Pediatric Dentistry Restorative Technique

These are the basic goals of and criteria for judging the various procedures.  The student will be able to:

1. List and explain the rationale for the sequence of the "operative principles:"

   Operative Principles:

   1. Anesthesia
   2. Isolation
   3. Establish depth
   4. Outline form
   5. Ideal preparation completed
   6. . Excavation completed




2. Demonstrate on a typodont tooth the ability to prepare a primary molar to receive Class I and Class II amalgam restorations so that:
   
   1. the margins of the restoration will place in self-cleansing areas; the proximal walls will parallel the external surface of the tooth;
   2. internal line angles are rounded to reduce incidence of mechanical pulp exposure and reduce concentration of internal stresses in the tooth
   3. the buccal and lingual cusps are not undermined;
   4. all areas of potential carious involvement on the occlusal surface are included in the preparation;
   5. for the class II preparations the isthmus will be less than ½ but more than 1/3 of the distance between the buccal and lingual cusp tips;
   6. the buccal axial line angle and the lingual axial line angle approach 90°;
   7. the pulpal axial line angle is beveled; and
   8. no level is created on the gingival margin.
   
   
3. Demonstrate the ability to place a matrix band and to utilize appropriate condensation technique so that:
   1. anatomy and contact are restored; and
   2. porosity is not evident in the restoration.
   
   
4. Demonstrate the ability to carve an amalgam restoration so that:
   1. anatomy and proximal contact are restored;
   2. correct occlusion is restored; and
   3. marginal discrepancies are not created.
   
   
5. Demonstrate on a typodont tooth the ability to prepare a primary molar for a stainless steel crown restoration so that:
   1. the occlusal surface is reduced approximately 1mm providing ample clearance for the thickness of the crown;
   2. the proximal reductions are parallel to the long axis of the tooth (not tapered);
   3. creation of a gingival shoulder has been avoided; and
   4. all sharp line and point angles and cusps are rounded.
   
   

   (Note: reduction of the gingival 2/3's of the buccal and lingual surfaces is generally avoided).

6. Demonstrate the ability to adapt a stainless steel crown to a prepared primary molar so that:
   1. the cervical margin of the crown rests approximately 1mm below the free margin of the gingival;
   2. the buccal and lingual surfaces are contoured to restore the appropriate heights of contour;
   3. appropriate proximal contact is reestablished;
   4. there are no marginal discrepancies between the crown and the tooth;
   5. the cervical margin is smoothly polished; and
   6. correct occlusion is restored.
   
   
7. Demonstrate the ability to mix and place Dycal, I.R.M., Ketac-Cem and Durelon following the manufacturer's directions.
   
   
8. Demonstrate the ability to:
   1. prepare a tooth to receive a pit and fissure sealant;
   2. apply and polymerize sealant material according to the manufacturer's directions, and
   3. evaluate the sealant for retention.
   
   
9. Demonstrate the ability to fabricate a band and loop space maintainer so that:
   1. the band is well-adapted to the tooth (no large voids between band and tooth; band cannot easily be displaced);
   2. the loop follows the gingival contours;
   3. the loop is wide enough to allow partial eruption of the succedaneous tooth; and
   4. the loop contacts the mesial abutment at the  height of contour of the distal surface.
   
   
10. Demonstrate on a typodont tooth the ability to prepare a primary and permanent molar to receive posterior resin restoration:
    1. excavate all the decay;
    2. no specific outline form required;
    3. apply a liner such as Dycal/Vitrebond if dentin is exposed when all the decay is excavated;
    4. apply and polymerize the composite according to the manufacturer's directions;
    5. apply and polymerize sealant material over the resin restoration, according to the manufacturer's directions;
    6. evaluate the sealant for retention; and
    7. check the occlusion and adjust if necessary