3rd lecture - Pediatric Operative Dentistry Part 1 Class I II PDF

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USTF - Pre-Clinical Pediatric Dentistry II

2/11/2021

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Pediatric Operative Dentistry Dr. Maryam Al Sharqi DDS, MSD, CAGS Pediatric Dentist

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Anatomic Differences between Primary and Permanent Teeth Lecture 3

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Primary teeth have thinner enamel and dentin thickness than permanent teeth.

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The pulps of primary teeth are larger in relation to crown size than permanent pulps.

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The pulp horns of primary teeth are closer to the outer surface of the tooth than permanent pulps. The mesio-buccal pulp horn is the most prominent.

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In primary teeth, the enamel rods of the gingival third of the crown extend in an occlusal direction from the DEJ. While in permanent dentition the rods extend in a cervical direction.

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Primary teeth demonstrate greater constriction of the crown and have a more prominent cervical contour than permanent teeth.

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Primary teeth have broad, flat proximal contact areas.

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Primary teeth have relatively narrow occlusal surfaces in comparison with their permanent successors.

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Dr. Maryam Al Sharqi, DDS, MSD, CAGS

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USTF - Pre-Clinical Pediatric Dentistry II

2/11/2021

Interim Therapeutic Restoration (ITR) 3 3

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Interim Therapeutic Restoration (ITR)

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Is used to restore, arrest or prevent the progression of carious lesions in young patients, uncooperative patients, or patients with special health care needs or when traditional cavity preparation and/or placement of traditional dental restorations are not feasible and need to be postponed.

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Additionally, ITR may be used for ste wise excavation in children with multiple open carious lesions prior to definitive restoration of the teeth, in erupting molars when isolation condition are no optima fo a definitive restoration o fo caries control in patients with active lesions prior to treatment performed unde genera anesthesi .

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Figure A-D, Partial caries excavation of tooth No 74 is done with spoon excavator followed by the temporary placement of GIC restoration till a definitive diagnosis for the tooth is established.

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Dr. Maryam Al Sharqi, DDS, MSD, CAGS

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USTF - Pre-Clinical Pediatric Dentistry II

Interim Therapeutic Restoration (ITR)

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The use of ITR has been shown to reduce the levels of cariogenic oral bacteria (e.g., Mutans streptococci, lactobacilli) in the oral cavity immediately following its placement. However, this level may return to pretreatment counts over a period of six months after ITR placement if no other treatment is provided.

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The ITR procedure involves removal of caries using hand or rotary instruments with caution not to expose the pulp.

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Leakage of the restoration can be minimized with maximum caries removal from the periphery of the lesion.

2/11/2021

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Interim Therapeutic Restoration (ITR)

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Following preparation, the tooth is restored with an adhesive restorative material such as glass ionomer or resin-modified glass ionomer cement.

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ITR has the greatest success when applied to single surface or small two surface restorations. Inadequate cavity preparation with subsequent lack of retention and insufficient bulk can lead to failure.

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Follow-up care with topical fluorides and oral hygiene instruction may improve the treatment outcome in high caries-risk dental populations, especially when glass ionomers (which have fluoride releasing and recharging properties) are used.

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Dr. Maryam Al Sharqi, DDS, MSD, CAGS

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USTF - Pre-Clinical Pediatric Dentistry II

2/11/2021

Cavity Preparation in Primary Teeth

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Class I Cavity Preparation 8 8

Dr. Maryam Al Sharqi, DDS, MSD, CAGS

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USTF - Pre-Clinical Pediatric Dentistry II

2/11/2021

Cavity Preparation in Primary Teeth

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The use of small, rounded-end carbide burs in the high-speed handpiece to establish the cavity outline and perform the gross preparation is advocated.

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The figure illustrates four high-speed carbide burs designed to cut efficiently and yet allow conservative cavity preparations with rounded line angles and point angles.

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Rounded-end, high-speed carbide burs No. 329, No. 330, No. 245, and No. 256, which may be used for cutting cavity preparations.

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Basic Principles in the Preparation of Cavities in Primary Teeth ▪

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Cavity preparations for class I and class II carious lesions should consider the following: a. Caries

extension and depth - Areas that have carious involvement.

b. Areas

that retain food and plaque material and may be considered of potential carious involvement.

c. Restorative

material planned to be used.

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Dr. Maryam Al Sharqi, DDS, MSD, CAGS

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USTF - Pre-Clinical Pediatric Dentistry II

2/11/2021

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Initial Class I Cavity in a Very Young Child

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For a child younger than 2 years of age.

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Present with small but definite carious lesion in the central fossa.

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Affecting one or two 1st primary molars, with all other teeth being sound.

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Minimal restorative treatment is needed.

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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 or her lap in the dental chair.

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This helps the child feel more secure and provides a better opportunity to restrain the child’s movement during the operative procedure.

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Initial Class I Cavity in a Very Young Child

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A small-cavity preparation is made without the aid of a rubber dam or local anesthetic.

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Isolation is achieved by cotton rolls or absorbent pads and the mouth is maintained open by the bite-block.

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No. 329 or 330 bur is used to open the decayed area and extend the cavosurface margin only to the extent of the carious lesion.

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Resin-modified glass ionomer arrests the decay and at least temporarily prevents further tooth destruction without a lengthy dental appointment for the child.

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If the child is cooperative, a resin restoration, preceded by application of etchant and a dentin-bonding agent is done.

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A – B) Initial enamel carious lesions in the occlusal surface of teeth No 64, and 65. C) Class I Composite Restoration was done.

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Dr. Maryam Al Sharqi, DDS, MSD, CAGS

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USTF - Pre-Clinical Pediatric Dentistry II

2/11/2021

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Deep-Seated Class I Cavity

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With deep carious lesions and near pulp exposures, the depth of the cavity should be covered with a biocompatible base material to provide adequate thermal protection for the pulp.

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If a composite resin and/or glass ionomer restoration is planned, any diseasefree pits and grooves may be sealed as part of the bonded restoration.

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For amalgam restoration, the first step in the preparation is to remove the over hanged enamel around the extensive carious lesion.

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Then the cavity preparation should be extended throughout the remaining grooves and anatomic occlusal defects.

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The carious dentin should next be removed with large, round burs or spoon excavators.

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A – B) Occlusal carious lesion extending in the enamel and dentin of tooth No 85. C) Caries removal, D – E) Dycal and GIC are applied, F) Composite Restoration is done..

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Class I Amalgam Cavity Preparation ▪

Initial tooth preparation - is defined as establishing the outline form by extension of the external walls to sound tooth structure while maintaining a specified, limited depth inside the DEJ and providing resistance and retention forms.

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The outline form for the Class I occlusal amalgam tooth preparation should include only the defective occlusal pits and fissures.

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Dr. Maryam Al Sharqi, DDS, MSD, CAGS

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USTF - Pre-Clinical Pediatric Dentistry II

2/11/2021

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Class I Amalgam Cavity Preparation

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The outline form - Should include all retentive fissures and carious areas, and should compose of smoothly flowing arcs and curves, and all internal angles should be rounded slightly to help prevent stress concentration rendering the tooth more resistant to fracture from occlusal force.

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Pulpal floor depth - is 0.5 mm into dentin (1.5 mm from the enamel surface).

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Note - The length of the cutting end of the no. 330 bur is 1.5 mm, so this becomes a good tool for gauging cavity depth.

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The cavosurface margin - should be placed out of stress-bearing areas and should have no bevel.

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Class I Amalgam Cavity Preparation

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Oblique ridges - should not be crossed unless they are undermined with caries.

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The buccolingual walls - should converge slightly in an occlusal direction providing adequate retention form for the tooth preparation.

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The isthmus - should be 1/3 of the intercuspal width.

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Dovetail - in the 2nd primary molars, its buccolingual width should be greater than the width of the isthmus so as to produce a locking form to provide resistance against occlusal torque, which may displace the restoration mesially or distally.

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Primary mandibular 2nd molars often exhibit buccal developmental pits. When carious, these should be restored with a small teardrop or ovoid-shaped restoration, including all the adjacent susceptible pits and fissures.

Oblique Ridge

Isthmus

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Dr. Maryam Al Sharqi, DDS, MSD, CAGS

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USTF - Pre-Clinical Pediatric Dentistry II

Class I Amalgam Cavity Preparation

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The mesial and distal walls - should flare at the marginal ridge by slight tilting of the bur distally (≤10 degrees). This creates a slight occlusal divergence to the distal wall to prevent undermining the marginal ridge of its dentin support.

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Thin liners - such as calcium hydroxide do not provide thermal insulation, and may hydrolyze gradually, leaving a small void underneath the restoration and ultimately weakening it. Glass ionomer or resin modified glass ionomer material is recommended as bases (0.5 mm) in primary teeth. It insulate the pulp, bonds to the dentin, reduce micro-leakage, releases fluoride and strong enough to resist the forces of condensation.

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Base

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Class I Amalgam Cavity Preparation

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The Resistance form – The shape given to the cavity to enable the tooth as will as the restoration to withstand the stresses of mastication to which it is subjected.

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Eliminating a weak wall of enamel by joining two outlines that come close together (i.e.,...