Quick reference/description
Overview
Treatment | Indications | Advantages | Disadvantages |
---|---|---|---|
I. Interim restorations | |||
Glass ionomer | Pain Sensitivity | Short-term alleviation of pain and sensitivity Short-term management of tooth surface loss Fluoride release and ease of application | Not a definitive restorative treatment |
II. Longer term restorations of posterior teeth | |||
Composite resin restorations | Defect is demarcated to a defined area, not more than two surfaces No significant sensitivity Supragingival margins of the defect | Tooth coloured, good compressive strength | Hypomineralised enamel can potentially reduce the strength and integrity bond of enamel to composite resin Further tooth structure loss leading to defective restorations |
Preformed metal crowns | The defect involves multiple surfaces There is significant sensitivity Margins of defects are subgingival There is involvement of the cusp tips in posterior teeth Enamel is prone to “chipping,” especially in some cases of hypocalcified Amelogenesis imperfecta (AI) Uncooperative child requiring treatment under general anaesthesia as such child would not allow further treatment in the future | Good occlusal support provided by stainless steel crowns Requires minimal tooth preparation less bulky Failure rate is much less than other restorative materials Moisture control is less critical than when restoring with other materials Placement is less time consuming than resin restorations Are more cost effective as shown by the outcomes over time | Low esthetic results due to full tooth silver colour |
Pre-veneered metal crowns and white crowns | Large lesions involving multiple surfaces Subgingival lesions Sensitivity | Good esthetic results | Require more extensive crown preparation Higher cost Chipping can occur in the pre-veneered metal crowns Subgingival preparation in the zirconia crowns with more tooth structure loss Possibility of pulp exposures compromising pulpal health No available high-quality long-term success studies |
III. Longer term restorations of anterior teeth | |||
Composite restorations | Demarcated lesions Large lesions involving multiple surfaces Sensitivity | Good esthetic results | Require tooth surface removal |
Composite veneers | Diffuse lesions Large lesions involving multiple surfaces Sensitivity | Good esthetic results | Bulkier teeth Risk of composite chipping |
Full coverage white crowns | Diffuse lesions Large lesions involving multiple surfaces Subgingival lesions Sensitivity | Good esthetic results | Require more extensive crown preparation Higher cost Chipping can occur in the pre-veneered metal crowns Subgingival preparation in the zirconia crowns with more tooth structure loss Possibility of pulp exposures compromising pulpal health No available high-quality long-term success studies |
IV. Extraction of primary teeth with DDE (developmental defects of enamel) | Extensive tooth surface loss resulting in unrestorable teeth Pulpal involvement-irreversible pulpitis/necrotic pulps | Space required for developing dentition may be affected |
Materials/instruments
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Resin-modified glass ionomer (Fuji VII/triage, GC Corporation, Singapore)*
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Compomer materials (Esthet.X, Dentsply, Surrey, UK)*
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Preformed metal crowns (3M™ ESPE™ Stainless Steel Primary Molar Crowns, USA)*1
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Pre-veneered metal crowns and white crowns such as NuSmile signature, pre-veneered kinder crowns®, and Zirconia crowns (NuSmile zirconia and Zirconia anterior kinder crowns®).
Procedure
- Types of enamel defect.
- Extent and severity of the defects,
- Associated symptoms,
- Esthetics with possible psychological effects on the child,
- Patient cooperation and the method of treatment.
Interim restorations
Longer term restorations of molar teeth
Composite resin restorations
- Defect is demarcated to a defined area, not more than two surfaces
- Cusp tips are not involved
- No significant sensitivity
- Supragingival margins of the defect.
Preformed metal crowns
- The defect involves multiple surfaces
- There is significant sensitivity
- Margins of defects are subgingival
- There is involvement of the cusp tips in posterior teeth
- Enamel is prone to “chipping,” especially in some cases of AI
- Treatment has to be carried out under general anesthesia and the child is unlikely to manage restorative care in the immediate future.
Long term restorations of anterior teeth
- Removal of approximately 1–2 mm of enamel from all the surfaces of the crown.
- The enamel is etched and prepared for bonding according to the manufacturer’s instructions and the crown is filled with composite, placed on the tooth, with excess removed from the margins and the composite cured.
- Once the strip crown has been removed, the restoration is finished in the usual manner.
Extraction of primary teeth with DDE
Pitfalls and complications
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Interim restorations are not a definitive restorative treatment.
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Hypomineralised enamel can potentially reduce the strength and integrity of composite resin bond to enamel.
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Pre-veneered and white crowns require more extensive crown preparation than preformed metal crowns.
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Higher cost of treatment in more generalized cases.
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Chipping can occur in the pre-veneered metal crowns.