Dental Restorations in Pediatric Dentisty

1. Dental Restorations in Pediatric Dentisty November 15th, 2008 Christopher Yue DMD, MS

2. Introduction • U of MB Bachelors of Science • U of MB dental school • U of MN for pediatric dentistry residency • Certificate • Masters with research in sealants

3. Restorative Goals • Cease disease process • Restore function • Improve esthetics • Preserve space for adult dentition

4. Primary Tooth Morphology • Mesiodistal diameter greater than cervical occlusal • Enamel and dentin thinner with large pulp chambers • Buccal and lingual converge to the occlusal • Cervical enamel rods converge cervically • Short clinical crown • Broad interproximal contacts

5. Types of Dental Materials • Amalgam • Composite • Glass Ionomer • Resin Modified Glass Ionomer • Stainless Steel

6. Amalgam • mixture of mercury (43%-54%) and powdered alloy (silver, tin, zinc and copper) • Once mixed sets automatically

7. Amalgam • Advantages • Quick and easy manipulation • Less moisture sensitive • Microleakage decreases with time • Good mechanical properties • economical

8. Amalgam • Disadvantages • Non bonding • Bulk for strength • Proper preparation to prevent fracture • Wide isthmus • Rounded line angles • Poor esthetics • Dental amalgam controversy

9. Amalgam Indications • Class I restorations • 2 surface class II restorations • preparation does not extend beyond proximal line angles • Class V restorations

11. Composite • Mixture of powdered glass and plastic resin • Polymerization reaction initiated by light • Various level of filler particles can change esthetics, mechanical properties, and viscosity

12. Advantages Micromechanical Bond Esthetic and polishable Conservative preparation Preventative Sealants Composites

13. Composites • Disadvantages • Moisture sensitive • Technique sensitive • Multiple steps • Time consuming • Polymerization shrinkage leads to microleakage • Public opinion possibly negative due to BPA scare

14. Composite Indications • Small pit and fissure caries • Class I, II, III, IV and V restorations in primary and permanent teeth

15. Anterior Strip Crowns • Anterior Restorations • Primary anterior crown forms

16. Glass Ionomer • Mixture of glass and organic acid • Chelating Reaction • Mixed prior to use • Chemically cured

17. Advantages Bond to tooth structure Physical properties similar to dentin Moisture tolerant Release fluoride (5 years) Fluoride rechargable Less microleakage Glass Ionomers

18. Glass Ionomers • Disadvantages • Not as strong • Poor wear • Increased setting time • Not as esthetic as composite

19. Glass Ionomer Indications • Smooth surface lesions • Small anterior proximal lesions • i.e. areas of low stress • High caries risk patients • Sealants • Base underneath deep carious lesions • Good cement for stainless steel crowns and brackets and bands • Interim Therapeutic Restorations

20. Interim Therapeutic Restorations • Removing carious tissues using hand instruments only • Less traumatic • No need for electricity • Conservation of tooth structure • Low cost • Glass Ionomer • Bonds to tooth • Releases fluoride

21. Resin Modified Glass Ionomer • Mixture of glass, an organic acid, and resin polymer that harden when light cured

22. Advantages Increased wear and fracture toughness Some fluoride release Comand cure Increased esthetics Disadvantages Not as strong as composite or amalgam Less fluoride release than glass ionomer Resin Modified Glass Ionomer

24. Stainless Steel • Pre-fabricated • Full coverage restoration • Pre-crimped with 6 sizes • Adapted to tooth

25. Advantages Strongest Preventative Can be adapted for space maintainer Disadvantages Poor esthetics Post op discomfort Stainless Steel

26. Stainless Steel Indications • Pulpotomy • Extensive caries • Fractured teeth • Hypoplastic molars

27. Stainless Steel Crown Indications • Space Maintainer • Distal Shoe / loop • High caries risk children • Patients that require general anesthetic for dental treatment

28. Stainless Steel Crown • Crown and loop • Placed on tooth that has extensive decay with space maintenance needs

29. Anterior Stainless Steel Crowns • Anterior SSC with windows • Flowable composite • Acid etched • Micromechanical and mechanical retention

30. Treat the patient, not the tooth Caries Risk Assessment Oral hygiene Diet Caries history Anticipated parental compliance Decision Making Process

31. Decision Making Process • Patient’s ability to cooperate for treatment • Need for space maintenance • Pulp status • Age of patient (eruption sequence)

32. Patient 1 • Behavior good • Cooperative • Responsive

33. Clinical Exam • Fair Oral Hygiene • White spot lesions around gum line • 1 small cavitated carious lesion

34. Diet • Good diet • No bottle at night • Healthy snacks • Juice in between meals • Non cariogenic

35. Parents • Educated parents • Conscientious • Motivated • Willing to change eating habits and oral hygiene

36. Treatment Plan • Small conservative composite restoration • Fluoride treatment for incipient lesions • Improve oral hygiene • Monitor at recalls

37. Patient 2 • Patient Behavior Bad • Apprehensive • Non-communicable • Pre-cooperative • Consistent with age • Will require general anesthetic for any restorative treatment

38. Clinical Exam • Early Childhood caries • Multiple interproximal and smooth surface lesions • Multiple incipient lesions

39. Child’s Diet • High sugar diet • Sugary in between snacks • High caries risk

40. Discussion with Father • Unable to understand • Unwilling to change • Too busy waging war and handing out bailouts • Not concerned with child’s dental health

41. How do you treat incipient lesions? • Treat active carious lesions aggressively with stainless steel crowns • Strong preventative program including fluoride and frequent recalls

42. Thank-you!