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• Pulpotec


  Radiopaque, Non resorbable, Rapid and long – term treatment by pulpotomy of vital molar, both permanent and deciduous, Setting time 7 hours, Aseptic treatment, Induce cicatrization of the pulpal stump at the chamber – canal interface, Maintaining the structure of underlying pulp

  
• Pulpotec Composition


  • Powder: Iodoform, polyoxymethylene, excipient
  • Liquid: phenol, Guaiacol, Formaldehyde, Dexamethasone Acetate, excipient
• Pulpotec Indications


  • Adults: Treatment of pulpitis on permanent vital molars
  • Pedodontics: Treatment of pulpitis on immature permanent vital molar, Treatment of infected deciduous molars with or without presence of an abscess

  
• Why indirect pulp capping and direct pulp capping not for primary teeth?

  
• Calcium hydroxide


  pH more than 11 -12, Highly toxic, Stimulate cells, Internal Root Resorption
• In primary tooth, when there is deep carious lesion not expose the pulp, A traumatic Restorative Treatment (ART) is used

  
• To be remembered for clinical work

  • Mirror, probe, tweezer
  • Cotton, cotton roll (For good dryness)
  • Case sheet
  • Sucker (For good dryness)
  • Use ( Air / Water Syringe )
  • Tricresol with large piece of cotton
• Clinical Procedures


  • Pulpotomy on primary tooth
  • Pulpectomy on primary tooth
  • Indirect pulp capping on primary tooth
  • Direct pulp capping on permanent tooth
  • Pulpotomy, Apexgenesis on immature permanent tooth

  
• Restorative materials


  Materials used in pediatric dentistry
• Choosing materials


  1. Determine what is the best available option for each clinical situation

  2. Determine what material will provide the desired characteristics

  3. Determine what technique can be completed successfully with minimal psychological trauma to the child
• Cavity varnish


  • Material applied in thin film thickness usually 2-5 microns
  • Can be applied to all prepared cavities on both enamel and dentin
  • Seals the dentinal tubules and reduces leakage around a restoration
  • Provides protective coating and barrier to leakage
  • Provides no thermal insulation

  
• Cements


  • Serve as luting agent
  • Provide mechanical retention
  • Some used as permanent or temporary restorations
  • Used as bases for other materials
• Types of cements


  • Silicate cement (no longer used)
  • Zinc phosphate cement (no longer used)
  • Polycarboxylate cement
  • Zinc oxide-eugenol cement
  • Resin cement
  • Glass ionomer cement
  • Resin modified glass ionomer cements

  
• Ideal requirements of cements


  • Medium working time
  • Short-medium setting time
  • Very high compressive strength
  • High bond strength to tooth
  • Release of fluoride
  • No pulpal response
  • Easy to remove excess

  
• Zinc polycarboxylate cement


  • Hybrid of silicate cement (powder) and polycarboxylate (liquid)
  • Setting reaction has 3 stages: dissolution, gelation (migration), precipitation and hardening

  
• Glass ionomer cement


  • Both chemical and light curing
  • Overcome moisture sensitivity and low early strength
  • Addition of polymerizable functional groups
  • Type I: Luting agent
  • Type II: Filling material
  • Type III: Base and liner

  
• Restorative materials used in pediatric dentistry

  • Amalgam Restoration
  • Restorative Resin
  • Class Ionomer
  • Full coverage in Pediatric Dentistry

  
• Requirements of an ideal restorative material


  • Restoration of esthetic
  • Maintenance of the crown strength
  • Preserve the anatomy of occlusal surface, thus preserving inter arch relations
  • Long working time and short setting time
  • Long term adhesion between tooth and restoration to ensure complete isolation

  
• Amalgam Restoration


  • Selection of alloy
  • Trituration
  • Condensation
  • Marginal breakdown and bulk fracture
  • Bonded Amalgam Restoration
  • Mercury Toxicity

  
• High copper alloy


  Improved laboratory properties and clinical performance, have low creep
• Zinc-free, high-copper alloy


  Should be used when the dentist operates in a field where moisture control is difficult
• Under trituration


  Appears dry and sandy and does not cohere into a single mass, Amalgam will set too rapidly, which results in a high residual mercury content, Reduced strength, Increased the likelihood of fracture or marginal breakdown

  
• Condensation


  • To adapt the amalgam to the walls of the cavity preparation as closely as possible, To minimize the formation of internal voids
• Marginal breakdown


  Severely chipped marginal areas, A thin ledge of amalgam may be left that extends slightly over the enamel at the margins, Cannot support the forces of mastication, Fracture, leaving an opening at the margins
• Bulk fracture


  Much less common with high copper amalgam alloys
• Bonded Amalgam Restoration


  Dental amalgam does not adhere to tooth structure, it must be retained mechanically by the design of the cavity preparation and/or mechanical devices such as pins, Chemically activated dentin-bonding system over which the amalgam is condensed before the resin adhesive has hardened

  
• Types of Restorative Resin

  • Conventional composite
  • Micro- filled composite
  • Small particles, Hyprid and Nanohyprid composite
  • Flowable composite
  • Posterior composite
• Composite material


  A combination of at least two chemically different materials with a distinct interface separating the components, Provides properties that could not be obtained with any of the components alone
• Resin matrix


  Bisphenol A-glycidyldimethacrylate (bis-GMA) or urethane dimethacrylate resin
• Fillers


  Ground particles of fused silica, crystalline quartz, and soft glasses such as barium, strontium, and zirconium silicate glass, Filler and the resin matrix must be chemically bonded together with a coupling agent on the surface of the filler
• Restorative materials


  Materials used in pediatric dentistry

  
• Types of crowns


  • Stainless Steel Crowns
  • Nickel Chromium Crowns
  • Veneered Stainless Steel Crowns
  • Strep crowns (Zirconia)
  • Ceramic Crowns

  
• Classification of Resin Restoration based on method of curing

  • Chemical cure
  • Light cure
  • Dual cure
• Stainless Steel Crown


  • Semi permanent restoration used in primary and permanent teeth
  • More frequently used in deciduous dentition than permanent dentition

  
• Conventional Composite (Macro-Filled)


  The fillers in conventional composite is in the 8 to 12 un range, Wear resistance increased, Surface roughness increased
• Micro- Filled Composite


  Use of an extremely small silica filler particle, whose size is 0.02 to 0.04 um, Improve the surface smoothness and polish ability of composite resins, Softer composite and have a slightly higher coefficient of thermal expansion, a higher water absorption, more polymerization shrinkage, and lower mechanical properties
• Factors to consider when using Stainless Steel Crowns

  • Dental age of the patient
  • Co-operation of the patient
  • Motivation of the patient
  • Medically compromised /disabled children
• Stainless Steel Crown Composition

  • 17-19% chromium
  • 10-13% nickel
  • 67 % iron
  • 4% minor elements
• Small –particle composite


  Have an average filler size of 1 to 5 um, with a broad distribution of sizes, Best combination of physical properties of all the currently available composites
• Nickel-Base Crown Composition


  • 72% nickel
  • 14% chromium
  • 6-10% iron
  • 0.o4% carbon
  • 0.35% manganese
  • 0.2% silicon