Operative Dentistry in Children II Flashcards
What is the aim of disking and fluoride and how is it carried out?
- Remove carious enamel/outer layer of dentine w/o restoration, followed by high fluoride application
- Usually using interprox bur
- Aim: create self-cleansing surfaces
What are the indications for disking and fluoride?
- Primary anterior teeth (lower > upper)
- Tooth near exfoliation but not loose yet (about 5-6 y/o)
- Shallow & wide caries in uncooperative px (resto likely to be non-retentive)
What are the advantages of disking and fluoride?
- Simple
- Inexpensive
- Requires minimal cooperation
What are the advantages and disadvantages of composite strip crowns?
Advantage: Aesthetic
Disadvantages:
- Moisture control imperative
- Expensive
- Cooperation needed
- Contraindicated for px who grind teeth
What are the clinical steps for a composite strip crown?
- LA + RDI
- Select size of strip crown and colour
- Prepare strip crown – cut along desired margin + small hole on palatal to allow excess to flow out
- Prepare tooth – caries free + crown reduction + crown margin
- Check fit
- Fit CR-loaded crown on tooth – check angulation, remove excess, cure
- Remove strip crown
- Polish – margins + venting hole
What are some things to note when preparing a tooth for a composite strip crown?
Caries free
- If near pulp, line w Vitrebond
- If pulp expose, do pulp therapy
Crown Reduction
- Incisal 2mm
- Proximal clear contact
Crown Margin
- Feather edge/light chamfer
- Supragingival
What material are stainless steel crowns made of?
Nickel-Chromium (must check allergies)
What are the advantages of SSCs?
- High strength
- Low chance of recurrent caries (highest success rate) => rarely needs to be replaced
- Moisture control not an issue
What are the disadvantages of SSC?
- Poor aesthetics
- Chairside time ↑ due to tooth prep
- Gingival inflammation (might have pus)
What are some problems faced when placing SSCs + possible future negative consequences of SCCs?
- Significant space loss (e.g mesial drift) => difficult/unable to fit
- Swallowed/aspirated/lost
- Impact/obstruct permanent teeth eruption (e.g permanent 6 caught under bulbosity)
What are the indications for SSCs?
- Grossly broken down teeth, but still restorable (usually as long as 1 wall left, can restore) – SSCs > Class II restorations **
- Previous pulp tx **
- Hypoplastic primary/permanent molars (AI, MIH)
- High caries risk
- Abutment for space maintainer
- Situations where other restorative materials will fail
- Posterior teeth only **
What are the contraindications for SSCs?
- Unresolved/severe periodontal/PA pathology
- Exfoliating tooth within 6-12 months
- Uncooperative px (might struggle until aspirate crown)
- Nickel allergy (Type III hypersensitivity, contact dermatitis)
What are the general steps for SSCs?
- LA
- Prepare tooth
- Fitting
- Cementation (crown about 1/2 filled with cement – must have excess after seating)
What are the things to note when preparing a tooth for SSC?
Crown margin: feather edge
Crown Reduction
- Occlusal: 1.5mm, maintain occlusal contour
- Proximal: explorer tip can pass through contact
- Buccal & lingual: minimal => surfaces needed for retention
What are some things to note when checking the fit of a SSC?
Trial fit in lingual to buccal direction (cervical bulge on buccal => interference)
Crown Margin
- 1-2mm subG (caries usually at gingival margin)
- No excessive gingival blanching
Check Fit
- Seat w “click” & not easily removed w finger pressure
- Explorer not able to go btw tooth & crown
- Adjust tightness: close crown margins using crimper/contouring pliers
- Check occlusion
