Restorative therapy in temporary dentition .
- Introduction :
- Restorative dentistry is the final stage when carious lesions have passed the remineralization stage. It is always done to the detriment of dental tissues, which is why it is essential to respect the concepts of dentistry to a minimum in order to preserve and restore them using biocompatible, even bioactive, materials.
- Restoration materials
- The amalgam:
- Amalgam has long been used because of its excellent physical properties
- Despite the many controversies regarding its indication, it still finds its place in restorative materials. Despite its obvious unaesthetic appearance, it is a material whose long-term effectiveness has been proven.
- Its ease of handling and low cost are additional arguments in its favor. However, it requires a mutilating cavity preparation of the tooth; which does not meet the principle of conservative dentistry.
- As a result, its scope of indication will be limited as far as possible.
- Glass ionomer cements: (GIC)
- These materials are characterized by an acid-base reaction, a self-adhesive character to dental tissues and a bioactive character by fluoride release.
- Their poor aesthetic and mechanical properties limit their use, which has led to the improvement of traditional conventional CVIs, and the emergence of new products.
- Hybrid or modified glass ionomers
- addition of CVIMAR resin
- photopolymerizable
- The use of CVI and especially CVIMAR can be used in many clinical situations:
- • Initial remineralization treatment
- • Sealing of pits and fissures
- • Occlusal and cervical restorations in temporary dentition
- • Temporary restorations in patients at high caries risk during the initial phase of treatment, pending favorable conditions for permanent restorations with better durability
- • Durable restorations for non-remineralizable cervical caries (site 3) as well as all restorations using “closed or open” sandwich techniques
- The compomers:
- These are biomaterials for filling that are derived from glass ionomer and composite technology. They consist of an organic matrix of polymers containing polyacid groups. Their setting reaction is obtained by photopolymerization.
- Both compomers and glass ionomers are hydrophilic, which improves their sealing. Since they are not self-adhesive, these materials require the use of an adhesive system.
- These materials have poorer mechanical qualities than composites and their fluoride release is much more limited than that of glass ionomers.
- Their use in temporary dentition should be limited to occlusal and proximal restorations of small extent for a period not exceeding 5 years.
2.4. Composites
Composite resins consist of a matrix of polymers and fillers. Depending on the filler content, several categories are distinguished
2.4.1. Micro-hybrid composites:
- High charge density, small particle microhybrid composites are the materials of choice both in the anterior sector for their optical qualities and in the posterior sector for their mechanical qualities.
- These products are photopolymerizable and require the use of an adhesive system because they do not have their own adhesion potential.
2.4.2. Fluid composites:
- Fluid composites, thanks to their wettability, allow to ensure an intimate contact with the cavity walls. They find their indications in the obturations, preventive with opening of the pits and grooves, cervical lesions, initial caries on the occlusal surfaces of the temporary teeth.
2.4.3. Condensable composites:
- Compactable composites have a higher load rate than microhybrid composites. They have the advantage of being placed in a single increment (< 2mm). Their use is therefore interesting in pediatric dentistry.
2-5 Preformed pedodontic crowns:
Introduced by Humphrey in 1950, its aim is to restore the coronal morphology of temporary molars. It remains the best solution, in the medium term, for the restoration of very dilapidated teeth (cavities, structural abnormalities), particularly after pulp treatment (pulpotomy or pulpectomy).
- Preformed metal crowns offer many advantages in pediatric dentistry:
– Quick and easy technique (installation in less than 15 minutes);
– Functional reconstruction of the tooth;
– Superior longevity compared to other restorations, particularly those with amalgam;
– Fewer recurrences of caries compared to other restorations;
– Economical catering.
- Indications:
- When the amalgam may not hold on a deciduous molar, for example a class II cavity in which the proximal part is open beyond the morphological angles
- Extensive caries, for example on three or more surfaces.
- Excessive wear of teeth due to bruxism.
- After pulp care, stainless steel crowns are considered the restoration of choice on a primary molar.
- Developmental anomalies, in cases of significant excision (amelogenesis imperfecta, dentinogenesis imperfecta, dental hypocalcification), Stainless steel crowns are useful as an emergency measure to reduce the often extreme sensitivity of these teeth, and allow the patient to eat and maintain effective oral hygiene.
- Surgical technique:
- Tooth preparation: Tooth preparation is based on a “minimum” size which will mainly concern the proximal faces and the occlusal face.
- The vestibular and buccal bulges of the temporary molars will be preserved to increase retention of the cap.
- The occluso-vestibular and lingual angles will be beveled.
- Choice of headdress:
It is done according to the space to be reconstructed. We will measure this space between the distal face of the anterior tooth and the mesial face of the posterior tooth. If one of the two is missing, we will refer to the equivalent tooth on the opposite side.
- Adjusting the headdress:
it will be juxstagingival all around. It can be easily cut with curved scissors. The edges will be carefully rounded with a rubberized grinder
The CCP is tried at each stage, ensuring that it does not whiten the gum too much. Care must be taken to ensure that it does not block in the interproximal spaces (a sign of insufficient preparation and the presence of an edge blocking the adaptation of the CCP).
Restorative therapy in temporary dentition
- Fitting the headdress:
To insert the crown on the prepared tooth, place it on the lingual side and pass it over the preparation to the vestibular limit.
When the crown passes the cervical undercut area, a “click” sound is heard. It is sometimes necessary to apply firm pressure to seat the crown in place.
- The sealing:
Many cements are available today, from zinc oxyphosphate cement to glass ionomer cements with added resin.
Restorative therapy in temporary dentition
- Choice of restoration material in temporary dentition:
The choice of material and restoration technique certainly depends on the mechanical properties of the material itself, but they must also be influenced by the type of temporary tooth to be restored, its stage of development, its residual life on the arch, the extent and location of the loss of substance as well as the cooperation of the young patient.
The therapeutic pyramid indicates, depending on the residual time of the temporary tooth on the arch (average: 7-8 years) and the stage of the carious lesion encountered clinically (in superscript), the different choices of possible materials. This pyramid may evolve depending on the technical improvement of these products or the appearance of new restorative materials (or new preventive techniques). The materials at the base of the pyramid can be used throughout the residual time; conversely, those at the top of the pyramid are not recommended for a longer period.
In addition, these therapeutic indications are adjustable according to the individual caries risk (RCI): the higher the RCI, the less risk we will take and we will therefore choose a material with a long lifespan.
Restorative therapy in temporary dentition
Figure : Indications for restorative therapies according to the residual life of the temporary tooth on the arch (the stages of development are indicated).
- Conclusion :
Restorative therapy in temporary dentition .
- Introduction :
- Restorative dentistry is the final stage when carious lesions have passed the remineralization stage. It is always done to the detriment of dental tissues, which is why it is essential to respect the concepts of dentistry to a minimum in order to preserve and restore them using biocompatible, even bioactive, materials.
- Restoration materials
- The amalgam:
- Amalgam has long been used because of its excellent physical properties
- Despite the many controversies regarding its indication, it still finds its place in restorative materials. Despite its obvious unaesthetic appearance, it is a material whose long-term effectiveness has been proven.
- Its ease of handling and low cost are additional arguments in its favor. However, it requires a mutilating cavity preparation of the tooth; which does not meet the principle of conservative dentistry.
- As a result, its scope of indication will be limited as far as possible.
- Glass ionomer cements: (GIC)
- These materials are characterized by an acid-base reaction, a self-adhesive character to dental tissues and a bioactive character by fluoride release.
- Their poor aesthetic and mechanical properties limit their use, which has led to the improvement of traditional conventional CVIs, and the emergence of new products.
- Hybrid or modified glass ionomers
- addition of CVIMAR resin
- photopolymerizable
- The use of CVI and especially CVIMAR can be used in many clinical situations:
- • Initial remineralization treatment
- • Sealing of pits and fissures
- • Occlusal and cervical restorations in temporary dentition
- • Temporary restorations in patients at high caries risk during the initial phase of treatment, pending favorable conditions for permanent restorations with better durability
- • Durable restorations for non-remineralizable cervical caries (site 3) as well as all restorations using “closed or open” sandwich techniques
- The compomers:
- These are biomaterials for filling that are derived from glass ionomer and composite technology. They consist of an organic matrix of polymers containing polyacid groups. Their setting reaction is obtained by photopolymerization.
- Both compomers and glass ionomers are hydrophilic, which improves their sealing. Since they are not self-adhesive, these materials require the use of an adhesive system.
- These materials have poorer mechanical qualities than composites and their fluoride release is much more limited than that of glass ionomers.
- Their use in temporary dentition should be limited to occlusal and proximal restorations of small extent for a period not exceeding 5 years.
2.4. Composites
Composite resins consist of a matrix of polymers and fillers. Depending on the filler content, several categories are distinguished
2.4.1. Micro-hybrid composites:
- High charge density, small particle microhybrid composites are the materials of choice both in the anterior sector for their optical qualities and in the posterior sector for their mechanical qualities.
- These products are photopolymerizable and require the use of an adhesive system because they do not have their own adhesion potential.
2.4.2. Fluid composites:
- Fluid composites, thanks to their wettability, allow to ensure an intimate contact with the cavity walls. They find their indications in the obturations, preventive with opening of the pits and grooves, cervical lesions, initial caries on the occlusal surfaces of the temporary teeth.
2.4.3. Condensable composites:
- Compactable composites have a higher load rate than microhybrid composites. They have the advantage of being placed in a single increment (< 2mm). Their use is therefore interesting in pediatric dentistry.
2-5 Preformed pedodontic crowns:
Introduced by Humphrey in 1950, its aim is to restore the coronal morphology of temporary molars. It remains the best solution, in the medium term, for the restoration of very dilapidated teeth (cavities, structural abnormalities), particularly after pulp treatment (pulpotomy or pulpectomy).
- Preformed metal crowns offer many advantages in pediatric dentistry:
– Quick and easy technique (installation in less than 15 minutes);
– Functional reconstruction of the tooth;
– Superior longevity compared to other restorations, particularly those with amalgam;
– Fewer recurrences of caries compared to other restorations;
– Economical catering.
- Indications:
- When the amalgam may not hold on a deciduous molar, for example a class II cavity in which the proximal part is open beyond the morphological angles
- Extensive caries, for example on three or more surfaces.
- Excessive wear of teeth due to bruxism.
- After pulp care, stainless steel crowns are considered the restoration of choice on a primary molar.
- Developmental anomalies, in cases of significant excision (amelogenesis imperfecta, dentinogenesis imperfecta, dental hypocalcification), Stainless steel crowns are useful as an emergency measure to reduce the often extreme sensitivity of these teeth, and allow the patient to eat and maintain effective oral hygiene.
- Surgical technique:
- Tooth preparation: Tooth preparation is based on a “minimum” size which will mainly concern the proximal faces and the occlusal face.
- The vestibular and buccal bulges of the temporary molars will be preserved to increase retention of the cap.
- The occluso-vestibular and lingual angles will be beveled.
- Choice of headdress:
It is done according to the space to be reconstructed. We will measure this space between the distal face of the anterior tooth and the mesial face of the posterior tooth. If one of the two is missing, we will refer to the equivalent tooth on the opposite side.
- Adjusting the headdress:
it will be juxstagingival all around. It can be easily cut with curved scissors. The edges will be carefully rounded with a rubberized grinder
The CCP is tried at each stage, ensuring that it does not whiten the gum too much. Care must be taken to ensure that it does not block in the interproximal spaces (a sign of insufficient preparation and the presence of an edge blocking the adaptation of the CCP).
Restorative therapy in temporary dentition
- Fitting the headdress:
To insert the crown on the prepared tooth, place it on the lingual side and pass it over the preparation to the vestibular limit.
When the crown passes the cervical undercut area, a “click” sound is heard. It is sometimes necessary to apply firm pressure to seat the crown in place.
- The sealing:
Many cements are available today, from zinc oxyphosphate cement to glass ionomer cements with added resin.
Restorative therapy in temporary dentition
- Choice of restoration material in temporary dentition:
The choice of material and restoration technique certainly depends on the mechanical properties of the material itself, but they must also be influenced by the type of temporary tooth to be restored, its stage of development, its residual life on the arch, the extent and location of the loss of substance as well as the cooperation of the young patient.
The therapeutic pyramid indicates, depending on the residual time of the temporary tooth on the arch (average: 7-8 years) and the stage of the carious lesion encountered clinically (in superscript), the different choices of possible materials. This pyramid may evolve depending on the technical improvement of these products or the appearance of new restorative materials (or new preventive techniques). The materials at the base of the pyramid can be used throughout the residual time; conversely, those at the top of the pyramid are not recommended for a longer period.
In addition, these therapeutic indications are adjustable according to the individual caries risk (RCI): the higher the RCI, the less risk we will take and we will therefore choose a material with a long lifespan.
Restorative therapy in temporary dentition
Figure : Indications for restorative therapies according to the residual life of the temporary tooth on the arch (the stages of development are indicated).
- Conclusion :
- Pediatric restorative dentistry aims to reconstruct the temporary tooth in its anatomical integrity so that it can fulfill its roles:
- Functional (chewing, speaking, swallowing)
- From space maintainer
- From eruption guide
- Growth (organization of inter-arcade relationships)
- aesthetic.
Restorative therapy in temporary dentition
Baby teeth need to be taken care of to prevent future problems.
Periodontal disease can cause teeth to loosen.
Removable dentures restore chewing function.
In-office fluoride strengthens tooth enamel.
Yellowed teeth can be treated with professional whitening.
Dental abscesses often require antibiotic treatment.
An electric toothbrush cleans more effectively than a manual toothbrush.