restorative dentistry for the pediatric patient

Question 1

what is one distinguishing feature of mandibular incisors?

Answer 1

central is symmetrically flat when viewed from buccal; lateral has a more rounded DI angle.

Question 2

what clamps to use for where?

Answer 2

Clamps
– 8A: For partially erupted molars
– 14, 14A: For partially erupted molars
– 12A: For lower right and upper left molars – 13A: For lower left and upper right molars

SECURE CLAMPS WITH FLOSS

Question 3

What are the advantages of rubber dam use?

Answer 3

Retraction of soft tissues allows better visualization and access.
 Moisture control.
safety - prevents aspiration or swallowing of
foreign bodies.
 Decreased operating time.

Question 4

What are general principles for cavity preparation in deciduous teeth?

Answer 4

– Smaller
– More delicate 
– More rounded
– Obtain outline form
– Obtain resistance and retention form 
– Convenience form
– Removal of residual carious dentin
– Finishing the enamel walls
– Toilet of the cavity

Question 5

How to prepare the isthmus regions?

Answer 5

Isthmus region
– Wide enough BL without weakening cuspal areas
 1⁄2 of the Intercuspal dimension of the tooth
– Deep enough to allow sufficient material without endangering the pulp
 ~ 0.5mm pulpally from dentino-enamel junction

Question 6

How should axial walls be and pulpal axial line angle?

Answer 6

Axial wall should follow outline of proximal tooth surface
 Pulpal axial line angle should be rounded
– Allow proper condensation of material
– Liberate stress
 Extension to all areas affected with caries and PF which will retain food

Question 7

How should class one preps be?

Answer 7

 Follow the outline of decay.
 Extend throughout remaining grooves and
 Walls should be parallel or slightly convergent occlusally.
 Do not cross oblique ridge unless undermined by caries.
 Pulpal floor should be flat at least 0.5mm into dentin and 1.5mm from outer enamel surface.
Deep carious lesions should be removed with slow speed round bur
– The use of spoon excavator can result in small pulp exposures due to the direction of dentin layers removed

Question 8

How should class II preps be?

Answer 8

Most common prep in primary teeth.
 DO 1st primary molar.
 If one lesion appears others will
appear soon after.
 Restore incipient lesions ASAP
- Establish outline form of prep.
 Establish isthmus width (1⁄2 the intercuspal distance, not more than 1/3 entire BL width)
 Move bur gingival to start box
– BL direction with pendulum motion
– Widest width at gingival margin
– Look like inverted cone
– Break contacts (explorer should go through)
 
 Axio-pulpal line angle should be rounded to reduce stress.
BL walls should be parallel or convergent to the external crown outline.
Rounded internal angles will result in:
– Less concentration of stress
– Reduced restoration fracture
– More complete condensation of
amalgam

 Poorly supported marginal enamel is susceptible to fracture.
 Modify cavity prep removing all unsupported enamel.
 If destruction is extensive, consider SSC.

Question 9

What are common errors in class II preps?

Answer 9

Failure to extend occlusal outline
B. Isthmus too wide
C. Failure to follow outline of cusps
D. Flare of proximal wall too great
E. Internal line angles not defined
F. Axial wall not conforming to proximal contour
G. Axial wall too deep towards pulp (gingival seat should be 1 mm wide)

Question 10

How should class III restorations be?

Answer 10

 Modifications
– Dovetail (lingual lock) placed in lingual or buccal of the prep
Additional retention
Access for restorative material – Bur 256/330/556 FG
 Gingival portion should clear contact
 Labial margin on cleansable area
 Lingual lock achieved by extending prep mesially to cleave lingual enamel
– Depth ~ 0.5 mm into dentin
– Handpiece perpendicular to lingual surface of
tooth (uniform depth and parallel to lingual
surface)
– Cut proximal box in gingival direction
(avoid incisal fractures)  Similar to Class II

Labial lock more convenient
– Consider aesthetics (mand -vs- max)
– Distal surfaces of canines ideally restored with amalgam.
– Acid etched composite can be used.

Extent of lesion determines the type of restoration to be used

Question 11

What about class III conventional preparation or conventional with dovetail?

Answer 11

1.
Conventional:
– Not well advanced into dentine
– Caries removal will not weaken incisal edge

2.
Conventional with
dovetail
– If incisal edge is not undermined
– Dovetails added to increase retention

 If incisal edge is undermined use restorations recommended for proximal-incisal surfaces in primary teeth
 Check degree of root resorption!

1.
Conventional:
– Same principles as in permanent incisors
– Modified by pulp size and enamel thinness
– Cervical seat extended gingivally to break contact with adjacent tooth
1.
Conventional:
– Incisal extension to remove all caries (do not weaken incisal edge
– Axial wall parallel to the proximal surface of the tooth
– Confined to cervical 2/3 of primary incisor

2. With Dovetail:
   – Incisal-gingival walls of the dovetail are slightly divergent pulpally (add retention)
   – Axial wall parallel to the proximal surface of the tooth

2.
With Dovetail:
– Rounded internal line angles
– Dovetail placed above the gingiva and confined to the mesial or distal 1/2 of the labial or lingual surface
– Dovetail must not undermine the incisal edge, placed at the expense of cervical 2/3 not incisal 1/3

Question 12

what are special considerations for the distal of the cuspid of class IIIs due to?

Answer 12

 Special considerations due to:

1. Arch position
2. Broad contact with mesial of molar
3. Gingival tissue height
4. Length of time prior to exfoliation

 Dovetail placed on:
a) Lingual of maxillary cuspids b) Labial of mandibular cuspids

 Amalgam is often the restorative material of choice
 Class II amalgam preparation lying on its side

Question 13

How do you prep a maxillary cuspid?

Answer 13

Approach the lingual surface at a right angle to the lingual surface (45o to the long axis of the tooth)
1. 2.
Dovetail 0.5 mm into dentin, walls should converge lingually
Proximal walls into self-cleansing
areas:
– Incisal and gingival walls are parallel
– Labial wall parallel to the labial surface
– Gingival wall under the free gingival
margin
3. Bevel the axio-pulpal line angle
4. Retention grooves (1/2 round bur) placed at the gingival proximal wall just inside the DEJ

Question 14

How do you prep mandibular cuspids?

Answer 14

 Proximal cut with bur perpendicular to the long axis of the tooth.
 Dovetail on the labial surface
1. Proximal walls beyond the contact area
2. Bevel axiopulpal line angle
3. Retention grooves same as in
maxillary cuspids

Question 15

What about class V preparations?

Answer 15

 Usually a sign of poor oral hygiene (easily accessible)
 Regular examination, preventive care, fluoride exposure should eliminate these types of lesions!
 Initially present as a white chalky line limited to enamel

Question 16

For class V lesions what should multiple lesions or decalcified areas be treated with?

Answer 16

 Multiple lesions or decalcified areas must be treated with:

1. Increased oral hygiene
2. Fluoride application
3. More frequent recall examinations
4. Diet investigation
5. Increased parental involvement or awareness

Question 17

What do class II and class V lesions have to do with stainless steel crowns?

Answer 17

 Class V lesion + Class II lesion =

Better to restore tooth with a stainless steel crown

Question 18

How do you prep the class Vs?

Answer 18

 Outline dictated by extent of decalcification (remove all caries and decalcification)
 Remove all unsupported enamel
 Gingival cavosurface margin should follow the gingival contour (unless is extends subgingivally)

Question 19

What are the requirements for matrices?

Answer 19

 Compatible size
 Good stability interproximally
 Stability to withstand condensation forces
 Easily contoured
 Retention to prevent dislodgement

Question 20

Why is it good to wedge?

Answer 20

 Increases cervical adaptation  Stabilizes the band

Question 21

What types of matrices are there?

Answer 21

1. T-band
2. Tofflemire band
   – #13 child sized retainer
3. Custom matrix band

Question 22

what are points to remember in a matrix band?

Answer 22

 Remove band in a B-L direction
 Check for overhangs immediately upon
removal
 Check adaptation prior to condensation
 Carve marginal ridge prior to removal

Question 23

What do you do with bases and liners in shallow preps and deep preps?

Answer 23

 Shallow preps
– 2 coats copal varnish: seals dentinal tubules,
reduces marginal leakage  Deeper preps
– CaOH2 (Dycal) on axial wall
– CaOH2 + ZOE to level floor
– GI: bonds to dentin, cariostatic,
non-yielding
– Base + 2 coats copal varnish

Question 24

for amalgam should you have deep anatomy?

Answer 24

no, you burnish, remove excess, and have shallow anatomy.

Question 25

For finishing the amaglam wha tdo you do?

Answer 25

 Gently floss between
contacts to remove fine excess.
 Wash & dry restorations.
 Removal of rubber dam.
 Check occlusion and adjust as needed. 
 Polish restorations.