Operative Dentistry in Children I Flashcards
What are the aims of restoring primary teeth?
- Control of disease
- Preserve pulp vitality: prevent potential damage/pain/infection to permanent teeth
- Restore function: mastication & speech
- Restore occlusion & maintain arch length
- Aesthetics
- Avoid extractions:
- Unpleasant experience
- Potential space loss
- Psychological effects
- Some medical scenarios warrant delay of extraction (rare) - Adverse effects on underlying permanent teeth (e.g Turner’s hypoplasia)
What are the tooth factors to consider when restoring primary teeth?
- Restorability
- Arrested lesions
- Extent of pulpal pathology
- Significant pathologic root resorption (internal/external) => cannot do RCT
- Periodontal support (not that impt, perio not common in bbs)
- Access difficulty
- Space loss
What are the host factors to consider when restoring primary teeth?
- Developmental status of dentition
- Caries risk & oral hygiene
- Systemic medical conditions
- Px ability to cooperate for tx
- Anticipated px & parental compliance (e.g likelihood of timely recall)
What are the general differences between primary and permanent teeth?
- Fewer in no.
- Smaller in size
- Morphologic diff in crown, pulp & roots
What are the anatomical differences of the crowns of primary teeth?
- Shorter clinical crown — Mesiodistal > cervico-occlusal dimension => crown look “fat”
- Broad & flattened interproximal contact areas
- Marked cervical constriction
- Mamelons not present in primary incisors
- Buccal & lingual surface converge towards occlusal tubercles
What are the anatomical differences of the roots of primary teeth?
- Long & slender => easier to fracture
- Molars roots greater curvature (more flared) => accommodate dev of underlying tooth
- No. of accessory canals ↑, esp in floor
How does the enamel, dentine and pulp of primary teeth compare to that of permanent teeth?
Enamel
- Thinner
- Whiter
- Cervical enamel rods slope occlusally & ends abruptly
at cervix, instead of being oriented gingivally
Dentine: thinner
Pulp
- Larger volume
- Mesial pulp horn closer to surface
What are the things to consider when choosing a restorative material for primary teeth restorations?
- No. of tooth surfaces affected by active/incipient caries
- RCT needed? => if yes, prefer SSC
- Anterior vs posterior teeth => consider aesthetics & moisture control
- Caries risk
- Others:
- Px ability to cooperate for tx
- Anticipated px & parental compliance
What are the indications for GIC?
- Class I, II, III & V in primary teeth
- Class III, V in permanent teeth
- Caries control (e.g high caries risk (no polymerisation shrinkage = less recurrent caries), repair resto)
What are the advantages and disadvantage of GIC?
Advantages
- Chemical bonding to enamel & dentine
- Thermal expansion similar to tooth structure
- Uptake & release of fluoride
- Lower moisture sensitivity (vs CR)
Disadvantage: Lower strength compared to CR and amalgam
What are the indications for amalgam?
- Class I, II, V
- Primary & permanent teeth
What are the advantages of amalgam?
- Durability
- Relatively low cost
- Lower technique sensitivity (vs CR)
- Success rates in primary teeth:
- Class I: 85-96% in 7 years
- Class II: minimum 3.5 years
What are the disadvantages of amalgam?
- Poor aesthetics
- Environmental concerns (mercury toxicity)
*studies found that mercury release from AR has no
effect on nervous systemic & kidney function in children
What are the indications for CR?
- Class I, II, III, IV & V
- Strip crowns
What are the advantages of CR?
- Conservative tooth prep
- Aesthetic
