Lecture 3 Principles of Restorative Treatment in Pediatric Dent-2.pdf

Dent 4002 Pediatric Dentistry II Associate Professor Banu Öter, DDS,PhD Bahçeşehir University School of Dental Medicine Department of Pediatric Dentistry Course 3: Restorative Treatment Planning in Pediatric Patient Restorative treatment planning in pediatric patient 16.10.2023 Treatment plann...

Dent 4002 Pediatric Dentistry II Associate Professor Banu Öter, DDS,PhD Bahçeşehir University School of Dental Medicine Department of Pediatric Dentistry Course 3: Restorative Treatment Planning in Pediatric Patient Restorative treatment planning in pediatric patient 16.10.2023 Treatment planning There are two objectives 1: Ensure that the child reaches adulthood with the optimum achievable dental health. 2: The child learns to trust the dental team and develops a positive attitude towards dental treatment. Restorative treatment planning in pediatric patient 16.10.2023 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 Restorative treatment planning in pediatric patient 16.10.2023 Why restore primary teeth ? Our child patients deserve the best You will shape their dental future. Restorative treatment planning in pediatric patient 16.10.2023 Why restore primary teeth The objective of any restorative treatment is to: ● Repair or limit the damage of dental caries. ● Protect and preserve remaining the pulp and remaining tooth structure. ● Ensure adequate function. ● Restore aesthetics (where applicable). ● Provide ease in maintaining good oral hygiene. In addition restoring primary teeth ensures that the natural spaces in the child’s primary dentition are retained for the developing permanent dentition Restorative treatment in pediatric patient 10.10.2022 Treatment of dental caries in the preshool child Early childhood caries (ECC) is defined as one of the most common disease of 10 dental health conditions that affects the physical, psychological and oral health quality of life of both children aged 71 months and younger and their parents. ECC is defined as the infectious disaese of any primary tooth showing decayed, missing or filled tooth surfaces in a child. Restorative treatment in pediatric patient 10.10.2022 Treatment of dental caries in the preshool child Since 1994-2004 years the prevalence of ECC has been reported as 23.7% in developed countries and by the development and implementation of community-based preventive programs it is aimed to decrease to a level of 11% for 2010. However, the prevalence of ECC remains still high (40,7%-69,8%) among preschool children in Turkey Restorative treatment in pediatric patient 10.10.2022 Treatment of dental caries in the preshool child 1. STEP: Temporization of open cavities. As an initial step in the management of caries, open caries should be excavated and temporized with a suitable material such as a zinc oxide and eugenol cement or better packable glass ionomer cement. Restorative treatment in pediatric patient 10.10.2022 Treatment of dental caries in the preshool child Caries exposure of vital or non-vital teeth can be dressed with a small amount of antibiotic and steroid paste on cotton wool covered by a suitable dressing material. Restorative treatment in pediatric patient 10.10.2022 Treatment of dental caries in the preshool child Do we have to restore every teeth ? Restorative treatment in pediatric patient 10.10.2022 Treatment of dental caries in the preshool child Historically, the management of dental caries was based on the belief that caries was a progressive disease that eventually destroyed the tooth unless there was surgical and restorative intervention. Today it is now recognized that restorative treatment of dental caries alone does not stop the disease process and that restorations have a finite lifespan. Conversely, some caries lesions may not progress and, therefore, may not need restoration. Restorative treatment in pediatric patient 10.10.2022 Treatment of dental caries in the preshool child The benefits of restorative therapy  Eliminate areas that are susceptible to caries,  Stop the progression of tooth demineralization,  Restoring tooth structure and function,  Preventing the spread of infection into the dental pulp,  Preventing the shifting of teeth due to losstreatment of tooth structure. Restorative in pediatric patient The risks of restorative therapy  Reduce the longevity of teeth by making them more susceptible to fracture,  Recurrent lesions,  Restoration failure,  Pulp exposure during caries excavation,  Future pulpal complications in addition to the risk of iatrogenic damage to adjacent teeth.  Primary teeth may be more susceptible to restoration failures than permanent teeth. 10.10.2022 Treatment of dental caries in the preshool child Guidelines on restorative dentistry in pediatric patients Official but Unformatted Recommendations: 1. Management of dental caries should include identification of an individual’s risk for caries progression, understanding of the disease process for that individual, and active surveillance to assess disease progression and manage with appropriate preventive services, supplemented by restorative therapy when indicated. 2. Decisions for when to restore caries lesions should include at least clinical criteria of visual detection of enamel cavitation, visual identification of shadowing of the enamel, and/or radiographic recognition of progression of lesions. Restorative treatment in pediatric patient 10.10.2022 Treatment of dental caries in the preshool child Restorative treatment in pediatric patient 10.10.2022 Treatment of dental caries in the preshool child The techniques employed for definitive restoration in young children should take into account the often active nature of the disease in this age group. The use of plastic restorative materials for definitive restoration should be limited to occlusal and small approximal lesions. Extensive caries, teeth with caries affecting more than two surfaces, and teeth requiring pulpotomy or pulpectomy should be restored with stainless steel crowns. Restorative materials commonly used in pre-school children include glass ionomer cements, resinmodified glass ionomer cements, polyacid-modified resins (compomers), and composite resins. These materials are moisture sensitive so adequate isolation, preferably under rubber dam, is important Restorative treatment in pediatric patient 10.10.2022 Maintenance of a Clean Field The maintenance of a clean operating field during cavity preparation and placement of the restorative material helps ensure efficient operation and development of a serviceable restoration that will maintain the tooth and the integrity of the developing occlusion. Restorative treatment planning in pediatric patient 16.10.2023 Rubber Dam The rubber dam aids in the maintenance of a clean field. The use of the rubber dam is known of offer the following advantages 1. Saves time. The time spent in placing the rubber dam is negligible as long as the dentist works out a definite routine and uses a chairside assistant. 2. Aids management. A few explanatory words and reference to the rubber dam as a “raincoat” for the tooth or as a “Halloween mask” help allay the child’s anxiety. Restorative treatment planning in pediatric patient 16.10.2023 Rubber Dam 3. Controls saliva. Control of saliva is an extremely important consideration when one is completing an ideal cavity preparation for primary teeth. The margin of error is appreciably reduced when a cavity is prepared in a primary tooth that has a large pulp and extensive caries involvement. Small pulp exposures may be more easily detected when the tooth is well isolated. 4. Provides protection. The use of the rubber dam prevents foreign objects from coming into contact with oral structures. When filling material, debris, or medicaments are dropped into the mouth, salivary flow is stimulated and interferes with the operative or restorative procedure. Restorative treatment planning in pediatric patient 16.10.2023 ARMAMENTARIUM FOR RUBBER DAM PLACEMENT The armamentarium consists of 5 × 5-inch sheets of medium latex, a rubber dam punch, clamp forceps, a selection of clamps, a flat-blade instrument, dental floss, and a rubber dam frame. Restorative treatment planning in pediatric patient 16.10.2023 ARMAMENTARIUM FOR RUBBER DAM PLACEMENT https://kisakisaendo.com/Video/klemp-cesitleri-rubber-damuygulama-yontemleri-i-rubber-dam-2/ Restorative treatment planning in pediatric patient 16.10.2023 ARMAMENTARIUM FOR RUBBER DAM PLACEMENT Restorative treatment planning in pediatric patient 16.10.2023 ARMAMENTARIUM FOR RUBBER DAM PLACEMENT Restorative treatment planning in pediatric patient 16.10.2023 Morphologic considerations The crowns of the primary teeth are smaller but more bulbous than those of the corresponding permanent teeth, and the molars are bell-shaped, with a definite constriction in the cervical region. The characteristic sharp lingual inclination occlusal to the facial surfaces results in the formation of a distinct faciogingival ridge that ends abruptly at the cemento-enamel junction. Restorative treatment planning in pediatric patient 16.10.2023 Morphologic considerations The sharp constriction at the neck of the primary molar necessitates special care in the formation of the gingival floor during class II cavity preparation. The buccal and lingual surfaces of the molars, sharply converging occlusally, form a narrow occlusal surface or food table; this is especially true of the first primary molar. The pulpal outline of the primary teeth follows the dentino-enamel junction more closely than that of the permanent teeth. Restorative treatment planning in pediatric patient 16.10.2023 The pulpal horns are longer and more pointed than the cusps would indicate. The dentin also has less bulk or thickness, so the pulp is proportionately larger than that of the permanent teeth. The enamel of the primary teeth is thin but of uniform thickness. The enamel surface tends to be parallel to the dentino-enamel junction. Restorative treatment planning in pediatric patient 16.10.2023 Dent 4002 Pediatric Dentistry II Associate Professor Banu Öter, DDS,PhD Bahçeşehir University School of Dental Medicine Department of Pediatric Dentistry