30: Pediatric Dental Procedures

Chapter 30 Pediatric Dental Procedures

Relevance to Esthetic Dentistry

Parents are more concerned about esthetics than ever before. In the past, parents accepted whatever restoration the dentist used, whether it was dental amalgam or stainless steel crowns. Those are still used in pediatric dentistry, but parents are asking more and more that the dentist incorporate an esthetically desirable approach into the restorative dentistry or other procedures. It may be an extension of the phenomenon in society that everything is about esthetics, perhaps as a result of the consumer marketing world or the professional world of dentistry. In pediatric dentistry, parents are typically young and often have had whitening or veneers. The difference between adult dentistry and pediatric dentistry with regard to esthetics is that pediatric patients are rarely brought in specifically for esthetic purposes. Esthetics is an added part of restoration fairly exclusively, whereas in adult dentistry esthetics is often the primary objective.

Effect of Esthetically Undesirable Teeth on Child’s Self-Image, Growth, and Development

If a child loses the primary maxillary incisors prematurely, that is, before the permanent successors are erupted, he or she can have 2 or 3 years during which there is a space. The child might be made fun of in school or other social situations. Many studies show that children with crowded teeth may have low self-esteem.1,2 A main cause of crowding in the permanent dentition is space lost in the primary dentition because orthodontic treatment was not performed. If the skeletal causes of orthodontic problems are excluded, crowding in the permanent dentition most often results from the early loss of primary teeth through decay or infections. Space may also be lost without loss of the tooth when an interproximal caries lesion remains untreated. Clearly the primary dentition can have an effect on the permanent dentition and can potentially damage the child’s self-esteem.

Clinical Considerations

Primary Anterior Teeth

The greatest area of challenge in primary anterior teeth is the degree of surface decay present. Typically, interproximal and lingual decay sites are found in early childhood caries, formerly termed nursing bottle decay. Restoring these teeth esthetically with composite is a significant challenge for pediatric dentists because these lesions are mostly close to the pulp and may extend subgingivally. It is necessary to determine the pulp’s status before the tooth is restored. If the pulp is involved in the preparation, with or without disease, pulpectomy should be included in the treatment plan. The diameter of the crown mesio-distally is greater than the length cervico-incisally, which makes the tooth appear wider. The retention of the restoration is compromised by the short crown length.

Treatment of Choice

Resin Composite (Strip) Crowns

Resin composite crowns are the most esthetically desirable anterior restorations for primary anterior teeth but are also among the most technique-sensitive procedures. With crowding of the anterior teeth, it is quite challenging to perform a direct composite restoration. Also, primary teeth are whiter than permanent teeth. Most of the time, shade A1 or Extra White must be used. If in doubt, a tab of composite can be placed on the tooth and light cured to account for the shade changes occurring during polymerization. Once the proper shade has been selected, the process continues using that composite. Figure 30-1 presents an example of adhesively bonded resin composite (strip) crowns.

Summary—Primary Anterior Teeth

Esthetically, resin composite crowns are the best option among the other substitutes. In terms of gingival health, properly finished resin composite crowns are also better than either stainless steel crowns with window facings or veneered stainless steel crowns. However, adequate remaining tooth structure and controllable gingival hemorrhage are crucial for their success. Studies have reported high parental satisfaction with veneered stainless steel crowns.4,5 The failure of the resin facings can be problematic, and these crowns cannot be repaired easily, as opposed to resin composite crowns. The stainless steel crowns with window facings are very retentive and can be used for teeth with minimal remaining structure. The facings may be dislodged as with veneered stainless steel crowns. Owing to their time-consuming and compromised esthetics compared with other options, stainless steel crowns are not very promising for a future in which alternative and easier solutions may be available.

Jan 3, 2015 | Posted by in Esthetic Dentristry | Comments Off on 30: Pediatric Dental Procedures
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