revision

Lab exercise
Co Ordinator
SIDDIQUE SHA M
MDS IN PEDIATRIC DENTISTRY
 CHILDREN ORAL CAVITY( PRIMARY DENTITION)
• Presence of 20 teeth all are primary below 6 years, 5
teeth per quadrant, usually spacing present between
the teeth.
 MIXED DENTITION
• Presence of both primary and permanent dentition
starts from the age of 6 years till 12- 14 years
 MAIN OBJECTIVES
• PLEASANT ENVIRONMENT(sharp objects should be
away)
• COMMUNICATION(one sided story- during treatment)
• GREETINGS AND APPRECIATION
• PARENTAL PRESENCE AND ABSENCE(below 6 yrs
parents must be present and child can be managed by
presence and absence of parent)
 Tsd(commonest technique )
Management of child should always include
TSD
• TELL
• SHOW
• DO
 ORAL EXAMINATION OF INFANT
• KNEE TO KNEE TECHNIQUE
TILL 3 YEARS
• Head on dentist lap and legs on
parents lap and examination done
without any instruments if
possible .
 EMERGENCY -space infection
• Space infection is seen as swelling of the face usually with a
pulp involved teeth.
• Treatment is drainage of the area and treatment of the cause.
• Radiograph should be taken if
No trismus(unable to open mouth)
• Resorbed roots-extraction and
Antibiotics
• If trismus and pain- antibiotics
(Metronidazole should be included), after
3 days then Pulpectomy if roots are not
Resorbed.
 PERIODONTAL ABSCESS
 SEEN AS SOFT TISSUE SWELLING OF
GINGIVA IN A TEETH WITH PULPAL
INVOLVEMENT AND PERIDONTIUM
INVOLVEMENT.
 TREATMENT- DRAIN ABSCESS, TREAT
THE CAUSE(PULPECTOMY),ANTIBIOTICS
 NON VITAL TEETH
• SEEN AS BLACK DISCOLOURATION IN TRAUMATIZED
TEETH OR PULPALLY INVOLVED TEETH NOT TREATED
FOR A LONG TIME.
• TREATMENT-PULPECTOMY AND CROWN
 ERUPTION CYST
• Bluish coloured gingiva seen during the eruption of
permanent teeth
• Usually resolve on its own sometimes need excision if
pain exists.
 DENTAL CARIES
• Early childhood caries. Due to bottle feeding at night.
• TREATMENT-Restoration(if pulp not involved),
PULPOTOMY(reversible pulpitis),
PULPECTOMY(irreversible pulpitis).
 ENAMEL CARIES OR INCIPIENT CARIES
• White discoloration seen usually in isolated spots in
white teeth.
• Localized to individual teeth, surface is smooth usually.
• Seen in cervical region usually initial sign of
demineralization.
 pulpectomy
• If more than half of crown is lost due to caries- the
treatment plan is only pulpectomy, no pulpotomy, if
roots resorbed -extraction.
 Root stumps
• Entire crown structure is lost without eruption of permanent
successors and time of eruption of permanent has till more
time, do pulpectomy and save the teeth.
• Do not extract anterior- to prevent development of tongue
thrusting habit
• Do core build up using post after pulpectomy, post should not
exceed beyond 3mm cervically to prevent hindrance of
eruption of permanent dentition .
 CLEFT LIP AND PALATE
• Seen as separation of lips
• Treatment – cleft surgery
MORPHOLOGY AND DIFFERENCE
Lab exercise
Co Ordinator
SIDDIQUE SHA M
MDS IN PEDIATRIC DENTISTRY
 MAXILLARY PRIMARY CENTRAL INCISOR
• MESIODISTAL DIMENSION LARGER THAN INCISAL TO
CERVICAL REGION OF TOOTH
 SLOPE OF MAXILLARY AND MANDIBULAR CANINE
• MESIAL SLOPE LARGER – IN MAXILLARY CANINE
• DISTAL SLOPE LARGER -MANDIBULAR CANINE
 MAXILLARY FIRST PRIMARY MOLAR
• MESIO LINGUAL ROOT IS LONGEST
• CERVICAL THIRD BULGE THAN OCCLUSAL
• MESIOBUCCAL CUSP BULGE
 MAXILLARY SECOND PRIMARY MOLAR
• CUSP OF CARABELLI
 MANDIBULAR FIRST PRIMARY MOLAR
• MESIAL SIDE IS LARGER WHEN VIEWED BUCALLY
• LINGUAL CUSP IS LARGER
 MANDIBULAR SECOND PRIMARY MOLAR
• DISTAL CUSP IS MUCH SMALLER INPERMANENT
DENTAL MATERIALS IN PEDIATRIC DENTISTRY
LAB EXERCISE
Co Ordinator
SIDDIQUE SHA M
MDS IN PEDIATRIC DENTISTRY
 PREVENTIVE MATERIALS- FLUORIDE

SILVER DIAMINE FLUORIDE-

 Silver diamine fluoride is a colorless or blue-tinted liquid
with a Deep caries management
 INDICATION-SDF may be a preferred option to arrest
caries in deciduous teeth, older individuals, when
physical limitations do not allow more extensive
treatment or when access to conventional restorative
techniques, such as resin composite or amalgam
restorations, are not available
APPLICATION-
 38% SDF solution biannually to arrest advanced cavitated
carious lesions on coronal surfaces of primary teeth
DISADVANTAGES-
 potential pulpal and oral soft tissue irritation and dental
staining.
 Gingival irritation.
 Mature and sound enamel is not stained, unless there is
any superficial defect, such as hypomineralization or
carious/demineralized or immature enamel, where the
porosities allow silver ions to penetrate
SMART TECHNIQUE – SDF and GIC
ADVANCEMENT- Potassium iodide to reduce discolouration
 Preventive materials-
remineralizing agents
CPP-ACP
 Casein phosphopeptides-amorphous calcium phosphate
 RECALDENT(chewing gum) is a unique ingredient containing
the naturally occurring protein found in cow’s milk, called
casein
 Whites spot initial lesions-remineralized
 PREVENTIVE MATERIALS- PIT AND FISSURE
SEALANT
EMBRACE WETBOND
 A Unique Moisture-Tolerant, Resin-Based Pit-and-Fissure
Sealant that is remarkable for its ability to penetrate and form
an intimate association with the slightly moist tooth.
 It is tooth-integrating, creating a margin-free interface
between the resin and the tooth that eliminates microleakage.
• Better physical properties than GIC.
 Restorative material – glass ionomer cement
GIOMER-
 Hybrids of glass ionomers and composites •
 Light activated ,require a bonding agent.
 Advantages:
 Fluoride release
 Fluoride recharge
 Excellent esthetics
 Easy polishability
 Biocompatibility
 Clinical Stability.
• Recharges fluoride from environment.
 Restorative materials-smart burs
SMART BURS-
 These are polymer burs that cuts only infected dentin.
 The affected dentin which has the ability to remineralize is
left intact.
 Over cutting of tooth structure that usually occurs with
conventional burs can be avoided by the use of these smart
preparation burs
 CHEMO MECHANICAL CARIES REMOVAL-CARISOLV

 Chemomechanical method is an effective alternative for

caries removal, because it brings together atraumatic
characteristics and bactericide/bacteriostatic action.
 The method was created so as that an active ingredient
would soften the predegraded collagen of the lesion
without pain or undesirable effects to adjacent healthy
tissues.
 Management of primary carious lesions in deciduous teeth
 The care of caries in dentally anxious patients, notably
needle phobics.
 CARISOLV- SODIUM HYPOCHLORITE(0.5%)
TWO SYRINGE TECHNIQUE
 CARIES REMOVING SOLUTIONS
PAPACARIE-
 bactericide, bacteriostatic, and anti-inflammatory
characteristics(less pulpal reaction)
 Antimicrobial activity-Streptococcus and Lactobacillus.
METHOD OF APPLICATION-
 PULP THERAPHY OBTURATING MATERIALS

VITAPEX
• Premixed calcium hydroxide paste containing iodoform used
as a temporary or permanent root canal filling material after
pulpectomy.
• This paste is packaged in a convenient syringe to eliminate
messy mixing.
• Iodoform-antibacterial effect
 Pulpotomy material

MTA
 Silicate based cement
 Hydrophilic material – can contact blood
• APPLICATIONS OF MTA-
MIXING-
• Kept always in closed containers or free from moisture.
• Powder: Water = 3: 1 •
• Glass or paper slab used for mixing with – plastic/ metal
spatula.
• It requires moisture to set.
• Once the mix is dry sandy form its ready for application.
 PULPOTOMY MATERIAL-BIODENTINE

 Dentin replacement(silicate cement)

 Capsule form, liquid in pipette
MIXING-
APPLICATIONS OF BIODENTINE
 fluoride
Lab exercise
Co Ordinator
SIDDIQUE SHA M
MDS IN PEDIATRIC DENTISTRY
 Anticariogenic action of fluoride
Anticaries mechanism can be broadly grouped into
1.Increased enamel resistance
2.Increased rate of maturation
3.Remineralization of incipient lesion
4.Antimicrobial activity – change of surface tension
 Fluoride gel
 APF-Acidulated phosphate fluoride.
 concentration of fluoride 12,300 ppm.
 Fluoride gel can be applied up to 2 times per year
 Fluoride gel not recommended for child under 6 years.
 Brudevold’s technique-The gel is administered in a stock
tray, one third of the tray is filled with gel and the patient is
asked to bite the tray and hold it , while the suction is placed
in the buccal side.
 The application time is recommended to be 4 minutes, and
the patient can expectorate the gel afterward.
 Contains a relatively high amount of fluoride, there is a
chance of unnecessary ingestion by small children, which
could result in mild toxic side effects.
 Fluoride varnish
 Fluoride varnish is 5% sodium or
22,600 PPM
 Fluoride varnish can be applied
up to 4 times per year or every 3
months
 Apply varnish using applicator
tip to all surfaces of teeth after
drying the teeth, start with
mandible quadrant by quadrant
then maxilla.
 It forms a sticky covering over
the tooth and becomes hard as
soon as saliva in the mouth
touches it.
 It takes 2 minutes to apply
varnish.
 Low risk of ingesting and toxicity
 Silver Diamine Fluoride

 SDF (38%) contains a high

aggregation of fluoride ions,
 which is 44,800 ppm.
 Silver Diamine Fluoride SDF is a
colorless topical solution containing
 25% silver ion- antimicrobial
 8% - solvent
 5% fluoride
 It is also an alkaline pH 10 reagent,
which provides arrest the caries,
antibacterial and remineralizes the
teeth.
 INDICATION- deep dentinal caries
Advantage
• Control of pain and infection
• The treatment doesn't required
expensive equipment
• The treatment is non invasive and
thus the risk of spreading infection
is very low
Disadvantage
• The inherent drawback of using
SDF to arrest carries is that the
lesion will be stained black
ADVANCEMENT
• Potassium iodide to prevent
staining
 PIT AND FISSURE SEALANT
LAB EXERCISE
Co Ordinator
SIDDIQUE SHA M
MDS IN PEDIATRIC DENTISTRY
 PITS AND FISSURES sealants
• The teeth that have 'pits' (small hollows) and 'fissures'
(grooves) on their occlusal surfaces.
• Microscopically this pit and fissures are deep that even
brushes and explorer are inaccessible.
 Indication and contraindication.
• Self cleanable U and V type
fissures usually do not need
sealant unless patient is high
risk of developing caries and
has many active caries in his
mouth.
• All other deep pit and fissure
where food can be trapped
easily and chances of caries
development needs sealant.
• I, IK, INVERTED Y – need
sealant
 Technique of sealant application
Step 1: Isolate the tooth from salivary contamination.
Step 2: Clean the tooth surface ( pumice and rubber cap)
Step 3: Acid-etch for 15 to 20 sec.
Step 4: Rinse and dry the surface and apply bonding agent.
Step 5: Apply the sealant to the etched surface.
Step 6: Polymerize the sealant.
Step 7: Evaluate the sealant with explorer.
Step 8: Evaluate and adjust the occlusion.
STAINLESS STEEL CROWN
Lab exercise
Co Ordinator
SIDDIQUE SHA M
MDS IN PEDIATRIC DENTISTRY
 ARMAMENTERIUM
PLIERS
Hoe pliers, No. 114 Johnson contouring pliers,
 ARMAMENTERIUM
No. 417 Crimping pliers Crown remover
 armamenterium
CROWN BOX – No size 0 and 1
• Two digits letter represents the tooth and number
represents the size
• L shaped denotation represents the either upper or
lower, left or right
 TOOTH PREPARATION
 Evaluation of Preoperative Occlusion
 OCCLUSAL REDUCTION Start the occlusal reduction with
pear-shaped bur. Reduce the occlusion by about 1.0–1.5
mm uniformly along the cuspal structure so as to create
a reduced tooth but the same occlusal anatomy.
 TOOTH PREPARATION
• PROXIMAL SLICING
Using thin needle bur the interdental contact is broken at
both mesial and distal proximal by running the bur
parallel to the tooth buccolingually in a straight line
• FINISHING USING POLISHING BURS
 Crown selection
• Any of the following three different methods can be
used for crown selection with predictable success:
1.Trial and error method by arbitrarily selecting different
sizes
2. Measuring the internal MD measurement by using a
boley gauge or vernier calipers
3. By using charts
SIZE CHART
 CROWN ADAPTATION
FESTOONING
The proximal contours of all the primary molars look like
frown (∩). The gingival margins of the trimmed crowns
must correspond to their respective gingival margins of
the tooth.
Using stone burs the mesial and distal
cervical region of the ssc are trimmed
in the shape of frown (∩).
• NOTE THE FESTOONING ON PROXIMAL SIDE OF THE
CROWN - frown (∩).
 CROWN ADAPTATION
• CONTOURING The next step in adaptation is to contour
the crown with pliers so as to reciprocate the original
contour of the tooth.
• Most of the crowns provided today are precontoured
• Contouring is done with the help of No. 114 Johnson
contouring pliers.
• the buccal and lingual surfaces by holding the crown
firmly with the pliers, and force is exerted from the
opposite side of the crown to bend the middle third and
gingival of the crown inward
• Not done on mesial and distal sides.
• BULGY SURFACE OF
PLIER IS PLACED INSIDE
OF THE CROWN
• CURVED SURFACE ON
OUTSIDE OF CROWN
 Crown adaptation
CRIMPING
• poorly adapted crown will serve as a collection point for
bacteria, contributing to recurrent caries or incipient
periodontal disease.
• Using the No. 417 Crimping pliers, the crown is crimped
in the gingival third.
• The procedure of crimping is that the pliers must be
“walked” through the entire crown continuously without
lifting – Walking method
• After completion of crimping, there will be a gradual
bend in the gingival third of crown
• The uses of crimping are protection of soft tissues,
prevention of leakage of cements, prevention of
contamination, and adequate retention.
• BULGY SURFACE OF PLIER IS
PLACED INSIDE OF THE
CROWN
• CURVED SURFACE ON
OUTSIDE OF CROWN
 Crown adaptation
• Check for final fit and occlusion the crown should have a
snap fit
 CROWN ADAPTATION
• Fix the crown with type 2 GIC and remove the excess
cement by the help of explorer