PEDIATRIC OPERATIVE DENTISTRY Saturday October 31 2020 1

PEDIATRIC OPERATIVE DENTISTRY Saturday, October 31, 2020 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. Saturday, October 31, 2020 2

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 Saturday, October 31, 2020 3

Smaller More bulbous Cervical constriction Narrow occlussal table Saturday, October 31, 2020 4

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 Saturday, October 31, 2020 5

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 Saturday, October 31, 2020 6

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. Saturday, October 31, 2020 7

CLASS IØ All pit and fissure cavities Ø Occlusal surfaces of posterior teeth Ø Occlusal 2/3 of buccal and lingual surfaces of premolars & molars Ø Lingual surfaces of anterior teeth. CLASS IIØ All proximal surface cavities on the premolars and molars. Saturday, October 31, 2020 8

CLASS III- Ø All proximal surface cavities on the incisors and canines which do not involve the removal and restoration of the incisal angle. CLASS IVØ All proximal surface cavities on the incisors and canine which involve the removal and restoration of the incisal angle. CLASS VØ 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 Saturday, October 31, 2020 9

CLASS VIØ Cavities on the incisal edges and cusp tips of all teeth. Acc to some authors-MOD cavities are Cl VI cavities Saturday, October 31, 2020 10

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 Site 2 - Proximal enamel immediately below areas in contact with adjacent teeth Site 3 -The cervical one-third of the crown or, following gingival recession, the exposed root. (Australian dental journal 1998) Saturday, October 31, 2020 11

The four sizes of carious lesions: Size 1 - Minimal involvement of dentin just beyond treatment by remineralization alone. Size 2 - 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. Saturday, October 31, 2020 12

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. Saturday, October 31, 2020 13

• (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. Saturday, October 31, 2020 14

MINIMAL INTERVENTION MINIMALLY INVASIVE TECHNIQUE PRESERVATIVE DENTISTRY Saturday, October 31, 2020 15

Blacks concept extension for prevention. 1. 2. 3. 4. 5. 6. 7. Obtaining Outline form Obtaining Resistance form Obtaining Retention form Obtaining Convenience form Removal of infected dentin Finishing enamel walls Debridement /toilet of the cavity 16 Saturday, October 31, 2020

PREPARATION OF CLASS I CAVITY Saturday, October 31, 2020 17

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. Saturday, October 31, 2020 18

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 Saturday, October 31, 2020 19

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) Saturday, October 31, 2020 20

(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. Saturday, October 31, 2020 21

(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. Saturday, October 31, 2020 22

(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. Saturday, October 31, 2020 23

(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. Saturday, October 31, 2020 24

PROXIMAL BOX OF DECIDUOUS TEETH • Box converges occlusally • Minimal flare to prevent weakening of enamel walls • Isthmus 1/4 th to 1/5 th 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 Saturday, October 31, 2020 25

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DIAGRAM ILLUSTRATING THE INCREASED DANGER OF PULP EXPOSURE WHEN THE GINGIVAL WALL IS CARRIED TOO DEEPLY Saturday, October 31, 2020 27

• Shallow groove • Cervical seat • Labial & lingual locks • Proximal slice Saturday, October 31, 2020 28

CLASS 1 V CAVITY Saturday, October 31, 2020 29

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. Saturday, October 31, 2020 30

DIFFERENT MATRIX BANDS AND RETAINERS Saturday, October 31, 2020 31

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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 Saturday, October 31, 2020 33

4. Matrices for Class III for tooth coloured restorations Ø Transparent celluloid strips 5. Matrices for Class IV for tooth coloured restorations Ø Celluloid strips Ø Aluminum foil (non-light cure) Ø Anatomic matrix. Ø Modified S shaped band of copper, tin, aluminum foil (non-light cure) Saturday, October 31, 2020 34

A stainless steel band material of 0. 00508 cm x 1. 27 cm x 3. 81 cm (0. 002"x 3/6" x 1 W') 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. Saturday, October 31, 2020 35

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. Saturday, October 31, 2020 36

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. Saturday, October 31, 2020 37

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Sectional matrix with G-rings (retainers) for postcrior composites Saturday, October 31, 2020 40

1. 2. 3. 4. Q. 1) Enamel rods at cervical third in primary teeth are directed Vertically Occlusally Cervically In any of the above directions Saturday, October 31, 2020 41

1. 2. 3. 4. Q. 2) As compared to permanent teeth, supplemental grooves are More common in primary teeth Less common in primary teeth More deep in primary teeth Both 2) and 3) Saturday, October 31, 2020 42

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 Saturday, October 31, 2020 43

1. 2. 3. 4. Q. 4) As compared to permanent teeth interproximal contacts in primary teeth are More pointed and more cervically placed More pointed and more occlusally placed Broader and more cervically placed Broader and more occlusally plced Saturday, October 31, 2020 44

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 one-third to two- third of the inter cuspal width Half to two- third of the inter cuspal width 2. 3. 4. Saturday, October 31, 2020 45

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 Saturday, October 31, 2020 46

1. 2. 3. 4. Q. 7). The purpose of the matrix bands is to hold the restorative material in the cavity restore the tooth to original form preserve the arch length and anatomic function All of the above Saturday, October 31, 2020 47

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 Saturday, October 31, 2020 48

Q. 1 -2 Q. 2 -2 Q. 3 -2 Q. 4 -3 Q. 5 -1 Q. 6 -1 Q. 7 -4 Q. 8 -1 Saturday, October 31, 2020 49