ideal
choose crown size and CR (kids usually A1)
cut with scissors and have a hole around palatal for excess composite to flow out
prepare the tooth, caries free line with vitrebond, pulp therapy
crown reduction: incisor 2mm, proximal clear contact, feather edge/ light chamfer, try keeping it supragingival
fit over tooth, etch, prime, bond, one single fill
fit crown and remove excess CR, cure
score palatal with sickle or bur, polish excess
stainless steel crowns pros and cons and material
stainless steel: nickel-chromium
pros: biocompatibility, high strength, moisture control not an issue (fuji cam cement)
cons: poor esthetics, gingival inflammation, increase chair side time, cannot use in nickel allergy type 3 hypersensitivity contact dermatitis
indications for ssc
indications:
posterior teeth
grossly broken down teeth (if patient is below 5, crown is caries extend to marginal ridge)
pulp treatment
hypoplastic molars / amelogenesis imperfecta
if other materials fail
abutment for space maintainer
contras for ssc
unresolved/severe periodontal/periapical pathology
exfoliating tooth within 6-12 months
allergy
uncooperative
