Guidelines on Pediatric Restorative Dentistry

Resident’s Name: Brian Schmid DMD Date: 12/11/09
Article title: Guidelines on Pediatric Restorative Dentistry
Author(s): Clinical Affairs Committee - AAPD
Journal: Pediatric Dentistry Clinical Guidelines Reference Manual 2006-2007
Month, Year: 2007
Major topic: Restorative dentistry in children
Type of Article: Review
Findings: Poor, rural and minority children are at greater risk for caries mostly due to limited access to care. DMFS scores higher than the patients age, numerous white spot lesions, low SES, cariogenic diet, high caries rate in siblings or parents and the presence of dental appliances are predispose children to caries. Tooth morphology including relative pulp size and dental dimensions make pediatric restorative care different from adult care. SSC’s are recommended for primary teeth which have received pulp treatments, except in cases with conservative pulpal access and exfoliation expected within the next 2 years. Dentin and enamel bonding has been proven equally successful in primary and permanent teeth, allowing for more conservative restorations, provided that manufacturers directions are followed. One, two and three bottle systems have all been found to be successful. Sealants are highly successful at stopping cares causing bacteria into pits and fissures of primary and permanent teeth, where 80% of childhood decy occurs. Enameloplasty and pre-op fluoride application have neither improved nor undermined successful sealant placement. High risk surfaces should be sealed first and with proper isolation. You can seal over incipient lesions as long as proper follow-up in maintained. Currently, glass ionomer is not recommended as a long term sealant. Glass ionomers, however, do uptake and release fluoride, are more moisture tolerant, biocompatible and have a similar coefficient of expansion as tooth structure. Fluoride turnover may continue for as long as 5 years. GI is recommended for use as luting cement, cavity base/liner, restorations in primary teeth, Class III and IV restorations in permanent teeth and caries control including ART. Resins and composites are more esthetic but have more complex handling properties and lower long term integrity. They come in a variety of filler size and concentration which affects their polishability, esthetics and strength. They are contra-indicated in patients where isolation is impossible or patients with poor OH/unavailable for followup. Amalgam restorations have long history of successful but are now being replaced by more esthetic, but less effective alternatives. It is recommended for Class I and II restorations, provided the interproximal box does not extend beyond the proximal line angles, in which case an SSC is recommended. SSC’s are an excellent option for large carious lesions, pulp treated primary teeth or in patients with rampant decay and/or special needs. Veneered SSC’s are available but are often less retentive and liable to loss of facing. Veneers can be used on teeth with developmental or acquired defects. Full coverage PFM’s are a good option for highly carious permanent teeth as well as intra-osseous implants, but growth and changes in occlusion must be taken into account before this track is taken. Fixed and removable prosthetic devices may be used for esthetics, orthodontics, space maintenance etcetera.
Assessment of article: Great overall review of biomaterials, some techniques and indications/contraindications.