Simplified primary incisor proximal restoration

Resident: J. Hencler
Date: 11/01/2010

Article title: Simplified primary incisor proximal restoration
Author(s): Croll DDS, Berg DDS, MS
Journal: Pediatric Dentistry–25:1, 2003

Major topic: Clinical restorative technique
Type of Article: Clinical

Main Purpose:
Describe class III restoration of 2 carious primary incisors using a self-etching adhesive system and a simplified resin-based composite bonding technique.

Technique:
Shade guide, LA, RDI. Access to lesion was approached from labial aspect. After decay was excavated, prep outline form included small labial and lingual dovetail preparations to increase mechanical interlocking retention. The peripheral enamel was roughened w/ a diamond bur. Following matrix/wedge isolation, self-etching adhesive bonding solution (L-Pop) was applied for 20 seconds w/in the prep and surrounding enamel and cured initially for 10 seconds. A hybrid resin-based composite was injected into the prep slightly overfilling from both the labial and lingual directions and compressed w/ a plastic instrument. The restoration was then cured for 30 seconds from both a labial and lingual direction. Slow speed diamond buy and aluminum oxide disks were used to contour and polish before a final cure of 20 seconds.

Discussion:
How do you decide when a GI liner should be placed when restoring primary teeth w/ resin-based composite? A resin-modified GI liner/base, w/ it’s high fluoride content, chemical bond to dentin, hydrophilic nature, “cushioning” effect from resin polymerization dynamics, and biocompatibility all make this material an ideal direct-application dentin replacement. Primary teeth with moderate dentin exposure can be restored successfully using a resin-based composite or compomer restorative material directly bonded to enamel and dentin. B/c such teeth will eventually exfoliate, long-term pulpal protection against microleakage and resin deterioration is not of concern like it would be in a permanent tooth restoration. In addition, complaints from children about tooth sensitivity from bonded resin-based composite restorations are very rare. The self-etching, resin adhesive agent save time and are known for improving the resin/dentin hybridization band as well as decreasing post-op tooth sensitivity. Additional tx time was save by applying the resin-based composite all at once. B/c primary maxillary incisors are relatively thin teeth and mechanical interlocking retention form was included in the prep, the amount of polymerization shrinkage is small enough that the resin mass does not pull away from the tooth structure significantly during curing.

Summary of conclusions:
Using self-etching resin adhesive and bulk filling preps saves time. The authors claim that at GI liner is not required in preps into dentin but present no scientific data/info to support this claim. If a cavity preparation is deep and into dentin, I will usually will place a GI liner.

Assessment of article: Article was okay, not much new here.