Restorative management of caries in the primary dentition Flashcards
Why bother restoring caries?
Maintain function, eliminate disease, restore health, prevent pain, avoid infection, preserve space, growth and development & have a positive attitude to oral health
Why is it important to restore health?
52 million school hrs/year are missed due to toothache
What % of 5 y/o are in pain?
12%
What is the purpose of preserving space?
Resorption of primary tooth sets place for permanent tooth to move into (without this may get delayed eruption etc)
Why is important to maintain a positive attitude to oral health?
To protect permanent teeth in the future
What % of 5y/o are caries free?
70%
What % of 5y/o have caries with an average dmft of 1.1?
30%
Why is so much untreated?
General problems: Co-operation, understanding, concentration, motivation, fear, parent
Oral problems: access, moisture control, dental anatomy, transient dentition, keeping mouth open
What are the different issues with crown morphology of primary teeth and their clinical significance?
- narrow occlusal table = B-L width of cavity needs to be reduced
- broad, flat, interproximal contact areas = problems with diagnosing caries
- thinner enamel and dentine layers = caries progresses more quickly to the pulp
What % of all caries by the age of 10 in the primary dentition are interproximal?
60%
What is made especially difficult by children’s difficulty in keeping their mouth open?
toleration of bitewings is poor = lateral obliques and DPTs used instead = are not so good
- for early diagnosis bitewings are essential (18-71% detected clinically, 40-470% detected radiographically
What order do we do treatment planning in?
- following a full history and examination
- operative management based various factors
- choice of restorative material
What is the purpose of doing a full history and exam?
So we can deal with pain, plan prevention and manage caries
What is operative management based on?
Childs ability to cope, no. and size of lesions, time until exfoliation, presence of infection, family support for prevention
What is the preferred treatment if a tooth is not near to exfoliation?
pulp treatment and restore tooth with preformed metal crown
What different factors play a role in choice of restorative material?
Patient factos, Tooth factors and operator factors
What are the different options for restorative material?
Composite, amalgam, compomer, stainless steel crown, temporise (GIC)
What are the different patient factors?
caries status, general health, parafunction (grinding/occlusion), age, diet and co-operation
What are the different operator factors?
Material properties, quality of finished, moisture control, expertise and anaesthesia
Which materials are best for temporary restorations?
Conventional GIC (triage = fugi VII)
Which materials are best for permanent restorations?
If can rubber dam = composites, if not RMGIC (Fugi II) or compomer
What are the different tooth factors?
Tooth location (accessibility and aesthetics), cavity design, pulp involvement (metal crown = no root fill), dentition, occlusal load and tooth quality
What are the different stages of cavity prep?
- Gain access
- Remove caries
- Look, think and design (based on extent of caries, material)
BE CONSERVATIVE
How do we manage interproximal caries that are confined to enamel?
Encourage to arrest = monitor, preventative advice, topical fluoride, avoid using bur
Why do we avoid using a bur if possible?
Lifetime of fillings with cavity size increasing each time you replace
How do we manage interproximal caries that are inter dentine?
Intracoronal restorations or extracoronal restorations
What are the differences in anatomy for primary teeth?
- smaller size of occlusal lock
- omit dovetail
- rounded line angles
- minimal extension for prevention
- mechanical retention = small grooves inside EDJ
What are the benefits of amalgam?
cheap, easy to use, relatively technique tolerant, familiarity
What are the disadvantages of amalgam?
not adhesive, not aesthetic, mechanical retention required (more tooth removal), no fluoride and amalgam toxicity
What are the benefits of composite?
adhesive (micro mechanical), aesthetic, conservative, durable, setting under control (light)
What are the disadvantages of composite?
technique sensitive, need for isolation (moisture control keep mouth ope, tongue move all over), no fluoride
Tell me more about composites?
not widely used in primary teeth, needs etching, bonding then laying in increments
-Study = fillings remaining at 2 yrs 12-17%. and 62% at 6 yrs
What are the benefits of anterior strip crowns?
They are the most aesthetic restoration for decayed primary incisors
What are the disadvantages of anterior strip crowns?
They are very technique sensitive (if not incremental = susceptible to fractures and if too big size chosen = excess material around the gingivae)
What is a RMGIC a combination of?
GIC and resin
How does a RMGIC’s viscosity and strength compare to a compomer?
Lower viscosity and similar strength
How do we place a RMGIC?
Condition, place and cure
What are the benefits of a RMGIC?
Adhesive, aesthetic, leach F?, light cured, radiopaque, wear resistant
What are the disadvantages of a RMGIC?
Limited data, leach F?, needs good moisture control
When do we place RMGIC?
When pt doesn’t want a stainless steel crown
What is a compomer?
A polyacid modified resin (dyract and compoglass)
What are the benefits of a compomer?
Adhesive, aesthetic, leach F?, light cured and radio-opaque
What are the disadvantages of a compomer?
Multistage techniques, leach F?, needs good moisture control
How do we place a compomer?
Etch?, condition, place and cure
How long do GIC’s usually last?
What are the benefits of a GIC?
Adhesive, aesthetic, F leeching, good temp material = useful for
What are the disadvantages of a GIC?
long set time, brittle, radio-lucent, poor resistance to wear and erosion, moisture damage
If higher caries what should you also consider with GIC?
Sealant (“finger press” to fill fissures if unco-operative)
n.b. difficult if poor moisture control or partially erupted teeth
What are the indications for a stainless steel preformed crown?
most interproximal cavities, 2 + carious surfaces, all pulpally involved primary molars and young children
What do we stick a stainless steel crown down with?
GIC cement
What are the contraindications for a stainless steel preformed crown?
non-vital tooth (needs xla), small occlusal cavities, tooth soon to exfoliate and parental preference (aesthetics)
What is interproximal discing?
= smooth area inter proximally to make self cleansing area without a restoration
When is interproximal discing used?
If minimal caries between two centrals
What are the trade names for composites?
Spectrum (anterior) and herculite (posteriors)
What are the trade names for GIC?
Chemfil
What are the trade names for a self cure RMGIC?
Fuji IX
What are the trade names for a light cure RMGIC?
Fuji II LC, Triage/Fuji VII
What are the trade names for a compomer?
Dyract
