Pediatric Dentistry Operative Treatment PDF

Pediatric Dentistry Operative Treatment and Common Dental Materials Used in Pediatric Dentistry 1 Presented by :dr Mohira Ezzeldin 1  Morphologic Differences Between Primary and Permanent Teeth  Crowns:  The crowns in the primary dentition are shorter r...

Pediatric Dentistry Operative Treatment and Common Dental Materials Used in Pediatric Dentistry 1 Presented by :dr Mohira Ezzeldin 1  Morphologic Differences Between Primary and Permanent Teeth  Crowns:  The crowns in the primary dentition are shorter relative to the length of the root (i.e., smaller crown: root ratio).  The occlusal tables of primary molars are constricted buccolingually and much narrower mesiodistally when compared with those of the permanent molars  Enamel and dentin of primary teeth are thinner than those of permanent teeth.(approximately 1 mm thick for enamel)  The enamel rod direction in the cervical area is angled occlusally compared with the apical direction in permanent teeth.  2 3  Crowns of primary teeth are characterized by signifiant cervical constriction in both the mesiodistal and faciolingual dimensions.  The primary molars have a pronounced buccal cervical bulge.(making matrix placement more difficult.)  The contact areas of primary molars are flat and very broad buccolingually compared with those of the permanent molars (This makes detection of interproximal caries more difficult.)  The crown color of the primary teeth is whiter and a lighter shade. 4 5  Roots  The roots of the primary molars have a greater flare, which accommodates the developing crowns of the succedaneous permanent premolars of the permanent dentition.  The mesiodistal width of the roots of primary anterior teeth is much narrower than the crown when compared with those of the permanent anterior teeth.  The primary molar roots are relatively longer and more slender, i.e., mandibular molar roots are narrower mesiodistally, maxillary mesiobuccal and distiobuccal roots are narrower mesiodistally, and maxillary palatal roots are narrower buccolingually. 6 7  Pulp and Root Canal Systems  The size of the pulp relative to the crown is larger in the primary teeth.  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 (accessory canals). 8 9  Why restore primary teeth? o Repair or limit the damage of dental caries. o Protect and preserve remaining the pulp and remaining tooth structure. o Ensure adequate function. o Restore aesthetics (where applicable). o Provide ease in maintaining good oral hygiene. o preventing the shifting of teeth due to loss of tooth structure 10 Risk 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. 11  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 enlargement of lesions over time. 12  Restorative treatment is based on the results of an appropriate clinical examination and is ideally part of a comprehensive treatment plan. The treatment plan should consider the following: 1.The developmental status of the dentition. 2.A caries-risk assessment. 3.Patient’s oral hygiene. 4.Anticipated parental compliance and likelihood of timely recall. 5.Patient’s ability to cooperate for treatment. 13  Choice of materials o Age :  The age of a child will influence their ability to cooperate with procedures such as rubber dam application and local anaesthesia.  How long a restoration is required to remain A restoration in a first primary molar in a 9-year-old child does not require the same durability as a restoration in 1st permanent molar in a 6-year-old child or a second primary molar in a 4-year-old child. 14 o Caries risk high risk of caries use of a fluoride releasing material, (GICs) GICs have a useful role in initial caries control & in cases of rampant caries Stainless steel crowns it eliminates the need to re-treat in the future 15 o Cooperation of the child: In uncooperative children: highly technique-sensitive procedures are inappropriate. amalgam that can tolerate a certain amount of moisture contamination. The use of GICs in the management of caries in anterior primary teeth may be an excellent method of slowing the carious process and temporarily restoring aesthetics in a 2-year-old child, without recourse to general anaesthesia. By the age of 3 or 4 years, the child may be able to cope with more definitive treatment with composite and strip crowns. 16 o Restorative situation o In physical or intellectual disabilities patient necessitating the completion of treatment under sedation or GA. highest standard of dentistry possible should be provided to reduce future dental treatment for these high-need children. Use of materials and techniques that are known to have longevity, such as stain SSCs is mandatory. 17 Requirement of ideal restorative materials Restoration of aeshetic Maintenance of physical strength of the crown Preserving the anatomy of the occlusal surface and thus preserving the interarch relation with the opposing and adjacent teeth Prevention of further ingress of bacteria or their byproducts into the micro spaces b/w the restoration and teeth Long term adhesion b/w the restoration and tooth to ensure complete isolation 18  Restorative materials Glass Ionomer. Resin Modified Glass Ionomer. Compomers. Composite. Amalgam. Stainless steel crowns (SSCs). Composite resin strip crowns. 19  Glass Ionomer Glass-ionomer cements are based on the reaction of silicate glass-powder (calciumaluminofluorosilicate glass and polyacrylic acid, an ionomer. sets by acid–base reaction between the two components. A principal benefit of GIC is that it will adhere to dental hard tissues. Mixed prior to use. Chemically cured 20  -mixing: -amalgamator -cold glass slab or non absorbent paper pad. Mixing time :no more than 40 seconds. -working time from start of mix must not exceed 3 minutes 21  GIC loses and gains water easily: Early moisture contamination leads to increased solubility and poor esthetics,(protect for first 7 minutes). Later desiccation causes shrinkage and crazing, (maybe even months later). 22  ADA Classification Type I: luting agents (Ketac-Cem, Fuji I) Type II: restorative material a = tooth-colored (Ketac-Fil, Fuji IX) b = reinforced (Ketac-Silver, “Miracle Mix”) Type III: fast-set liners and bases (Ketac-Bond) 23  Glass Ionomer Advantages chemical bonding to both enamel and dentin thermal expansion similar to that ; of tooth structure(dentin) biocompatibility; do not suffer from polymerization shrinkage decreased moisture sensitivity when compared to resins. Release fluoride (5 years) Fluoride rechargeable 24 Less microleakage  Fluoride release is considered one of the important advantages of glass-ionomer cements.It can be sustained for very long periods of time ,and shows a pattern of an initial rapid release (“early burst”), followed by a sustained, lower level diffusion- based release 25  Fluoride release from glass-ionomers increases in acidic conditions. In addition, these cements are able to counteract such acidity, increasing the pH of the external medium. This process has been termed buffering, and may be clinically beneficial because it may protect the tooth from further tooth decay. 26  Fluoride is released from glass ionomer and taken up by the surrounding enamel and dentin, resulting in teeth that are less susceptible to acid challenge. Glass ionomers can act as a reservoir of fluoride, as uptake can occur from dentifrices, mouth rinses, and topical fluoride applications 27  Glass Ionomer Disadvantages –Not as strong(Not recommended for stress-bearing areas) –Low wear resistance –Increased setting time –Not as esthetic as composite 28 Glass Ionomer Indications Smooth surface lesions Small anterior proximal lesions i.e. areas of low stress High caries risk patients (restoration repair) Sealants Base underneath deep carious lesions Good cement for stainless steel crowns and brackets and bands Interim Therapeutic Restorations (IRT), (ART) 29  AAPD, 2022 Glass ionomers can be recommended as: 1. luting cements; 2. cavity base and liner; 3. Class I, , III, and V restorations in primary teeth; 4. Class III and V restorations in permanent teeth in high risk patients or teeth that cannot be isolated; 5. caries control with: a. high-risk patients; b. restoration repair; c. ITR; d. ART. 30  Based on findings of a systematic review and meta-analysis, conventional glass ionomers are not recommended for Class II restorations in primary molars or permanent teeth. Evidence is insufficient to support the use of conventional GIC as long-term restorative material in permanent teeth. 31  Glass ionomer and resin “sandwich technique” was developed on the basis of the best physical properties of each. A glass ionomer is used as dentin replacement for its ability to seal and adhere and F release while covered with a surface resin because of its better wear resistance and esthetics. 32  Resin Modified Glass Ionomer addition of resin monomers or a co-monomer of acrylic acid and a methacrylate such as hydroxyethyl methacrylate to the glass-ionomer formulation. 33  Resin Modified Glass Ionomer Advantages: Increased mechanical properties Physiochemically bonds to tooth structure Biocompatible. Similar coefficient of thermal expansion as dentin. Fluoride release (anticariogenic action). Minimal polymerization shrinkage. 34  Resin Modified Glass Ionomer Disadvantages Not as strong as composite or amalgam Less fluoride release than glass ionomer 35  AAPD, 2022 Resin modified glass ionomers can be recommended as: Class I, II , III, and V restorations in primary teeth; Class I, III and V restorations in permanent teeth in high risk patients or teeth that cannot be isolated; ITR and ART. Data from a meta-analysis shows that RMGIC is more caries preventive than composite resin with or without fluoride. Another meta-analysis showed that cervical restorations (Class V) with glass ionomers may have a good retention rate but poor esthetics. Evidence is insufficient to support the use of RMGICs as long-term restorative material in permanent teeth 36 37