paeds 2nd year Flashcards
1
Q
early problems
A
gingival cysts
congenital epulis
natal tooth
eruption cysts
2
Q
when would you extract a natal tooth?
A
- if mobile - inhalation risk
- feeding problem
- trauma (ulcer)
3
Q
when would you treat a congenital epulis?
A
- causing feeding problems
- respiratory problem
4
Q
what happens to a congenital epulis as you age?
A
shrinks
5
Q
what should be done for gingival and eruption cysts?
A
keep eye
6
Q
when do teeth start to form?
A
week 5 IUL
7
Q
when does hard tissue formation start?
A
week 13 IUL
8
Q
what do systemic disturbances during calcification cause?
A
defects in Enamel which was forming
- birth - 2nd molars
9
Q
approximate calcification of crowns at birth
A
1/2 central incisors 1/3 lateral incisors tip of canines 1/2 1st molars 1/3 2nd molars tip of cusps of FPM
10
Q
multifactorial theories of eruption process
A
cellular proliferation at apex
localised change in bp/hydrostatic pressure
metabolic activity within PDL
resorption of overlying hard tissue
11
Q
resorption of overlying hard tissue
A
due to enzymes in dental follicle - dark halo on radiograph
need remodelling of bone/ primary tooth tissue for eruption
BUT not necessary for tooth to erupt to cause resorption of bone
12
Q
what happens when the dental follicle is activatedin eruption?
A
initiate OC activity in alveolar bone ahead of tooth
once crestal bone breached - follicle likely to play lesser role
- into supra-alveolar phase
13
Q
theories about tooth pushing into mouth that have been discounted as major factors?
A
root elongation
PDL
local changes in vascular pressure
14
Q
bone growth at where is essential for eruption?
A
at base of crypt (socket)
- but could be reactive to tooth movement
15
Q
when does eruption stop?
A
when tooth contacts something - usually opposing arch
throughout life - compensate for vertical growth of jaws and tooth wear
16
Q
primary dentition - lower/upper eruption
A
generally lowers before uppers except lateral incisors
17
Q
what may variation in primary dentition eruption be due to?
A
genetic?
18
Q
when do contralateral teeth usually erupt in primary dentition?
A
within 3m of each other
19
Q
at what age is the primary dentition usually complete?
A
2.5-3years
very variable - some normal children have no teeth at 1
20
Q
primary dentition - lower a
A
6m
21
Q
primary dentition - lower b
A
12m
22
Q
primary dentition - lower c
A
16m
23
Q
primary dentition - lower d
A
13m
24
Q
primary dentition - lower e
A
24m
25
primary dentition - upper a
8m
26
primary dentition - upper b
9m
27
primary dentition - upper c
17m
28
primary dentition - upper d
14m
29
primary dentition - upper e
25m
30
order of eruption primary dentition
A B D C E
31
primary dentition - how is permanent teeth fitting into the arch?
anterior spacing so no crowding in permanent
anthropoid/primate spacing
leeway space
facial growth
**proclined path of eruption** of permanent incisors - increases AP arch length so more space
32
primate/anthropoid spacing
- mesial to U 3
- distal to L 3
33
leeway space
extra MD space occupied by the primary molars and canine which are wider than the premolars and canine which will replace them
34
leeway space U arch
1.5mm per side
35
leeway space L arch
2.5mm per side
36
how does the facial skeleton grow?
downwards and forward
37
when does the mixed dentition stage begin and end?
when 1st permanent tooth erupts until exfoliation of last primary tooth
usually 6-11/12/13 years
FPM - exfoliation of U3
38
permanent dentition - order of eruption U arch
1st molars then front to back except canines
| 6 1 2 4 5 3 7 8
39
permanent dentition - order of eruption L arch
1st molars then front to back
| 6 1 2 3 4 5 7 8
40
permanent dentition - L/U eruption
generally L before U except 2nd premolars
41
where do permanent incisors develop?
palatal to primary
42
permanent dentition - L1
6yrs
43
permanent dentition - L2
7yrs
44
permanent dentition - L3
9yrs
45
permanent dentition - L4
10yrs
46
permanent dentition - L5
11yrs
47
permanent dentition - L6
6yrs
48
permanent dentition - L7
12yrs
49
permanent dentition - U1
7yrs
50
permanent dentition - U2
8yrs
51
permanent dentition - U3
11yrs
52
permanent dentition - U4
10yrs
53
permanent dentition - U5
11yrs
54
permanent dentition - U6
6yrs
55
permanent dentition - U7
12yrs
56
ugly duckling phase
transient spacing U1s due to
- close proximity of roots to erutping 2s, 3s
- self correct when canine erupts
57
primary incisor root
may bend towards distal
58
what do primary incisor edges often show?
considerable wear
59
primary canines morphology
proportionately larger m-d - bulbous
| mesial edge straighter
60
primary U first molar
```
irregularly quadrilateral
narrower lingually than buccally
MD groove
3 roots
MB tubercle
```
61
primary U second molar morphology
```
transverse ridge - MP to DB
3 roots
2 distinct fissures - mesial c, distal straight
largest cusp usually MB
similar to U FPM
```
62
primary lower 1st molar
```
rectangular, broad m-d
MB tubercle
4 cusps
2 roots
buccal steeply lingually inclined
```
63
primary lower 2nd molar
similar to L FPM
3 buccal cusps - largest usually mesial
2 roots
64
primary incisor crowns
smaller and plumper
E in cervical region bulbous
distal edge of crown flares a bit more
Ls smaller
65
MIH definition
hypo mineralisation of **systemic origin** of 1-4 permanent molars, frequently associated with affected incisors
if on other teeth not MIH
66
MIH appearance
```
'cheesy molars'
patches/whole tooth
incisors v well demarcated
- white/yellow/brown
- not symmetrical
```
67
MIH prevalence
10-20%
68
MIH most commonly affected teeth
4 molars
69
MIH tx need
10x more tx
fear and anxiety more common
behavioural management problems more common
70
hypomineralisation
Qualitatative enamel defect.
Reduced mineral content
- problem with amelogenesis
- secretory phase fine, maturation phase problem
71
bonding to hypo mineralised teeth
may be harder to bond to
72
hypoplasia
Quantitative defect : reduced bulk/thickness of E
amorphous
- secretory phase of amelogenesis affected
73
true hypoplasia
E never formed
74
acquired hypoplasia
post-eruptive loss of E bulk
75
bonding to hypoplastic teeth
should bond properly
76
why is it hard to determine the aetiology of MIH?
unclear diagnostic criteria
most parents can't remember details from 8-10years before
variations in quality and completeness of case records
study pops small
77
critical period for MIH formation
generally agreed 1st year of life - developmental condition not hereditary
E matrix of crown of FPMs is complete by one
78
is MIH hereditary or developmental?
developmental
79
MIH 3 clinical periods of enquiry
pre-natal
perinatal
post-natal
80
MIH prenatal enquiry
health in 3rd trimester
81
MIH perinatal enquiry
birth trauma/anoxia
hypocalcaemia
pre-term birth (higher prevalence)
82
MIH post-natal enquiry
```
prolonged breastfeeding (past 6m)
dioxins in breast milk
fever and meds (infections - measles, rubella, chicken pox)
SE status
rural v urban
```
83
yellow brown MIH teeth histology
more porous - whole enamel layer
84
white/cream MIH teeth histology
inner parts of E affected
85
how does MIH histology explain why sensitivity/difficult to anaesthetise?
increase in neural density in pulp horn and subodontoblastic region
lots more innervation
86
MIH histology and immune cells
increase in immune cells, esp with post-eruptive E loss
87
MIH histology vascularity
increase in vascularity in sensitive MIH samples
88
MIH 3 pain mechanism theories
dentine hypersensitivity
peripheral sensitisation
central sensitisation
89
MIH pain mechanisms - dentine hypersensitivity
porous E/exposed D facilitates fluid flow within dentinal tubules to activate **A delta nerve fibres** (hydrodynamic theory)
90
MIH pain mechanisms - peripheral sensitisation
underlying pulpal inflammation leads to sensitisation of **C fibres**
91
MIH pain mechanisms - central sensitisation
from continued nociceptive input?
92
MIH clinical problems
```
loss of tooth substance
- breakdown of E
- toothwear faster
- secondary caries (poor resistance)
sensitivity
- not all
- some - can cause OH problem as may be too painful to brush
appearance
```
93
MIH tx options for FPMs
composite/GIC Rx
SSCs - much harder on FPM
adhesively retained copings - gold best
extraction around 8.5-9.5yrs
94
MIH tx of affected incisors
```
acid pumice microabrasion
- removes yellow/brown marks
external bleaching
- makes rest of tooth whiter so less of a contrast
localised composite placement
- camouflage
full composite veneers
full porcelain veneers >20yrs
```
95
considerations for extracting HFPMs
dental age - radiograph
skeletal pattern
future ortho needs
quality of teeth e.g. caries
96
what is ideal to see when timing ext of HFPMs?
calcification of bifurcation of L7s
before L7 erupts starts to drift forwards
like to see developing 8s - not always possible
97
what do you often ext at the same time as HFPMs?
U at same time (not necessarily now) according to RCS 2023 guidelines
98
if ortho and crowded dentition when would you ext HFPMs?
keep 6s until 7s erupt - keep space in a crowded dentition to avoid ext of good premolars
99
jaw relationship at birth
- gum pads widely separated anteriorly (U &L)
- Gum pad contact posteriorly
- tongue resting on L gum pad and in contact with L lip
- AOB
100
characteristics of primary dentition
incisors spaced and upright
teeth smaller
reduced overjet
whiter
101
psychology of child development
```
motor
cognitive
perceptual
language
social
```
102
why is it suggested that motor development may be genetically programmed?
predictability of early "motor milestones"
103
when is motor development completed?
in infancy
| changes following ability to walk are refinements
104
two aspects of motor development - eye-hand coordination and walking
walking 9-15m but variations
| eye-hand coordination gradually becomes more precise and elaborate with increasing experience
105
stages of cognitive development
sensorimotor
preoperational thought
concrete operations
formal operations
106
sensorimotor
until about 2yrs
| object permanence
107
preoperational thought
```
2-7yrs
predict outcomes of behaviour
egocentric
facilitated by language development
unable to understand why areas and vols remain unchanged even though shape and position may change
```
108
concrete operations
7-11yrs
logic
see others perspective
still difficult to think in an abstract manner
109
formal operations
11 years +
| logical abstract thinking
110
perceptual development
most research looks at eye movement
compared to adult a 6yr old will cover less of an object, take in less info and become fixated on details
selective attention by 7yrs
111
what is needed for language development?
stimulation
112
language - 1 yr old
understands 20 words, simple phrases, relates objects to words
uses 2-3 words, repetitive babble, tuneful jargon
sounds: b, d, m
113
language - 2yr old
understands: simple commands, questions, joins in action songs
uses 100 words, puts 2 words together, echolalia
sounds: p, t, k, g, m
114
language - 3yr old
understands prepositions (on, under), fcts of objects, simple conversations
uses 4 word sentences, what/who/where, relates experiences
sounds: f, s, l
115
language - 4yr old
understands: colours, numbers, tenses, complex instructions
uses long grammatical sentences, relates stories
sounds: v, z, ch, j
116
feeding skills - pre 40 wks gestation
28wks - non-nutritive sucking
| 34wks - nutritive sucking
117
feeding skills - 0-3m
rhythmical sucking
primitive reflexes
semi-reclined feeding position
liquid diet
118
feeding skills 4-6m
```
head control
more control of suck/swallow
munching
move towards semi-solid diet
starts babbling
```
119
feeding skills 7-9m
```
sitting feeding position
mashed
finger food
U lip involvement
chewing and bolus formation
bite reflex
```
120
feeding skills 10-12m
```
lumpy food
sustained bite
active lip closure
chewing - lateralisation
cup drinking
```
121
feeding skills 24m
mature and integrated feeding pattern
122
cleft type speech
resonance
articulation
nasal emission
123
velopharyngeal incompetence
Soft palate doesn't close tightly against back wall of throat during speech. Causes air to escape through nose
124
bad effects of the family unit
```
-enhance child's anxiety
behaviour contagion
improper preparation
discuss tx in hearing of child
threatening child with dental tx
```
125
knee to knee
infants
Age under 3
| parents can hold arms and legs
126
3 aspects of behaviour management
communication
education
interaction
127
components of communication
verbal 5%
paralinguistic 30%
non-verbal 65%
128
language alternatives - cotton wool rolls
tooth pillows
129
language alternatives - topical
bubblegum/minty gel
130
language alternatives - probe
pointer/tooth counter
131
language alternatives - excavator
tooth spoon
132
language alternatives - HS
tooth shower
133
language alternatives - SS
"mr bumpy"
| tooth scrubber
134
language alternatives - LA
special spray, sleepy juice
135
What paralinguistic has to do with
tone
136
2 reason to exclusion of parents from surgery
Competing with dentist for child's attention
Convey own anxieties to their child( body language and words)
137
anxiety in children
more irrational and less restrained than adults
wide variation
may be largely genetically determined
138
anxiety influencing factors
```
psychological make up
understanding
emotional development
prev experience
attitude of family/friends
behaviour of dentist
```
139
role of dentist in reducing anxiety
prevent pain
friendly
establish trust
**work quickly**
calm
give moral support
be reassuring about pain
empathy
**stop signals**
Q for feeling
140
what are anxious more likely to report?
pain
141
Pros of good communication
improves **info obtained** from pt
enables dentist to **communicate info** to pt
increases likelihood of **pt compliance**
reduces pt **anxiety**
142
increasing fear related behaviours
```
ignoring or denying feelings
inappropriate reassurance
coercing/coaxing
humiliating
losing patience with pt
```
143
aims of paediatric dentistry
- reach adulthood with intact permanent dentition,
- no active caries,
- few Rxs as possible,
- positive attitude to future care
144
operative differences (Paeds and adults)
```
developmental maturity/behaviour
constant change
developing dentition
access (small mouths)
tooth size and shape
preventive care
choice of Rx
```
145
sequence of tx planning
```
prevention
FS
preventive Rxs
simple fillings e.g. shallow cervical cavities
fillings needing LA but not into pulp
pulpotomies - U arch first
```
146
factors that influence how caries is managed
```
age
cooperation of child
extent of caries
tooth type
dental attendance
```
147
what cavities may not require LA?
minimal
| e.g. hand excavation/limited caries removal with SS
148
lignocaine max dose
4.4mg/kg
149
prilocaine max dose
6mg/kg
150
preparing an occlusal cavity
around 1.5mm depth
preserve transverse ridge
maintain MR
straight walls - hold bur at right angle
151
Primary lower molars occlusal fissure shape
S
152
upper second molars occlusal cavity shape
D - straight
| M - kidney bean
153
interproximal cavity prep
isthmus 1/2-1/3 width of occlusal surface
axial wall follow contour of tooth
rounded line angles
occlusal extension should be shallower (pulp)
154
box prep
```
axial wall follows contour of tooth
rounded Line angles
no occlusal extension
SS rosebud to remove carious D
occlusal section no wider than width of bur
```
155
material and whether LA depends on
caries extent
longevity of tooth
cooperation of child
156
most successful material
PMCs
157
longevity of Rx in primary molars
age (younger less cooperation)
type of tooth (1st molars small, Rxs don't last as long)
type of cavity - surfaces involved
- occ last longer than IP
158
fissure sealants
protective plastic coating used to seal pits and fissures to prevent food and bacteria getting caught in them and causing decay
- Bis GMA resin
159
why are fissures vulnerable to caries?
less protected by F than IP or smooth surfaces
| can't clean base of fissures with a toothbrush - bristle won't fit
160
FS materials
bis-GMA resin (after acid etch)
| GIC
161
FS indications
high caries risk
medically compromised
learning difficulties
physical/mental disability
162
FS tooth selection
greatest benefit on occlusal surfaces of permanent molar teeth
should also seal cingulum pits of U incisors, buccal pits of L molars, palatal pits of U molars
may seal primary molars in high risk
163
resin FS placement procedure isolation options
single tooth dental dam
| dry guards and cotton wool
164
resin FS placement procedure
clean occlusal surface **pumice and water**
**35% phosphoric acid etch**
wash and dry
check chalky/frosted
resin to fissure pattern -brush/microbrush/excavator
remove excess with dry micro brush
spidery not swimming pools
light cure
Check with probe
165
what happens to any etched surface not eventually covered with sealant?
will remineralise within 24hrs
166
FS checks
firmly adhered - use probe
no air blows
no material flowed IP - remove with sharp probe and floss
check no excess distal to tooth in STs
167
FS reviewing
```
clinically every 4-6m
radiographically as per CRA
- check no shadowing underneath
- high risk every 6m
- low risk every 12-18m
```
168
indications for GI FS
where good moisture control can't be achieved
- high risk children with **PE** molars
- special needs children
- poorly cooperating children
where high **sensitivity** - developmental or hereditary E defects
- drying tooth can be extremely painful
169
pros and cons of GI FS
F release
poorly retained, require regular reapplication
- not as durable as composite - wears down over time
170
GI FS placement
attempt to dry tooth with air/CW
apply GI from applicator
smooth into fissures using a gloved finger
keep finger over GI until set or place Vaseline to reduce moisture contamination
171
stained fissure
a fissure that is discoloured, brown or black
also includes fissures where area of white/opaque E i.e. normal translucency lost but no evidence of surface breakdown/cavitation
172
diagnosis of a stained fissure
```
visual (dry tooth)
probe
BWs
electronic
FOTI -Fiber-optic transillumination
CO2 laser
air abrasion
```
grater accuracy when 2-3 methods used together
173
stained fissure - investigation possible outcomes
1 - caries doesn't enter dentine
2 - inconclusive
3 - into dentine
174
tx of stained fissure where caries doesn't enter dentine
FS and monitor
175
tx of stained fissure where inconclusive
clean stained fissure with small SS bur - if only hard material encountered then FS
176
tx of stained fissure where into dentine
Rx tx
small PRR or SR - where defect filled with small amount of composite then sealed over the top with a FS
large - conventional composite (/amalgam)
177
caries in FPMs tx planning
maximise prevention
always prioritise FPMs in any mixed dentition tx plan
pulp much more likely to be exposed on caries removal
178
ext of poor prognosis of FPMs
if poor prognosis can allow development of a caries free dentition in adolescent without spacing
appropriate removal time
- calcification of bifurcation of L7s forming (8.5-10yrs)
- 5s and 8s all present and in good position on OPT
- mild buccal segment crowding
- class 1 incisors
179
conventional crown prep - components of reduction
MR reduction
occ reduction
buccal and lingual
180
conventional crown prep - MR reduction
knife edge
see gingivae
tapered diamond separating bur at 90 degrees
181
conventional crown prep - occ reduction
1-2mm
follow contour
straight fissure bur
182
conventional crown prep - buccal and lingual
peripheral reduction only
| removing any sharp angles produced
183
SSC instruments
```
tapered diamond separating bur
PMCs
GIC
crown crimping pliers
curved crown scissors
```
184
common problems with SSCs
rocking
canting to one side
loss of space (due to caries removal)
185
SSCs - rocking
cervical margin >1mm beyond max curvature, difficult to contour margins sufficiently to contact tooth throughout
= open margins and unstable crown
solution - adjust tooth prep - stable crown 0.5mm beyond max curvature
186
SSCs - canting to one side
uneven reduction of occlusal surface
187
SSCs - loss of space
extensive caries - drifting of adjacent teeth
ideal - rectangular prep
not ideal - square prep
188
SSCs crown selection
measure MD width of crown or space with dividers
OR trial and error after crown prep
OR impression and crown prep on model
189
contouring crown
Ensure tight cervical fit but not snap fit
- pliers
don't establish contact area (with adjacent tooth) if there wasn't one present
190
disadvantages of conventional SSCs
LA and extensive tooth prep
need child cooperation
risk damage to FPM when prepping E
191
indications for conventional SSC
large multi surface Rxs
abutment for space maintainers
rampant caries
protection of molars in children with Bruxism
192
Hall technique procedure
```
dry crown and fill with GIC
dry tooth
partially seat crown until engages with contact points
remove finger and encourage child to bite or fully seat with finger pressure
- blanching of gingivae good
remove extruded cement ASAP
hold/bite (CW) 2-3mins
reassurance
floss between contacts
```
193
Hall technique parent and child reassurance
crown supposed to fit tightly, gum will adjust
will get used to feeling of crown within 24hrs
occlusion tends to adjust to give even contacts bilaterally within a few weeks
194
Hall technique airway protection
sitting up
sticky material
Gauze in airway
195
split dam technique
floss - thread through one hole in clamp, tie to secure then wrap floss around bow then through second hole. tie. 2 ends should hang out of mouth - safety feature in case clamp breaks
put clamp in mouth with clamp holders
punch two holes in dam 1cm apart. join with scissors
put in mouth - stretch over clamp until visible
then stretch forward - hold at anterior teeth with wedget elastic
frame - ensure it doesn't discomfort pt and that they can breathe through nose
196
what is the Hall technique known as?
biological caries management - no LA/prep
197
what to call SSC to child
princess/transformer tooth
Iron man helmet
198
Hall technique - what to do if contacts are an issue
separators - remove 3-5days
199
cementing crown in Hall technique
GIC
200
where should Hall technique crown sit?
ideally sub gingival or at least below margins of cavitation
201
Hall crown sizes
2-7
202
Hall technique contraindications
pulpal involvement
insufficient sound tissue left to retain crown
dental sepsis
aesthetics
PAP
at risk of **endocarditis**
203
how to place separators and where shouldn't they sit?
2 pieces of floss
| not sub gingival
204
Hall technique indications
non-cavitated/cavitated occlusal lesions if pt unable to accept FS/Rx
proximal lesions - cavitated/non-cavitated
205
review of hall crown tech - minor failure
new/secondary caries
worn/lost but tooth restorable
reversible pulpitis txed without requiring pulpotomy/ext
206
review of hall crown tech - major failure
irreversible pulpitis
abscess requiring pulpotomy/ext
interradicular radiolucency
unrestorable
207
restoration of primary incisors - cervical
hand excavate/SS
wash and isolate - dam/CW
GIC and Vaseline or compomer
208
restoration of primary incisors - IP
hand excavate/SS
wash and isolate
acetate strip, restore with compomer/composite
209
space maintainers
band and loop (band on 6’s)
distal shoe retainer (crown on Ds)
210
band and loop space maintainer
cement with GI
| as soon as you see premolar erupting take it off
211
distal shoe retainer
sits subgingivally to guide 6
212
disadvantages of unplanned primary extractions
```
loss of space (malocclusion risk)
decreased masticatory function
impeded speech development
psychological disturbance
trauma from anaesthesia/surgery
```
213
indications for pulp tx of primary teeth
good cooperation
MH precludes ext - e.g. inherited bleeding disorder
missing permanent successor
need to preserve tooth e.g. space maintainer
child under 9 - otherwise starting to exfoliate
214
contraindications for pulp tx
```
poor cooperation
poor dental attendance
cardiac defect
multiple grossly carious teeth
advanced RR
severe/recurrent pain or infection - ext
```
215
endo options for a vital tooth and success
pulp capping - poor
| vital pulpotomy - 85-100%
216
endo options for a non-vital tooth and success
pulpectomy - 90%
217
potential complications of pulp tx
early resorption leading to early exfoliation
| over-preparation
218
aim of vital pulpotomy
preserve radicular pulp
219
vital pulpotomy
LA and dam
access - remove caries
amputation
- remove coronal pulp with excavator/SS
- **ferric sulphate** 20s - control bleeding
pulp stump evaluation - minimal oozing
restore
- ZOE/CaOH
- GIC
- SSC
220
hyperaemic pulp
continued bleeding
deep crimson
221
how to spot a non-vital primary molar - signs (after opening pulp)
hyperaemic pulp - bleeding +++
pulp necrosis and furcation involvement
222
how to spot a non-vital primary molar - symptoms
irreversible pulpitis
periapical periodontitis
chronic sinus
223
primary molar pulpectomy
```
EWL: pre-op radiograph
access - open roof and remove caries
remove coronal pulp
RC prep (2mm short of apex)
- CHX irrigation
obturate with Vitapex (2mm) - CaOH and iodoform paste
GIC core
SSC
post-tx radiograph
```
224
follow up of pulp tx - clinical
```
clinical failure
- pathological mobility
- fistula/chronic sinus
- pain
review every 6m
```
225
follow up of pulp tx - radiographic
```
radiographic failure
- increased radiolucency
- internal/external resorption
- furcation bone loss
review every 12-18m
```
226
direct pulp cap
arrest haemorrhage with pressure (moist CW)
| Ca(OH)2
227
apexification with CaOH2 and cons
induces calcific barrier
But:
porous
makes dentine brittle (reduced mineral content )- root fracture
228
MTA - apical barrier formation
Mineral trioxide aggregate
5mm
after 24hrs can obturate with heated GP system
place using obtura probes, disposable MTA carriers or experimentally using Venflon
229
flexible composite splint
```
0.3mm SSW - bend to ensure passive
cut to size
etch, bond, apply composite
sink wire
cure
smooth
keep away from gingivae
one abutment either side
```
230
pulpal involvement occurs quickly in primary molars
small
large pulp chambers
broad contact points make caries diagnosis difficult
irreversible pathological changes before pulpal exposure
early radicular pulp involvement
231
why can't you use conventional RCT?
roots variable in number, divergent and curved
canals ribbon-shaped
physiological resorption
root morphology changes with age
potential to damage developing permanent successor
small mouths - access restricted
232
why shouldn't you keep carious primary teeth under observation?
pain
infection
interference with development of underlying permanent - enamel hypoplasia
233
potential complications of pulp therapy
early loss
failure to exfoliate
enamel defects of successor
over-preparation - perforation
234
indications for SSCs
```
badly broken down teeth
following pulp tx
severe E hypoplasia on malformed teeth
as abutment for space maintainer
fractured teeth
```
235
what can physiologic mesial drift lead to?
decrease in arch length
FPMs (esp mandibular) exert big force
if space - molars erupt medially and premolars and canines erupt distally
236
deciduous teeth
```
molars wider than premolars
incisors smaller
molars more bulbous
whiter
roots flare apically
pulp
- large
- horns high occlusally
RCs
- ribbon shaped
thin E, thin coronal D
shorter posterior arch length
```
237
space maintainers - loss of incisor
none
238
space maintainers - loss of canine
Band and loop but balancing ext preferable
239
space maintainers - loss of D
band/crown loop
240
space maintainers - loss of E
if FPM - band/crown and loop
| UE FPM - distal shoe, guides FPM
