Presentation on theme: "PRIMARY DENTITION ANATOMY AND CAVITY PREPARATION"— Presentation transcript:
1PRIMARY DENTITION ANATOMY AND CAVITY PREPARATION 2004-2005 D262 Division of Orthodontic & Paediatric Dentistry University of Western Ontario Dr. Sahza Hatibovic-KofmanPRIMARY DENTITION ANATOMY AND CAVITY PREPARATION
2GENERAL OBJECTIVES:To present the anatomy of primary teeth and key anatomical differences between primary and permanent teeth that influence cavity preparation.
3SPECIFIC OBJECTIVES: (1) Describe the general morphological differences between primary andpermanent teeth and their clinicalimplications.(2) Identify special features and location of theroots of primary teeth. Comment onclinical applications.(3) Describe the general morphology of thedental pulp, location of the pulp horns andorifices of canals in the primary teeth.Comment on clinical considerations.
4Specific Objectives (continued): (4) Identify histological differences betweenthe pulp of primary and permanent teethand the clinical relevance.(5) Identify the reason for most restorativeproblems in paediatric dentistry.(6) Describe the principles of operativedentistry.(7) Describe the steps for preparation andrestoration of Class I and Class II amalgamrestorations.
5Specific Objectives (continued): (8) Describe common errors in Class I and IIrestorations.(9) Describe the differences in cavitypreparation when composite is used asa restorative material for primary teeth.
6Most problems in paediatric dentistry occur because of failure to prepare and restore the teeth in a way that takes into account their:ANATOMIC or MORPHOLOGIC structural characteristics and limitations.
7ANATOMIC CONSIDERATIONS OF PRIMARY TEETH 1. Crowns of primary teeth are smaller, andmore bulbous than permanent teeth.2. Both lingual and buccal walls of theprimary teeth taper occlusally, thereforethe occlusal surface is quite narrow.3. Primary teeth demonstrate greater cervicalconstriction and have more prominentcervical enamel contour than permanentteeth.
9Anatomic considerations (continued) 4. Primary teeth have thinner enamel anddentin than permanent teeth.5. The pulp of primary teeth are larger inrelation to the crown than permanent teeth.The pulp horns of primary teeth are closerto the outer surface of the tooth than forpermanent teeth.The MESIOBUCCAL pulp horn is the most prominent.
12Anatomic considerations (continued) 6. Fine canals.7. Thin pulpal floor.8. The roots of primary teeth are long, slenderand curved. Interradicular space canaccommodate the developing permanenttooth.9. In primary teeth the enamel rods of thegingival third of the crown extend in anocclusal direction. The rods of thepermanent teeth extend in a cervicaldirection.
33INFORMATIONIn order to provide the best care for the child patient and teach excellence, we, at the children’s clinic, have decided to use tooth-coloured 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.
34Montreal, November 27, 2000It was very refreshing for us, as clinicians, to hear from a university professor that the University of Western Ontario actually teaches dental materials and techniques that are up-to-date, in order to prepare the students to the challenges of everyday clinical dental pediatric practice.… J. Victor LegaultQuebec Assoc. of Pediatric Dentists
35Information (continued) Currently, there are four conventional and two hybrid restorative materials available for the restorations in primary teeth.Conventional materials:1. Stainless steel crowns (SSC).2. Amalgam.3. Composite resin.4. Glass ionomer cement (GIC).
37Information (continued) The restorative material for primary teeth should possess the following properties:be biocompatiblejoin a strong adhesive bond to reminded toothstrengthen residual tooth structureeasy handling characteristicbe economical
38Information (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.
39Information (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.
40GUIDELINES for Usage of the Restorative Materials in Mixed Dentition First step in restorative dentistry is to perform good caries diagnosis and elimination of the lesion.Under diagnosis = misdiagnoses.In the SPEC clinic after visual diagnosis, we will use regularly light caries detector “DIAGNOdent” and/or dye caries detector “Seek and Sable”.
46STATE OF THE TOOTHCaries free primary and permanent teethSmall decalcificationSmall lesion in dentin occlusallyTREATMENTPit and fissure sealantsBur preparation or air abrasion - pit and fissure sealantsCavity preparation, and use caries seek and restore it with composite
47STATE OF THE TOOTHMO or DODO or MO next to permanent tooth if exfoliation will occur within two years.TREATMENTConservative preparation without extensions for prevention and use combination of flowable and filled composite.Conservative cavity preparation and glass ionomer cement.
48Guidelines (continued) Multi surface lesions and teeth after pulp therapy will be restored with stainless steel crown (SSC).
49STEPS FOR PREPARATION AND RESTORATION OF CLASS I AMALGAM RESTORATIONS Administer appropriate anaesthesia and place the rubber dam.Using a No. 330 bur gain access and penetrate into the tooth to a depth of 0.5 mm into dentin.Removal all carious dentin by using large, round bur.Provide retention and resistance by making cavity surface parallel with its external surface.
50Steps Class I (continued) Smooth the enamel walls and refine the final outline form with No. 330 bur.Place pulp protection as needed.Place and condense amalgam.Carve amalgam.Burnish the carved amalgam when it has begun its initial set and resists deformation.Remove the rubber dam and check the occlusion.
54COMMON ERRORS WITH CLASS I AMALGAM RESTORATIONS Not including all susceptible fissures.Preparing the cavity too deep.Undercutting the marginal ridges.Carving the anatomy of the amalgam too deep.Not removing the amalgam flash from the cavosurface margins.Undercarving, which leads to fracture of the amalgam from hyperocclusion.
55STEPS FOR PREPARATION AND RESTORATION OF CLASS II AMALGAM RESTORATIONS Administer appropriate anaesthesia and place the rubber dam.Place a wooden wedge in the in interproximal area.With No. 330 bur in the high speed turbine handpiece, prepare the occlusal outline form at the ideal depth.
56Steps Class II (continued) To prepare the proximal box, use the same bur moving it buccolingually in a pendulum motion and in a gingival direction. The contact should be broken between the adjacent tooth gingivally, buccally and lingually.Remove any remaining caries.Round axiopulpal line angle.Remove any unsupported enamel off the buccal, lingual and gingival walls.
57Steps Class II (continued) Place pulp protection if necessary.Remove the wedge, place a matrix band, and reinsert the wedge.Condense amalgam.Carving of the occlusal portion is performed with a small carver. The marginal ridge can be carved with the tip of the explorer.Remove the wedge and the matrix.Gently floss the interproximal contact.Burnish the restoration.Remove the rubber dam and check occlusion.
77PROCEDURE OF CLASS II CAVITY PREPARATION FOR COMPOSITE RESTORATION 1. A local anaesthetic will be administered in the usual fashion and in the appropriate amount to ensure adequate anaesthesia during the procedures.2. A rubber dam will be used routinely.3. Wooden wedges will be inserted in the proximal areas to maximize the protection of gingiva and the adjacent tooth, and protection from tearing the rubber dam by bur.
78Procedure Class II(continued) 4. The outline form of the cavity preparationswill be conservative as presented in thepicture.5. No flaring buccal and lingual walls of theproximal box.6. Caries has to be completely removed,please use seek and sable.7. The line angles will be rounded slightly,but the cavity will not be extended forprevention.8. Do not remove healthy and unsupportedenamel.
79Procedure Class II(continued) 9. Rinse the cavity.10. A “cure-thru” celluloid matrix band oronmi-paedo matrix will be inserted firmlyinto place.11. Acid etch the cavity for 25 seconds.12. Rinse it for 20 seconds.13. Rub in one bottle bonding system, air dryand cure for 10 seconds.14. Apply flavable composite on the edgescure it.
80Procedure Class II(continued) 15. Restore with filled composite (do goodmodeling to be able to avoid finishing).16. Cure for 40 seconds.17. The matrix band will be removed and therestoration will be finished and polished.Finishing and polishing will be done byusing finishing and polishing discs andstrips.18. The rubber dam will be removed and theocclusal contacts evaluated and adjustedas necessary.
81Procedure Class II(continued) 19. Any tooth with carious or iatrogenic pulpinvolvement will obtain pulp treatment, andstainless steel crown.
92PREVENTIVE RESIN RESTORATION (PRR) OBJECTIVES:1. List the indications and contra-indications for PRR for primary and permanent teeth.2. Describe the PRR materials.3. Describe the clinical procedures for PRR.4. Identify the advantages of using PRR and their cost effectiveness.
93PRR (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.
132RUBBER DAM AND MATRIX APPLICATION 2004-2005 D262 Division of Orthodontic & Paediatric Dentistry University of Western Ontario Dr. Sahza Hatibovic-KofmanRUBBER DAM AND MATRIX APPLICATION
133GENERAL OBJECTIVES:Discuss the armamentarium and application of the rubber damin paediatric patients.
134SPECIFIC OBJECTIVES: (1) Identify the need, indications and relative contraindications for the paediatric patient.(2) State the advantages of rubber dam anddescribe its preparation for a paediatricpatient.(3) Describe clamps and their applications.(4) Describe the explanation of the rubber damto the child.(5) Select and apply the matrices for Class IIpreparations in primary molars.
135RELATIVE CONTRINDICATIONS: All paediatric restorative procedures should be completed with the rubber dam in place.RELATIVE CONTRINDICATIONS:(1) Fixed orthodontic applicance.(2) Partially erupted teeth.(3) A child with upper respiratory infection.
136ADVANTAGES: 1. Saves time. 2. Improvement of access. 3. Controls saliva.4. Retraction and protection of soft tissues.5. Prevention of the ingestion and inhalationof foreign bodies.6. Provision of aseptic environment.7. Aid management.8. Helps the dentist to educate parents.