Pediatric Restorative Dentistry

	Class 1 and 2 restorations for
	primary teeth
	G.Metcalf, DDS

TYPES OF RESTORATIONS

	ADHESIVE  DENTISTRY:
	Preventive Resin Restorations (PRR)- defined as a single or multiple, small, discontinuous, carious pits or fissures. May extend into enamel, dentin or DEJ. Excavated and restored with resin. Occlusal surface sealed for prevention.
	Composite/Resin Restorations - involves the excavation of single, larger carious lesion followed by restoration with a resin based material.
	Retention and resistance forms of cavity preparation do not apply, therefore more conservative. Tooth isolation is critical.

TYPES OF RESTORATIONS

	2.   AMALGAM RESTORATIONS:
	Follow G.V. Black’s principles of cavity preparation.
	Less conservative.
	More forgiving in terms of moisture control.

ANATOMIC CONSIDERATIONS OF PRIMARY TEETH

	Thinner enamel and dentin.
	Larger and higher pulp horns.
	Enamel rods in cervical area directed occlusally.
	Greater cervical constriction.
	Broad, flat proximal contacts.
	Narrow occlusal table.

STEPS IN CLASS 1 AMALGAM RESTORATIONS

	Appropriate anesthesia
	Rubber dam isolation
	Cavity preparation
	Excavation of remaining caries
	Trituration and placement of amalgam
	Condensation, carving, burnishing
	Check occlusion
	Finishing and polishing

CAVITY PREPARATION
Class 1 Amalgam

	External outline form:
	- Dovetail
	- Inclusion of pits, fissures, grooves, caries
	- Extension of occlusal portion varies
	depending on primary molar involved
	- Slight occlusal convergence of walls
	- Sharp cavosurface margins
	- Adequate tooth structure at marginal ridges
	- Width of prep 1/3 of occlusal table
	- Rounded line angles

Class 1 Amalgam

	Internal outline form:
	- Establish depth at 0.5-1mm into dentin
	using # 330 bur
	- Walls are wider at pulpal floor
	- All internal line angles should be rounded
	- Slightly rounded pulpal floor

Slide 8

 Class 2 cavity preparation - Primary molars

	Complete class 1 using #330 bur
	Extend occlusal outline to marginal ridge
	Switch to #245 Bur - 3 mm length
	Sweep bur buccolingually in a pendulum motion and in a gingival direction.
	Break contacts and check with explorer
	Axial wall should follow external contour
	Width of isthmus 1/2 of occlusal table
	Proximal box widest at gingival margin
	Rounded axiopulpal line angle
	No bevel at the gingival margins

Class 2 cavity preparation
Primary molars

Class 2 amalgam - primary molar

Class 2 cavity prep
Primary molars

Slide 13

Class 2 slot preparation

Matrix bands and retainers

	Contour, insert and place wedge
	Purpose: Restoration of proximal contact
	Types: Tofflemire,
	T-band, compositight*

Condensing and Carving of Amalgam

	Using an amalgam carrier, add increments and condense using positive finger rest.
	Overfill prep and begin to carve and burnish the occlusal portion with a lateral condensor
	After initial set, create the marginal ridge using an explorer
	Carve restoration and remove excess from margins using a cleoid-discoid or hollenback carver
	Carefully remove band and burnish restoration using a ball burnisher. Apply moist cotton pellet or pumice paste for final smoothening
	Remove rubber dam and check occlusion*

Slide 17

Finishing of Amalgam Restorations

	Objectives:
	Reduce tarnish and corrosion
	Improve marginal integrity
	Note:  Polishing should be delayed for 24 hours/subsequent visit

Amalgam restorations for primary teeth