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Division of Orthodontic & Paediatric Dentistry University of Western Ontario Dr. Sahza Hatibovic-Kofman
GENERAL OBJECTIVES: To present the anatomy of primary teeth and key anatomical differences
SPECIFIC OBJECTIVES:
(1) Describe the general morphological differences between primary and permanent teeth and their clinical implications. Identify special features and location of the roots of primary teeth. Comment on clinical applications. Describe the general morphology of the dental pulp, location of the pulp horns and orifices of canals in the primary teeth. Comment on clinical considerations.
(2)
(3)
Describe common errors in Class I and II restorations. Describe the differences in cavity preparation when composite is used as a restorative material for primary teeth.
failure to prepare and restore the teeth in a way that takes into account their: ANATOMIC or MORPHOLOGIC structural characteristics and limitations.
Crowns of primary teeth are smaller, and more bulbous than permanent teeth.
Both lingual and buccal walls of the primary teeth taper occlusally, therefore the occlusal surface is quite narrow. Primary teeth demonstrate greater cervical constriction and have more prominent cervical enamel contour than permanent teeth.
3.
9.
Primary teeth have broad, flat proximal contact areas. Primary teeth are whiter in colour than their permanent successors.
INFORMATION
In order to provide the best care for the child patient and teach excellence, we, at the childrens clinic, have decided to use toothcoloured materials and stainless steel crowns as a first choice of treatments. Occasionally other materials will be used according to the medical indications and/or child/guardian demand.
Information (continued)
Currently, there are four conventional and two hybrid restorative materials available for the restorations in primary teeth. Conventional materials: 1. 2. 3. 4. Stainless steel crowns (SSC). Amalgam. Composite resin. Glass ionomer cement (GIC).
Information (continued)
Hybrids:
1. Resin-modified glass ionomer cement (RMGIC). 2. Polyacid-modified resin composite materials (PMRC), compomer.
Information (continued)
The restorative material for primary teeth should possess the following properties: be biocompatible join a strong adhesive bond to reminded tooth strengthen residual tooth structure easy handling characteristic be economical
Information (continued)
Amalgam is good material and has been used successfully for about 200 years, but tooth coloured materials accompanied with the bonding systems offer advantages over dental amalgam in: Preservation of healthy tooth structure. Today literally we can restore a tooth by removing only decayed structure. To accommodate amalgam a lot of healthy tooth structure has to be removed to provide mechanical retention of the restoration.
Information (continued)
Repairability. Esthetics. Release of fluoride. Our students are performing high quality care for the child patient and will be using the most current tooth-coloured materials.
STATE OF THE TOOTH Caries free primary and permanent teeth Small decalcification
Bur preparation or air abrasion - pit and fissure sealants Cavity preparation, and use caries seek and restore it with composite
TREATMENT Conservative preparation without extensions for prevention and use combination of flowable and filled composite. Conservative cavity preparation and glass ionomer cement.
Guidelines (continued)
Multi surface lesions and teeth after pulp therapy will be restored with stainless steel crown (SSC).
2. 3.
5. 6. 7.
8.
18.
PRR (continued)
Non-surgical management of initial carious lesions by remineralizaiton offers an opportunity to extend preventive dentistry into early therapy. It is now recommended, for smooth surface, that cavity preparation and restoration placement is appropriate only after the lesion has progressed into the dentin.
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Division of Orthodontic & Paediatric Dentistry University of Western Ontario Dr. Sahza Hatibovic-Kofman
GENERAL OBJECTIVES:
SPECIFIC OBJECTIVES:
(1) (2) Identify the need, indications and relative contraindications for the paediatric patient. State the advantages of rubber dam and describe its preparation for a paediatric patient. Describe clamps and their applications. Describe the explanation of the rubber dam to the child. Select and apply the matrices for Class II preparations in primary molars.
INDICATIONS:
All paediatric restorative procedures should be completed with the rubber dam in place.
RELATIVE CONTRINDICATIONS:
(1) (2) (3) Fixed orthodontic applicance. Partially erupted teeth. A child with upper respiratory infection.
ADVANTAGES:
1. 2. 3. 4. 5. 6. 7. 8. Saves time. Improvement of access. Controls saliva. Retraction and protection of soft tissues. Prevention of the ingestion and inhalation of foreign bodies. Provision of aseptic environment. Aid management. Helps the dentist to educate parents.
Molars
Table 2 - Success/Failure of Amalgam and Composite Restoration in SPEC Clinic and Private Practice - A Two-Year Study
AMALGAM
Location
SPEC
PRIVATE PRACTICE
% Success % Failure
% Success
% Failure
% Success
% Failure
96
95
93.7
6.3
96.3
3.7
100 90 80 70
Percent (%)
2 Year