Restorative Dentistry in Children Flashcards
basis for treatment plan consideration
- dental status of the patient
- caries risk assessment based upon the caries history of the patient
- patient’s oral hygiene
- anticipated parental compliance and likelihood of timely recall
- px’s ability to cooperate for treatment
why we need to restore primary dentition
- restore damage caused by dental caries
- protect and preserve remaining pulp and tooth structure
- retain adequate function
- restore esthetics
- facilitate early maintenance of good oral hygiene
- maintain arch length and space
types of restorations
- conventional restoration
- full coverage restoration
types of conventional restorations
- amalgam
- composite
types of full coverage restorations
- stainless steel crown (SSC)
- strip off crown (SOC)
inclination of enamel rods of primary molars
occlusally
inclination of enamel rods of permanent molars
apically
thicker enamel and dentin: primary or permanent
primary
primary molars resemble permanent teeth except
primary mandibular first molar
why primary mandibular first molar differs from its permanent counterpart
mesial pulp horn is higher than distal pulp horn
principles of cavity preparation
- outline form: dovetailed
- transverse ridge: not included unless undermined
- wall coverage: slightly with the greatest width of pulpal floor
- CSM: sharp
- angle of walls and floors: slightly rounded
- APL angle: rounded
principles of cavity preparation: outline form
dovetailed
principles of cavity preparation: transverse ridge
not included unless undermined
principles of cavity preparation: wall coverage
slightly with the greatest width of pulpal floor
principles of cavity preparation: CSM
sharp
principles of cavity preparation: angle of walls and floors
slightly rounded
principles of cavity preparation: APL angle
rounded
class I cavity prep: internal outline form
- 1.5mm cavity depth
- rounded line angles
- rounded pulpal floor
- sharp cavosurface margins on lateral walls
class I cavity prep: isthmus width
1/3 of occlusal table
class II cavity prep: proximal box
- buccal and lingual walls: extend into self-cleansing areas
- cavosurface angle: sharp 90° angle (butt-joint)
- B and L walls: converge occlusally
- internal line angles: rounded
- B and L retentive grooves: contraindicated
- gingival floor: beneath contact point
- no bevel
- axial wall: follows contour of tooth
why marginal failure increases
when excess tooth structure is removed
% of multi-surface amalgam restorations needing replacement
70%
common errors in class II AM restorations
- occlusal outline: extended into all susceptible pits and fissures
- outline: follows cusps
- isthmus: too wide
- proximal walls: flare too great
- axial, buccal, lingual wall: too great
- gingival contact with adjacent tooth: not broken
- axial wall: does not conform with proximal contour; M-D width of gingival floor greater than 1mm
matrix bands and retainers: uses
- restore normal contact areas of primary teeth
- prevent extension of access of restorative materials beyond the band into gingival tissue
- convenient and easy to use for Am condensation and carving
- easily removed
matrix bands and retainers: indications
class II cavity prep
matrix bands and retainers: difficulties
- deep cervical constriction
- broad contacts
- prominent bulge
matrix band commonly used in pediatric dentistry
t-band
occurs when t-band is cut too long
can cut px’s cheek
occurs when t-band is cut too short
t-band cannot be adjusted anymore
occurs when their is faulty wooden wedge placement
- overextension of restorative material (overhang)
- open contact due to inadequate wedge pressure
solution for overhang
make sure band is tight and wedge is parallel
the use of a metal instrument to smooth and shape the surface of a newly inserted Am restoration
burnishing
when Am polishing is done
24-48 hours after restoration
objectives of polishing
- resist corrosion and tarnish
- reduction in recurrent caries and marginal failure
qualities of well-polished amalgam
- no flash; no submarginal area
- clearly defined grooves
- anatomy and contour resemble corresponding tooth on opposite side
- marginal ridge height equal to adjacent tooth
– surface free of scratches - shiny surface finish
- interproximal contact should be undisturbed
composite restorations: advantages
- elimination of mercury in dental environment
- improved appearance and esthetics
- reduced thermal stimulation too pulp
- color matching potential
- bonding with cavity walls
- longevity
composite restorations: disadvantages
- increased tendency for abrasion
- possible interproximal contacts
- appearance of microscopic voids; can cause recurrent caries
- lack of composite resin that is truly radiopaque
- pulpal protection with liner is necessary
- shrinkage during polymerization
pulpal protection for class B depth
calcium hydroxide/dycal
full coverage restorations: advantages
- restore esthetics
- prevent psychological trauma
- restore function (speech and mastication)
- maintain occlusion
- prevent fracture
full coverage restorations: indications
- primary anterior teeth with extensive or multiple surface caries
- malformed teeth with congenital anomalies
- fractured teeth
- final restoration after pulp therapy
- disclosed anterior teeth
examples of congenital anomalies that indicate full coverage restorations
- peg laterals
- microdontia/macrodontia
- Hutchinson’s incisors (congenital syphilis)
examples of conditions that cause tooth discoloration
- fluorosis
- tetracycline stains
how to measure M-D width of SOCs
- use a caliper
- incisor-incisor measurement
- take an impression and make a cast before indirectly measuring
- trial and error
advantage of taking an impression to measure M-D width of SOC
hygiene
SOC: reduction for incisal edge
1-1.5mm; fine needle-like taper bur
SOC: reduction for interproximal surface
0.5-1mm; tapering diamond bur
SOC: margin
knife edge margin
SOC: purpose for placing small undercut on facial surface with inverted cone
mechanical lock
SOC: fit of a properly trimmed crown
fit 1mm below gingival crest
SOC: purpose for punching hole in lingual surface of celluloid crown with explorer
serve as vent for the escape of trapped air as crown is placed
SOC: surfaces to be polished
all surfaces except labial
SSC: indications
- multi-surface caries for primary molars
- children with rampant caries
- teeth with hereditary anomalies
- fractured teeth
- restoration for pulpotomized or pulpectomized tooth
- primary teeth for abutments for space maintainers
- protection of molars with bruxism
- hypomineralized young permanent molar
SSC: components
- chromium: 17-20%
- nickel: 8-12%
- carbon: 0.15%
- iron: 0.08-0.12%
SSC: chromium %
17-20%
SSC: nickel %
8-12%
SSC: carbon %
0.15%
SSC: iron %
0.08-0.12%
SSC: advantages:
- easy to place
- durable
- wear resistance
- attached firmly to tooth until exfoliation
SSC: armamentarium
- No. 110 Howe Pliers
- No. 417 Crimping Pliers
- No. 114 Johnson Pliers
- No. 112 Ball and Socket
SSC armamentarium: flatting interproximal contour of crown
No. 110 Howe pliers
SSC armamentarium: marked gingival crimping
No. 417 Crimping pliers
SSC: use of No. 417 Crimping pliers
used to have snug fit on gingival 3rd
SSC armamentarium: contouring occlusal and middle 3rd of crown
No. 114 Johnson pliers
SSC armamentarium: most commonly used
No. 114 Johnson pliers
SSC armamentarium: exaggerating interproximal contour in open contacts
No. 112 Ball and Socket
No. 112 Ball and Socket
- exaggerating interproximal contour in open contacts
- not commonly used
No. 114 Johnson Pliers
- contouring occlusal and middle 3rd of crown
- most commonly used
No. 417 Crimping Pliers
- marked gingival crimping
- used to have snug fit on gingival 3rd
No. 110 Howe Pliers
flattening interproximal contour of crown
SSC armamentarium: not commonly used
No. 112 Ball and Socket
SSC: reason for using knife-like edge gingival margin
to be able to insert SSC easily while fitting
SSC: how to check the prep
pass through all surfaces around the area using explorer
SSC: occlusal surface reduction
1-1.5mm
SSC: common tooth prep errors
- presence of ledge
- too tapered
SSC: main considerations for crown selection
- adequate M-D diameter
- proper occlusal height
- light resistance to seating
SSC: size for primary 2nd molar
E2
SSC: size for primary 1st molar
D4
SSC: points to be considered once SSC is seated
- no blanching of gingival tissue must occur
- adjacent proximal contact must be maintained
- occlusal relationship must be re-established
- crown normally extends 1mm into sulcus
SSC: used for cutting SSC
crown scissors and green stone bur
SSC: cement of choice for non-vital tooth
polycarboxylate
SSC: cement of choice for vital tooth
GIC
SSC: liquid-powder ratio for GIC as cement
2:4
SSC: why gauze is always put near the airway
to prevent aspiration
SSC: clinical modifications for adjacent SSC
- posterior most prep first
- crown adjusted over and fitted into occlusion
- crown reduction of adjacent crown alone
- for broad contact: use no. 110 Howe plier
SSC: failures
- inadequate tooth reduction
- inadequate crown contouring and crimping
- innappropriately established occlusion
- improper cementation methods with lost crowns/open margin
- failure of pulp treatment
- induced ectopic eruption of permanent 1st molar
- recurrent caries
- crown abrasions
SSC: common errors
- underreduced preparations
- all around prep
- overreduced SSC
- no crimping; open margin
- not fitted subgingivally
- wrong sizing of SSC
