Lecture 8 Pediatric Crowns and Prosthetic Approaches in Pediatric Patients (1).pdf

Pediatric Crowns and Prosthetic Approaches in Pediatric Patients Assist. Prof. Selin Şen Kemeç Bahçeşehir University School of Dental Medicine Department of Pediatric Dentistry [email protected] 27.03.2023 Why and in which situation do we need to prosthetic application in pediatric...

Pediatric Crowns and Prosthetic Approaches in Pediatric Patients Assist. Prof. Selin Şen Kemeç Bahçeşehir University School of Dental Medicine Department of Pediatric Dentistry [email protected] 27.03.2023 Why and in which situation do we need to prosthetic application in pediatric patients? Caries Extensive caries Excessive loss of tooth structure Missing teeth Trauma Trauma Pulpotomy and pulpectomy Ectodermal Dysplasia Developmental defects affecting dental hard tissues Amelogenesis Imperfecta Dentinogenesis Imperfecta Cleft and Life Palate Oligodontia / Anadontia (congenital) Down Syndrome Oral-facial-digital Syndromes Extensive caries Stainless Steel Crown (SSC) Excessive loss of tooth structure Trauma Open-faced SSC Pre-veneered SSC Pulpotomy and pulpectomy Developmental defects affecting dental hard tissues Amelogenesis Imperfecta Dentinogenesis Imperfecta Polycarbonate Crowns Resin Strip Crowns Pediatric Zirconia Crowns Stainless Steel Crown INDICATIONS Restorations for pulpotomized or pulpectomized primary or young permanent teeth when there is increased danger of fracture of the remaining coronal tooth structure Restorations for primary or young permanent teeth with extensive and/or multiple carious lesions Restorations for teeth with hereditary anomalies, such as dentinogenesis imperfecta or amelogenesis imperfecta Restorations for hypoplastic primary or permanent teeth that cannot be adequately restored with bonded restorations Restorations for fractured teeth Restoration for teeth with extensive wear Restorations for primary teeth to be used as abutments for appliances, space maintainers, habit breakers Patients who are unlikely to attend follow up appointments Stainless Steel Crown CONTRAINDICATIONS Primary teeth that exhibit more than a half of root resorption Primary tooth approaching exfoliation (6 to 12 months) The tooth is with excessive mobility Patients with nickel allergies and sensitivity Inability to fit the crown due to lack of cooperation ARMAMENTARIUM FOR SSC 1. Burs and stones 2. Pliers / instruments 3. Cementation materials Stainless Steel Crown Advantages SSC is the most durable, long lasting and cost effective method SSC has better protection feature for remaining tooth surface Disadvantages Esthetic properties of SSC are not good Stainless Steel Crown Clinical Procedure 1.Evaluation of pre-operative occlusion 2. Local anesthesia administration Midline, cusp fossa relationship, canine relation 3. Placement of rubber dam should be evaluate 4. Appropriate crown size selection The opposing tooth may be extruded or adjacent 5. Tooth preparation and evaluation of preparation tooth may drift to mesial 6. Crown adaptation 7. Crown finishing and polishing 8. Crown cementation and removal of residual cement Stainless Steel Crown Clinical Procedure 1. Evaluation of pre-operative occlusion 2.Local anesthesia administration 3. Placement of rubber dam 4. Appropriate crown size selection 5. Tooth preparation and evaluation of preparation 6. Crown adaptation 7. Crown finishing and polishing 8. Crown cementation and removal of residual cement It reduces discomfort during sub gingival preparation Stainless Steel Crown Clinical Procedure 1. Evaluation of pre-operative occlusion 2.Local anesthesia administration 3.Placement of rubber dam 4. Appropriate crown size selection 5. Tooth preparation and evaluation of preparation 6. Crown adaptation 7. Crown finishing and polishing 8. Crown cementation and removal of residual cement Rubber dam protects surrounding tissues from bur injuries Rubber dam increases comfort of the patient Stainless Steel Crown Clinical Procedure 1. Evaluation of pre-operative occlusion 2.Local anesthesia administration 3. Placement of rubber dam The crown can be selected in different ways: 1. Measurement of the mesiodistal dimension of the tooth 4.Appropriate crown size selection before tooth preparation 5. Tooth preparation and evaluation of preparation 2. Trial and error method (after the preparation) 6. Crown adaptation 7. Crown finishing and polishing 8. Crown cementation and removal of residual cement Stainless Steel Crown Clinical Procedure 1. Evaluation of pre-operative occlusion Aim of the preparation, 2.Local anesthesia administration To provide sufficient space for SSC 3. Placement of rubber dam To have sufficient tooth retention of crown 4. Appropriate crown size selection 5.Tooth preparation and evaluation of preparation 6. Crown adaptation 7. Crown finishing and polishing 8. Crown cementation and removal of residual cement 5.Tooth preparation and evaluation of preparation Occlusal reduction Proximal reduction The original contour of the cusps should be preserved Preparation is evaluated with a dental probe. Dental A smooth taper from occlusal to gingival, free probe can easily move between the opposing tooth and of ledges or shoulders, should be achieved. the prepared tooth. 5.Tooth preparation and evaluation of preparation Buccal and lingual/palatal reduction The convexity of the buccal and lingual surfaces increases the retention of the crown. For this reason, over-preparation should not be done. Lastly, all line and point angle should be round. All margins should be sub gingival and feather edge Stainless Steel Crown Clinical Procedure 1. Evaluation of pre-operative occlusion 2.Local anesthesia administration 3. Placement of rubber dam 4. Appropriate crown size selection Gum should be protected and obtained crown retention 5. Tooth preparation and evaluation of preparation If retention is not sufficient, it can cause plauqe and 6.Crown adaptation bacterial accumulation, gingivitis and cervical caries. 7. Crown finishing and polishing If the crown margin is too big for the tooth, the crown can 8. Crown cementation and removal of residual cement be reduced with a siccisor or bur. Counturing and crimping is made with pliers Stainless Steel Crown Clinical Procedure 1. Evaluation of pre-operative occlusion 2.Local anesthesia administration 3. Placement of rubber dam 4. Appropriate crown size selection 5. Tooth preparation and evaluation of preparation 6. Crown adaptation 7.Crown finishing and polishing 8. Crown cementation and removal of residual cement Stainless Steel Crown Clinical Procedure Luting cement is prepared and placed the crown. 1. Evaluation of pre-operative occlusion Glass ionomer cement can be used, but glass ionomer cement 2.Local anesthesia administration should be preferred because it contains fluorine. 3. Placement of rubber dam After the crown is placed on the prepared tooth, it must be kept 4. Appropriate crown size selection under pressure while the cement hardens. 5. Tooth preparation and evaluation of preparation Excess cement should be removed for gingival health. A probe 6. Crown adaptation and dental floss should be used. 7. Crown finishing and polishing 8.Crown cementation and removal of residual cement Stainless Steel Crown FOR ANTERIOR TEETH The teeth have extensive proximal lesions involving the incisal portion. Application technique is the same with posterior crowns, A stainless-steel crown of appropriate size is selected, contoured at the cervical margin, polished, and cemented into place. Stainless Steel Crown open-face stainless-steel crown Cutting labial metal Leaving labial ‘window’ Restored with resin based-composite More esthetic than full coverage SSC Inexpensive Time consuming Placement of the composite facing may be compromised when gingival hemorrhage or gingival moisture and Metal margin is still seen Preparation of labial window Application of bonding agent view of labial window Placing of composite resin Stainless Steel Crown Pre-veneered stainless-steel crown The SSC is covered on its buccal or facial surface with a tooth colored coating of polyester/epoxy hybrid composition. No need to labial window preparation Relatively short operating time Less gingival bleeding More esthetic properties They are relatively inflexible compared to traditional SSC limited color choice more expensive compared to conventional SSC Polycarbonate Crowns Polycarbonate crowns are heat-molded acrylic resin shells that are adapted to teeth with self-curing acrylic resin. Good esthetic property Operation time; composite strip crown ~ SSC ~ preveneered SSC < open face SSC They are not appropriate for bruxist patient Require great amount tooth reduction Brittle/fragile Composite Strip Crowns Composite strip crowns are composite filled celluloid (transparent plastic) crown forms Their adhesion is based on dentin and enamel adhesion to composite It provides good esthetic Operation time is reasonable It requires technique sensitivity It is not durable as SSC İt is not appropriate for bruxist patients Moisture control may be difficult for uncooperative patients Pediatric Zirconia Crowns Zirconia crowns are used for the aesthetic restoration of primary anterior-posterior and permanent first molar teeth. Zirconia have become very popular because of their durability and aesthetics. This crowns don’t allow the plaque accumulation and don’t allow the discolor. This crowns require considerably more tooth structure removal to fit the crown. Application technique is very sensitive. Pediatric Zirconia Crowns Cementation resin-modified glass ionomer (RMGI) cements resin cements bioactive RMGI cements Treatment for Missing Teeth Edentulous causes, Speech impairment Caries Deforming lingual habits Missing teeth Poor nutrition Trauma Ectodermal Dysplasia Cleft and Life Palate Oligodontia / Anadontia (congenital) Down Syndrome Oral-facial-digital Syndromes Mastication is difficult or impossible Removable/fixed partial/total prosthesis for pediatric patients Hypodontia cases require a multidisciplinary approach. Pediatric dentist Orthodontist Prosthodontist Maxillofacial surgeon Periodontist The aim of orthodontic treatment is, Evaluate the existing spaces Place the existing teeth in the optimum position The surgical/periodontal treatments may be necessary, skeletal discrepancy dento-alveolar deficiency Alveolar ridge disorders In this cases following situation should be considered, the number and position of the missing dental units, the age of the child, their level of and attitude towards oral health the wishes and expectations of the individual and their family As the child grows, prosthesis dentures will lost their compatibility with the dental arch and must be replaced regularly. He is 4-year-old boy with characteristics of ectodermal dysplasia. Many primary and permanent teeth are congenitally missing. The skin is dry and the hair is sparse. The anterior primary teeth are typically conical. A full maxillary overdenture and a partial mandibular denture were constructed. A patient with bilateral complete cleft lip and palate in which the maxillary six permanent anterior teeth have been removed. Removable prosthodontic appliance providing acceptable occlusal and aesthetic results. Children can use this prosthesis? For which patients may a removable prosthesis be unsafe? For epileptic patients Why? During attacks, the prosthesis may break or be inhaled Solution? If possible, removable prosthesis should not be made. If removable prostheses are required, they should be well retained with clasps