3030DOH

Trimester 2, 2017

Restorative techniques for

primary teeth
(Intracoronal)
Professor Anut Itthagarun
Objectives
Realize the importance of deciduous teeth
Know the differences between deciduous and permanent
teeth
Knowledge about :
Minimal Intervention
Pit & Fissure Sealant
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques (ART)
Lecture Outline
Importance of deciduous teeth
Differences between deciduous and permanent teeth
Minimal Intervention
Restorations
Isolation techniques
Cavity preparation
Materials used
Pit & FS
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques
Conclusions
Further readings
Questions
Importance of deciduous teeth
Mastication
Proper development of muscles of mastication
Formation of bones of the jaws and dental arches
Self esteem
Speech development s eth no front teeth

Maintain space for permanent teeth

solid food at 4 months

Why restore deciduous teeth
Untreated caries :
Pain
Loss of sleep
Behaviour disturbance
Mastication: general health, Interfere with nutrition
Low self esteem
Speech development problem
Premature loss creating space problem for permanent teeth
Lecture Outline
Importance of deciduous teeth
Differences between deciduous and permanent teeth
Minimal Intervention
Restorations
Isolation techniques
Cavity preparation
Materials used
Pit & FS
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques
Conclusions
Further readings
Questions
Differences between deciduous and permanent teeth
FDI Notation
Differences between deciduous and permanent teeth
Differences between deciduous and permanent teeth

Deciduous teeth usually lighter in colour

Teeth not so highly calcified
Differences between deciduous and permanent teeth
54 14
Morphology
Deciduous crowns shorter and more bulbous
Markedly prominent cervical ridges especially
1st molars
Markedly constricted neck
Differences between deciduous and permanent teeth
55 16
Morphology
Buccal and lingual surfaces of
molars flatter thereby narrowing
the occlusal surfaces
Molars have broad contact areas
Differences between deciduous and permanent teeth

Enamel/Dentine
Enamel thinner and of a consistent
depth
Enamel rods in gingival third extend
occlusally

Dentine much thinner between pulp

chambers and enamel
Differences between deciduous and permanent teeth

Pulp/Root
Pulp chambers are relatively large in
comparison with the crowns that envelope
them
Pulp horns extend rather high occlusally
and therefore much closer to the enamel

Roots are narrower and flare apically to

allow room in between for developing
perm crowns
 Fundamental differences in the anatomy, morphology
and histology of deciduous teeth compared to
permanent teeth

Therefore modifications are required for cavity

preparation
Lecture Outline
Importance of deciduous teeth
Differences between deciduous and permanent teeth
Minimal Intervention
Restorations
Isolation techniques
Cavity preparation
Materials used
Pit & FS
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques
Conclusions
Further readings
Questions
Minimal Intervention
Modern medical approach to the management of caries

Utilizing caries risk assessment, and focusing on the early

prevention and interception of disease

Moving the focus away from the restoration of teeth allows

the dentist to achieve maximum intervention, with minimal
invasive treatments.

Walsh and Brostek, 2013

Minimal Intervention

The four core principles :

Recognition early identification and assessment of potential
caries risk factors
Reduction to eliminate or minimize caries risk factors by altering
diet and lifestyle habits
Regeneration to arrest and reverse incipient lesions, using
appropriate topical agents including fluorides and casein
phosphopeptides-amorphous calcium phosphates (CPP-ACP)
Repair conservative caries removal, bioactive materials are used
to restore the tooth and promote internal healing of the dentine

Walsh and Brostek, 2013

Minimal Intervention

The four core principles :

Recognition early identification and assessment of potential
caries risk factors
Reduction to eliminate or minimize caries risk factors by altering
diet and lifestyle habits
Regeneration to arrest and reverse incipient lesions, using
appropriate topical agents including fluorides and casein
phosphopeptides-amorphous calcium phosphates (CPP-ACP)
Repair conservative caries removal, bioactive materials are
used to restore the tooth and promote internal healing of the
dentine
Walsh and Brostek, 2013
Minimal Invasive Restorations: Techniques
1. Isolate teeth
2. Gain access to caries
3. Remove all peripheral caries at DEJ and walls of cavity: hand excavator
or Slow Speed round bur
4. Carefully remove caries on pulpal floor of cavity
5. Restore the cavity with bioactive materials : usually Composite / GIC
Isolation Techniques in Paediatric Dentistry
Minimal Invasive Restorations: Cavity preparation

Occlusal Surface
Minimal Invasive Restorations: Cavity preparation

Proximal of Posterier teeth

Minimal Invasive Restorations: Cavity preparation

Proximal of Anterior- Lingual/palatal approach

Minimal Invasive Restorations : Occlusal Composites
Minimal Invasive Restorations : Proximal Composites
Minimal Invasive Restorations : Occlusal GIC
Minimal Invasive Restorations : Proximal GIC
Minimal Invasive Restorations

Complete restorations with Pit & Fissure Sealant

Lecture Outline
Importance of deciduous teeth
Differences between deciduous and permanent teeth
Minimal Intervention
Restorations
Isolation techniques
Cavity preparation
Materials used
Pit & FS
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques
Conclusions
Further readings
Questions
Pit & Fissure Sealant
Pit & Fissure Sealant: Techniques
Pit & Fissure Sealant Techniques
Pit & Fissure Sealant Techniques
wont etch properly. f- decreases acidity
Pit & Fissure Sealant Techniques
Pit & Fissure Sealant Techniques

Chalky white appearance

Frosty white appearance

second attempt is less

because there is no more
space for resin to flow
into the resin tags

Retention
Pit & Fissure Sealant Techniques

Dont forget: Buccal groove of lower molars & Palatal groove of upper molars
Pit & Fissure Sealant Techniques
Pit & Fissure Sealant Techniques
Lecture Outline
Importance of deciduous teeth
Differences between deciduous and permanent teeth
Minimal Intervention
Restorations
Isolation techniques
Cavity preparation
Materials used
Pit & FS
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques
Conclusions
Further readings
Questions
Preventive Resin Restoration (PRR)

Resin restorations + FS = PRR

If caries present in part(s) of the pit and fissure area

The particular caries is removed and the cavities are restored with
resin materials

Remaining pits and fissures are protected with sealant

Composite restoration + FS = PRR
Preventive Resin Restoration (PRR)
Preventive Resin Restoration (PRR)

COMPOSITE
Lecture Outline
Importance of deciduous teeth
Differences between deciduous and permanent teeth
Minimal Intervention
Restorations
Isolation techniques
Cavity preparation
Materials used
Pit & FS
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques
Conclusions
Further readings
Questions
Atraumatic Restorative Techniques (ART)

ART is a minimally invasive approach to both prevent dental caries and to stop its
further progression

It consists of two components: restoring cavitated dentin lesions and sealing

caries prone pits and fissures

An ART restoration involves the removal of soft, completely demineralised carious

tooth tissue with hand instruments

This is followed by restoration of the cavity with an adhesive dental material that
simultaneously seals any remaining pits and fissures that remain at risk
Atraumatic Restorative Techniques (ART)

Temporary caries control for gross caries

May not be a permanent restoration
Monitor

It can be perform in public health behaviour management

Atraumatic Restorative Techniques (ART)

use hand instruments only

use spoon excavator
Lecture Outline
Importance of deciduous teeth
Differences between deciduous and permanent teeth
Minimal Intervention
Restorations
Isolation techniques
Cavity preparation
Materials used
Pit & FS
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques
Conclusions
Further readings
Questions
Importance of deciduous teeth / Why to restore
Lecture Outline
Importance of deciduous teeth
Differences between deciduous and permanent teeth
Minimal Intervention
Restorations
Isolation techniques
Cavity preparation
Materials used
Pit & FS
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques
Conclusions
Further readings
Questions
Differences between deciduous and permanent teeth

Colour & calcification

Crown shorter, prominent ridge, constrict cervical

Narrower occ., contact

Lecture Outline
Importance of deciduous teeth
Differences between deciduous and permanent teeth
Minimal Intervention
Restorations
Isolation techniques
Cavity preparation
Materials used
Pit & FS
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques
Conclusions
Further readings
Questions
Minimal Intervention
Four R, Recognition, Reduction, Regeneration and Repair

Restorative techniques

Isolation

Cavity prep

Materials :

Complete with FS

Walsh and Brostek, 2013

Lecture Outline
Importance of deciduous teeth
Differences between deciduous and permanent teeth
Minimal Intervention
Restorations
Isolation techniques
Cavity preparation
Materials used
Pit & FS
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques
Conclusions
Further readings
Questions
Pit & Fissure Sealant: Techniques
Preventive Resin Restoration (PRR)

Resin restorations + FS = PRR

Atraumatic Restorative Techniques (ART)
Lecture Outline
Importance of deciduous teeth
Differences between deciduous and permanent teeth
Minimal Intervention
Restorations
Isolation techniques
Cavity preparation
Materials used
Pit & FS
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques
Conclusions
Further readings
Questions
Further readings

Minimal Intervention Dentistry (MID) for managing dental caries a review

Frencken et al, Int dent J Oct 2012; 62(5): 223243
Objectives
Realize the importance of deciduous teeth
Know the differences between deciduous and permanent
teeth
Knowledge about :
Minimal Intervention
Pit & Fissure Sealant
Preventive Resin Restorations (PRR)
Atraumatic Restorative Techniques (ART)
List 5 reasons why deciduous teeth are important What is minimal intervention? explain the core principle
- maintain space - Modern approach to drill only caries
- mastication - Recognition
- self esteem - Reduce risk
- speech - Regeneration
- formation of bones and jaws - Repair

List 3 characteristics that make deciduous teeth more susceptible to Explain fit and fissure technique
pulpal exposure than peramanent teeth - 7 steps
- Enamel and dentine are thinner - Isolation
- Less calcified -Cleaning
- Pulp horn high - Etch for 20 seconds
- Wash and dry

Questions -Apply upper teeth have palatal grooves and

lower teeth have buccal grooves
-
Write short notes on Preventive
Resin Restorations (PRR)
- Restoration with fissure sealant
- Pit and fissure sealant prevents
decay
- Remove particular caries and fill
remaining pits and fissures with
sealant