Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_98_библиотеки_им_акад_М_И_Перельмана
.pdf
101Dental Caries Management Using the Hall Technique
https://t.me/med1917
University of Dundee the Hall technique a child centred approach to managing the carious primary molar
a users manual. https://heeoe.hee.nhs.uk/sites/default/les/1311845532_nqvh_the_hall_technique_
manual.pdf.
Van der Zee, V.; van Amerongen, W.E. Short communication: Inuence of preformed metal crowns
(Hall technique) on the occlusal vertical dimension in the primary dentition. European Archives of
Paediatric Dentistry 2010;11:225–227.
t.me/Dr_Mouayyad_AlbtousH
7
https://t.me/med1917
Aesthetic Full Coverage Restorations: Strip Crowns
for Primary Incisors
M S Duggal, H Nazzal, and A J Robertson
Introduction
Unsightly or discoloured primary incisor teeth will often be the reason that, for the rst time, parents
seek dental treatment for their children. Such teeth may be carious, discoloured due to a congenital
defect or trauma, or simply malformed. Caries of upper primary incisors is a consistent feature of
‘nursing caries syndrome’ (also known as ‘nursing bottle caries’ or ‘bottle mouth caries’ or ‘early
childhood caries’) and will often need restoration. Nursing caries is seen in preschool children and
results from frequent or prolonged consumption of uids containing fermentable carbohydrate from
a bottle or feeder cup. Fruit-based infant drinks are most commonly involved, but similar patterns of
caries can also be seen with milk-based drinks and in infants breastfed on demand. Such infants are
often allowed to suck on the bottle as a pacier throughout the night. During sleep, there is a considerable reduction in salivary ow rate, and consequently, salivary buffering and mechanical cleansing
are reduced to minimal levels. This results in rapid demineralization and clinically rampant caries.
Typically, the maxillary incisors and rst primary molars are most severely affected. The lower incisors are rarely affected, since they are protected during suckling by the tongue and directly bathed in
secretions from the submandibular and sublingual glands.
The treatment of decayed primary incisors depends upon the stage of decay and the age and cooperation of the child patient. There are several options available to the dentist in treating such teeth. First
and foremost, a comprehensive preventive programme, including dietary counselling, oral hygiene
instruction, and appropriate use of topical and systemic uorides, is essential to arrest the caries process and prevent any further destruction (Chapter1). In the past, interproximal disking of the teeth to
render them self-cleansing has been described, although this technique does not remove the decay, nor
is it aesthetically pleasing. Others have advocated the use of orthodontic bands, open-faced preformed
metal crowns, acrylic crowns, or polycarbonate crowns. More recently, the use of zirconia crowns has
gained popularity (Chapter7). In this chapter, a method is described for the aesthetic restoration of
primary incisors utilizing preformed celluloid crown forms specially produced for primary incisors
to produce a mouth-formed, direct, full coverage composite resin restoration. This is known as the
‘strip crown technique’. Decayed, discoloured, or malformed primary incisors may be restored using
this method.
Indications for Strip Crowns
• Extensive or multisurface caries in primary incisors
• Congenitally malformed primary incisors
• Discoloured primary incisors following trauma
102 DOI: 10.1201/9781003273646-7
t.me/Dr_Mouayyad_AlbtousH
103Aesthetic Full Coverage Restorations
https://t.me/med1917
• Fractured primary incisors following trauma
• Congenitally discoloured primary incisors (e.g., through congenital er ythropoietic porphyria)
• Tooth structure defects such as Amelogenesis imperfecta
Materials
Most materials required in this technique will be readily available in any dental surgery. These
include standard restorative dental instruments, handpieces, a tapered high-speed bur, a small slowspeed round bur for caries removal, calcium hydroxide or glass ionomer lining cement, a light-cured
composite with appropriate etchant and bonding agents, visible curing light, and ne curved scissors.
The celluloid crown forms are marketed as the 3M Strip Crown Kit (3M ESPE Dental, Lough borough, UK). This provides a range of sizes of crowns specically designed and made for upper primary
incisors.
Most modern hybrid or microlled composite resin restorative systems can be used for the strip
crown technique. However, there are several factors that should be taken into account when choosing
materials if the best results are to be attained.
Several composite systems now include dentine shades that are more opaque than standard anterior
composite. These are particularly useful, since they more effectively mask any residual discolouration
of the underlying dentine or the whiteness of lining materials. In addition, encapsulated presentation
is to be preferred, since it allows easy lling of the crown form.
Figures7.1–7.24 show the preparation of four maxillary incisors—but of course, a single tooth may
be restored on its own. If it is proposed to restore all four maxillary incisors, this is best accomplished
in one visit. However, if restoration over two visits is planned, it is advisable to restore the two central
FIGURE 7.1 The teeth should be anaesthetized, if necessary, and then isolated. Cotton wool roll isolation is usually
sufcient, although rubber dam or dry dam may be used if preferred.
FIGURE 7.2 The size of the celluloid crown form is chosen. This may be accomplished by measuring the mesio-distal
dimension of the space available with callipers and then checked by holding the form up to the incisal edge of the tooth.
t.me/Dr_Mouayyad_AlbtousH
104 Restorative Techniques in Paediatric Dentistry
https://t.me/med1917
FIGURE 7.3 All caries is removed using a small round bur in a slow-speed handpiece.
FIGURE 7.4 The teeth are then prepared for the strip crown. Using a tapered diamond or tungsten carbide bur in a
high-speed handpiece, the length of the crown is reduced incisally. Mesial and distal slices are made, tapered to a knife
edge at the gingival margin.
FIGURE 7.5 Diagram illustrating the mesial and distal walls of incisors prepared for strip crowns. The caries has
been removed.
FIGURE 7.6 The shade of composite resin is chosen. When the tooth is discoloured, an adjacent tooth or the lower
incisors can be used for shade matching.
t.me/Dr_Mouayyad_AlbtousH
105Aesthetic Full Coverage Restorations
https://t.me/med1917
FIGURE 7.7 The celluloid crowns are trimmed using ne curved scissors. Care should be taken at this stage to avoid
splitting or distorting the crown form.
FIGURE 7.8 The trimmed celluloid crowns are tted onto the prepared incisors. The length and cervical t should
be checked at this stage.
FIGURE 7.9 Vent holes are made in the mesial and distal corners of the incisal edge of each crown form to allow air
and excess composite resin to escape.
FIGURE 7.10 Glass ionomer cement is applied to the pulpal wall of any exposed dentine.
t.me/Dr_Mouayyad_AlbtousH
106 Restorative Techniques in Paediatric Dentistry
https://t.me/med1917
FIGURE 7.11 Composite resin is squeezed into the crown form and hollowed out in the centre to reduce the amount
of excess.
FIGURE 7.12 The teeth are etched for 1 minute with a proprietary etchant, washed, and dried. The opaque, frosty
appearance of the enamel is evident in the illustration.
FIGURE 7.13 The bonding agent is applied and then cured for 15 seconds, if applicable, according to the manufac-
turer’s instructions.
FIGURE 7.14 The crown forms, containing composite resin, are rmly seated on the prepared teeth. Again, care
should be taken at this stage, since excess pressure can result in splitting of the crown form.
t.me/Dr_Mouayyad_AlbtousH
107Aesthetic Full Coverage Restorations
https://t.me/med1917
FIGURE 7.15 Excess composite resin is removed with a probe or Ward’s carver. It is important to do this thoroughly,
since it will make nal nishing easier and quicker.
FIGURE 7.16 The composite resin is cured for 1 minute, labially and palatally.
FIGURE 7.17 An excavator or probe is inserted beneath the edge of the celluloid, and the crown form is stripped off
(hence the name of the technique) after the composite resin has been cured. If reduction of incisal length is required,
this can be done with the form still in situ. This will facilitate easy removal of the form.
FIGURE 7.18 The last step is to smooth and polish the crowns, although nishing is usually minimal. Flexible car-
borundum (Soex, 3M ESPE Dental) discs are ideal for this, although ne diamond or Baker Curzon high-speed burs
may be preferred.
t.me/Dr_Mouayyad_AlbtousH
108 Restorative Techniques in Paediatric Dentistry
https://t.me/med1917
FIGURE 7.19 Alabial view of the nished strip crown restoration.
FIGURE 7.20 Apalatal view of the nished strip crown restoration clearly demonstrating the full coverage provided
by this restoration technique.
FIGURE 7.21 Pre-operative photograph of extensive caries of primary maxillary incisors.
FIGURE7.22 Post-operative photograph showing restored primary maxillary incisors from Figure 7.21.
t.me/Dr_Mouayyad_AlbtousH
FIGURE 7.23 Pre-operative photograph of extensive caries of primary maxillary incisors.
https://t.me/med1917
109Aesthetic Full Coverage Restorations
FIGURE 7.24 Post-operative photograph showing restored primary maxillary incisors from Figure7.23.
incisors at one and the two lateral incisors at the second. This allows for more accurate matching of
colour and shape between left and right sides.
Discussion
The strip crown technique is a quick, simple, and effective method for the restoration of primary incisors. Most children are delighted by the improvement in their appearance, and it is hoped that this
will encourage an interest in their dental health from both parents and child. Nevertheless, there are a
few problems that might be encountered by the dentist. Some of these and their solutions are outlined
in Table7.1.
TABLE 7.1
Problems and Solutions That May Be Encountered When Using Strip Crowns
Problem Solution
Tearing of celluloid crown form when
trimming
Splitting of lled crown form when
seating it
Difculty in stripping off crown form Remove excess composite from gingival margin before curing.
Time-consuming trimming of crowns
at preparation
Keep scissors exclusively for strip crown preparation.
Hollow out composite to reduce excess and use gentle pressure. Aslow
‘rocking’ motion while seating the form helps excess composite to escape.
Take sectional impression and trim crowns prior to appointment, thus reducing
chairside time.
t.me/Dr_Mouayyad_AlbtousH
8
https://t.me/med1917
Aesthetic Full Coverage Restorations:
Primary Tooth Zirconia Crowns
Osama I El Shahawy and H Nazzal
Introduction
The demand for aesthetics restorations in dentistry has been growing rapidly. The social impact of having a natural and aesthetically pleasing appearance is affecting the choices of not only adults but children as well. Amongst children, the perception of appearance is diverse, being inuenced by both the
child and his parents, therefore often posing a challenge to the operator. Some children perceive preformed metal crowns as an appealing tooth, while often parents view it as overly unnatural or articial.
Adhesive materials bonded using celluloid crown forms are still the most used full coverage restorative techniques in restoring anterior primary teeth. As for posterior full coverage restorations, preformed metal crowns are still considered the gold-standard material.
Over the years, many attempts have been made to develop durable and yet easy-to-use aesthetic
full coverage primary tooth restorations. Such restorations could be categorized as either bonded or
cemented restorations. Bonded restorations include celluloid strip crowns, paediatric jacket crowns,
indirect composite crowns, and biological restorations. Cemented restorations, however, include openfaced preformed metal crowns, pre-veneered preformed metal crowns, glass bre–reinforced crowns,
CAD-CAM milled crowns, and prefabricated zirconia crowns. Table 8.1 presents a comparison
between different methods of aesthetic restorations of primary teeth.
The Need for Full Coverage
According to the American Association of Pediatric Dentistry (AAPD), the main indications for primary tooth full coverage restoration include:
• Restoration of teeth with extensive caries or those affecting multiple surfaces
• Teeth with cervical decalcication and/or developmental defects
• When failure of other available restorative materials is likely (interproximal caries extending between line angles, patients with bruxism)
• Following pulpotomy or pulpectomy
• Denitive, restorative treatment for children at high risk of caries
• When caries is minor but oral hygiene is very poor
• When the child’s behaviour makes moisture control very difcult
• Used more frequently in patients receiving treatment under sedation or general anaesthesia
The use of aesthetic full coverage primary tooth crowns can be considered a good alternative to
SSC when managing posterior teeth, and an alternative to anterior full coverage strip crown restorations in anterior teeth.
110 DOI: 10.1201/9781003273646-8
t.me/Dr_Mouayyad_AlbtousH
Соседние файлы в папке Библиотека им академика М.И. Перельмана