About restoring teeth in child

1. Restorative
paediatric dentistry

2. Why Restore Primary Teeth?
• Restore the damage caused by dental caries.
• Protect and preserve the remaining pulp and tooth structure; thereby managing and
preventing symptoms and pain.
• Retain adequate function.
• Restore aesthetics (where applicable).

3.  • Facilitate easy maintenance of good oral hygiene.
 • Maintain arch length and space for the developing permanent
dentition.

4. Primary Versus Permanent Teeth

5. Restorative materials

6.  Amalgam
Historically, due to its simplicity, dental amalgam was the most
popular restorative material. However today, as a result of concerns
surrounding its potential toxicity and unfavourable aesthetics,
amalgam is rarely used in the primary dentition. Indeed, in some
parts of the world, it has been banned in children altogether. Today,
dental amalgam has been largely superseded by alternative
materials and techniques in the restoration of the primary dentition.

7.  Glass Ionomer Cements (GICs)
A glass ionomer consists of a basic glass and an acidic water-soluble
powder that sets by an acid–base reaction between the two components. A
principal benefit of GIC is that it will adhere chemically to dental hard
tissues. A number of GICs are available on the market today, each having its
advantages and disadvantages, however indications for the use of GICs are
limited and inappropriate use is likely to lead to failure.

8.  Conventional GICs
Conventional GICs are chemical-set glass ionomers with the weakest mechanical
properties. The initial setting reaction is complete within minutes but the material
continues to ‘mature’ over the following months. It is important to protect these materials
from salivary contamination in the hours following placement or the material may shrink,
crack and even debond. Adhesion of all GICs may be enhanced by the use of a dentine
conditioning agent before placement. Today, chemically curing GICs are available as both
restorative and protective sealant types of materials with high fluoride releasing properties.

9.  High-viscosity GICs
High-viscosity GICs were developed for the atraumatic restorative technique (ART).
These chemically cured materials have significantly better mechanical properties
than the conventional GICs and are fast setting. Research suggests that these
materials have a durability comparable with amalgam, when used in occlusal (Class
I) restorations in primary teeth, although the success rate is lower in inter-proximal
(Class II) restorations, when other materials should be considered.

10.  Resin-modified glass ionomer cements
Resin-modified glass ionomer cements were developed to overcome the problems of
moisture sensitivity and low initial mechanical strength. They consist of a GIC along with a
water-based resin system which allows photopolymerization to occur before the acid–base
reaction of the glass ionomer is complete. This reaction then occurs within the light
polymerized resin framework. The resin increases the fracture strength and wear resistance
of the GIC. Resin modified GICs are manufactured as restorative and lining materials for use
in both primary and permanent teeth.

11.  Composite Resins
Resin-based composites (along with photopolymerization) have revolutionized clinical
dentistry. 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, as there is no doubt that patient compliance and
adequate moisture isolation can prove difficult in the younger, more challenging child. There
is little evidence to support this approach and yet, the demand for aesthetic restorations
makes this an attractive option.

12.  Compomers (Polyacid-Modified Composite Resin)
Polyacid-modified resin composite resins or ‘compomers’ are materials that
contain a calcium aluminium fluorosilicate glass filler and polyacid
components. They contain either or both essential components of a GIC.
However, they are not water-based and therefore no acid–base reaction can
occur. As such, they cannot strictly be described as a glass ionomer. They
set by resin photopolymerization. The acid–base reaction does occur in the
moist intra-oral environment and allows fluoride release from the material.
Successful adhesion requires the use of dentine-bonding primers before
placement.

13.  Stainless Steel Crowns
 Stainless steel crowns are preformed extra-coronal restorations that are
particularly useful in the restoration of large multisurface cavities and grossly
broken down teeth. They cover the entire clinical crown and therefore
recurrent or further caries is very unlikely. Placement of traditional stainless
steel crowns is associated with considerable tooth preparation that can be
challenging for patient and clinician alike. However, the introduction of
minimal intervention sealed restorations (known as the ‘Hall crown technique’)
has made the use of these restorations more realistic. They are, without doubt,
the most durable restoration in the primary dentition and should be the
technique of choice in the high-caries mouth.

14. Choice Of Materials
 Age
 Caries risk
 Cooperation of the child
 Restorative implications of behaviour management