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TREATMENT PLANNING,
ISOLATION,RESTORATION OF
CLASS I,III,IV,V LESIONS
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in...
DIAGNOSIS AND
REGISTRATION OF CARIOUS
LESIONS
 Diagnostic tools
The visual-tactile method with light, mirror,
and gentle ...
 The visual method
with temporary
elective
tooth separation
www.indiandentalacademy.comwww.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.comwww.indiandentalacademy.comwww.indiandentalacademy.com
Indian Dental...
 The conventional
bitewing radiographic
method
www.indiandentalacademy.comwww.indiandentalacademy.com
The fiber-optic
transillumination
method
www.indiandentalacademy.comwww.indiandentalacademy.com
 DIAGNODent
Laser Device
www.indiandentalacademy.comwww.indiandentalacademy.com
 Quantitative Light-
induced Fluorescence
www.indiandentalacademy.comwww.indiandentalacademy.com
Electrical conductance (fixed
Frequency) method
www.indiandentalacademy.comwww.indiandentalacademy.com
 ELECTRONIC CARIES MONITOR
 CARIES DETECTING DYES
 DIGITAL RADIOGRAPHIC METHOD
 THE RVG SYSTEM
 COMPUTER-AIDED RADIOG...
TREATMENT PLANNING
“It is not feasible to describe a precise
treatment planning in the child patient.”
welbury
www.indiand...
OBJECTIVES
A CHILD GAINS ADULTHOOD IN A STATE OF GOOD DENTAL
HEALTH
THAT THE CHILD DEVELOPS A POSITIVE ATTITUDE TO
DENTA...
PHYLOSOPHY OF TREATMENT
PLANNING
 TREATMENT PLAN MUST BE DEVELOPED AND
DESIGNED TO PROVIDE HIGH QUALITY
RESTORATIVE CARE ...
1.NO RESTORATIVE CARE HAS
BEEN ATTEMPTED
 SEQUENCED INTRODUCTION TO THE PROCEDURES OF
RESTORATING TEETH.
 STEP BY STEP P...
2. HAD ALREADY VISITED
 TOTALLY UNCO-OPERATIVE
 RELUCTANT TO CO-OPERATE BUT PERSUADABLE
www.indiandentalacademy.comwww.i...
COMMUNICATION WITH CHILD AND
PARENT
 Objective - Allay anxiety of first dental visit
 Reception and waiting areas - Shou...
Talking to parents
• Never guarantee that we will finish in a certain number of
appointments
• Never guarantee what treatm...
– Discuss with the parent WHY the patient needs the
care we are proposing
– Discuss with the parent after each appointment...
PRINCIPLES OF TREATMENT
PLANNING
NEW PATIENT
↓
HISTORY AND EXAMINATION
↓
MANAGAMENT OF ACUTE PROBLEMS
↓
ASSESSMENT
↓
www.i...
↓
LONGTERM TREATMENT OBJECTIVES PATIENT
PARENTAL CO-OPERATION
↓
ASPECTS OF CARE
↓
PREVENTIVE -RESTORATIVE –ESTHETIC
↓ ↓ ↓
...
↓
DISCUSSION
↓
PARENT-PATIENT-DENTIST-REFERRAL
↓
DEFINITIVE TREATMENT PLAN
www.indiandentalacademy.comwww.indiandentalacad...
AIMS OF THE FIRST SESSION
 To establish good communication with the child and parent
 To obtain important background inf...
CARIES RISK ASSESSMENT
 RISK FACTORS
 Sucrose exposure
 Previous carious experience
 Levels of cariogenic bacteria
 O...
 STAINING OF PIT AND
FISSURES
 DISCOLORATION OF THE
ENAMEL
 CONDITION OF THE
MARGINAL RIDGE
WHETHER INTACT OR
BROKEN
 ...
SUMMARY OF THE FIRST
APPOINTMENT
Take the history
a. social
b. dental
c. medical
Examine the child
a. extra-oral
b. intra-...
Perform a simple operative procedure
a. prophylaxis: incisors only (in young child)
or full mouth, including removal of ca...
Explain aims of treatment to parent
a. Emphasize the need for preventive as well as operative
treatment
b. Request that th...
An outline for treatment planning
Operative treatment
general Restorations
Extractions
Orthodontic treatment
www.indianden...
LONG TERM TREATMENT
PLANNING
Overall assessment of the general attitude of the
child and parents to dental care
“ Delaying...
Order of treatment:
general guidance
First visit
 Take radiographs.
 Introduce the child to operative treatment-'polish'...
2nd visit
 Assess tooth brushing technique - observe the child
brushing - determine Oral Debris Index Stan oral
hygiene i...
3rd visit
 Collect diet record leaflet.
 Continue oral hygiene instructions
 Amalgam restoration in maxillary molar-inf...
Fourth visit
Continue oral hygiene instruction.
At this and subsequent visits, introduce progressively to
more complex res...
Rampant caries
• Consider gross caries removal and temporization
• Discuss baby bottle syndrome if the patient is
young
• ...
Pain
• Always treat the area that is painful to the patient,
regardless of treatment plan order
• Never let a patient leav...
Two factors significantly reduce the survival
rate of restorations
……….walls et al 1985
 Lack of local analgesia
 Age of...
www.indiandentalacademy.comwww.indiandentalacademy.com
QUADRANT DENTISTRY
 Reduces the number of times local analgesia is used
 Makes maximum use of time available
 Economica...
ISOLATION OF TEETH
GOALS OF ISOLATION
 MOISTURE CONTROL
 RETRACTION AND ACCESS
 HARM PREVENTION
www.indiandentalacademy...
 SALIVA EJECTORS
 COTTON WOOL ROLLS
 ABSORBENT PADS
 RUBBER DAM
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SALIVA EJECTORS
Hygoformic saliva ejector / tongue protector
www.indiandentalacademy.comwww.indiandentalacademy.com
Cotton rolls,
cellulose wafers,
gauze sponges
Cotton roll holder
www.indiandentalacademy.comwww.indiandentalacademy.com
Cotton roll alternative
Absorbs without the bulk of rolls
www.indiandentalacademy.comwww.indiandentalacademy.com
Atropine Sulfate, 0.4mg Tablets.
effectively reduces saliva flow within 60
seconds,
persists for 4-6 hours.
www.indiandent...
RUBBER DAM ISOLATION
S.C.BarnumS.C.Barnum in 1864 introduced rubber dam into
dentistry
ADVANTAGES:
 Dry clean operating f...
Improves access and visualization
operator efficiency and increased productivity
Superior moisture control
Prevents aspira...
Disadvantages:
Time consumption and patient objection
www.indiandentalacademy.comwww.indiandentalacademy.com
Certain oral conditions that preclude
the use of rubber dam
 Erupting teeth with insufficient support for retainer
 Thir...
Rubber dam kit
www.indiandentalacademy.comwww.indiandentalacademy.com
ClampsClamps
 Bland clamps – jaws are flat and point directly
towards each other
Designed to grasp the tooth at or above
...
RETAINER/CLAMPS
Partially erupted permanent
molars
Fully erupted
permanent molars
Second primary molars
First primary mola...
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www.indiandentalacademy.comwww.indiandentalacademy.com
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 BW, JW Molar clamps (wingless)
 K Molar Clamps
 GW Premolar clamps
 EW Clamps ( for small tooth)
 AW Molar wingless ...
Rubber clamp
Four point prong
contact with tooth
www.indiandentalacademy.comwww.indiandentalacademy.com
Winged - small projections allow it to be mounted
on dam prior to application
Wingless - applied directly to tooth
www.ind...
Rubber dam clamp for broken down and partially
erupted tooth
www.indiandentalacademy.comwww.indiandentalacademy.com
RUBBER DAM
 Size 5*5 6*6
 Thickness Thin 0.006”
Medium 0.008”
Heavy 0.010”
Extra heavy 0.012”
Special heavy 0.014”
 Col...
RUBBER DAM TEMPLATE
www.indiandentalacademy.comwww.indiandentalacademy.com
RUBBER DAM FRAMES
 ASH PATTERN
 MODIFIED YOUNG’S
PATTERN
 SVENSKA N- O FRAME
www.indiandentalacademy.comwww.indiandenta...
Universal U shaped
 Nygaard ostby
 Sauveor (oval)
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CLAMP PLACEMENT FORECEPS
STOKES BREWER ASH
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RUBBERDAM PUNCH
Ainsworth Ash
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Ainsworth Ivory
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Punching the holes
 Lower molars & large upper molars
 Upper molars, small molars, 2nd
primary molars
 Canines, premola...
Additional retention devices
wooden wedges, elastics, latex cord
www.indiandentalacademy.comwww.indiandentalacademy.com
Rubber dam Application
www.indiandentalacademy.comwww.indiandentalacademy.com
Why Ligate the Clamp?
 All retainers applied before the rubber dam is in place
must be ligated. A 12” piece of floss shou...
Clamp secured with floss
www.indiandentalacademy.comwww.indiandentalacademy.com
TECHNIQUE 1 – Clamp placement
prior to rubber dam
ADVANTAGESADVANTAGES
 Tooth and gingival margins are clearly visible.
...
 Clamp usedClamp used – winged type ; wingless with specially
shaped jaws
Wingless for multiple tooth isolation
 Punchin...
Clamp is placed on the tooth
to be isolated
Clamp is placed on the forceps,
expanded and the forceps is
locked
www.indiand...
Clamp forceps are removed
leaving behind clamp on the
tooth
The rubber dam sheet is carried
into the mouth with both index...
Placement of
rubber dam
frame
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www.indiandentalacademy.comwww.indiandentalacademy.com
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TECHNIQUE 2 - Clamp and rubber dam placed
together
INDICATIONS:INDICATIONS:
 Posterior most teeth, 3rd
molars
 Condition...
Extra oral placement of clamp (winged) helpful
when isolating small number of teeth
www.indiandentalacademy.comwww.indiand...
TECHNIQUE 3 - Clamp placed after
the rubber dam
 It should be carried out with assistance
 Restricted to anterior teeth ...
MULTIPLE TOOTH ISOLATION
 Clamps should not be placed on a tooth which requires which
requires restoration
 If the is na...
QUADRANT ISOLATION
www.indiandentalacademy.comwww.indiandentalacademy.com
 ADDITIONAL
RETENSION
www.indiandentalacademy.comwww.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com
Anterior Teeth
www.indiandentalacademy.comwww.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com
ISOLATION OF LOWER INCISORS
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Removal of Rubber Dam
 Thoroughly cleanse area.
 Cut/remove interproximal ligatures.
 Stretch rubber dam facially and c...
www.indiandentalacademy.comwww.indiandentalacademy.com
Block type and Ratchet type mouth props
www.indiandentalacademy.comwww.indiandentalacademy.com
General Considerations
Adhere to GV Black’s principles with respect to
outline, resistance, retention and convenience
form...
Advantages and disadvantages of materials used
in pediatric dentistry
Advantages Disadvantages
 Amalgam Simple Not adhesi...
 Stainless-steel Very durable Extensive tooth
preparation
crowns
Protects and support Patient cooperation
remaining tooth...
Polyacid-modified
Adhesive
Technique sensitive
 composite resin
Aesthetic Less fluoride release
than glass ionomer
Comman...
Guide to the use of materials
 Primary dentitionPrimary dentition
 Occlusal (class I) Glass ionomer
Composite resin
 In...
Permanent dentitionPermanent dentition
Occlusal table Fissure sealant
 Occlusal enamel caries Fissure sealant
 Occlusal ...
ModificationsModifications
View from distal surface
of primary 1st molar
B L
www.indiandentalacademy.comwww.indiandentalac...
Black-type Modern
 Gain access Gain access to the
(not necessarily caries) caries
 Prepare the cavity to Remove the cari...
Modifications
Relatively wider isthmus width
• one-third the intercuspal
distance
Conservative proximal
extensions
• you c...
Modifications
No proximal grooves
No reverse curves
www.indiandentalacademy.comwww.indiandentalacademy.com
Class I cavity preparation
CLASS I – Pit and fissure cavities in the
occlusal surface in posterior and lingual surface in
...
Instrumentation
Utilize a # 330 bur
Tip -
• measure width and
length of cutting shank
High speed
Minimal use of hand
instr...
Mandibular Molars Outline Form
www.indiandentalacademy.comwww.indiandentalacademy.com
It is unnecessary
to cross the
central ridge
Mandibular Molars Outline Form
www.indiandentalacademy.comwww.indiandentalaca...
Maxillary Molars Outline Form
www.indiandentalacademy.comwww.indiandentalacademy.com
Pulpal Floor Depth –
0.5 - 1 mm into dentin
primary molars - 1.25 to
1.50 mm
Intercuspal width - 1/3rd
Rounded internal li...
Flat FloorFlat Floor
Relatively parallel to the cusp tips
www.indiandentalacademy.comwww.indiandentalacademy.com
Internal Form of a Class I Prep
1) Depth 0.5 into dentin
2) Angle of floor and walls is
rounded
3) Slightly rounded pulpal...
A Maxillary right first and
second
molars (occlusal view)
Maxillary second primary
molar (lingual view)
Mandibular right f...
 Method for glass ionomer restorations
1. Local anesthesia may not always be necessary; however,
rubber dam isolation sho...
5.When using encapsulated materials, ensure that the capsules
are compressed for atleast 3 seconds to facilitate adequate
...
POSTERIOR COMPOSITE
RESTORATION
www.indiandentalacademy.comwww.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com
Amalgam
composite
composite
www.indiandentalacademy.comwww.indiandentalacademy.com
INCREMENTAL PLACEMENT OF
COMPOMER OR COMPOSITE
www.indiandentalacademy.comwww.indiandentalacademy.com
Incipient Class I Cavity in a Very Young
Child
child under 2 years of age
small cavity preparation made without the aid of...
CLASS III CAVITY PREPARATION
CLASS III – Proximal surface of anterior teeth
without the involvement of the incisal angle
w...
 Conserve as much tooth structure as possible
 Stress on access and caries removal only
 Composite – bevel cavosurface ...
EXTENSION – LOCK/ KEYWAY SHOULD BE POSITIONED TO
ONE
SIDE OF THE MIDLINE IN MIDDLE ONE THIRD OF
THE LINGUAL SURFACE
OUTLIN...
PROXIMAL WALLS - SHOULD BE PLACED AT RIGHT
ANGLES TO THE CAVOSURFACE
DEPTH- 0.5 TO DENTIN,FOLLOW CONTOUR
OF THE EXTERNAL S...
CLASS IV CAVITY PREPARATION
CLASS IV – Proximal surface of anterior teeth
with the involvement of the incisal angle
www.in...
www.indiandentalacademy.comwww.indiandentalacademy.com
 Interproximal slice & labial and
lingual dove tails
 Include any class V lesions
 At the gingival aspect a definite
in...
Restoration of Proximal-Incisal Caries
in Primary Anterior Teeth
Esthetic Resin Restoration
Stainless Steel Crown
Open-Fac...
CLASS V CAVITY PREPARATION
 CLASS V – Cavities in the gingival third
www.indiandentalacademy.comwww.indiandentalacademy.c...
 # 330 bur is used to cut the cavity
 Outline form – limited to carious lesion and adjacent
decalcified areas
 Kidney s...
Bevelled conventional preparation
www.indiandentalacademy.comwww.indiandentalacademy.com
REFERENCESREFERENCES
 A MANUAL OF PAEDODONTICS .A MANUAL OF PAEDODONTICS .
R.J.ANDLAW AND W.P.ROCK
 KENNEDY’S PAEDIATRIC...
 PICKARD`S MANUAL OF OPERATIVE DENTISTRYPICKARD`S MANUAL OF OPERATIVE DENTISTRY
 G.J MOUNTS BASIC PRINCIPLES OF FORG.J M...
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Diagnosis, treatment planning, restoration / dental crown & bridge courses

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Diagnosis, treatment planning, restoration / dental crown & bridge courses

  1. 1. TREATMENT PLANNING, ISOLATION,RESTORATION OF CLASS I,III,IV,V LESIONS INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY Leader in continuing Dental EducationLeader in continuing Dental Education www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. DIAGNOSIS AND REGISTRATION OF CARIOUS LESIONS  Diagnostic tools The visual-tactile method with light, mirror, and gentle probing www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3.  The visual method with temporary elective tooth separation www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. www.indiandentalacademy.comwww.indiandentalacademy.comwww.indiandentalacademy.comwww.indiandentalacademy.com Indian Dental academy • www.indiandentalacademy.com • Leader continuing dental education • Offer both online and offline dental courses
  5. 5.  The conventional bitewing radiographic method www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. The fiber-optic transillumination method www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7.  DIAGNODent Laser Device www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8.  Quantitative Light- induced Fluorescence www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9. Electrical conductance (fixed Frequency) method www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10.  ELECTRONIC CARIES MONITOR  CARIES DETECTING DYES  DIGITAL RADIOGRAPHIC METHOD  THE RVG SYSTEM  COMPUTER-AIDED RADIOGRAPHIC METHOD  THE ENDOSCOPIC FILTERED FLUORESCENCE METHOD(EFF) www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11. TREATMENT PLANNING “It is not feasible to describe a precise treatment planning in the child patient.” welbury www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. OBJECTIVES A CHILD GAINS ADULTHOOD IN A STATE OF GOOD DENTAL HEALTH THAT THE CHILD DEVELOPS A POSITIVE ATTITUDE TO DENTAL CARE www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13. PHYLOSOPHY OF TREATMENT PLANNING  TREATMENT PLAN MUST BE DEVELOPED AND DESIGNED TO PROVIDE HIGH QUALITY RESTORATIVE CARE FOR EACH INDIVIDUAL CHILD’S NEED 1.NO RESTORATIVE CARE HAS BEEN ATTEMPTED 2.ALREADY HAD RESTORATIONS www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. 1.NO RESTORATIVE CARE HAS BEEN ATTEMPTED  SEQUENCED INTRODUCTION TO THE PROCEDURES OF RESTORATING TEETH.  STEP BY STEP PROCEDURE FOR THE CONTROL OF PAIN (LOCAL ANAESTHESIA), RUBBER DAM, ROTARY INSTRUMENTS AND RESTORATIONS. www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. 2. HAD ALREADY VISITED  TOTALLY UNCO-OPERATIVE  RELUCTANT TO CO-OPERATE BUT PERSUADABLE www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. COMMUNICATION WITH CHILD AND PARENT  Objective - Allay anxiety of first dental visit  Reception and waiting areas - Should communicate a sense of friendship and welcome  Should gain patient’s interest and co-operation  Show interest in child www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. Talking to parents • Never guarantee that we will finish in a certain number of appointments • Never guarantee what treatment we will do next • Don't give encounter forms to parents • Relay parental concerns to the faculty www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18. – Discuss with the parent WHY the patient needs the care we are proposing – Discuss with the parent after each appointment what was accomplished and patient cooperation (be as positive as possible) www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. PRINCIPLES OF TREATMENT PLANNING NEW PATIENT ↓ HISTORY AND EXAMINATION ↓ MANAGAMENT OF ACUTE PROBLEMS ↓ ASSESSMENT ↓ www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20. ↓ LONGTERM TREATMENT OBJECTIVES PATIENT PARENTAL CO-OPERATION ↓ ASPECTS OF CARE ↓ PREVENTIVE -RESTORATIVE –ESTHETIC ↓ ↓ ↓ DIETARY ADVICES STABILIZATION DISCOLORATION FLUORIDE RESTORATIONS SHAPE ORAL HYGIENE EXTRACTIONS POSITION FISSURE SEALANTS ↓ www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. ↓ DISCUSSION ↓ PARENT-PATIENT-DENTIST-REFERRAL ↓ DEFINITIVE TREATMENT PLAN www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. AIMS OF THE FIRST SESSION  To establish good communication with the child and parent  To obtain important background information (patient’s history)  To examine the child and obtain radiographs)  To introduce the child to a simple treatment procedure  To explain treatment aims to the child and parents www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. CARIES RISK ASSESSMENT  RISK FACTORS  Sucrose exposure  Previous carious experience  Levels of cariogenic bacteria  Oral hygiene practices  Fluoride exposure  Saliva  Social and family practices www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24.  STAINING OF PIT AND FISSURES  DISCOLORATION OF THE ENAMEL  CONDITION OF THE MARGINAL RIDGE WHETHER INTACT OR BROKEN  PULPAL PATHOLOGY www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25. SUMMARY OF THE FIRST APPOINTMENT Take the history a. social b. dental c. medical Examine the child a. extra-oral b. intra-oral Take radiographs if required www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26. Perform a simple operative procedure a. prophylaxis: incisors only (in young child) or full mouth, including removal of calculus ifrequired b. perform simple palliative treatment if necessary c. possibly topical fluoride treatment or other non traumatic procedure www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27. Explain aims of treatment to parent a. Emphasize the need for preventive as well as operative treatment b. Request that the child's toothbrush be brought at the next visit c. Give an estimate of the number of visits that will be required to complete treatment www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28. An outline for treatment planning Operative treatment general Restorations Extractions Orthodontic treatment www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29. LONG TERM TREATMENT PLANNING Overall assessment of the general attitude of the child and parents to dental care “ Delaying the final treatment planning until the acute problems have resolved is very worthwhile” www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30. Order of treatment: general guidance First visit  Take radiographs.  Introduce the child to operative treatment-'polish' a few teeth or full prophylaxis. www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31. 2nd visit  Assess tooth brushing technique - observe the child brushing - determine Oral Debris Index Stan oral hygiene instruction  Topical fluoride or fissure sealant or preventive resin restoration.  Provide a diet record leaflet and explain its purpose to the parent and/or child. www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32. 3rd visit  Collect diet record leaflet.  Continue oral hygiene instructions  Amalgam restoration in maxillary molar-infiltration local analgesia­ www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33. Fourth visit Continue oral hygiene instruction. At this and subsequent visits, introduce progressively to more complex restorations. Delaying treatment of mandibular teeth if possible until the child happily accepts maxillary infiltrations. Diet counseling. www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. Rampant caries • Consider gross caries removal and temporization • Discuss baby bottle syndrome if the patient is young • Consider diet history and extended oral hygiene instructions with parent • Consider fluoride supplementation, either systemic or topical www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. Pain • Always treat the area that is painful to the patient, regardless of treatment plan order • Never let a patient leave in pain! www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36. Two factors significantly reduce the survival rate of restorations ……….walls et al 1985  Lack of local analgesia  Age of the patient  Topical analgesia before giving an injection  Careful measured technique with full explanation to the child through out the local anesthesia procedure flavoured topical gel fine gauge needle warmed analgesia solution slow administration of the solution constant reinforcementwww.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37. www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. QUADRANT DENTISTRY  Reduces the number of times local analgesia is used  Makes maximum use of time available  Economically beneficial to parents as well as the dentists www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39. ISOLATION OF TEETH GOALS OF ISOLATION  MOISTURE CONTROL  RETRACTION AND ACCESS  HARM PREVENTION www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40.  SALIVA EJECTORS  COTTON WOOL ROLLS  ABSORBENT PADS  RUBBER DAM www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41. SALIVA EJECTORS Hygoformic saliva ejector / tongue protector www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. Cotton rolls, cellulose wafers, gauze sponges Cotton roll holder www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43. Cotton roll alternative Absorbs without the bulk of rolls www.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44. Atropine Sulfate, 0.4mg Tablets. effectively reduces saliva flow within 60 seconds, persists for 4-6 hours. www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45. RUBBER DAM ISOLATION S.C.BarnumS.C.Barnum in 1864 introduced rubber dam into dentistry ADVANTAGES:  Dry clean operating field  Improved access and visibility  Improved properties of dental materials  Protection of the patient and operatorwww.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46. Improves access and visualization operator efficiency and increased productivity Superior moisture control Prevents aspiration or swallowing of foreign bodies Protects soft tissues Aids behavior management Child becomes nasal breather Helps dentist educate parents www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47. Disadvantages: Time consumption and patient objection www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48. Certain oral conditions that preclude the use of rubber dam  Erupting teeth with insufficient support for retainer  Third molars  Extremely malpositioned teeth  Asthmatic patients  Psychological reasons  Latex allergy www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49. Rubber dam kit www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50. ClampsClamps  Bland clamps – jaws are flat and point directly towards each other Designed to grasp the tooth at or above the gingival margin  Retentive clamps - -jaws are directed gingivally so that they can grasp tooth below gingival margin www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51. RETAINER/CLAMPS Partially erupted permanent molars Fully erupted permanent molars Second primary molars First primary molars Primary incisors www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52. www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53. www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54. www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55.  BW, JW Molar clamps (wingless)  K Molar Clamps  GW Premolar clamps  EW Clamps ( for small tooth)  AW Molar wingless (erupting tooth)  Cervical Clamp (Ferrier pattern) for anterior teeth)  Ivory #7,8,8A,14 A for molars  #0, 1,2 for premolars  # 212 for anterior teethwww.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. Rubber clamp Four point prong contact with tooth www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. Winged - small projections allow it to be mounted on dam prior to application Wingless - applied directly to tooth www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58. Rubber dam clamp for broken down and partially erupted tooth www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59. RUBBER DAM  Size 5*5 6*6  Thickness Thin 0.006” Medium 0.008” Heavy 0.010” Extra heavy 0.012” Special heavy 0.014”  Color black, green , blue beige, transparent Side shiny , dullwww.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60. RUBBER DAM TEMPLATE www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. RUBBER DAM FRAMES  ASH PATTERN  MODIFIED YOUNG’S PATTERN  SVENSKA N- O FRAME www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62. Universal U shaped  Nygaard ostby  Sauveor (oval) www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63. CLAMP PLACEMENT FORECEPS STOKES BREWER ASH www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64. RUBBERDAM PUNCH Ainsworth Ash www.indiandentalacademy.comwww.indiandentalacademy.com
  65. 65. Ainsworth Ivory www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66. Punching the holes  Lower molars & large upper molars  Upper molars, small molars, 2nd primary molars  Canines, premolars and 1st primary molars  Upper incisors  Lower incisors www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67. Additional retention devices wooden wedges, elastics, latex cord www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68. Rubber dam Application www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69. Why Ligate the Clamp?  All retainers applied before the rubber dam is in place must be ligated. A 12” piece of floss should be attached to the retainer and threaded though both holes to catch all of the pieces should the retainer break.  Prevents the patient accidentally swallowing the clamp.  Prevents injury to the dental team from flying debris caused by an improper seat of the clamp. www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70. Clamp secured with floss www.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71. TECHNIQUE 1 – Clamp placement prior to rubber dam ADVANTAGESADVANTAGES  Tooth and gingival margins are clearly visible.  This will enable to place the clamp precisely with minimal risk of gingival trauma. INDICATIONSINDICATIONS  Posterior teeth in children and adults except 3rd molars www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72.  Clamp usedClamp used – winged type ; wingless with specially shaped jaws Wingless for multiple tooth isolation  Punching holesPunching holes – 2/3 overlapping www.indiandentalacademy.comwww.indiandentalacademy.com
  73. 73. Clamp is placed on the tooth to be isolated Clamp is placed on the forceps, expanded and the forceps is locked www.indiandentalacademy.comwww.indiandentalacademy.com
  74. 74. Clamp forceps are removed leaving behind clamp on the tooth The rubber dam sheet is carried into the mouth with both index finger being used to stretch and place over the clamp www.indiandentalacademy.comwww.indiandentalacademy.com
  75. 75. Placement of rubber dam frame www.indiandentalacademy.comwww.indiandentalacademy.com
  76. 76. www.indiandentalacademy.comwww.indiandentalacademy.com
  77. 77. www.indiandentalacademy.comwww.indiandentalacademy.com
  78. 78. TECHNIQUE 2 - Clamp and rubber dam placed together INDICATIONS:INDICATIONS:  Posterior most teeth, 3rd molars  Conditions in which other techniques are impractical DISADVANTAGE:DISADVANTAGE:  Limited vision Clamp usedClamp used  winged clamp www.indiandentalacademy.comwww.indiandentalacademy.com
  79. 79. Extra oral placement of clamp (winged) helpful when isolating small number of teeth www.indiandentalacademy.comwww.indiandentalacademy.com
  80. 80. TECHNIQUE 3 - Clamp placed after the rubber dam  It should be carried out with assistance  Restricted to anterior teeth and possibly pre-molar because of limited access  When large sized clamps are used www.indiandentalacademy.comwww.indiandentalacademy.com
  81. 81. MULTIPLE TOOTH ISOLATION  Clamps should not be placed on a tooth which requires which requires restoration  If the is narrow mesio-distally then the second tooth to the distal is preferable  When several teeth require treatment the operating field is extended mesially or across the arch to provide clear access and maximum retention  Distal tooth will usually be clamped and the mesial is not clamped www.indiandentalacademy.comwww.indiandentalacademy.com
  82. 82. QUADRANT ISOLATION www.indiandentalacademy.comwww.indiandentalacademy.com
  83. 83.  ADDITIONAL RETENSION www.indiandentalacademy.comwww.indiandentalacademy.com
  84. 84. www.indiandentalacademy.comwww.indiandentalacademy.com
  85. 85. Anterior Teeth www.indiandentalacademy.comwww.indiandentalacademy.com
  86. 86. www.indiandentalacademy.comwww.indiandentalacademy.com
  87. 87. ISOLATION OF LOWER INCISORS www.indiandentalacademy.comwww.indiandentalacademy.com
  88. 88. Removal of Rubber Dam  Thoroughly cleanse area.  Cut/remove interproximal ligatures.  Stretch rubber dam facially and cut each interproximal septum with scissors.  Remove clamp with clamp forceps.  Remove dam and examine it for any missing pieces.  Examine site for remaining rubber; remove with floss or explorer.  Rinse oral cavity, wipe off patient’s lips. www.indiandentalacademy.comwww.indiandentalacademy.com
  89. 89. www.indiandentalacademy.comwww.indiandentalacademy.com
  90. 90. Block type and Ratchet type mouth props www.indiandentalacademy.comwww.indiandentalacademy.com
  91. 91. General Considerations Adhere to GV Black’s principles with respect to outline, resistance, retention and convenience form and finishing of enamel walls. www.indiandentalacademy.comwww.indiandentalacademy.com
  92. 92. Advantages and disadvantages of materials used in pediatric dentistry Advantages Disadvantages  Amalgam Simple Not adhesive Quick Requires mechanical retention in cavity Cheap Environmental and occupational hazards Technique insensitive Public concerns Durable  Composite Resin Adhesive Technique sensitive Aesthetic Rubber dam required Reasonable wear properties Expensive Command setwww.indiandentalacademy.comwww.indiandentalacademy.com
  93. 93.  Stainless-steel Very durable Extensive tooth preparation crowns Protects and support Patient cooperation remaining tooth required Structure Unaesthetic  Glass ionomer Cement Adhesive Brittle Aesthetic Susceptible to erosion and wear Fluoride leaching  Resin-modified Adhesive Water absorption glass ionomer Aesthetic Significant wear Command set Simple to handle www.indiandentalacademy.comwww.indiandentalacademy.com
  94. 94. Polyacid-modified Adhesive Technique sensitive  composite resin Aesthetic Less fluoride release than glass ionomer Command set Simple to handle Radio-opacity www.indiandentalacademy.comwww.indiandentalacademy.com
  95. 95. Guide to the use of materials  Primary dentitionPrimary dentition  Occlusal (class I) Glass ionomer Composite resin  Interproximal (class II) Glass ionomer Amalgam Composite resin/GIC sandwich Stainless-steel crown  Gross carious breakdown or restoration after pulp therapy Stainless-steel crown www.indiandentalacademy.comwww.indiandentalacademy.com
  96. 96. Permanent dentitionPermanent dentition Occlusal table Fissure sealant  Occlusal enamel caries Fissure sealant  Occlusal caries with minimal involvement of dentin Preventive resin restoration  Occlusal caries with extension into dentine Composite resin  Interproximal Amalgam  Incisal edge Composite resin  Cervical Glass ionomer Composite resin www.indiandentalacademy.comwww.indiandentalacademy.com
  97. 97. ModificationsModifications View from distal surface of primary 1st molar B L www.indiandentalacademy.comwww.indiandentalacademy.com
  98. 98. Black-type Modern  Gain access Gain access to the (not necessarily caries) caries  Prepare the cavity to Remove the caries standard outline & shape  Remove any remaining caries Plan the final cavity outline and shape Complete the cavity preparation www.indiandentalacademy.comwww.indiandentalacademy.com
  99. 99. Modifications Relatively wider isthmus width • one-third the intercuspal distance Conservative proximal extensions • you can see light, but cannot pass an explorer tip through www.indiandentalacademy.comwww.indiandentalacademy.com
  100. 100. Modifications No proximal grooves No reverse curves www.indiandentalacademy.comwww.indiandentalacademy.com
  101. 101. Class I cavity preparation CLASS I – Pit and fissure cavities in the occlusal surface in posterior and lingual surface in anterior teeth www.indiandentalacademy.comwww.indiandentalacademy.com
  102. 102. Instrumentation Utilize a # 330 bur Tip - • measure width and length of cutting shank High speed Minimal use of hand instruments www.indiandentalacademy.comwww.indiandentalacademy.com
  103. 103. Mandibular Molars Outline Form www.indiandentalacademy.comwww.indiandentalacademy.com
  104. 104. It is unnecessary to cross the central ridge Mandibular Molars Outline Form www.indiandentalacademy.comwww.indiandentalacademy.com
  105. 105. Maxillary Molars Outline Form www.indiandentalacademy.comwww.indiandentalacademy.com
  106. 106. Pulpal Floor Depth – 0.5 - 1 mm into dentin primary molars - 1.25 to 1.50 mm Intercuspal width - 1/3rd Rounded internal line angles B-L walls slightly undercut M-D walls flare at marginal ridges www.indiandentalacademy.comwww.indiandentalacademy.com
  107. 107. Flat FloorFlat Floor Relatively parallel to the cusp tips www.indiandentalacademy.comwww.indiandentalacademy.com
  108. 108. Internal Form of a Class I Prep 1) Depth 0.5 into dentin 2) Angle of floor and walls is rounded 3) Slightly rounded pulpal floor Avoids pulp 4) sharp cavo- surface angle www.indiandentalacademy.comwww.indiandentalacademy.com
  109. 109. A Maxillary right first and second molars (occlusal view) Maxillary second primary molar (lingual view) Mandibular right first and second primary molars www.indiandentalacademy.comwww.indiandentalacademy.com
  110. 110.  Method for glass ionomer restorations 1. Local anesthesia may not always be necessary; however, rubber dam isolation should be used where possible 2. The outline of the cavity should follow the extent of the carious lesion. There should be no extension for prevention. An additional retention form for minimal proximal cavities can be achieved by placing grooves into the dentine using very small (size 1 –2 )round burs  3.Remove all soft caries using a slow round burr or hand instruments. Be aware of the large pulp chamber as it is easy to expose the pulp of a primary molar.  4.Pre-condition the dentine using 10%polyacrylic acid for 10 seconds, wash and dry. www.indiandentalacademy.comwww.indiandentalacademy.com
  111. 111. 5.When using encapsulated materials, ensure that the capsules are compressed for atleast 3 seconds to facilitate adequate mixing of the powder and liquid components. Mix for 10 seconds in the amalgamator, discard the rest 3 –4 mm of the mixed materials as this is often unsatisfactory. Place the remainder directly into the cavity. 6.Once the relatively thick material has been placed into the cavity it is compressed with a ball burnisher – the use of a small amount of bonding agent prevents sticking to the instrument. www.indiandentalacademy.comwww.indiandentalacademy.com
  112. 112. POSTERIOR COMPOSITE RESTORATION www.indiandentalacademy.comwww.indiandentalacademy.com
  113. 113. www.indiandentalacademy.comwww.indiandentalacademy.com
  114. 114. Amalgam composite composite www.indiandentalacademy.comwww.indiandentalacademy.com
  115. 115. INCREMENTAL PLACEMENT OF COMPOMER OR COMPOSITE www.indiandentalacademy.comwww.indiandentalacademy.com
  116. 116. Incipient Class I Cavity in a Very Young Child child under 2 years of age small cavity preparation made without the aid of the rubber dam or local anesthetic objective -to restore the tooth with amalgam to arrest decay and to prevent further tooth destruction without a lengthily or involved dental appointment www.indiandentalacademy.comwww.indiandentalacademy.com
  117. 117. CLASS III CAVITY PREPARATION CLASS III – Proximal surface of anterior teeth without the involvement of the incisal angle www.indiandentalacademy.comwww.indiandentalacademy.com
  118. 118.  Conserve as much tooth structure as possible  Stress on access and caries removal only  Composite – bevel cavosurface margin throughout www.indiandentalacademy.comwww.indiandentalacademy.com
  119. 119. EXTENSION – LOCK/ KEYWAY SHOULD BE POSITIONED TO ONE SIDE OF THE MIDLINE IN MIDDLE ONE THIRD OF THE LINGUAL SURFACE OUTLINE – THE LOCK SHOULD HAVE A SMOOTH FLOWING AND ROUNDED OUTLINE ISTHMUS – ROUNDED MARGIN ,LARGE ENOUGH TO ACOMMODATE COMPOSITE / AMALGAM www.indiandentalacademy.comwww.indiandentalacademy.com
  120. 120. PROXIMAL WALLS - SHOULD BE PLACED AT RIGHT ANGLES TO THE CAVOSURFACE DEPTH- 0.5 TO DENTIN,FOLLOW CONTOUR OF THE EXTERNAL SURFACE EXTENSION- JUST BEYOND THE CONTACT AREA OF THE ADJACENT TOOTH ADDITIONAL RETENSION - PIT AT THE GINGIVO-LABIAL JUNCTION www.indiandentalacademy.comwww.indiandentalacademy.com
  121. 121. CLASS IV CAVITY PREPARATION CLASS IV – Proximal surface of anterior teeth with the involvement of the incisal angle www.indiandentalacademy.comwww.indiandentalacademy.com
  122. 122. www.indiandentalacademy.comwww.indiandentalacademy.com
  123. 123.  Interproximal slice & labial and lingual dove tails  Include any class V lesions  At the gingival aspect a definite interproximal shoulder / gingival seat www.indiandentalacademy.comwww.indiandentalacademy.com
  124. 124. Restoration of Proximal-Incisal Caries in Primary Anterior Teeth Esthetic Resin Restoration Stainless Steel Crown Open-Face Steel Crowns Direct Resin Crowns www.indiandentalacademy.comwww.indiandentalacademy.com
  125. 125. CLASS V CAVITY PREPARATION  CLASS V – Cavities in the gingival third www.indiandentalacademy.comwww.indiandentalacademy.com
  126. 126.  # 330 bur is used to cut the cavity  Outline form – limited to carious lesion and adjacent decalcified areas  Kidney shaped, a gently curved outline form is acceptable as a square, sharp outline form at the mesial and distal margins  Remaining caries is removed with slow running ,round #2 bur  Gingival enamel margin should follow a regular curve parallel to the gingival attachment unless the lesion extends subgingivally. www.indiandentalacademy.comwww.indiandentalacademy.com
  127. 127. Bevelled conventional preparation www.indiandentalacademy.comwww.indiandentalacademy.com
  128. 128. REFERENCESREFERENCES  A MANUAL OF PAEDODONTICS .A MANUAL OF PAEDODONTICS . R.J.ANDLAW AND W.P.ROCK  KENNEDY’S PAEDIATRIC OPERATIVE DENTISTRYKENNEDY’S PAEDIATRIC OPERATIVE DENTISTRY M.E.J. CURZON 4TH EDITION  ART & SCIENCE OF OPERATIVE DENTISTRYART & SCIENCE OF OPERATIVE DENTISTRY T.M.ROBERSON 4TH EDITION  HAND BOOK OF PEDIATRIC DENTISTRYHAND BOOK OF PEDIATRIC DENTISTRY www.indiandentalacademy.comwww.indiandentalacademy.com
  129. 129.  PICKARD`S MANUAL OF OPERATIVE DENTISTRYPICKARD`S MANUAL OF OPERATIVE DENTISTRY  G.J MOUNTS BASIC PRINCIPLES OF FORG.J MOUNTS BASIC PRINCIPLES OF FOR RESTORATIVE DENTISTRYRESTORATIVE DENTISTRY  OPEARTIVE DENTISTRY 1983;8:57-63 :148-151OPEARTIVE DENTISTRY 1983;8:57-63 :148-151  QNINTESSENCE INT 2000;31:527-533 535-QNINTESSENCE INT 2000;31:527-533 535- 546 :621-629546 :621-629  JADA 1996;127:107-108JADA 1996;127:107-108  JOURNAL OF PEDIATRIC DENTISTRY 2002;24:JOURNAL OF PEDIATRIC DENTISTRY 2002;24: REVIEWREVIEW www.indiandentalacademy.comwww.indiandentalacademy.com

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