Restorative Dentistry for Primary Teeth

What is an ideal restorative material?

Simple Durable Painless Acceptable Insensitive

Factors

Developmental state of the dentition (Age) Caries Risk Patients oral hygiene Cooperation of child Parental compliance and likelihood for timely recall

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 exfoliate 6 permanent

Caries Risk

OH and past caries experience High caries risk

dmfs>age,white spots, lowsocioeconomic, high sugar diet

Fluoride GIC Compomer SSC

Cooperation of child and parental compliance

Amalgam less sensitive than composite Compomer requires less moisture control than composite

Dental factors

Extent of lesion in primary molars destruction of 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 rather than restoration.

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 that extraction of more than one premolar per quadrant would be required.

compensating (same tooth in opposing arch) 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 result in a clearance!,

In general, loss of C, , or D in a crowded patient should be balanced to prevent a centre-line shift.

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

Restoration of primary posterior teeth

Location of caries Occlusal caries in primary molars are more common than interproximal lesions in preschool children

When posterior contacts, prevalence of interproximal lesions will increase

Mandibular teeth more than maxillary teeth Bitewings

differs from restoration of permanent teeth, The mesiodistal diameter of a primary molar crown is greater than the cervicoocclusal dimension. 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 being oriented gingivally, gradually becoming thinner as in permanent teeth.

Restoration of primary teeth

The pulp chambers of primary teeth are proportionately larger and closer to the surface. Primary teeth contact areas are broad and flattened rather than being a small distinct circular contact point, as in permanent teeth. Shorter clinical crown heights of primary teeth also affect the ability of these teeth to adequately support and retain intracoronal restorations.

 Tooth preparation should include the removal of caries or improperly developed tooth structure to establish appropriate outline, resistance, retention, and convenience form compatible with the restorative material to be utilized. Rubber-dam isolation should be utilized when possible during the preparation and placement of restorative materials.

Diagnosis

Explorer
Good source of light Bitewing radiograph Dry teeth

Bitewings

Class II lesion Diagnosis

Bitewings Gray discoloration marginal ridge -->? pulp involved Broken marginal ridge pulp involvement

Class II lesions

Surface adjacent to class II lesion

Mesial surface of E distal caries on D

Full mouth picture

If caries in one quadrant check contralateral and opposing teeth

Anterior teeth
Nursing bottle caries Labial surfaces of anterior teeth
Mesial of primary anterior teeth (class III) Class V commonly seen on labial surface of canines

Dental Materials

Amalgam Composite Resin Stainless steel crowns Resin modified glass ionomer cement Polyacid modifed composite resin (Compomer)

Amalgam

Quick Simple Cheap Insensitive DURABLE

Disadvantages

Aesthetics
Failure if improper cavity preparation or technique Lack of adhesion - destructive

Concerns about toxicity

Toxicity

Dimensions of cavity preparation

Minimum cavity depth 1.5 mm (0.5 mm pulpal to 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 line angle) No need for dovetail extension - outdated

Failures

Fracture at isthmus

insufficient amalgam at isthmus Overcarving or shallow preparation Sharp axiopulpal line angle

Recurrent caries

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

Dental Materials

Amalgam Stainless steel crowns Composite Resin Resin modified glass ionomer cement Polyacid modifed composite resin (Compomer)

Stainless steel crowns

Prefabricated crowns forms are adapted to individual teeth and cemented with luting agent

Stainless steel crowns

Extremely durable < 4 yrs SSC success rate twice as long as amalgam
Full crown coverage

Disadvantage

Expensive
Need cooperation

Indications

High risk
Extensive decay, large lesions or multisurface lesions Pulpotomized teeth GA

Dental Materials

Amalgam Stainless steel crowns Composite Resin Glass ionomer cements Resin modified glass ionomer cement Polyacid modifed composite resin (Compomer)

Composite resin
Advantages Aesthetic Adhesive (no need for retentive cavity form) Reasonable wear resistance
Disadvantages Sensitive Secondary caries (shrinkage) expensive

Indications

Small fissure caries Minimal class II caries Class III, IV, and V Strip crowns in anterior teeth

Dental Materials

Amalgam Stainless steel crowns Composite Resin Glass ionomer cements Resin modified glass ionomer cement Polyacid modifed composite resin (Compomer)

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

Glass ionomer

Uses

Luting cements Bases and liners Temporary restoration ART atraumatic restorative technique

Resin-modifed GIC

Convential GIC with added monomer (bisGMA) and photoinitiator

Sets by acid base reaction and curing of monomer

Advantages

Fluoride release Improved aesthetics Improved tensile strength Adhesion to enamel and dentine

Polyacid Modified Composite Resin (Compomer)

Composite resin with modest GIC characteristics
Advantage Adhesion Ease of use Better mechanical properties

Disadvantage

Less fluoride release (10% that of GIC)

Cannot be recharged with fluoride Less wear resistance than composite

Compomers

Recommended for load-bearing areas in primary teeth

Conclusion

Careful examination and diagnosis of caries important

New restorative materials useful in the child patient Stainless steel crowns show best results

Thank you