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Julie Maniate BSc, DMD, FRCD(C)

Childrens Dental World

Deciduous Teeth
Meaning: Latin, to fall off or are shed

Nick names
Milk teeth, temporary teeth

70 Year-Old Person
91% life chewing on permanent teeth
6% life chewing on primary teeth

Primary Teeth
Incisors: Functional ~5 years
Molars: Functional ~9 years

Controlling Caries in Primary Teeth

Prevent:

Pain & discomfort


Local & general infections
Negative attitudes & promote keeping good OH
Caries in permanent teeth
Malocclusion
Self-esteem issues

Controlling Caries in Primary Teeth:

Maintain:
Good mastication
Aesthetics
Overall well-being

Deciduous teeth play important role in


permanent teeth:
Proper alignment
Spacing
Occlusion

Premature loss of primary teeth due to dental


caries is preventable and is to be avoided.

Cost
Patient co-operation/behaviour
Moisture control & haemostasis
Lack of restorative options for mandibular
incisors
Lack of scientific literature concerning
success rates

Pulp:
larger, higher pulp horns
Increased risk of pulpal exposure during preparation or

carious excavation

Dentin
Decreased etching time recommended (15 sec)

Enamel
Prismless layer resists etching, remove with diamond
Increase surface area with dovetails & bevels

Prevention
Cornerstone of good dental caries management

History Taking
Fundamental to execution of restorative care

Communication Skills
Essential in obtaining childs cooperation

1.

Developmental status of the dentition

2.

Caries-risk assessment

3.

Patients oral hygiene

4.

Anticipated parental compliance and likelihood


of recall

5.

Patients ability to cooperate for treatment

6.

Child: age, physical condition, cooperation

Many restorative options exist


Insufficient controlled, clinical data to
suggest that one type is superior to another

Best Restore

Most durable?
Most conservative?
Least technique sensitive?
Most esthetic?

The restorative treatment plan must be


prepared in conjunction with an
individually-tailored preventive program.

Intracoronal Restoration
Class V
Class III

Full Coronal Restoration


Luted
Bonded

Other
Disking
ART

Composite Resins:
Best strength, wear resistance, esthetics, colour
Most technique-sensitive, intolerant of moisture

and/or hemorrhage

Compomers:
Similar characteristics to composite and esthetics
Some fluoride release, little more moisture

tolerant

Resin-modified glass ionomers


Slightly less esthetic
Release Fl- , no etching, less moisture sensitive

Wear and strength not as good

Glass ionomers
Self curing, high Fl- release
Chemical bond, somewhat tolerant of moisture

Physicial properties and esthetics not as good


Use mostly for ART

Class V
Prep: beyond cervical decalcifiactions, undercuts

Material: GI, compomers, RMGI, composite resin


Resin ideal (esthetics, color, bonded), requires isolation
Success rate: 98% using RMGI, avg 4.2 years

Class III
Prep: conservative in depth, attention to detail
Small, slot preps not adequate
Mand incisorssmall, location of pulp chamber
Better option: disking

Material: composite resin, RMGI

Success rate: 100% with RMGI for almost 4.5 yrs

Stainless steel crowns


Facial cut-out SSCs
Resin-veneered SSCs

Advantage:
quick & successful with little tooth structure
place in presence of blood, saliva

crimp margin

Stainless steel crowns


Most durable and reliable
Easy to place, fracture-proof, wear resistant,

attached firmly to tooth

Disadvantage: esthetics
Parents: may prefer extraction vs SSCs

Facial cut-out SSCs/Open-face SSCs


Enhanced SSC: resin/composite material placed in

labial fenestration of SSC


Esthetic improvement over SSC

Disadvantage: time consuming, metal margins,


require hemorrhage control

Resin-veneered SSCs
Composite resins/thermoplastics bonded to SSCs
More esthetically pleasing, less chair-time

First choice for many clinicians, favourite crown

Disadvantage: crimping, cost, loss of resin facing,

difficult to fit, lingual crimping, repair


Parents: satisfied overall
concern over large size, color, metal shown

Strip crown: celluloid crown-form with composite


Most esthetic option, easily repaired

Disadvantage: most technique-sensitive option,


adequate tooth structure
Hemorrhage/salivabond, colour/shade

21% general dentists, 73% pediatric dentists

Pedo Jackets Space Maintainers Lab


heat-cured acrylic crown forms
crown form is left on the tooth after curing

Advantages vs. Strip Crowns:


Form does not have to be removed after curing

Disadvantages vs. Strip Crowns:


Available in only one shade
Cannot be trimmed with high-speed burr
Acrylic melts to burr

Recently advocated for primary dentition

Use microglass & silica filler particles


locked in a cross-linked, 3-D polymer
increased durability & aesthetics vs. traditional composite

resins (i.e. strip crowns)

Available in only one shade at this time

Aluminium crowns painted with epoxy paint

Currently undergoing clinical trials


Questions about durability
If successful may present the best mixture of aesthetics

with ease of placement

Disking
Conservative, early stages of decay
Excellent option for mandibular incisors

Interproximal reduction/removal of caries


allows improved OH
Reduction using a carbide or diamond burr,

usually no LA required
Fluoride application when complete

ART (atraumatic restorative treatment)


Removal of caries using hand instrument
Restoration with fluoride-releasing restorative

material

Long-term success requires maintenance

Caries of primary anterior teeth primarily


due to ECC
Educate parents re. nocturnal and at-will feeding

Education alone is inadequate, rather,


parents must be motivated to alter their childs
feeding behavior patterns.

Children with ECC who had GA for dental tx:


79% had detectable caries at next hygiene visit
17% required retreatment under GA within 2 yrs

Clinicians:
Inform and motivate parents/guardians to

improve OH and understand cariogenic diet


Future caries susceptibility implies future failure
of current restorations

Resin-based composites:

Class III and V restorations, strip crowns

GI or RMGIs:

Class II or V restorations, poor isolation

Full-coverage crowns

Multiple carious surfaces


Incisal edge involvement
Extensive cervical decalcification
Pulpal therapy
Hypoplasia
Poor moisture or hemorrhage control

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