Restorative procedures for the child 1: Why restore primary dentition

Question 1

What are the reasons to restore primary dentition?

Answer 1

• prevent pain/infection
• space maintenance
• preserve/restore function
• unpredictable rate of caries
• aesthetics/appearance
• prevent extractions

Question 2

to remove/restore a primary tooth, what are the 4 essential variables to consider?

Answer 2

1-the child (child’s cooperation/ moisture control, parent’s wishes/demands)

2-the tooth (exfoliation/eruption stage, destruction of sound tooth tissue/adjacent tooth, restorability of tooth and how much remaining tooth tissue there is)

3-stage of the disease of the tooth (difficulty of diagnosis)

4-extent of the disease within the whole mouth (unpredictability of caries attack/arrest)

Question 3

To diagnose caries, what are the 3 required conditions?

what are the 3 helpful conditions?

Answer 3

Required:

• clinical symtoms (sensitivity)
• visual
• radiographs

Helpful:

• fibre optic transillumination (FOTI)
• electrical caries meter
• laser fluorescence device

Question 4

What is the definition of ART (Atraumatic Restorative Technique)?

Answer 4

-removal of carious tooth tissue using hand instruments, followed by restoration with sealant (adhesive) material.

Question 5

In what circumstances would we use ART?

Answer 5

• to stabilise dentition
• uncooperative patients
• developing countries

Question 6

What are the advantages of ART?

Answer 6

• cheap
• non-threatening
• conservative
• usually no LA needed

Question 7

What are the disadvantages of ART?

Answer 7

• one-surface restoration
• hand fatigue
• mixing of GIC must be adequate (technique sensitive)

Question 8

What are the restorative materials used in paediatric dentistry?

Answer 8

• composite
• glass ionomer
• compomers (hybrid of composite and GICs)
• amalgam (rarely used)
• preformed crowns

Question 9

What are the indications for PRR?

Answer 9

• small pits and fissures
• lesion is more extensive than a sealant can endure
• stained fissure / suspect lesion requiring some tissue removal

Question 10

What are the steps involved in the PRR technique?

Answer 10

1- give LA if required, isolate tooth (rubber dam, cotton wool)
2-gain access and remove all caries, especially at the ADJ
3-if lining is indicated (deep) apply calcium hydroxide: Dycal. Or lining may not be indicated
4-fill cavity with composite and restore to morphological level. Light cure
5-fissure seal over the restoration and the rest of the fissure pattern. Light cure
6-Assess occlusion, patient comfort