OD in kids

Question 1

why we restore baby teeth?
c
p
f
o
a
e

Answer 1

control of disease
preserve pulp vitality- prevent pain/sepsis/damage to perm
restore function
restore occlusion/arch length
aesthetics
avoid extractions

Question 2

what to consider when restoring baby teeth

tooth factors/host factors

Answer 2

tooth factors: restorability, pulpal pathology, arrested lesions, periodontal support, periapical condition
host factors: developmental status of dentition, caries risk, anticipated compliance, space loss

Question 3

whats different bout deciduous teeth appearance

Answer 3

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,

Question 4

whats different about the enamel, dentine, pulp, roots

Answer 4

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

Question 5

amalgam adv

Answer 5

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

Question 6

amalgam disadvantage

Answer 6

poor esthetics, environmental concerns *no health risk

Question 7

cavity prep amalgam

Answer 7

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

Question 8

why do amalgams fail?

Answer 8

operator error
fracture of isthmus from insufficient bulk, large proximal box with narrow intercuspal isthmus, excessive flare of cavosurface margin

Question 9

GIC adv

Answer 9

chemical bonding to both enamel and dentine, thermal expansion similar to tooth, biocompatible, fluoride release and uptake

Question 10

when to use amalgam

Answer 10

class I, II, V for primary and perm

Question 11

when to use GIC

Answer 11

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

Question 12

CR adv

Answer 12

esthetics, conservative

Question 13

CR disadvantage

Answer 13

longer time, moisture sensitive, technique sensitive, recurrent decay from polymerisation shrinkage

Question 14

CR contraindications

Answer 14

poor moisture isolation, high caries risk

Question 15

when to use CR

Answer 15

class I/II/III/IV/V plus bevel
minimum depth required for compactable CR is 1.5mm
strip crowns

Question 16

anterior teeth crown options

Answer 16

composite strip crowns

veneered stainless steel crowns

Question 17

posterior teeth crowns

Answer 17

stainless steel

Question 18

what is disking and fluoride

Answer 18

create self cleansing surfaces for primary anterior teeth

removing carious enamel/dentine without restoration, followed by high fluoride application

Question 19

indication and adv for disking and fluoride

Answer 19

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

Question 20

composite strip crowns adv and disadvantage

Answer 20

adv: esthetics
disadvantage: cooperation needed, expensive, moisture control imperative, cannot grind

Question 21

how to do composite strip crowns

Answer 21

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

Question 22

stainless steel crowns pros and cons and material

Answer 22

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

Question 23

indications for ssc

Answer 23

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

Question 24

contras for ssc

Answer 24

unresolved/severe periodontal/periapical pathology
exfoliating tooth within 6-12 months
allergy
uncooperative

Question 25

crimpling pliers and contouring pliers which is which

Answer 25

see pictures

Question 26

SSC steps

Answer 26

LA!! must
caries free
occlusal reduction 1.5mm, proximal reduction with long tapered diamond, probe can pass through, feather edged margins
minimal buccal and lingual reduction (for retention) esp buccal cervical
choose crown size (2-7, 4/5 most common)
trial from lingual to buccal
crown margin 1-2mm subg, but no excessive gingival blanching
crown seats with a click, not easily removed, explorer should not be able to go under the crown
adjust tightness using crimplers/contouring pliers
check occlusion
cement wit GIC, fill half and then remove excess with explorer/gauze
floss

Question 27

SSC problems

Answer 27

difficult to fit when theres significant space loss
may be swallowed/aspirated
impact perm 6 eruption

Question 28

what are the techniques for minimally invasive dentistry

Answer 28

atraumatic restorative technique: hand instruments, IRM, GIC
Interim therapeutic restoration: can use bur the put GIC, for very young patient, uncooperative, special needs
38% silver diamine fluoride: turns caries black, can only do 1 drop per day
hall technique: use crown and temporary resto

Question 29

fissure sealant materials

Answer 29

unfilled resin or unfilled GIC