Which Restorative Materials Would You Recommend for Use in Primary Teeth

8/13/2019 Which Restorative Materials Would You Recommend for Use in Primary Teeth

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Recommended Restorative Materials in

Pediatric Dentistry

Name: Kelvin Bird

Subject : Pediatric Dentistry

ID#: 0012448

Lecturer: Dr H. Jones


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Which restorative materials would you recommend for use in primary teeth?

Restoration of the primary dentition is of paramount importance in dentistry since primary teeth

act as natural spaces for the permanent teeth. If lost prematurely, the other baby teeth drift into

spaces and block the erupting permanent tooth out. The presence of primary tooth also allows for

the underlying permanent tooth to develop at a normal rate and guide the permanent teeth intoposition and allow normal development of the jawbone and muscles. Decayed primary teeth left

untreated can cause a child great pain and can lead to a life threatening systemic infection. The

primary teeth are important in your child's ability to eat comfortably and to chew food into easy

to digest pieces. They are also important in learning to speak properly and to be understood.

Taking care of primary teeth is instrumental in enhancing the health of the growing adult teeth.

In restoring primary teeth one should consider

Patients age caries risk, childs ability to cooperate Characteristics of different materials. Epidemiology of caries of the primary dentition (various surfaces have different risk

concerns)

Expected time period before exfoliation. Technique sensitivity of the restoration material


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Analgesia requirements. Functional demands (i.e., occlusion and habits) to be placed on the restored tooth and

dentition.

Caries risk (i.e. potential for new or recurrent decay of the restored tooth) Pulp health (prognosis) Pulp therapy required. Patient cooperation and management demands. Cost. Caregiver expectation

Choice of materials

Choice of restorative materials for primary teeth is large at the present time. Whereas several

years ago the only possibility was amalgam, today there are various alternatives at the dentistsdisposal. The dental practitioner must consider:

What is the best available option for each clinical situation What material will provide the characteristics you want What technique can be completed successfully with minimal psychological trauma to the

child

MultifactorialMultifactorial disposition includes the age of the child and what the child can handle, such as

Local Anesthetic, length of attention span and how long will the restoration need to last. TheCaries risk susceptibility should also be evaluated and considered in the treatment plan and

choice of material. These include:

Number of carious teeth Size of lesions Likelihood of further acid attack Need for caries control first Fluoride-releasing materials desired Motivation and compliance of patient and caregiver Oral hygiene Diet Cooperation of Child Nature of childs behavior Highly technique-sensitive procedures may be inappropriate in children whose behavior

is not conducive

Consideration of caries control procedures (Interim Therapeutic Restorations or fluoridevarnish clinics)


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Restorative Materials Used in Pediatric Dentistry

Amalgam Stainless Steel Crowns Composite Resins Glass Ionomer Cements Resin-Modified Glass Ionomer Cements Nano-Ionomers Dentin/enamel adhesives Bisphenol A and dental materials Pit and fissure sealants

Amalgam

Amalgams have a known quality with long-proven history and research. They have been proven

more economical for the dentist and the patient.. Amalgam possesses excellent physical

properties and its use in primary molars has resulted in highly successful long-term restorations.

Dental amalgam has been used for restoring teeth since the 1880s. Amalgams propertiesincludes; ease of manipulation, durability, relatively low cost, reduced technique sensitivity

compared to other restorative materials, have contributed to its popularity

Amalgams are easily completed and the margins are easily identifiable when carving.Radiographically, amalgams are easily distinguished from the tooth structure and enablethe dentist to identify recurrent decay and margins.

Amalgams have a long shelf life and easy storage of materials. Amalgam restoration has also been known for superior interproximal contacts and

superior marginal integrity that becomes tighter with age. It also has a superior wear rateand can be extremely long-lasting

The esthetics of the amalgam filling is, however, unsatisfactory and can cause darkstaining of the tooth and a tattoo of the gingival and buccal mucosa.

Marginal disintegration of amalgam fillings is material inherent and ultimately limits thelongevity of restorations.

The decision to use amalgam should be based upon the needs of each individual patient.

Amalgam restorations often require removal of healthy tooth structure to achieve adequate

resistance and retention.

Dental amalgam is recommended for:

1. Class I restorations in primary


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2. Class II restorations in primary molars where the preparation does not extend beyond the

proximal line angles;

3. Class II restorations in permanent molars and premolars;

4. Class V restorations in primary and permanent posterior teeth.

5. Stainless Steel Crown repairs

6. Undesirable environment

7. When complete removal of decay is possible

There are many disadvantages with the use of amalgam. Amalgam is not adhesive and therefore

cavity design needs to include some form of mechanical retention resulting in larger restorations

which are inevitably closer to the pulp. Possibly the biggest problem associated with its use is the

recent upsurge in public opinion concerning its safety. In many countries the use of amalgam in

childrens teeth has beenrestricted. The rationale for these restrictions is based on environmental

concerns rather than concerns over amalgam toxicity. Nevertheless, the dental profession may be

forced to use alternatives to amalgam by a combination of public opinion and legislation. The

ADA's Council on Scientific Affairs has concluded that "based on available scientific

information, amalgam continues to be a safe and effective restorative material and that there

currently appears to be no justification for discontinuing the use of dental amalgam.

Acceptable materials have been formulated in recent years and steadily improved especially as

regards their physical properties. Trials were developed for permanent teeth restoration, but they

can also be successfully used for the treatment of primary dentition, especially in minimally

invasive techniques, atraumatic tooth restoration, and preventive interventions. Composite resins,glass ionomers, resin modified glass ionomers, and compomers are the materials of choice in the

form of direct filling. Indirect filling (inlays), composite resins or ceramics are not used forprimary teeth restoration

Amalgam restorations

Stainless Steel Crowns

Stainless steel crowns are preformed extra-coronal restorations that are particularly useful in the

restoration of grossly broken down teeth, primary molars that have undergone pulp therapy, and

hypoplastic primary or permanent teeth. They are adapted to individual teeth and cemented with

a biocompatible luting agent.

They are also indicated when restoring the dentition of children at high risk of caries,

particularly those having treatment under general anesthesia. Stainless steel crowns (SSC) are a

very durable restoration and should be the technique of choice in the high-caries mouth. SSC


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relatively inexpensive, subject to minimal technique sensitivity during placement, and offers the

advantage of full coronal coverage.

Indication

SSCs have been indicated for the restoration of primary and permanent teeth with

Caries, Cervical decalcification, Developmental defects ( hypoplasia, hypocalcification), When failure of other available restorative materials is likely (eg, interproximal caries

extending beyond line angles, patients with bruxism),

Following pulpotomy or pulpectomy, For restoring a primary tooth that is to be used as an abutment for a space maintainer, or For the intermediate restoration of fractured teeth. In high caries-risk children, definitive treatment of primary teeth with SSCs is better over

time than multi-surface intra-coronal restorations.

SSCs have a success rate greater than that of amalgams in children under age 4. To restore anterior teeth in cases where multiple surfaces are carious, where there is

incisal edge involvement, following pulp therapy, when hypoplasia is present, and when

there is poor moisture control.

The use of SSCs also should be considered in patients with increased caries risk whosecooperation is affected by age, behavior, or medical history. These patients often receive

treatment under sedation or general anesthesia.

For patients whose developmental or medical problems will not improve with age, SSCsare likely to last longer and possibly decrease the frequency for sedation or general

anesthesia with its increased costs and its inherent risks.

Resin-Based Composites

Resin-based composites have revolutionized clinical dentistry, although problems related to wear

resistance, water absorption and polymerization contraction can limit their use in larger

restorations in the posterior permanent dentition. In the primary dentition, composite resins are

being increasingly used in combination with GICs in a sandwich-style aesthetic restoration.Placement of these materials is highly technique sensitive, and patient compliance and adequate

moisture isolation can prove difficult in the younger, more challenging child patient.Resin-basedcomposite is an esthetic restorative material used for posterior and anterior teeth. There are a

variety of resin products on the market, with each having different physical properties andhandling characteristics based upon their composition. Resin-based composites

are classified according to their filler size, because filler size affects polish ability/esthetics,

polymerization depth, polymerization shrinkage, and physical properties.

Microfilled resins have filler sizes less than 0.1 micron.


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Minifilled particle sizes range from 0.1 to 1 microns. Midsize resin particles range from 1 to 10 microns. Macrofilled particles range from 10 to 100 microns.

The smaller filler particle size allows greater polishability and esthetics, while larger size

provides strength. Hybrid resins combine a mixture of particle sizes for improved strength whileretaining esthetics. Flowable resins have a lower volumetric filler percentage than hybrid resins.

Highly-filled, small particle resins have been shown to have better wear characteristics.

Indications:

Resin-based composites are indicated for:

Class I pit-and-fissure caries where conservative preventive resin restorations areappropriate;

Class I caries extending into dentin; Class II restorations in primary teeth that do not extend beyond the proximal line angles; Class II restorations in permanent teeth that extend approximately one third to one half

the buccolingual intercuspal width of the tooth;

Class III, IV, V restorations in primary and permanent teeth; Strip crowns in the primary and permanent dentitions. When there is enough remaining, decay-free tooth to Fairly good patient cooperation In non-fracture locations

Contraindications:

Resin-based composites are not the restorations of choice in the following situations:

Where a tooth cannot be isolated to obtain moisture control; In individuals needing large multiple surface restorations in the posterior primary

dentition;

In high-risk patients who have multiple caries and/or tooth demineralization and whoexhibit poor oral hygiene and compliance with daily oral hygiene, and when maintenance

is considered unlikely.

Resins require longer time for placement and are more technique sensitive than amalgams. In

cases where isolation or patient cooperation is compromised, resin-based composite may not be

the restorative material of choice.

Glass Ionomers Cements


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Glass ionomer has been used as a dental material since its introduction in the 1970s.1 At its

introduction as a restorative material there were some limitations to the material. The handling

characteristics were less than ideal, it tended to wash out of the restoration over time, and the

material was not highly polishable. Since their introduction, glass ionomers have evolved and

have been improved immensely. Today's glass ionomers are easier to handle, have better wear

resistance, and have better esthetics than the original glass ionomers.

Glass ionomers have many advantages as a restorative material. These include, but are not

limited to:

The ability to bond chemically to dentin and enamel Biocompatibility Favorable thermal expansion Decreased moisture sensitivity The ability to act as a fluoride release and then as a reservoir

As a result of these qualities, glass ionomer is ideal for the pre-cooperative or uncooperativechild as well as the "high caries risk" child. The ability to bond chemically in a moist

environment is critical in some of the techniques employed in pediatric dentistry. Moisture

control in a pre-cooperative or uncooperative child is often a challenge. It can be difficult at bestto maintain a dry field. Composite materials require a dry field in order to be successful in their

bond and set. Glass ionomers allow some moisture in the field of operation and still form a

reliable bond and therefore a successful restoration. The fluoride release of glass ionomer makes

it an ideal choice for those patients at "moderate to high risk" for dental caries.

Glass ionomers display a cariostatic quality in their ability to act as a reservoir for fluoride. Not

only are glass ionomers a source of fluoride when they are initially placed, but in addition to thisquality, glass ionomers are absorbent and act as a sponge in the uptake and subsequent release of

fluoride. This "recharge" of fluoride can occur from exposure of the glass ionomer restoration to

fluoridated dentifrice and mouth rinses, and professionally applied fluoride treatments. Fluoridehas long been recognized as a powerful tool in the battle against caries. It is effective as an

antibacterial, in remineralizing enamel and in creating more acid resistant enamel by the

formation of fluorapatite.Other applications of glass ionomers where fluoride release has

advantages are for interim therapeutic restorations (ITR) and the atraumatic/alternativerestorative technique (ART). These procedures have similar techniques but different therapeutic

goals

Indications for Glass IonomerThe American Academy of Pediatric Dentistry, in the following instances, indicates the use of

glass ionomer as a restorative material:

Luting cements; Cavity base and liner; Class I, II, III, and V restorations in primary teeth;


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Class III and V restorations in permanent teeth in high risk patients or teeth that cannot beisolated

Caries control with:A. high-risk patients; B. Restoration repair; C. ITR; D. ART.

Other uses include:

When fluoride release is high priority When esthetics arent major issue Very young/uncooperative children

Nano-Ionomers

Latest generation of resin-modified glass ionomer Improved aesthetics and polishability

High fluoride release Easy and quick Increased resistance to wear (higher filler content) Light cure

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Which Restorative Materials Would You Recommend for Use in Primary Teeth