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Restorative Techniques in
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Paediatric Dentistry
One of the rst books on the market to illustrate the various clinical techniques for restoration,
this revised and updated new edition offers new material on treatment planning, local analgesia,
biomaterials, biological and contemporary approaches, and aesthetic crowns. The book addresses the
specic needs of the paediatric patient and helps the clinician manage the restoration with those needs
in mind. As a classic volume, it is essential for every dentist working with children and adolescent
patients.
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Restorative Techniques in
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Paediatric Dentistry
An Illustrated Guide to Conventional and
Contemporary Approaches
ird Edition
Edited by
M S Duggal
BDS, MDS, FDSRCS, PhD, Dean of the College of Dental Medicine,
QU Health, Qatar University, Doha, Qatar
BDS, MFDS RCS Ire, FRCD Can Paed Dent, PhD Paed Dent, MPaed Dent
RCS Glas, FDS Paed Dent, Professor and Senior Consultant of Paediatric
Dentistry, Hamad Dental Centre, Hamad Medical Corporation and College of
Dental Medicine, QU Health, Qatar University, Doha, Qatar
Clinical Illustration, Formerly Head of Medical and Dental Illustration,
H Nazzal
A J Robertson
MBE, BSc, DipIMI, FIMI, HonFIMI, Principal Fellow in
Leeds Dental Institute, University of Leeds, Leeds, England
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Third edition published 2024
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by CRC Press
2385 NW Executive Center Drive, Suite 320, Boca Raton FL 33431
and by CRC Press
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
CRC Press is an imprint of Taylor& Francis Group, LLC
© 2024 M S Duggal, H Nazzal and A J Robertson
First edition published by CRC Press 1995
Second edition published by CRC Press 2002
This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts
have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal
responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any
views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not
necessarily reect the views/opinions of the publishers. The information or guidance contained in this book is intended
for use by medical, scientic or health-care professionals and is provided strictly as a supplement to the medical or other
professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and
the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on
dosages, procedures or diagnoses should be independently veried. The reader is strongly urged to consult the relevant
national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their
websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book
does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is
the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and
treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material
reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been
obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any
future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or
utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including
photocopying, microlming, and recording, or in any information storage or retrieval system, without written
permission from the publishers.
For permission to photocopy or use material electronically from this work, access www.copyright.com or contact the
Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978–750–8400. For works that are
not available on CCC please contact mpkbookspermissions@tandf.co.uk
Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for
identication and explanation without intent to infringe.
ISBN: 978-1-032-13230-3 (hbk)
ISBN: 978-1-032-22665-1 (pbk)
ISBN: 978-1-003-27364-6 (ebk)
DOI: 10.1201/9781003273646
Typeset in Times LT Std
by Apex CoVantage, LLC
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Contents
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List of Contributors ............................................................................................................................. vii
1. Treatment Planning ..................................................................................................................... 1
M S Duggal, H Nazzal, and A J Robertson
Children as Individuals
Quality Care for Children
Philosophy of Treatment Planning
Diagnosis
Dental Caries Assessment
Dental Charting
Radiographs
Choice of Restoration
Local Analgesia
Rubber Dam
Medical History and Treatment Planning
Examples
2. Local Analgesia ..........................................................................................................................12
M S Duggal, H Nazzal, and A J Robertson
Introduction
Basic Principles
Inltration Analgesia
Maxillary Molar Block
Palatal Analgesia in Children
Inferior Dental Block
Intraligamentary Injection
Computer-Controlled Local Analgesic Delivery
3. Rubber Dam ................................................................................................................................27
M S Duggal, H Nazzal, and A J Robertson
........................................................................................................................................2
....................................................................................................................................6
.................................................................................................................................10
...................................................................................................................................... 11
.................................................................................................................................. 12
..................................................................................................................1
..............................................................................................................1
.................................................................................................1
..............................................................................................................4
..............................................................................................................................5
.....................................................................................................................8
............................................................................................................................10
.................................................................................... 10
............................................................................................................................ 15
....................................................................................................................17
................................................................................................................18
......................................................................................................19
...................................................................................................................22
...........................................................................................................24
.........................................................................25
Armamentarium
Contraindications/Cautions Regarding the Use of Rubber Dam
Preparation of the Child Patient for Rubber Dam
Single Molar Isolation
Quadrant Isolation: The Trough Technique
4. Pulp Therapy for Primary Teeth ..............................................................................................40
M S Duggal, Nebu Philip, H Nazzal, and A J Robertson
The Pulpotomy Technique
The Pulpectomy Technique
Emergency Management of the Acute Abscess
Lesion Sterilization and Tissue Repair (LSTR)
Further Reading
...........................................................................................................................27
.................................................29
........................................................................30
..................................................................................................................30
.................................................................................34
...........................................................................................................40
.......................................................................................................... 55
...........................................................................69
...........................................................................69
...........................................................................................................................70
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vi Contents
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5. Preformed Metal Crowns for Primary Molars ....................................................................... 72
M S Duggal, H Nazzal, and A J Robertson
Indications for Preformed Metal Crowns
6. Dental Caries Management Using the Hall Technique ..........................................................89
Alaa BaniHani and M S Duggal
Introduction
The Rationale behind the Use of Hall Technique
Advantages of Hall Technique
When Should the Hall Technique Be Considered?
Steps for the Placement of a PMC Using the Hall Technique
Some Concerns Expressed by Clinicians about the Hall Technique
What Is the Success Rate of the Hall Technique, and How Well Is It Accepted by
Children and Parents? ..................................................................................................................98
The Use of Silver Diamine Fluoride (SDF)
Silver-Modied Atraumatic Restorative Technique (SMART)
Further Reading
7. Aesthetic Full Coverage Restorations: Strip Crowns for Primary Incisors ....................... 102
M S Duggal, H Nazzal, and A J Robertson
Introduction
Indications for Strip Crowns
Materials
Discussion
8. Aesthetic Full Coverage Restorations: Primary Tooth Zirconia Crowns ..........................110
Osama I El Shahawy and H Nazzal
..................................................................................................................................89
.....................................................................................................90
...........................................................................................................................99
................................................................................................................................ 102
...................................................................................................... 102
.....................................................................................................................................103
..................................................................................................................................109
.....................................................................................73
........................................................................89
......................................................................90
.....................................................91
...........................................95
.................................................................................98
...................................................99
Introduction
The Need for Full Coverage
Zirconia Crowns
Further Reading
9. Plastic Restorations for Primary Teeth .................................................................................121
M S Duggal, H Nazzal, and A J Robertson
Preventive Resin Restoration
One-Surface Restorations
Two-Surface Restorations
Further Reading
10. Comprehensive Care: Examples of Treated Cases ...............................................................134
M S Duggal, H Nazzal, Osama I El Shahawy, and A J Robertson
Case A
........................................................................................................................................134
........................................................................................................................................140
Case B
Case C
........................................................................................................................................145
........................................................................................................................................ 147
Case D
..................................................................................................................................................151
Index
................................................................................................................................ 110
....................................................................................................... 110
......................................................................................................................... 111
.........................................................................................................................120
.....................................................................................................122
..........................................................................................................122
..........................................................................................................126
.........................................................................................................................133
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Contributors
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Osama IEl Shahawy
Professor of paediatric dentistry
CairoUniversity
Cairo, Egypt and Headofpaediatric dentistry
department
FutureUniversity
Cairo, Egypt
Alaa BaniHani
Consultant in Paediatric Dentistry
King’s College Hospital
London, UK
Nebu Philip
Assistant Professor in
Paediatric Dentistry
College of Dental Medicine
QU Health
Qatar University
Qatar
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vii
1
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Treatment Planning
M S Duggal, H Nazzal, and A J Robertson
Children as Individuals
A treatment plan must be developed and designed to provide high-quality restorative care for each
individual child’s needs. The details will vary according to the types of restorations needed, as will
the sequence of placing restorations.
In this book the objective is to provide an atlas describing the techniques for the restorative care
of children, and therefore, the approach to treatment planning is very much orientated to that end. It
is accepted that every child will require some degree of preventive dentistry and behaviour management, but these subjects will not be covered here.
Quality Care for Children
Children are the future dental patients, and the dental care that they receive should therefore promote positive dental experiences, which, in turn, promote positive dental attitudes. It makes disturbing reading when
some dental professionals, particularly in the UK, question whether children’s teeth should be restored at
all. We feel that this type of thinking, promoted usually by some public health dentists, rather than paediatric dentists, is more to do with economics than conviction. There can be no doubt that untreated caries in
the primary dentition can cause abscesses, pain, and suffering in children. Indeed, hospital-based consultants in paediatric dentistry frequently deal with patients referred to them with severe infections related to
long-standing untreated caries in the primary dentition of children who have had regular check-ups with
their dentist (Figure 1.1). These children then require hospital admissions and treatment under general
anaesthesia, whereas a simple restoration at the time when the caries was diagnosed would have prevented
this extremely distressing episode for the child. There are also implications for costs of carrying out this
hospital-based treatment, which is substantially more than the cost of simple restorative and preventive
treatment. In addition, a negative dental experience for a young child could alter their attitude to dentistry
and dental health for life. It is therefore essential for all dentists involved in the care of young children to
learn restorative techniques that give the best results in primary teeth. This approach, alongside excellent
preventive programmes, would form the basis of ‘quality dental care for children’, which this book seeks to
promote. Good-quality restorative care, as and when caries is diagnosed, would also obviate the need for
extractions of primary teeth under general anaesthesia for thousands of children, particularly in the UK, a
practice that should have only a small place in the dental care of young children.
Philosophy of Treatment Planning
In planning for the restoration of teeth, allowance must be made for two types of children. The rst
will be those for whom no restorative care has been attempted in the past but who now do need it.
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1DOI: 10.1201/9781003273646-1
2 Restorative Techniques in Paediatric Dentistry
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FIGURE 1.1 Photograph of a young child with severe infection resulting from an unrestored carious upper second
primary molar.
For these children, a sequenced introduction to the procedures of restoring teeth is needed. Treatment
planning for them must include a step-by-step introduction to the use of pain control (local analgesia),
use of rotary instruments, rubber dam, and the placing of restorations. The time needed for this introduction may be anything from a few minutes to several visits.
Most children will not normally be afraid, and one of the important aspects of providing care for
them will be to ensure that they do not develop a fear of dentistry.
The second group of children comprises those who may already have had some restorations or perhaps attempted restorations. With these children, there may be a history of being totally uncooperative
or only reluctant to cooperate but persuadable. In such cases, the treatment planning must take into
account the degree of cooperation and again an amount of time allowed for behaviour modication.
In this atlas, it is assumed that a child is cooperative or that cooperation has been obtained.
The technique of treatment planning is to obtain all the necessary information on the dental history and dental status of a child. Using this information, a plan of dental visits is drawn up so as to
complete the restorative care needed in the shortest possible time appropriate for that child. It is our
philosophy that the ideal approach for restoring children’s teeth involves the practice of quadrant
dentistry.
Diagnosis
The dental problems of a child must be assessed before a treatment plan is designed. This involves not
only examining the teeth but also assessing the child’s behaviour. This should start before the child
has entered the dental ofce and should begin by observing the child with his or her parents or carers
in the waiting room. As the family enter, the child’s behaviour and relationship with parents or carers
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