Pedo Sheet #9 By ŶẶŜḾiЙ HiJẶzŶ

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Pedo Sheet #9 By ŶẶŜḾiЙ HiJẶzŶ

Post by Sura on 13/5/2012, 1:38 am

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Sura

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Re: Pedo Sheet #9 By ŶẶŜḾiЙ HiJẶzŶ

Post by Shadi Jarrar on 13/5/2012, 2:30 am

1
What's an ideal restorative material? No material is perfect as tooth structure
Ideal dental material is:
- Simple
- Durable..last for a long time
- Painless
- Acceptable
- insensitive
Dental materials:
- Amalgam
- Composite
- Stanless steel crown (ssc)
- Glass ionomer (GI)
- RMGI
- Polyacid modified composite resin
How do we actually select a material? It's different than cons clinic .. we have to consider certain things(factors) ..
Factors :
- develop metal state of dentition age : one of most imp things is to look at developmental stage of a dentition ..the clue : is the age of the pt.
It's not a condition enno el chronological age = dental age ..
- caries risk
- patient oral hyiegen
- co-opration of the child..we need a co-oprative child to get successful restoration
- following plans??? .. that the pt will come back to yr clinic and check if he follows yr instructions
2
FACTORS IN DETAILS…..
Age :
How long u expect that filling u r going to put on the tooth will stay in the mouth ?? it depends on how long the tooth will stay in the mouth.
If u have 9 years old pt and he has (D,E,6)
Let's think about each tooth and how the developmental age affects our choice for restorative material
 D - 1 year & exfoliate at age of 10 .. so the material is not important to be durable.. u won't use ssc for a tooth will last for a year
 E- 2,3 year & exfoliate at age of 10-12 ..similar to D
 6- perment .. here we need durable material
Caries risk: how can u tell enno el pt has high caries risk?
1- pt is not brushing
2- level of OH
3- huge amount of food derbies
4- past caries experience .. if he had alots of caries& fillings before
## Increase caries risk >> use flourid .. we can use fillings that release floride like:
- GIC.. releases good amount of FLUORIDE - compomer .. releases lesser amount of fluoride than GIC - ssc.. is not fluoride releaser.. but it's good for high risk caries pt cause it covers the surface so in that way we prevent caries to affect the surface of the tooth again
Co-operation of child
- Amalgam less sensitivity than composite
- Composite needs moisture control.. so if the pt is not co-oprative definitely we will not use composite
- Compomer requires lesser moisture control than composite
- Amalgam doesn't require moisture control
>>> compomer & amalgam can be used with un-co-operative child
3
Parental compliance if u expect enno el child will not be seen later on in the clinic, u have to change yr treatment plane..and if he has alot of teeth need complicated procedures like pulp therapy , ssc ,.. and this makes treatment needs more time and more than 1 visit.. EXTRACTION will be the choice
- Caries with in enamel >>> resistance
- Questionable fissure >>> open cavity
- Large # of teeth require advanced pulp therpy & ssc >>> extraction
Temporization
 Initial step in management of caries (1st visit)
 Open cavities hand excavated and temporized with ZnOE or GIC
 Introduction to dental treatment
 Decrease oral loading of strep. Coccus bacteria
 Decrease pain & sensitivity .
IMP. >>>
# restoration treatment based on clinical examination is a part of comprehensive treatment plane
# treatment must be in combination with prevention
Restoration of primary posterior teeth
Location of caries
 occlusal caries in primary molars are more common than interproximal pre-school children
 u should know at which stage the child is more susibtable to caries
 when u r looking at a child before the contacts closed between D & E.. occlusal caries are more common ,, and after contact closed , interproximal caries more common.
 Usually lower teeth are more affected than the upper ones
 We can detect more caries by using bitewing
 Even if u don't see interproximal caries,, u have to take bitewing
 If u have a pt who can come back and he doesn't have high risk caries.. start using prevention like floride then resotorations in other visits
 If u have a pt who can't come back start resotorations
4
Diagnosis
- explorer
- good source of light
- bitwing x-ray
- dry teeth
Note:
 avoid distress to patient that u may cause by proping open cavity .. NO NEED to prope an open cavity cause I know that there's caries.. propping opening cavity may lead to loss pt co-opration.
 gray discoloration >> dry tooth to check if there's a destruction in enamel
 deep fissure >> susibtability to caries
 topical floride..occlusal caries may be more difficult to be diagnosed because of using topical floride
 hard pits and fissures >> caries may extent deeper…enamel thickness there is v.small so its destruction is v.extensive
 sticky fissure
 fissure sealant >> leakage may happen and that might cause caries and smtimes fissure sealent may break and cause leakage then u should remove all fissure sealent and check 4 caries
Hidden caries
class 2 lesion diagnosis
- bitewing r important
- gray discoloration of marginal ridge >> pulp involved
- broken marginal redge >> pulp involvement and to be sure we need periapical radiograph.
- surface adjacent to calss 2 lesion.. when u make a cavity class 2 on E as an example on mesial side..u have to chek also the distal of D if there is caries or not
mesial surface of E – distal caries of D
- clinical examination preparation of calss 2 cavity demineralization.. and u can applied fluoride varnish before placing the filling
full mouth picture
-if caries in one quadrant , check contra-lateral & opposing tooth
5
Restoration of anterior teeth
- caries >> most common cause to restore ant. tooth
- trauma
- developmental defect
nursing bottle caries:
 labial surface of anteriors
 mesial of primary (class 3)
 class 5 commonly seen in labial surface of canines
Note :
# Modified by large pulp & thin enamel so try to make small preparation as possible
Dental Materials :
1 – amalgam:
Advantages :
o quick
o simple
o cheap
o insensitive
o DURABLE
Disadvantages :
o Esthetic
o Failure if improper cavity preparation ,, (keep retention, resistance)
o Destructive..U have to remove from sound tooth structure to prepare the cavity
o Lack of adhesion
o Toxicity of mercury .. when u look at countries and their guidelines according to amalgam use .. most of the countries have no recommendations & no guidelinds prohibit using amalgam.. so it is not a concern.. there's no alternative to amalgam to be used
Dimension of cavity preparation :
- Minimum cavity depth,, u need at least 1.5 mm depth
- Narrowness
- Intercuspal distance – not > 1/3
- Rounding internal line angels…axio-pulpal line
- No need to do dovetail
Failure of amalgam :
1- Fracture
2- Recurrent caries
6
2- Stanless Steel crown (SSc)
It's a prefabricated crown.. it's not a crown u will take impression for. (no need for lab ) it's a readymade crown in different sizes
Prepared crowns forms are adopted to indicated tooth & cemented w\ lueting agent
Advantages :
o Extremely durable <4 yrs..if u have v.young child and u want to protect his tooth (E) .. the best choice is ssc .
o Ssc success rate is twice as long as amalgam
o Full crown coverage>> protect the whole crown
Disadvantages :
 Expensive
 Need co-opration
Indications:
- high risk pt.
- extensive decay , large resine , multisurface lesion
- pulpotomized tooth.. the best restoration b3d el pulpotomy is ssc.
- GA .. we don’t want to re-use GA with a child .. so when using ssc, we can insure enno teeth will be protected.
3-Composite resin:
Advantages:
 Aesthetic
 Adhesion
 Resonal wear resistance
Disadvantages:
 Sensitivity
 2ndry caries becz of polymerization shrinkage
 Expansion
Indication :
 Small fissure caries
 Minimal class 2 lesions
 On anterior tooth w\ co-oprative child (class 3, 4 ,5)
If the tooth is very destructive>>use cellulose crowns
7
4-GI:
Advantages :
 Chemical bonding to enamel & dentine
 Thermal expansion similar to tooth
 Uptake & release of fluoride
 Decrease moisture sensitivity
Disadvantage
 Poor wear resistance
 Not durable
 Can't be used in stress bearing area
 Poor tensile strength
 Increase setting time
Uses (forms of GI ) :
 Luting cement>> is used to stick crowns and band space maintainer.
Using space maintainer makes the banded tooth more susibtable to caries .. so using space maintainer bonded to tooth by GI is preferable coz of releasing floride
 Bases & liners
 Temporary restoration
 ART .. Atrumatic Restorative Technique>> just remove the caries and put GI.. used in the areas where difficult to get an access to caries
 Modification of conventional GI >> high viscous GI
Increase viscosity of the GIC:
- condensable GIC's..like amalgam
- finer grain size
Ratio of powder & liquid foe:
Conventional GI : 3:1 Modified GI : 6:1
More powder is used with modified GI .. to get proper consistency
- Flourise release similar to conventional GIc
- Improved tensile strength & abrasion resistance & wear resistance
- more durable
5-RMGI :
o Conventional GIc with added monomer
8
(bis+ GMA) + photo-initiator
Means (GI +composite)
o Sets by acid, base reaction & curing monomer
Advantages:
 Command set
 F release
 Better esthetic
 Improved tensile strength
 Adhesion to enamel and dentine
RMGI byejma3 el advantages mn el COMPOSITE wel GI
6-Polyacid modified composite resine (COMPOMER):
Composite resin w\ modest GIC characteristics.. so it has more composite charachteristics
Advantages:
 Adhesion
 Easy to use
 ??
Disadvantages:
 Less F release (10% of GIC)
 Can not be recharged w\ floride
 Less wear resistance than composite
 Less durable than composite.
CONCLUSION:
o Carful examination & diagnosis of caries
o New materials are v. useful in terms of restoration
o Ssc shows the best results
The END
Pedo lect. # 9.. Dr. Hawazen done by : YASMIN HIJAZI
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Shadi Jarrar
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