Overview
Restorative treatment is based upon the results of an appropriate clinical examination and is ideally part of a comprehensive treatment plan. The treatment plan shall take into consideration:
- Developmental status of the dentition
- Caries-risk assessment (Anderson, 2002; American Academy of Pediatric Dentistry, 2008)
- Patient's oral hygiene
- Anticipated parental compliance and likelihood of timely recall
- Patient's ability to cooperate for treatment
The restorative treatment plan must be prepared in conjunction with an individually-tailored preventive program.
Tooth preparation should include the removal of caries or improperly developed tooth structure to establish appropriate outline, resistance, retention, and convenience form compatible with the restorative material to be utilized. Rubber-dam isolation should be utilized when possible during the preparation and placement of restorative materials.
Dentin/Enamel Adhesives
The dental literature supports the use of tooth bonding adhesives, when used according to the manufacturer's instruction unique for each product, as being effective in primary and permanent teeth in enhancing retention of restorations, minimizing microleakage, and reducing sensitivity (García-Godoy & Donly, 2002).
Pit and Fissure Sealants
- Sealants should be placed into pits and fissures of teeth based upon the patient's caries risk, not the patient's age or time lapsed since tooth eruption.
- Sealants should be placed on surfaces judged to be at high risk or surfaces that already exhibit incipient carious lesions to inhibit lesion progression. Follow up care, as with all dental treatment, is recommended (Feigal, 2002).
- Sealant placement methods should include careful cleaning of the pits and fissures without removal of any appreciable enamel. Some circumstances may indicate use of a minimal enameloplasty technique (Feigal, 2002).
- A low-viscosity hydrophilic material bonding layer, as part of or under the actual sealant, is recommended for long-term retention and effectiveness (Feigal, 2002).
- Glass ionomer materials could be used as transitional sealants (Feigal, 2002).
Glass Ionomer Cements
Glass ionomers cements can be recommended (Berg, 2002) as:
- Luting cements
- Cavity base and liner
- Class I, II, III, and V restorations in primary teeth
- Class III and V restorations in permanent teeth in high risk patients or teeth that cannot be isolated
- Caries control with:
- High-risk patients
- Restoration repair
- Interim therapeutic restorations (ITR)
- Alternative (atraumatic) restorative technique (ART)
Resin-Based Composites (Donley & García-Godoy, 2002)
Indications
Resin-based composites are indicated for:
- Class I pit-and-fissure caries where conservative preventive resin restorations are appropriate
- Class I caries extending into dentin
- Class II restorations in primary teeth that do not extend beyond the proximal line angles
- Class II restorations in permanent teeth that extend approximately one third to one half the buccolingual intercuspal width of the tooth
- Class III, IV, V restorations in primary and permanent teeth
- Strip crowns in the primary and permanent dentitions
Contraindications
Resin-based composites are not the restorations of choice in the following situations:
- Where a tooth cannot be isolated to obtain moisture control
- In individuals needing large multiple surface restorations in the posterior primary dentition
- In high-risk patients who have multiple caries and/or tooth demineralization and who exhibit poor oral hygiene and compliance with daily oral hygiene, and when maintenance is considered unlikely
Amalgam Restorations
Dental amalgam is recommended (Fuks, 2002) for:
- Class I restorations in primary and permanent teeth
- Class II restorations in primary molars where the preparation does not extend beyond the proximal line angles
- Class II restorations in permanent molars and premolars
- Class V restorations in primary and permanent posterior teeth
Stainless Steel Crown (SSC) Restoration
- Children at high risk exhibiting anterior tooth caries and/or molar caries may be treated with SSCs to protect the remaining at-risk tooth surfaces.
- Children with extensive decay, large lesions, or multiple-surface lesions in primary molars should be treated with SSCs.
- Strong consideration should be given to the use of SSCs in children who require general anesthesia (Seale, 2002).
Labial Resin or Porcelain Veneer Restoration
Veneers may be indicated for the restoration of anterior teeth with fractures, developmental defects, intrinsic discoloration, and/or other esthetic conditions. (Horn, 1983)
Full-Cast or Porcelain-Fused-to-Metal Crown Restoration
Full-cast metal crowns or porcelain-fused-to-metal crown restorations may be utilized in permanent teeth that are fully erupted and the gingival margin is at the adult position for:
- Teeth having developmental defects, extensive carious or traumatic loss of structure, or endodontic treatment
- As an abutment for fixed prostheses
- For restoration of single-tooth implants (Simonsen, Thompson, & Barrack, 1983; Creugers, van't Hof, & Vrijhoef, 1986; McLaughlin, 1984)
Fixed Prosthetic Restorations for Missing Teeth
Fixed prosthetic restorations to replace 1 or more missing teeth may be indicated to:
- Establish esthetics
- Maintain arch space or integrity in the developing dentition
- Prevent or correct harmful habits
- Improve function (Thompson & Livaditis, 1982; Wood & Thompson, 1983)
Removable Prosthetic Appliances
Removable prosthetic appliances may be indicated in the primary, mixed, or permanent dentition when teeth are missing. Removable prosthetic appliances may be utilized to:
- Maintain space
- Obturate congenital or acquired defects
- Establish esthetics or occlusal function
- Facilitate infant speech development or feeding (Winstanley, 1984; Abadi, Kimmel, & Falace, 1982; Nayar, Latta, & Soni, 1981)
