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