Dental Restoration in Pediatric Dentistry

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Questions and Answers

What is a characteristic of pulp horns in primary teeth compared to permanent teeth?

They are lower in proportion

They are absent in primary teeth

They are higher in proportion and located closer to the dentino-enamel junction (correct)

They are similar in proportion and location

What is the shape of pulp chambers in primary teeth similar to?

The shape of the root

The shape of the crown from an occlusal view (correct)

The shape of the dentino-enamel junction

The shape of the surrounding bone

What is a reason to restore primary teeth?

To perform a pulpotomy

To restore aesthetics where applicable (correct)

To reduce the risk of restorative therapy

To replace missing teeth

What is a risk of restorative therapy?

All of the above Signup and view all the answers

What is a clinical criterion for deciding when to restore caries lesions?

Both A and B Signup and view all the answers

What should be considered in a comprehensive treatment plan for restorative treatment?

The developmental status of the dentition Signup and view all the answers

Why are pulp chambers of primary mandibular molar teeth typically larger than those of primary maxillary molars?

It is not specified why, but it is a characteristic Signup and view all the answers

What is a characteristic of the root canal system of fully developed primary molars?

It is extremely tortuous and complex Signup and view all the answers

What is one of the requirements of ideal restorative materials?

Preserving the anatomy of the occlusal surface Signup and view all the answers

What is a benefit of Glass Ionomer Cements (GICs)?

They adhere to dental hard tissues Signup and view all the answers

What is the maximum time for mixing Glass Ionomer Cements (GICs)?

40 seconds Signup and view all the answers

Why is it important to protect Glass Ionomer Cements (GICs) from moisture contamination?

It leads to increased solubility and poor esthetics Signup and view all the answers

What happens to Glass Ionomer Cements (GICs) when they undergo desiccation?

They shrink and craze Signup and view all the answers

What is the role of the 'amalgamator' in mixing Glass Ionomer Cements (GICs)?

Not mentioned in the text Signup and view all the answers

What is a significant factor to consider when choosing a restorative material?

Patient's caries risk Signup and view all the answers

Why might a restoration in a first primary molar in a 9-year-old child require less durability?

Because the tooth will be lost sooner Signup and view all the answers

What is an advantage of using GICs in caries control?

They release fluoride to help prevent future caries Signup and view all the answers

Why might stainless steel crowns be used in some cases?

Because they eliminate the need for future re-treatment Signup and view all the answers

What is a consideration when treating uncooperative children?

Using amalgam, which can tolerate moisture contamination Signup and view all the answers

Why might GICs be used in the management of caries in anterior primary teeth?

Because they can help slow the carious process and restore aesthetics Signup and view all the answers

What is a consideration when treating patients with physical or intellectual disabilities?

Providing the highest standard of dentistry possible Signup and view all the answers

What is an advantage of using materials like stain SSCs in patients with physical or intellectual disabilities?

They are durable and can last a long time Signup and view all the answers

What can glass ionomers act as?

A reservoir of fluoride Signup and view all the answers

What is a disadvantage of glass ionomers?

Increased setting time Signup and view all the answers

What are glass ionomers recommended for?

Small anterior proximal lesions Signup and view all the answers

What can glass ionomers be used as?

A luting cement Signup and view all the answers

What is a use of glass ionomers in high-risk patients?

Class III and V restorations Signup and view all the answers

What is the purpose of using a 'sandwich technique' with glass ionomers?

To improve wear resistance Signup and view all the answers

What is NOT a recommended use of conventional glass ionomers?

Class II restorations in primary molars Signup and view all the answers

What is a benefit of using glass ionomers?

Fluoride release Signup and view all the answers

What is an advantage of Resin Modified Glass Ionomer?

It has a similar coefficient of thermal expansion as dentin Signup and view all the answers

What is a disadvantage of Resin Modified Glass Ionomer?

It is not as strong as composite or amalgam Signup and view all the answers

In which type of restorations can Resin Modified Glass Ionomer be recommended?

Class I, II, III, and V restorations in primary teeth and class I, III, and V restorations in permanent teeth Signup and view all the answers

What is an advantage of Resin Modified Glass Ionomer compared to composite resin?

It is more caries preventive Signup and view all the answers

What is a limitation of using Resin Modified Glass Ionomer in permanent teeth?

The evidence is insufficient to support its use as a long-term restorative material Signup and view all the answers

What is a potential application of Resin Modified Glass Ionomer?

Cervical restorations with good retention rate Signup and view all the answers

Study Notes

Pulp and Root Canal Systems

In primary teeth, the size of the pulp relative to the crown is larger.
Pulp horns are higher in proportion and are located closer to the dentino-enamel junction and to the outer surface of the crown.
Mesial pulp horns are higher than distal pulp horns.
Pulp chambers are shaped comparably with the shape of the outline of the crown from an occlusal view.
Pulp horns are present under each cusp of the primary molars.
The pulp chambers of primary mandibular molar teeth are normally larger than the pulp chambers of primary maxillary molars.
The root canal system of fully developed primary molars is extremely tortuous and complex.

Restoring Primary Teeth

Reasons to restore primary teeth:
- Repair or limit the damage of dental caries
- Protect and preserve remaining pulp and tooth structure
- Ensure adequate function
- Restore aesthetics (where applicable)
- Provide ease in maintaining good oral hygiene
- Prevent the shifting of teeth due to loss of tooth structure
Risks of restorative therapy:
- Reducing the longevity of teeth by making them more susceptible to fracture
- Recurrent lesions
- Restoration failure
- Pulp exposure during caries excavation
- Future pulpal complications
- Iatrogenic damage to adjacent teeth

Deciding to Restore Caries Lesions

Clinical criteria for deciding to restore caries lesions:
- Visual detection of enamel cavitation
- Visual identification of shadowing of the enamel
- Radiographic recognition of enlargement of lesions over time
Restorative treatment should be part of a comprehensive treatment plan, considering:
- Developmental status of the dentition
- Caries-risk assessment
- Patient's oral hygiene
- Anticipated parental compliance and likelihood of timely recall
- Patient's ability to cooperate for treatment

Choosing Restorative Materials

Factors to consider when choosing restorative materials:
- Age of the child
- Caries risk
- Cooperation of the child
- Restorative situation
Ideal restorative material should:
- Restore aesthetics
- Maintain physical strength of the crown
- Preserve the anatomy of the occlusal surface and interarch relation with opposing and adjacent teeth
- Prevent further ingress of bacteria or their byproducts into the micro spaces between the restoration and teeth
- Ensure long-term adhesion between the restoration and tooth

Restorative Materials

Types of restorative materials:
- Glass Ionomer
- Resin Modified Glass Ionomer
- Compomers
- Composite
- Amalgam
- Stainless Steel Crowns (SSCs)
- Composite Resin Strip Crowns

Glass Ionomer

Composition: silicate glass-powder and polyacrylic acid
Setting reaction: acid-base reaction between two components
Properties:
- Adhesion to dental hard tissues
- Chemical cure
- Fluoride release
Limitations:
- Sensitive to moisture contamination
- Desiccation causes shrinkage and crazing
- Not recommended for stress-bearing areas
- Low wear resistance
- Not as esthetic as composite

Resin Modified Glass Ionomer

Composition: addition of resin monomers or co-monomer to glass-ionomer formulation
Advantages:
- Increased mechanical properties
- Physiochemically bonds to tooth structure
- Biocompatible
- Fluoride release (anticariogenic action)
- Minimal polymerization shrinkage
Disadvantages:
- Not as strong as composite or amalgam
- Less fluoride release than glass ionomer

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Description

Factors to consider when performing dental restorations in children, including parental compliance, patient cooperation, and material choice. Age and durability of restorations are also discussed.