Restorative pediatric dentistry, teeth restoration of children, primary teeth restoration, pediatric teeth restoration, Differences in anatomy of Primary teeth, compared with Permanent teeth, Anatomical features of primary teeth, Clinical significance, Restorative materials, Amalgam, Composite, Glass ionomer cement, Stainless steel crowns, Resin-modified glass ionomer, High viscosity glass ionomer, Polyacid-modified Composite resin, Compomer, Guide to the use of restorative materials in pediatric dentistry, class1, class1 occlusal, class2, class 2 proximal, badly destructive tooth, grossly destructive crown, cervical caries, class5, class3 proximal, class3, class4, proximal caries with extension cervically, New techniques for tooth preparation, stainless steel crown, pit and fissure sealant,

1. Advanced restorative dentistry
by Dr. Zainab Mohammed Al-Tawili 1

2. 1. The hydrochloric acid-pumice micro-abrasion technique:
• This is a controlled method of removing surface enamel in order to improve discolorations that are limited
limited to the outer enamel layer. Once completed the procedure should not be repeated again in the future.
by Dr. Zainab Mohammed Al-Tawili 2

3. by Dr. Zainab Mohammed Al-Tawili 3
(a) Characteristic appearance of fluorotic discoloration. (b) Rubber dam isolation with
bicarbonate of soda in position. (c) Application of hydrochloric acid⎯pumice slurry with a
wooden stick. (d) Appearance at 2 years' post-treatment.

4. 2. Non-vital bleaching:
• This technique describes the bleaching of teeth that have become discolored by the diffusion into
diffusion into the dentinal tubules of hemoglobin breakdown products from necrotic pulp tissue.
by Dr. Zainab Mohammed Al-Tawili 4

5. by Dr. Zainab Mohammed Al-Tawili 5
(a) Radiograph of upper right central incisor with a well-condensed root filling.
(b) Standard bur in a contra-angled head may not reach the dento-gingival junction.
(c) Correct depth achieved using a standard bur in a miniature head.

6. by Dr. Zainab Mohammed Al-Tawili 6
(a) and (b) Intensely darkened, non-vital, upper left central incisor treated by four changes
of bleach.

7. 3. The inside/outside bleaching technique:
• an alternative approach to the management of the discoloured endodontically
by Dr. Zainab Mohammed Al-Tawili 7

8. 4. Vital bleaching ⎯ chairside:
• This technique involves the external application of hydrogen peroxide to the surface of the tooth
the tooth followed by its activation with a heat source.
• Indications
• (1) very mild tetracycline staining without obvious banding.
• (2) mild fluorosis.
• (3) yellowing due to ageing.
• (4) single teeth with sclerosed pulp chambers and canals.
• This technique is very time consuming and retreatment may be necessary so the patient
patient must be highly motivated.
by Dr. Zainab Mohammed Al-Tawili 8

9. by Dr. Zainab Mohammed Al-Tawili 9
(a) and (b) A discoloured, upper right central incisor with radiograph confirming sclerosis of the
pulp chamber and root canal. (c) Appearance of upper right central incisor after four chairside
bleaching treatments.

10. 5. Vital bleaching ⎯ night guard:
• This technique involves the daily placement of carbamide peroxide gel into a custom fitted tray of either the
either the upper or the lower arch, it is carried out by the patient at home and is initially done on a daily
daily basis.
• Indications
• (1) mild fluorosis;
• (2) moderate fluorosis as an adjunct to hydrochloric acid-pumice microabrasion;
• (3) yellowing of ageing.
• Carbamide peroxide gel (10%) breaks down in the mouth into 3% hydrogen peroxide & 7% urea. Both urea &
urea & hydrogen peroxide have low molecular weights, which allow them to diffuse rapidly through enamel &
enamel & dentine & thus explains the transient pulpal sensitivity occasionally experienced with home bleaching
bleaching systems.
by Dr. Zainab Mohammed Al-Tawili 10

11. 6. Localized composite resin restorations:
• This restorative technique used to replace
• defective enamel with a restoration that bonds to and blends with enamel.
• Indications
• Well-demarcated white, yellow, or brown hypomineralised enamel.
by Dr. Zainab Mohammed Al-Tawili 11

12. by Dr. Zainab Mohammed Al-Tawili 12
(a) and (b) Well-demarcated white opacities on the upper central incisors treated by
localized composite restorations.

13. 7. Composite resin veneers
• Although the porcelain jacket crown (PJC) may be the most satisfactory long-term
restoration for a severely hypoplastic or discoloured tooth, it is not an appropriate solution
solution for children for two reasons:
(1)the large size of the young pulp horns and chamber.
(2)the immature gingival contour.
• Indications
(1) Discoloration; (2) Enamel defects;
(3) Diastemata; (4) Malpositioned teeth;
(5) Large restorations.
by Dr. Zainab Mohammed Al-Tawili 13

14. 7. Composite resin veneers
• Contraindications
• (1) insufficient available enamel for bonding;
• (2) oral habits, e.g. woodwind musicians.
• The exact design of the composite veneer will be dependent upon each clinical case, but will
will usually be one of four types:
• Intraenamel or window preparation.
• Incisal bevel.
• Overlapped incisal edge.
• Feathered incisal edge.
by Dr. Zainab Mohammed Al-Tawili 14

15. by Dr. Zainab Mohammed Al-Tawili 15
(a) A young patient with amelogenesis imperfecta. (b) Contoured matrix strip in position. (c)
Incremental placement of dentine shade composite. (d) Postoperative view showing final
composite veneers.

16. by Dr. Zainab Mohammed Al-Tawili 16
Types of veneer
preparation.

17. 8. Porcelain veneers:
• Porcelain has several advantages over composite as a veneering material: its
appearance is superior; it has a better resistance to abrasion; and it is well tolerated
tolerated by the gingival tissues.
by Dr. Zainab Mohammed Al-Tawili 17

18. by Dr. Zainab Mohammed Al-Tawili 18
(a) Peg-shaped lateral incisors in a 15-year old. (b) Laboratory model showing three-quarter
wrap-around,
porcelain veneers on the upper laterals. (c) Final restorations on the upper laterals 2 years' post
cementation.

19. • Adhesive metal castings:
• fabrication of cast occlusal onlays for posterior teeth and palatal veneers for
incisors and canines.
• These restorations are manufactured with minimal or no tooth preparation and
preparation and are ideal for cases where there is a risk of tooth tissue loss.
loss.
• Indications
• (1) amelogenesis imperfecta; (2) dentinogenesis imperfecta;
by Dr. Zainab Mohammed Al-Tawili 19

20. by Dr. Zainab Mohammed Al-Tawili 20
(a) Marked occlusal enamel loss of lower first permanent molars.
(b) Cast occlusal onlays in situ after replacement of amalgam restorations with
composite resin.

21. • Indirect composite resin onlays
• An alternative to cast metal onlays are indirect composite onlays. In addition to the
to the obvious aesthetic advantages these restorations can be modified relatively
relatively easily.
• The disadvantage of these restorations is that they need to be thicker than their
than their cast counterparts, are bulkier and can cause greater increases in
in vertical dimension.
by Dr. Zainab Mohammed Al-Tawili 21

22. by Dr. Zainab Mohammed Al-Tawili 22
Direct Composite Onlays made for lower posterior quadrants.

23. • There are three processes that make up the phenomenon of tooth wear:
• (1) Attrition : wear of the tooth as a result of tooth-to-tooth contact;
• (2) Erosion :irreversible loss of tooth substance brought about by a chemical process that does not
involve bacterial action;
• (3) Abrasion : physical wear of tooth substance produced by something other than tooth-to-tooth
contact.
• In children, abrasion is relatively uncommon.
• Smith and Knight in 1984 described a Tooth Wear Index (TWI), which included certain features that
features that they felt were diagnostic of pathological tooth wear.
• In young patients there are three main causes of tooth surface loss:
• (1) dietary. (2) gastric regurgitation.
• (3) parafunctional activity. (4) environmental factors
by Dr. Zainab Mohammed Al-Tawili 23

24. by Dr. Zainab Mohammed Al-Tawili 24

25. • The degree of erosive, tooth-surface loss may be related to:
• The frequency of intake.
• The timing of intake.
• Tooth brushing habits.
• perimolysis: A generalized loss of the surface enamel of posterior teeth is often
evident particularly
• on the first permanent molars, and characteristic saucer-shaped lesions develop on
develop on the cusps of the molars.
by Dr. Zainab Mohammed Al-Tawili 25

26. • Gastric regurgitation and tooth surface loss:
• The etiology of gastric regurgitation may be divided into two categories:
• (1) those with upper gastrointestinal
• (2) those with eating disorders.
by Dr. Zainab Mohammed Al-Tawili 26

27. by Dr. Zainab Mohammed Al-Tawili 27
(a) and (b) Teeth of a teenager who consumed considerable amounts of carbonated
drinks. Note chipping of incisal edges and characteristic palatal tooth surface loss.

28. by Dr. Zainab Mohammed Al-Tawili 28
(a) and (b) Upper and lower arch of a 10-year-oldboy with chronic gastro-
esophageal reflux.

29. • Immediate
• The most important aspect of the management of tooth surface loss is early diagnosis. So
diagnosis. So start with dietary counselling
• Definitive treatment
• Main treatment objectives for tooth-surface loss:
• Resolve sensitivity.
• Restore missing tooth surface.
• Prevent further tooth tissue loss.
• Maintain a balanced occlusion.
by Dr. Zainab Mohammed Al-Tawili 29

30. by Dr. Zainab Mohammed Al-Tawili 30
(a) and (b) Cast palatal veneers on upper central incisors. Note the 'shine through'
despite placement of labial composite veneers.

31. Reference:
by Dr. Zainab Mohammed Al-Tawili 31