Dental Restorations in Pediatric Dentisty

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Dental Restorations in Pediatric Dentisty
November 15th, 2008 Christopher Yue DMD, MS
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Introduction

• U of MB Bachelors of Science
• U of MB dental school
• U of MN for pediatric dentistry residency
• Certificate
• Masters with research in sealants

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Restorative Goals

• Cease disease process
• Restore function
• Improve esthetics
• Preserve space for adult dentition

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Primary Tooth Morphology

• Mesiodistal diameter greater than cervical
  occlusal
• Enamel and dentin thinner with large pulp
  chambers
• Buccal and lingual converge to the occlusal
• Cervical enamel rods converge cervically
• Short clinical crown
• Broad interproximal contacts

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Types of Dental Materials

• Amalgam
• Composite
• Glass Ionomer
• Resin Modified Glass Ionomer
• Stainless Steel

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Amalgam

• mixture of mercury (43-54) and powdered alloy
  (silver, tin, zinc and copper)
• Once mixed sets automatically

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Amalgam

• Advantages
• Quick and easy manipulation
• Less moisture sensitive
• Microleakage decreases with time
• Good mechanical properties
• economical

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Amalgam

• Disadvantages
• Non bonding
• Bulk for strength
• Proper preparation to prevent fracture
• Wide isthmus
• Rounded line angles
• Poor esthetics
• Dental amalgam controversy

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Amalgam Indications

• Class I restorations
• 2 surface class II restorations
• preparation does not extend beyond proximal line
  angles
• Class V restorations

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Composite

• Mixture of powdered glass and plastic resin
• Polymerization reaction initiated by light
• Various level of filler particles can change
  esthetics, mechanical properties, and viscosity

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Composites

• Advantages
• Micromechanical Bond
• Esthetic and polishable
• Conservative preparation
• Preventative
• Sealants

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Composites

• Disadvantages
• Moisture sensitive
• Technique sensitive
• Multiple steps
• Time consuming
• Polymerization shrinkage leads to microleakage
• Public opinion possibly negative due to BPA scare

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Composite Indications

• Small pit and fissure caries
• Class I, II, III, IV and V restorations in
  primary and permanent teeth

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Anterior Strip Crowns

• Anterior Restorations
• Primary anterior crown forms

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Glass Ionomer

• Mixture of glass and organic acid
• Chelating Reaction
• Mixed prior to use
• Chemically cured

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Glass Ionomers

• Advantages
• Bond to tooth structure
• Physical properties similar to dentin
• Moisture tolerant
• Release fluoride (5 years)
• Fluoride rechargable
• Less microleakage

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Glass Ionomers

• Disadvantages
• Not as strong
• Poor wear
• Increased setting time
• Not as esthetic as composite

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Glass Ionomer Indications

• Smooth surface lesions
• Small anterior proximal lesions
• i.e. areas of low stress
• High caries risk patients
• Sealants
• Base underneath deep carious lesions
• Good cement for stainless steel crowns and
  brackets and bands
• Interim Therapeutic Restorations

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Interim Therapeutic Restorations

• Removing carious tissues using hand instruments
  only
• Less traumatic
• No need for electricity
• Conservation of tooth structure
• Low cost
• Glass Ionomer
• Bonds to tooth
• Releases fluoride

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Resin Modified Glass Ionomer

• Mixture of glass, an organic acid, and resin
  polymer that harden when light cured

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Resin Modified Glass Ionomer

• Advantages
• Increased wear and fracture toughness
• Some fluoride release
• Comand cure
• Increased esthetics

• Disadvantages
• Not as strong as composite or amalgam
• Less fluoride release than glass ionomer

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Stainless Steel

• Pre-fabricated
• Full coverage restoration
• Pre-crimped with 6 sizes
• Adapted to tooth

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Stainless Steel

• Advantages
• Strongest
• Preventative
• Can be adapted for space maintainer

• Disadvantages
• Poor esthetics
• Post op discomfort

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Stainless Steel Indications

• Pulpotomy
• Extensive caries
• Fractured teeth
• Hypoplastic molars

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Stainless Steel Crown Indications

• Space Maintainer
• Distal Shoe / loop
• High caries risk children
• Patients that require general anesthetic for
  dental treatment

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Stainless Steel Crown

• Crown and loop
• Placed on tooth that has extensive decay with
  space maintenance needs

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Anterior Stainless Steel Crowns

• Anterior SSC with windows
• Flowable composite
• Acid etched
• Micromechanical and mechanical retention

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Decision Making Process

• Treat the patient, not the tooth
• Caries Risk Assessment
• Oral hygiene
• Diet
• Caries history
• Anticipated parental compliance

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Decision Making Process

• Patients ability to cooperate for treatment
• Need for space maintenance
• Pulp status
• Age of patient (eruption sequence)

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Patient 1

• Behavior good
• Cooperative
• Responsive

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Clinical Exam

• Fair Oral Hygiene
• White spot lesions around gum line
• 1 small cavitated carious lesion

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Diet

• Good diet
• No bottle at night
• Healthy snacks
• Juice in between meals
• Non cariogenic

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Parents

• Educated parents
• Conscientious
• Motivated
• Willing to change eating habits and oral hygiene

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Treatment Plan

• Small conservative composite restoration
• Fluoride treatment for incipient lesions
• Improve oral hygiene
• Monitor at recalls

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Patient 2

• Patient Behavior Bad
• Apprehensive
• Non-communicable
• Pre-cooperative
• Consistent with age
• Will require general anesthetic for any
  restorative treatment

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Clinical Exam

• Early Childhood caries
• Multiple interproximal and smooth surface lesions
• Multiple incipient lesions

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Childs Diet

• High sugar diet
• Sugary in between snacks
• High caries risk

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Discussion with Father

• Unable to understand
• Unwilling to change
• Too busy waging war and handing out bailouts
• Not concerned with childs dental health

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How do you treat incipient lesions?

• Treat active carious lesions aggressively with
  stainless steel crowns
• Strong preventative program including fluoride
  and frequent recalls

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Thank-you!