medical c restorative dentistry for primary teeth
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8/2/2019 Medical c Restorative Dentistry for Primary Teeth
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Restorative Dentistry for
Primary Teeth
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What is an ideal restorative
material? Simple
Durable
Painless
Acceptable
Insensitive
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Factors
Developmental state of the dentition (Age)
Caries Risk
Patient’s oral hygiene
Cooperation of child
Parental compliance and likelihood fortimely recall
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Age
How long tooth will be in the mouth
9 year old (D, E, 6)
D - 1 year and exfoliate
E – 2 – 3 years and exfoliate6 – permanent
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Caries Risk OH and past caries
experience
High caries risk – dmfs>age,white spots,lowsocioeconomic, highsugar diet
Fluoride GIC
Compomer
SSC
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Cooperation of child and
parental compliance Amalgam less sensitive
than composite
Compomer requires lessmoisture control thancomposite
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Dental factors
Extent of lesion in primary molars destructionof the marginal ridge indicates a high
probability of pulpal involvement. If several primary molars require pulp therapy,
and cooperation/motivation is poor, serious
thought should be given to extraction ratherthan restoration.
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It is worth considering the occlusion.
In a particularly crowded case, restoration
of a decayed tooth may be indicated if further space loss would mean thatextraction of more than one premolar per
quadrant would be required.
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compensating (same tooth in opposingarch) and balancing (contralateral tooth)
extractions, although this is still an area of an area of some controversy.
The rationale is that a symmetrical
problem is easier to deal with later, but if taken to its logical conclusion, it will resultin a clearance!,
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In general, loss of C, , or D in a crowdedpatient should be balanced to
prevent a centre-line shift.
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Temporization Initial step in management
of caries Open cavities hand
excavated and temporized
with GIC (ZnOE) Introduction to dental
treatment Decreases oral loading of
streptococci Decreases pain and
sensitivity
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Restoration of primary posterior
teethLocation of caries
Occlusal caries in primary molars are more common thaninterproximal lesions in preschool children
When posterior contacts, prevalence of interproximal lesions will increase
Mandibular teeth more than maxillary teeth
Bitewings
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Restoration of primary teethdiffers from restoration of permanent teeth, The mesiodistal diameter of a primary molar
crown is greater than the cervicoocclusaldimension.
The buccal and lingual surfaces converge toward the occlusal.
The enamel and dentin are thinner.
The cervical enamel rods slope occlusally,ending abruptly at the cervix instead of beingoriented gingivally, gradually becoming thinneras in permanent teeth.
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The pulp chambers of primary teeth areproportionately larger and closer to the surface.
Primary teeth contact areas are broad andflattened rather than being a small distinct
circular contact point, as in permanent teeth.
Shorter clinical crown heights of primary teethalso affect the ability of these teeth to
adequately support and retain intracoronalrestorations.
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• Tooth preparation should include the removal of caries or improperly developed tooth structure toestablish appropriate outline, resistance, retention,and convenience form compatible with therestorative material to be utilized.• Rubber-dam isolation should be utilized when
possible during the preparation and placement of restorative materials.
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Diagnosis
Explorer
Good source of light
Bitewing radiograph
Dry teeth
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Bitewings
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Class II lesion Diagnosis
Bitewings
Gray discoloration marginal ridge -->?
pulp involved
Broken marginal ridge pulp
involvement
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Class II lesions
Surface adjacent to class II lesion
Mesial surface of E – distal caries on D
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Full mouth picture
If caries in one quadrant check contralateral and opposing teeth
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Anterior teeth
Nursing bottle caries
Labial surfaces of
anterior teeth
Mesial of primary anteriorteeth (class III)
Class V commonly seen onlabial surface of canines
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Dental Materials
Amalgam
Composite Resin
Stainless steel crowns
Resin modified glass ionomer cement
Polyacid modifed composite resin(Compomer)
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Amalgam
Quick
Simple
Cheap
Insensitive
DURABLE
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Disadvantages
Aesthetics
Failure if improper cavity preparation or technique
Lack of adhesion - destructive
Concerns about toxicity
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Toxicity
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Dimensions of cavity preparation
Minimum cavity depth – 1.5 mm (0.5 mm pulpalto ADJ) to provide sufficient bulk of amalgam
Narrowness – can be as narrow as no. 330 bur
Intercuspal distance – not > 1/3
Rounding internal line angles (axiopulpal lineangle)
No need for ‘dovetail extension’ - outdated
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Failures
Fracture at isthmus
insufficient amalgam at isthmus Overcarving or shallow preparation
Sharp axiopulpal line angle
Recurrent caries
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Failures
Marginal deterioration Faulty cavity design Large proximal box Unsupported enamel Faulty manipulation of materials Failure to remove caries
Failure to extend to caries susceptible areas Differences in material wear to tooth wear at
occlusal interface
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Dental Materials
Amalgam
Stainless steel crowns
Composite Resin
Resin modified glass ionomer cement
Polyacid modifed composite resin(Compomer)
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Stainless steel crowns
Prefabricated crowns forms are adapted toindividual teeth and cemented with luting
agent
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Stainless steel crowns
Extremely durable
< 4 yrs – SSC success rate twice as long
as amalgam
Full crown coverage
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Disadvantage
Expensive
Need cooperation
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Indications
High risk
Extensive decay, large lesions or multisurfacelesions
Pulpotomized teeth
GA
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Dental Materials
Amalgam
Stainless steel crowns
Composite Resin
Glass ionomer cements
Resin modified glass ionomer cement
Polyacid modifed composite resin(Compomer)
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Composite resin
Advantages Aesthetic Adhesive (no need for retentive cavity form) Reasonable wear resistance
Disadvantages
Sensitive Secondary caries (shrinkage) expensive
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Indications
Small fissure caries
Minimal class II caries
Class III, IV, and V
Strip crowns in anterior teeth
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Dental Materials
Amalgam
Stainless steel crowns
Composite Resin
Glass ionomer cements
Resin modified glass ionomer cement
Polyacid modifed composite resin(Compomer)
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Glass ionomer Advantages Chemical bonding to enamel and dentine
Thermal expansion similar to tooth
Uptake and release of fluoride
Decreased moisture sensitivity
Disadvantage
Poor wear resistence Poor tensile strength
Long setting time
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Uses
Luting cements
Bases and liners
Temporary restoration
ART – atraumatic restorative technique
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Resin-modifed GIC
Convential GIC with added monomer (bis-GMA) and photoinitiator
Sets by acid base reaction and curing of monomer
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Advantages
Fluoride release
Improved aesthetics
Improved tensile strength
Adhesion to enamel and dentine
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Polyacid Modified Composite Resin(Compomer)
Composite resin with modest GICcharacteristics
Advantage
Adhesion
Ease of use
Better mechanical properties
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Disadvantage
Less fluoride release (10% that of GIC)
Cannot be recharged with fluoride
Less wear resistance than composite
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Compomers
Recommended for load-bearing areas inprimary teeth
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Conclusion
Careful examination and diagnosis of caries important
New restorative materials useful in thechild patient
Stainless steel crowns show best results
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Thank you
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