Operative Dentistry in pediatric department.ppt

PEDIATRIC OPERATIVE
DENTISTRY
Thursday, March 21, 2024 1

Acc to AAPD the objectives of restorative
treatment are to
repair or limit the damage from dental caries
protect and preserve the tooth structure
re-establish adequate function
restore esthetics ( where applicable)
provide ease in maintaining good oral hygiene.

REASONS FOR PRESERVATION OF PRIMARY TEETH
Necessary till the succedaneous teeth replace them
Mastication of food
Preservation and increase in arch length
Development of speech and phonetics
Prevention of any infection or caries to the
permanent teeth
Prevention of malocclusion of permanent teeth
Esthetics

 Smaller
 More
bulbous
 Cervical
constriction
 Narrow
occlussal
table

 Pulpal outline follows DEJ more
closely than in permanent tooth.
 Longer & more pointed pulp
horns.
 Less bulk/ thickness of dentin
 Larger pulp
 Thin enamel of uniform
thickness,which is parallel to DEJ
 Enamel rods are directed occlusally
at cervical third

 Occlusal anatomy of primary teeth not well defined &
supplemental grooves less common- cavity prep
sh/be kept more conservative
 Enamel thinner-cavity prep sh/ be kept shallow
 Pulp horns extend a greater distance into crown of
tooth – cavity sh/ be conservative to avoid pulpal
exposure
 Exaggerated cervical bulge- matrix adaptation
difficult – construction of a custom matrix to fit the
teeth

 Direction of enamel rods in cervical region or
gingival third of primary teeth extend from the
DEJ occlusally or horizontally- eliminates the need
for a gingival bevel in CL II prep.
 Interproximal contacts of primary molars are
generally broad, elliptical, flat & cervically placed –
require wide proximal cavity prep.

 CLASS I-
 All pit and fissure cavities
 Occlusal surfaces of posterior teeth
 Occlusal 2/3 of buccal and lingual surfaces of
premolars & molars
 Lingual surfaces of anterior teeth.
 CLASS II-
 All proximal surface cavities on the premolars and
molars.

 CLASS III-
 All proximal surface cavities on the incisors and
canines which do not involve the removal and
restoration of the incisal angle.
 CLASS IV-
 All proximal surface cavities on the incisors and
canine which involve the removal and restoration
of the incisal angle.
 CLASS V-
 All gingival cavities located within the gingival one
third of the tooth. These may be either on the
facial or lingual Gingival one third of the tooth

 CLASS VI-
 Cavities on the incisal edges and cusp tips of all
teeth.
Acc to some authors-MOD cavities are Cl VI
cavities

Mount & Hume (1998) classification
The three sites of carious lesions:
 Site 1- Pits, fissures and enamel defects on
occlusal surfaces of posterior teeth or other
smooth surfaces
 Site2- Proximal enamel immediately below areas
in contact with adjacent teeth
 Site3-The cervical one-third of the crown or,
following gingival recession, the exposed root.
(Australian dental journal 1998)

The four sizes of carious lesions:
Size 1- Minimal involvement of dentin just
beyond treatment by remineralization
alone.
Size2- Moderate involvement of dentin.
Following cavity preparation, remaining
enamel is sound, well supported by dentin
and not likely to fail under normal occlusal
load. The remaining tooth structure is
sufficiently strong to support the
restoration.

Size 3- The cavity is enlarged beyond
moderate. The remaining tooth structure
is weakened to the extent that cusps or
incisal edges are split, or are likely to fail
or left exposed to occlusal or incisal load.
The cavity needs to be further enlarged
so that the restoration can be designed to
provide support and protection to the
remaining tooth structure.
Size 4- Extensive caries with bulk loss of
tooth structure has already occurred.

(OLD CONCEPT- EXTENSION FOR PREVENTION)
• Cavity design dictated by site & extent of lesion.
• No need to extend cavity into the “caries free” area.
• Biologically active restorative material which
assists remineralization & healing of remaining
tooth structure.
• ONLY Irretrievable/ degenerated/ broken down
tooth surface to be removed.
• Completely control plaque accumulation by
eliminating surface cavitation as a result of caries.

 MINIMAL INTERVENTION
 MINIMALLY INVASIVE TECHNIQUE
 PRESERVATIVE DENTISTRY

Blacks concept extension for prevention.
1. Obtaining Outline form
2. Obtaining Resistance form
3. Obtaining Retention form
4. Obtaining Convenience form
5. Removal of infected dentin
6. Finishing enamel walls
7. Debridement /toilet of the cavity
Thursday, March 21, 2024
16

PREPARATION OF CLASS I CAVITY

 The extension and depth of the cavity will be
determined by the amount and location of caries
and preoperative occlusal anatomy. Every effort
should be made to retain as much well-supported
enamel as possible.
 The maximum inter cuspal cavity width should be
one-quarter to one-third of the inter cuspal width.
 0.5 mm pulpally to the DEJ to provide sufficient
bulk of amalgam to with stand occlusal forces.
 Pulpal floor should be flat & smooth
 Internal line angles should be rounded to reduce
any stresses in the set amalgam.

 The extension is made, buccal or lingual
cavity walls should be straight and either
parallel or converging occlusally
 The extension should be cut 0.5 mm into
dentine and should extend gingivally to
include the developmental pits.
 Retention grooves can be place in dentine
if considered necessary.
 The ‘isthmus’ area where the extension
meets the occlusal section can be rounded
or beveled to increase the bulk of
amalgam. as it is subjected to heavy
stresses during lateral movements

 Class II Cavity
(1) Outline: The outline follows the fissure pattern
so as to prevent secondary caries occurring
adjacent to the restoration. A smooth flowing
outline reduces stress and permits better of
the amalgam.
(2) Isthmus: This should be between 1/4 of the
inter cuspal distance (approximately 1.5 mm)

(3) Depth: This should be 0.5 mm below
dentino-enamel junction or 1.5 mm from the
cavosurface (i.e.. 'a'.)
(4) Internal angles: All the internal angles
should be rounded so as to limit stress and
to ensure that amalgam can be easily packed
into these regions.
(5) Pulpal floor: Pulpal floor should be slightly
concave.

(6) Buccal and lingual walls: should be converging
so making the cavity retentive. Also, the
cavosurface angle needs to be a right angle to
ensure maximum strength at the enamel-amalgam
junction.
(7)Gingival floor: should be located just below the
contact area with the adjacent tooth. But
supragingivally.

(8) Axial wall: The width of the floor of the box
should be approximately 1 mm. follows
external contour of tooth.
(9) Buccal and lingual walls: These should be
convergent, parallel to the appropriate
external surface and make a cavo surface
angle of 90 degree.
(10) Axio-pulpal line angle: This should be
rounded which gives the maximum thickness
of amalgam with the minimum of stress in this
area.

(11) Retention grooves- made to enhance
retention.
(12) Occlusal dovetail -It should be made
including all carious areas and shape
should be such that it locks the occlusal
portion of filling.

PROXIMAL BOX OF DECIDUOUS TEETH
• Box converges occlusally
• Minimal flare to prevent weakening of
enamel walls
• Isthmus 1/4th to 1/5th inter cuspal
width
•Rounded axio-pulpal angle grooved to
increase retention
•No bevel in gingival seat
•Depth minimal to prevent pulp
exposure at cervial constriction
•Wide gingival floor

DIAGRAM ILLUSTRATING THE INCREASED
DANGER OF PULP EXPOSURE WHEN THE
GINGIVAL WALL IS CARRIED TOO DEEPLY

•Shallow groove
•Cervical seat
•Labial & lingual locks
•Proximal slice

CLASS 1V CAVITY

 They hold the restorative material in the
cavity, restore the tooth to original form
and preserve the arch length and
anatomic function.
 The matrix band should be rigid enough
to allow adequate packing pressure,
ensuing a well-condensed restoration
free from an excessive mercury.
 Should also prevent extension of excess
restorative material beyond the band
into the gingival tissue causing over
hanging amalgam restoration.

DIFFERENT MATRIX
BANDS AND RETAINERS

1. Matrices for Class I cavity (compound cavity)
Double banded tofflemire
2. Matrices for Class II
 Single banded tofflemire
 Ivory matrix No. 1
 Ivory matrix NO. 8
 Black's matrices
 Soldered band matrix
 Anatomical matrix
 Auto-matrix
 S-shaped matrix band
 T-shaped matrix band
3. Matrices for a cavity preparation for amalgam on distal of
cuspid.
 S shaped matrix
 Tofflemire

4. Matrices for Class III for tooth coloured
restorations
 Transparent celluloid strips
5. Matrices for Class IV for tooth coloured
restorations
 Celluloid strips
 Aluminum foil (non-light cure)
 Anatomic matrix .
 Modified S shaped band of copper, tin, aluminum
foil (non-light cure)

 A stainless steel band material of
0.00508cm x 1.27cm x 3.81cm (0.002"x
3/6" x 1W') size is taken.
 Gripping band material with plier, it is
tightly adapted around the tooth for which
band has to be formed. In most of the
teeth the band should be made buccally,
i.e. ends of the band should be buccally
 Band is taken out by holding it with pliers.
Both the ends of the band material are
spot welded.

 Excess of the material is cut and removed
carefully. The band is fitted on the tooth. It
should fit tightly on the tooth surface. Mark the
band according to the height and contour. Band
height should not be above the marginal ridge
of the adjoining tooth.
 Wedge is inserted in the gingival embrasure for
the tight fitting & adaptation of the band
 Wedge should be inserted from the lingual side.
 Further burnishing of the band provides better
adaptation.

 It is available in two widths, broad and narrow.
Broad is used for permanent teeth and narrow
is used for deciduous teeth.
 They are made up of soft metal strip. This type
of band matrix can fit and adapt to most of the
teeth properly for proximal surface fillings.
 Its use is simple and easy. It can be easily
prepared, contoured, placed and removed from
deciduous and permanent teeth.
 To reduce the chair side time, the loop of
approximate size of the diameter of the tooth
can be prepared in advance.

 Sectional matrix with G-rings (retainers) for
postcrior composites

 Q.1) Enamel rods at cervical third in primary
teeth are directed
1. Vertically
2. Occlusally
3. Cervically
4. In any of the above directions

 Q. 2) As compared to permanent teeth,
supplemental grooves are
1. More common in primary teeth
2. Less common in primary teeth
3. More deep in primary teeth
4. Both 2) and 3)

 Q. 3) While preparing Cl. II Cavity in Primary
teeth
1. Gingival bevel should be kept minimal.
2. It is not made at all.
3. It is more pronounced in primary teeth.
4. Modified according to morphology of teeth

 Q. 4) As compared to permanent teeth
interproximal contacts in primary
teeth are
1. More pointed and more cervically placed
2. More pointed and more occlusally placed
3. Broader and more cervically placed
4. Broader and more occlusally plced

 Q. 5) The maximum inter cuspal cavity width
in Cl II cavity preparation in primary
teeth should be
1. one-quarter to one-third of the inter cuspal
width
2. one-third to two- third of the inter cuspal
width
3. Half of the inter cuspal width
4. Half to two- third of the inter cuspal width

 Q. 6) According to BLACK’S CLASSIFICATION
CLASS II cavity includes
1. All proximal surface cavities on the
premolars and molars.
2. All proximal surface cavities on all the
teeth.
3. All proximal surface cavities on the
incisors and canine which involve the
removal and restoration of the incisal angle.
4. Occlusal 2/3 of buccal and lingual surfaces of
premolars & molars

 Q. 7). The purpose of the matrix bands is to
1. hold the restorative material in the cavity
2. restore the tooth to original form
3. preserve the arch length and anatomic
function
4. All of the above

 Q. 8) G-Rings are used in maintenance of
1. Proximal contacts for restoration of
posterior teeth with composites
2. Proximal contacts for restoration of
anterior teeth with composites
3. Both of the above
4. None of the above

 Q.1-2
 Q.2-2
 Q.3-2
 Q.4-3
 Q.5-1
 Q.6-1
 Q.7-4
 Q.8-1

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