PD
OBJECTIVE
After termination of the practical
training the students will be familiar
with theoretical basis and practical
skills necessary for the treatment
of primary dentition by fill-
ings.
TARGET GROUP
Students of the 5th year, Den-
tistry.
aZLDL0922c
PEDIATRIC DENTISTRY
FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
PRACTICE
Vacational practice assigned to the 4th year of Dentistry is required.
KNOWLEDGE
Knowledge necessary for the enrolment of the subject is given in corresponding
prerequisites.
OUTCOMES
Students are familiar with working procedures essential for the treatment of
the primary dentition with fillings and are able to treat children in the clinical
part of the subject: Paediatric dentistry.
PD PEDIATRIC DENTISTRY
FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Remember – the primary teeth differ
from the permanent in number,
shape, size, structure and in the
color.
PRIMARY DENTITION
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Filling therapy is indicated in D3reaching
deeper in the dentine and
in D4 (cariea pulp. proxima)
DIAGRAMMATIC REPRESENTATIONS OF CARIES
DIAGNOSTICS ON BITE-WING RADIOGRAPHS
0
2
3
4
Sound on bitewing Radiolucency confined to enamel
(up to ½- caries incipiens)
Radiolucency in the enamel up
to the enamel-dentine junction
(caries superficialis)
Radiolucency in the enamel
and
in the outer half of dentine
Radiolucency in the enamel
and dentine
reaching to the inner half of
dentine
(caries pulp. prox.)
1
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Describe morphology of primary teeth,
especially that of molars.
MORHOLOGY OF PRIMARY TEETH IN THE UPPER
AND LOWER JAWS
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Describe number of cusps in individual
molars and depict the course of
the fissure complex in individual
molars.
THE STUDY STIMULUS
Repeat: morphology of teeth.
SCHEMATIC OUTLINE OF OCCLUSIAL SURFACES
OF PRIMARY MOLARS
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Preparation and filling materials for
class I according to Black.
DENTAL CARIES - PRIMARY DENTITION
CARIES DEPTH
OCCLUSAL CARIES
FILLING
• GIC (or. + alkaline cement)
• compomer ( or + alkaline cement)
• composite resin (+ dentine adhesive,or capping of pulpal wall
with alkaline cement)
2 mm — molar
a) car. pulp. proxima
b) caries media
a) 3 years b) 6 years
diameter of the bur – 1 mm, depth - 0,5 mm in dentin
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Repeat: important information for
preparations, materials for primary
teeth treatment.
WORKING PROCEDURE
• hand instruments
• low revolutions
• minimal pressure
• checking of the cavity
• Permanent filling
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Working procedures/steps for class
II preparation according to Black.
Compare morphology of primary
and permanent teeth.
Aim attention to the extent of the
dental pulp size – horns reaching almost
to the dentino-enamel junction.
APPROXIMAL CARIES
CARIES MEDIA
marginal ridge is not affected
otherwise
caries pulpae proxima or caries penetrans
THE FILLING SHOULD INCLUDE
preventive extention
retention
resistency
NEIGHBOURING TOOTH HAS TO BE INVESTIGATED
isthmus - 1/3 of the intercuspal distance not less than 1,5 mm
gingival wall - 1 mm
DENTAL PULP MUST NOT BE THREATENED
MESIAL HORN – EASY PERFORATION
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
All rules of the class II cavity preparation
have to be respected, i.e. rule
of preventive extention, retention
and resistency. Approximal walls of
the cavity converge occlusialy, must
not reach the cusps of the tooth, all
transitions are rounded. For composite
materials not only adhesion but
also macroretention are used.
PREPARATION OF THE APPROXIMAL WALL OF
THE PRIMARY MOLAR
PD PEDIATRIC DENTISTRY
FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Survay of the most frequent errors
in class II preparation in primary
molars. Dotted line represents the
correct preparation.
ERRORS DURING PREPARATION – CLASS II CAVITY
A. Insufficient preventive extention – fissure complex not involved
totally in the preparation.
B. Excessively involved cusps – loss of hard tissues
C. Isthmus too large – greater than 1/3 of the intercuspal distance
D. Approximal walls divergent too much: the cause of the following
errors
E. The angle between axial and buccal/lingual walls too great
F. gingivally small extension – point of contact is not in the filling
(in the gingival region)
G. gingival wall too great mesio-distally – more than než l mm
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Be carefull on preparation of the approximal
wall, on careless preparation
dental pulp can be exposed as
well as on large or deeply subgingivally
reaching shoulder.
ERRORS DURING CAVITY PREPARATION
APPROXIMALLY
Dental pulp exposure
(horn)
Loss of wall corvengence
Too deep shoulder preparation
Consequence – dental pulp exposure
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Access for class III. preparation is
from the labial surface. Extent of cavity
corresponds to the extent of
caries. Dovetail preparation can be
done on the labial surface in case of
an extensive caries..
Class III and V can be connected
into one cavity in case that only
narrow strip of healthy hard tissues
would remain between them.
Class V is not fequent in primary
dentition. If filling is used for the
treatment the preparation is performed
according to the rules valid for
the permanent dentition.
CLASS III.
Access opening from the labial surface, the size of cavity is given
by the caries size.
Access opening in primary maxillary canines may be from the palatatal
surface, in mandibular canines from vestibular surface.
The dovetail is usually placed into the strong marginal ridge, not directly
to the oral surface.
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Incisal edge is not restored in the
treatment of the class IV. The filling
usually covers only the dentine
wound.
CLASS IV.
• Not very frequent
• Crown must not be restored esthetically – a cover of the dentin
wound
• Teeth before shedding – grinding of approximal surface, impregnation
by fluorides
FILLING IN CLASS III. AND IV.
• Composite resin + etching technique
• glassionomer cement
• compomers + etching technique
• Ag- quite exceptionally in class III – gingival bleeding
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Tunnel preparation is indicated rather
in the permanent dentition, in
primary teeth, if it is possible, on the
second molars mesially. GICs, chemically
cured, reinforced by resin
are recommended.
TUNNEL PREPARATION
CONDITIONS
non affected marginal ridge
caries of small extent.
access – round bur
access channel – to
extend bucco-lingually
removal of carious masses,
matrix application + wedge
esthetic improvement by composite
resin(compomer) not
necessary
fissure complex has to be se-
aled
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
B-W projection, tunnel preparation,
26 a 35 (arrow).
RTG: BITE-WING PROJECTION
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Caries is localized approximally,
gingivally, marginal ridge is not
affected, not undermined, caries is
not too extensive and is localized
below the point of contact. Occlusial
box is replaced by preparation on the
buccal surface.
a) Model of the tooth 54. Auxilliary
cavity (dove-tail) on the buccal surface
does not require the istmus as it
is not exposed to strong masticatory
forces. Cavity on the approximal surface
is parallel to the cervical line
(i.e. horizontal) and terminates in the
healthy tissue. Carious tissue has to
be removed.
b) View on the buccal surface with
the cavity prepared mesially.
c) Matrix (for better visibility metallic)
secured with a wooden wedge.
Usually, transparent matrix for GIC
is used (no connection between the
GIC and metal). On GIC application
the matrix is slightly folded back (in
this case mesially). Chemically cured
dosed resin modified GIC is used.
Matrix is pressed toward the tooth
and is removed after the material
sets.
BUCCAL PREPARATION
a)
b)
c)
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
Working procedure for the preventive
filling making. X-ray in bitewing
projection is necessary for preventive
filling indication
PREVENTIVE FILLING
SEALANT FILLING
caries confined to enamel of pit or fissure
- only sealant
at the present time rather exceptionally,
(D1 –D3 are treated by prophylactic met-
hods)
PREVENTIVE FILLING
• Composite resin + etching technique
• glassionomer cement
• compomers
Indication:
primary molars, premolars, permanent molars
Contraindication:
approximal caries on the treated tooth (D1 and more), no open caries of
class II on remaining teeth, more extensive caries (more than 1/3 of intercuspal
distance), chronic caries, DMFT/dmft ≥ 5
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
a. Cavity preparation
b. Filling, GIC.
c. Enamel etching
d. Etched enamel in fissures
e. Sealed preventive filling
PREVENTIVE FILLING, WORKING PROCEDURE
a. b.
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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c. d.
e.
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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COMMENTARY
This method is used only exceptio-
nally.
Indication
• the crown is not destructed
• points of contact are maintained
(mesio-distal diameter)
• child is healthy
• the only gangrenous tooth in
dentition
Permanent drainage, the tooth 54,
16 not erupted yet. In case of extraction
of 54 there is a danger of
mesial movement of 55 and 16.
PERMANENT DRAINAGE
Modification of the open tooth technique
WORKING PROCEDURE
It is possible to restore the tooth
1. removal of gangrenous masses
2. desinfection of root canals
3. Calcium hydroxide is applied on the floor of the dental pulp cavity
4. the overlaied by zinc oxid cement
5. hermetic filling
6. Large communication reaching into the dental pulp cavity is prepared
from the vestibular surface- along the gingival margin
7. Calcium hydroxid is rinsed out of the dental pulp cavity
8. the only gangrenous tooth in the dentition
ADVANTAGE AGAINST THE
OPEN TOOTH METHOD
•better hygiene
•better masticatory function
•better function as space mainta-
inor
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FILLING THERAPY IN PRIMARY DENTITION
PRACTICAL TRAINING
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