Lecture 4 Basic Cavity principles in primary teeth PDF

Dent 4002 Pediatric Dentistry II Associate Professor Banu Öter, DDS,PhD Bahçeşehir University School of Dental Medicine Department of Pediatric Dentistry Course 3: Basic Principles in Cavity Preparation in Primary Teeth Basic Principles in Cavity Prepation 23.10.2023 Course headings 1- Treatme...

Dent 4002 Pediatric Dentistry II Associate Professor Banu Öter, DDS,PhD Bahçeşehir University School of Dental Medicine Department of Pediatric Dentistry Course 3: Basic Principles in Cavity Preparation in Primary Teeth Basic Principles in Cavity Prepation 23.10.2023 Course headings 1- Treatment of dental caries in the preshool child. 2- Operative treatment of dental caries in the primary dentition 3- Operative treatment of dental caries in the young permanent dentition 4-Advanced restorative dentistry Basic Principles in Cavity Prepation 23.10.2023 Traditional cavity preparations Traditional cavity preparations for class I and class II lesions include areas that have caries involvement and areas that retain food and plaque material and may be considered areas of potential caries involvement. A flat pulpal floor is generally advocated. However, a sharp angle between the pulpal floor and the axial wall of a two-surface preparation should be avoided. Rounded angles throughout the preparation will result in less concentration of stresses and will permit better adaptation of the restorative material into the extremities of the preparation. Basic Principles in Cavity Prepation 23.10.2023 Traditional cavity preparations The traditional treatment has been replaced, for the most part, by conservative caries excavation and restoration with a combination of bonding restorative and sealant materials. In the traditional class II cavity preparation for amalgam, the buccal and lingual extensions should be carried to self-cleansing areas. The cavity design should have greater buccal and lingual extension at the cervical area of the preparation to clear contact with the adjacent tooth. This divergent pattern is necessary because of the broad, flat contact areas of the primary molars and because of the distinct buccal bulge in the gingival third. Basic Principles in Cavity Prepation 23.10.2023 Traditional cavity preparations Ideally, the width of the preparation at the isthmus should be approximately one-third the intercuspal dimension. The axiopulpal line angle should be beveled or grooved to reduce the concentration of stresses and to provide greater bulk of material in this area, which is vulnerable to fracture. Basic Principles in Cavity Prepation 23.10.2023 Cavity preparation in primary teeth The steps in cavity preparation in a primary tooth are not difficult, but they do require precise operator control. Use small, round-ended carbide burs in the high-speed handpiece to establish the cavity outline and perform the gross preparation. For efficiency and convenience, all necessary high-speed instrumentation for a given preparation may be completed with a single bur in most situations. Basic Principles in Cavity Prepation 23.10.2023 Occlusal caries The occlusal surfaces of molar teeth account for about 90% of caries in children. The most rapid rise in rates of decayed, missing, and filled teeth (DMFT) occurs during late childhood and adolescence, a time when the enamel is still immature but when responsibility for oral hygiene and dietary choices is changing from parent to child. Basic Principles in Cavity Prepation 23.10.2023 Occlusal caries Basic Principles in Cavity Prepation 23.10.2023 INCIPIENT CLASS I CAVITY IN A VERY YOUNG CHILD During the routine examination of a child younger than 2 years of age, the dentist may occasionally discover a small but definite carious lesion in the central fossa of one or two first primary molars, with all other teeth being sound. Thus restorative needs are present but minimal. Should be eliminated Basic Principles in Cavity Prepation 23.10.2023 INCIPIENT CLASS I CAVITY IN A VERY YOUNG CHILD Because of the child’s psychological immaturity and because it is usually impossible to establish effective communication with the child, the parent should hold the child on his/her lap in the dental chair. This helps the child feel more secure and provides a better opportunity to restrain the child’s movement during the operative procedure. The small cavity preparation may be made without the aid of a rubber dam or local anesthetic. Basic Principles in Cavity Prepation 23.10.2023 INCIPIENT CLASS I CAVITY IN A VERY YOUNG CHILD A No. 329 or No. 330 bur is used to open the decayed area and extend the cavosurface margin only to the extent of the carious lesion. Restoring the tooth with amalgam or a resin-modified glass ionomer arrests the decay and at least temporarily prevents further tooth destruction without a lengthy or involved dental appointment for the child. If the child is cooperative, a preventive resin restoration, preceded by application of a dentin- bonding agent, may be used. Basic Principles in Cavity Prepation 23.10.2023 INCIPIENT CLASS I CAVITY IN A VERY YOUNG CHILD Basic Principles in Cavity Prepation 23.10.2023 CLASS I COMPOSITE RESİN Basic Principles in Cavity Prepation 23.10.2023 Occlusal caries Basic Principles in Cavity Prepation 23.10.2023 Occlusal caries Basic Principles in Cavity Prepation 23.10.2023 Occlusal caries Basic Principles in Cavity Prepation 23.10.2023 Occlusal caries Basic Principles in Cavity Prepation 23.10.2023 Occlusal caries Basic Principles in Cavity Prepation 23.10.2023 10.10.2022 Occlusal caries Basic Principles in Cavity Prepation 23.10.2023 Aproximal caries Class II Remember that the progression rate of lesions in the inner half of the enamel of the mesial surface of the first permanent molar is relatively fast between 6 and 12 years of age. About 20% progress into dentine within a year. • The progression rate of caries is considerably faster in dentine than in enamel. Restorative treatment in pediatric patient 10.10.2022 Lesions with greater dentin involvement The first step in the traditional preparation of a class II cavity in a primary tooth for an amalgam or an aesthetic restoration involves opening the marginal ridge area. Extreme care must be taken when breaking through the marginal ridge to prevent damage to the adjacent proximal surface. Basic Principles in Cavity Prepation 23.10.2023 Aproximal caries Basic Principles in Cavity Prepation 23.10.2023 Aproximal caries Basic Principles in Cavity Prepation 23.10.2023 Class III cavity Carious lesions on the proximal surfaces of anterior primary teeth sometimes occur in children whose teeth are in contact and in children who have evidence of arch inadequacy or crowding Basic Principles in Cavity Prepation 23.10.2023 Lesions with greater dentin involvement If the carious lesion has not advanced appreciably into the dentin and if removal of the caries will not involve or weaken the incisal angle, a small conventional class III cavity may be prepared and the tooth may be restored with the dentist’s choice of bonding materials Basic Principles in Cavity Prepation 23.10.2023 Lesions with greater dentin involvement The distal surface of the primary canine is a frequent site of caries attack in patients at high risk for caries if the canine is in proximal contact with the first molar. The position of the tooth in the arch, the characteristically broad contact between the distal surface of the canine and the mesial surface of the primary molar, and the height of the gingival tissue sometimes make it difficult to prepare a typical class III cavity and restore it adequately. The modified class III preparation uses a dovetail on the lingual or occasionally on the labial surfaces of the tooth. A lingual lock is normally considered for the maxillary canine, whereas a labial lock may be more conveniently prepared on the mandibular teeth, for which the aesthetic requirement is not as important (Figs. 12.11 and 12.12). The preparaion allows for the additional retention and access necessary for proper insertion of the restorative material Basic Principles in Cavity Prepation 23.10.2023 Dent 4002 Pediatric Dentistry II Associate Professor Banu Öter, DDS,PhD Bahçeşehir University School of Dental Medicine Department of Pediatric Dentistry