CSL 9 Restoration (hard)

Primary Tooth Restoration

• Stage 1: Acute Treatment

  • Cavities are excavated and filled with temporary cement
  • Necessary extractions and emergency endodontic treatment are performed

• Stage 2: Caries Disease Management

  • Patient's diet history is evaluated and counseling provided
  • Salivary and bacteriological tests are conducted
  • Oral hygiene instructions and plaque control are given
  • Topical fluoride application is included

• Stage 3: Restorative Treatment (Operative)

  • This stage involves permanent restorations.

• Stage 4: Risk Assessment and Follow-up

  • Risk factors are assessed
  • A follow-up program is implemented

Choice of Restoration

• The type of restoration for primary teeth depends on:
  • The specific tooth to be restored
  • The patient's past caries history
  • The level of cooperation from the child

Restoration Techniques

• Conventional Technique (G.V. Black):

  • Cavities are prepared using extension for prevention techniques and are filled.

• Tooth Substance Saving Preparations (Microdentistry):

  • Pits and fissures are prepared
  • Focus on preventing the spread of cavities
  • Filling without drilling
  • Examples of this includes laser and air abrasion procedures
  • Chemomechanical caries removal

Important Considerations for Primary Teeth

• Enamel and dentin are thinner in primary teeth than permanent teeth.

• Primary teeth pulps are larger relative to the crown size compared to permanent teeth

• Pulp horns in primary molars are more prominently positioned near the outer tooth surface.

• Enamel rods in the crown of the gingival third of primary teeth extend in an occlusal direction from the dentin-enamel junction, unlike permanent teeth that extend in a cervical direction.

• Primary teeth show significant constriction in the crown and have a more prominent cervical contour compared to permanent teeth.

• Primary teeth exhibit broader, flatter proximal contact surfaces.

• Primary teeth are typically whiter in color compared to permanent successors.

• Steps in Treatment

  • Local Anesthesia (LA) administration
  • Isolation of the affected area (RD/Isolation)
  • Order of restorations
  • Steps of caries excavation
  • Restoring the tooth
  • Types of restorations (Interim and Permanent)

• Caries Excavation

  • Different levels of caries removal exist, including complete (nonselective), partial, incomplete, ultraconservative, and no caries removal.
  • "Selective removal" implies varying levels of removal in different areas (peripheral and pulpal) depending on the depth of the decay, ensuring a stable restoration and no pulp exposure.

• Hand instruments and rotary instruments can be used during caries excavation

• Handpieces

  • The low-speed handpiece (500 to 15,000 rpm) is commonly used for caries removal and polishing.
  • A high-speed handpiece (100,000 to 300,000 rpm) can be used with coolant for more aggressive cutting; intermittent cutting is recommended to prevent heat generation.

• Instruments

  • Spoon excavators, burs.

• Restorations

  • Different materials suitable for pediatric patients, such as composites, compomers, resin-modified glass ionomers, glass ionomers, and Stainless steel crowns (SSC).
  • Distinctions exist regarding the number of tooth surfaces involved, such as one-surface and two-surface restorations.

• Additional Considerations

  • Adhesive restorations require meticulous technique, case selection, and skilled operators
  • Proper application of resin-based materials involves understanding adhesive systems, composites, polymerization kinetics
  • These materials are less forgiving to placement errors compared to amalgam.