Добавил:

Sekretar kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.

Вуз:

Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

Файл:

Книга_20_библиотеки_им_акад_М_И_Перельмана

.pdf

Скачиваний:

Добавлен:

30.08.2026

Размер:

53 Мб

Скачать

☆

<<< < Предыдущая 1 2 3 4 5 6 7 89 / 439 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 > Следующая >>>

CHAPTER 2

https://t.me/medicina_free

Self‐Study Answers

1. High caries risk

2. The radiographic exam should be individualized

per patient; however, if the posterior teeth are in contact, the patient should receive selected periapical/occlusal views and/or bitewing radiographs

3. The tell‐show‐do technique involves explanation, demonstration, and completion of a step

Bibliography

American Academy of Pediatric Dentistry. 2018–2019a.

Prescribing dental radiographs for infants, children, adolescents, and individuals with special health care needs. In:

Clinical Practice Guidelines and Best Practices (Reference Manual). Pediatr Dent 40:213–15. https://www.aapd.org/

research/oral‐health‐policies‐‐recommendations/prescribing‐ dental‐radiographs‐for‐infants‐children‐adolescents‐and‐ individuals‐with‐special‐health‐care‐needs

American Academy of Pediatric Dentistry. 2018–2019b.

Management of the developing dentition and occlusion in pediatric dentistry. In: Clinical Practice Guidelines and Best Practices (Reference Manual). Pediatr Dent 40:352–65. https://www.aapd.org/research/oral‐health‐policies‐‐ recommendations/management‐of‐the‐developing‐ dentition‐occlusion‐in‐pediatric‐dentistry

American Academy of Pediatric Dentistry. 2002. Pediatric

restorative dentistry consensus conference. Pediatr Dent 24(5):374–6.

4. 2.26% fluoride ion

5. Local anesthesia may not be necessary in small

class V restorations; nevertheless, some form of local anesthesia may be necessary for rubber dam placement

Berg J. 1998. The continuum of restorative materials in pediat-

ric dentistry – a review for the clinician. Pediatr Dent 20(2):93–100.

Donly KJ, Garcia‐Godoy F. 2015. The use of resin‐based com-

posite in children: an update. Pediatr Dent 37(2):136–43.

Featherstone JDB. 2006. Caries prevention and reversal based

on the caries balance. Pediatr Dent 28(2):128–31.

Malamed S. 2000. Medical Emergencies in the Dental Office,

5th edition. Maryland Heights: Mosby.

Quock RL, Barros JA, Yang SW, Patel SA. 2012. Effect of silver

diamine fluoride on microtensile bond strength to dentin. Oper Dent 37(6):610–16.

Soxman JA. 2005. Preventive guidelines for the preschool

patient. Gen Dent 53(1):77–80.

Waggoner WF, Nelson T. 2019. Restorative dentistry for the pri-

mary dentition. In: Pediatric Dentistry: Infancy through Adolescence, 6th edition. Nowak A, etal. (eds). Philadelphia: Elsevier.

Waggoner WF. 2015. Restoring primary anterior teeth: update

for 2014. Pediatr Dent 37(2):163–70.

60 Clinical Cases inPediatric Dentistry

t.me/Dr_Mouayyad_AlbtousH

Case 6

https://t.me/medicina_free

Class IV Resin

Figure 2.6.1 (A, B) Facial photographs.

A. Presenting Patient

• Eleven‐year‐, eleven‐month‐old male (Figure 2.6.1)

• Trauma follow‐up visit

B. Chief Complaint

• Mother states, “My son chipped his front tooth while skateboarding over a year ago. This tooth has never bothered him”

RESTORATIVE DENTISTRY

FUNDAMENTAL POINT 1

History foraHeart Murmur

• Obtain a thorough understanding of the status of the heart murmur

• Question on:

Documentation of heart murmur status Follow‐up evaluations of heart murmur Any consults to a pediatric cardiologist Any need for echocardiograms or chest films Any symptoms experienced by the patient Any medications that patient takes for this condition Any need for antibiotic prophylaxis for subacute bacterial endocarditis Any limitations or restrictions on any activities

(Lessard et al. 2005; Wilson et al. 2007)

C. Social History

• Patient is in sixth grade

• Patient is involved in skateboarding, soccer, basketball

Patient has a fourteen‐year‐old sister and nine‐year‐

• old brother

• Parents are married

• Father works full time; mother is a full‐time homemaker

• Family recently relocated; no previous dental records

• Socioeconomic status is low to mid‐level

D. Medical History

• Mild, innocent heart murmur detected at one‐month well baby check. Heart murmur has never been detected since the initial episode (see Fundamental Point 1 and Background Information 1)

• No medications

E. Medical Consult

• Consultation with child’s pediatrician confirms status of heart murmur as being innocent or nonexistent. Pediatrician reports there is no need for antibiotic coverage prior to high‐risk dental procedures

Dental History

• Family recently relocated; no previous dental record available

• Usually routine six‐month check‐ups, but last visit was one year ago

• Sealants placed

• Optimal water fluoridation levels

• Healthy, low‐cariogenic diet

• Brushes teeth without supervision one time per day

• Flosses without supervision, on occasion

• No history of dental caries or dental restorations other than sealants

t.me/Dr_Mouayyad_AlbtousH

Clinical Cases inPediatric Dentistry 61

CHAPTER 2

https://t.me/medicina_free

• History of trauma to the maxillary left permanent central incisor more than one year ago (never restored) (see Fundamental Point 2)

• Positive behavior for all previous care

BACKGROUND INFORMATION 1

Heart Murmurs

• A heart murmur is a prevalent nding in pediatric dental patients. Almost 90% of infants have a detectable heart murmur, particularly if they are febrile or dehydrated

• Most of these are clinically insignificant and are referred to as being “innocent.” They are caused by an increased flow or turbulence across anatomically normal valves

•

Murmurs are of major concern to dentists

because certain dental procedures occasionally induce severe cardiovascular complications

• Murmurs may indicate existing heart disease that is a risk factor for infective endocarditis following a dental procedure

• Echocardiography is the primary means of evaluating heart murmurs

• Understanding the medical evaluation and assessment of a heart murmur fosters better communication with other health care professionals and results in improved patient care

• Dentists should be familiar with the latest guidelines from the American Heart Association (AHA) for the prevention of infective endocarditis

(Lessard et al. 2005; Wilson et al. 2007)

G. Extraoral Exam (Figure 2.6.1)

• Head and neck: within normal limits

• Weight: 39.8 kg; height: 157.5 cm (62 inches); body mass index: normal

• No signs of trauma to extra‐oral hard or soft tissues

• No other significant findings

Figure 2.6.2 Preoperative view.

Intraoral Exam

• Soft tissues: within normal limits

• Late mixed dentition

• Maxillary right and left primary canines exfoliated recently

• Occlusion: 2 mm overjet, 30% overbite; adequate spacing both arches; class I permanent molars, permanent canines are erupting

• Mild plaque accumulation

• Oral hygiene is good

• Caries‐free dentition

• Poor margins on three sealants: maxillary permanent first molars and mandibular right permanent firstmolar

• Maxillary left permanent central incisor has an asymptomatic, nonmobile, uncomplicated crown fracture (Figure2.6.2)

I. Diagnostic Tools

• Routine radiographs were taken within one year by the child’s previous dentist, including bitewing radiographs and a panorex. Periapical radiographs had previously been obtained. These radiographs were requested but were not available

• Preoperative periapical radiograph of the maxillary leftpermanent central incisor was taken prior to restorative treatment and showed no pathology (Figure2.6.3)

•

Maxillary left permanent central incisor responded

normally to palpation, percussion, electrical, and thermal testing

FUNDAMENTAL POINT 2

Post‐Trauma Assessment

• Rule out additional, undiagnosed intraoral or extraoral trauma

• Rule out any possibility of child abuse

• Story is consistent and ts the clinical picture

• No additional trauma noted

• No other suspicious trauma locations

62 Clinical Cases inPediatric Dentistry

FUNDAMENTAL POINT 3

Mouthguards

• For preventing traumatic injury, custom mouthguards are more protective, comfortable, and retentive than preformed mouthguards. Therefore, they are more likely to be worn during sports (AAPD 2018–2019)

t.me/Dr_Mouayyad_AlbtousH

Figure 2.6.3 Anterior periapical radiograph.

https://t.me/medicina_free

J. Differential Diagnosis

Not applicable

•

K. Diagnosis andProblem List

Diagnosis

• Faulty margins on sealants on maxillary permanent molars and mandibular right permanent first molar

• Uncomplicated, crown fracture on the maxillary leftpermanent central incisor involving the mesial, incisal,facial, and lingual (MIFL) surfaces (more thanone year ago)

RESTORATIVE DENTISTRY

Figure 2.6.4 Administration of local anesthetic.

Figure 2.6.5 Preoperative view of the fractured maxillary permanent left central incisor.

Problem List

• Marginal defects on sealants on maxillary permanentfirst molars and mandibular right permanent firstmolar

• Uncomplicated, crown fracture of the maxillary leftpermanent central incisor MIFL

• Irregular dental home

L. Comprehensive Treatment Plan

• Establish a regular dental home

• Dental prophylaxis

• Fluoride treatment

• Review of oral hygiene (with parent and child)

• Re‐seal maxillary permanent first molars and mandibular right permanent first molar

• Restore maxillary left permanent central incisor MIFL fracture with resin restorative material (Donly and García‐Godoy 2015)

• Custom mouthguard to prevent further trauma because patient is involved in multiple contact sports (see Fundamental Point 3)

• Six‐month recall: re‐evaluate traumatized tooth number 9, re‐evaluate oral hygiene status

M. Treatment (Figures2.6.4–2.6.11)

Figure 2.6.6 (A–C) Placement of a 1.5 mm chamfer (arrow) on the enamel margins with a number 1 DT diamond bur.

Figure 2.6.7 (A–C) Placement of a slight 1 mm bevel (arrow) on the chamfer with a number 1/8A diamond bur.

Clinical Cases inPediatric Dentistry 63

t.me/Dr_Mouayyad_AlbtousH

CHAPTER 2

https://t.me/medicina_free

Figure 2.6.8 (A, B) Placement of a thin layer of glass ionomer liner on the exposed dentin.

Figure 2.6.10 (A, B) Polishing of restoration.

Figure 2.6.9 (A, B) Placement of a clear matrix band to prevent etching and bonding of adjacent tooth. Enamel margins were etched for 60 seconds with 35% phosphoric acid and thoroughly rinsed.

N. Prognosis andDiscussion

• The prognosis for maintaining the low caries rate is excellent due to good oral hygiene and history of no previous dental caries

• The prognosis for the traumatized tooth is good due to the lack of sensitivity after one year. The tooth responds normally to palpation, percussion, electrical, and thermal testing

• Moderate risk of traumatic injury can be reduced if parents and patient are compliant with mouthguard fabrication and use

Figure 2.6.11 Final restoration.

• Consider follow‐up periapical radiographs at the six‐month post‐trauma check, sooner if symptoms develop

O. Complications andAlternative TreatmentPlan

• How would the management differ if the patient had a severe heart murmur and a previous history of infective endocarditis?

• How would the management differ if the patient had excess overjet and severe lip incompetence?

64 Clinical Cases inPediatric Dentistry

t.me/Dr_Mouayyad_AlbtousH

Self‐Study Questions

https://t.me/medicina_free

RESTORATIVE DENTISTRY

1. What type of radiographs are indicated for a patient with a traumatized permanent incisor?

2. Following an uncomplicated crown fracture, when is nal restoration recommended?

3. If a root fracture in the middle third of the root

had occurred, what treatment would be indicated?

Answers are located at the end of the case

Clinical Cases inPediatric Dentistry 65

t.me/Dr_Mouayyad_AlbtousH

CHAPTER 2

https://t.me/medicina_free

Self‐Study Answers

1. Diagnostic errors are reduced when practitioners take two or more periapical radiographs following a traumatic injury. Each image should have a slightly altered beam direction

2. Final restoration is recommended in six to eight weeks

Bibliography

American Academy of Pediatric Dentistry. 2018–2019. Policy

prevention of sports‐related orofacial injuries. In: Clinical

Practice Guidelines and Best Practices (Reference Manual). Pediatr Dent 40:86–91. https://www.aapd.org/research/oral‐

health‐policies‐‐recommendations/prevention‐of‐sports‐ related‐orofacial‐injuries

Donly KJ, Garcia‐Godoy F. 2015. The use of resin‐based com-

posite in children: an update. Pediatr Dent 37(2):136–43.

Lessard E, Glick M, Ahmed S, Saric M. 2005. The patient with a

heart murmur: evaluation, assessment and dental considerations. J Am Dent Assoc 136(3):347–56.

3. Stabilization with a splint for six to eight weeks or

until mobility is reduced

Wilson W, Taubert KA, Gewitz M etal. 2007. Prevention ofinfec-

tive endocarditis. Guidelines from the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc 138(6):739–60.

66 Clinical Cases inPediatric Dentistry

t.me/Dr_Mouayyad_AlbtousH

Case 7

https://t.me/medicina_free

Strip Crowns

RESTORATIVE DENTISTRY

•

High cariogenic diet

• Optimal water fluoridation levels

• Patient is very apprehensive and anxious

Extraoral Exam

• Slightly convex profile (Figure2.7.1)

• No other significant findings

Figure 2.7.1 (A, B) Facial photographs.

A. Presenting Patient

• Two‐year‐, eleven‐month‐old Caucasian female (Figure2.7.1)

• New patient visit

B. Chief Complaint

• Mother states, “I think my daughter has cavities”

C. Social History

• Patient does not yet attend school

• Parents are married

• Socioeconomic status is mid‐level

Medical History

• Patient is American Society of Anesthesiologists (ASA) class I

• Patient has never been hospitalized or visited the emergency room for treatment

• No medications

• No known drug allergies

E. Medical Consult

• Not necessary at this time

H. Intraoral Exam

• Primary dentition (Figure2.7.2)

• Occlusion: mesial step primary molars, right and left; no crowding

• Soft tissue: within normal limits

• Moderate plaque accumulation

• Oral hygiene is poor

• Caries present in maxillary anterior and maxillary right first primary molars

• Patient very uncooperative for exam. Parent consents to treatment under general anesthesia

I. Diagnostic Tools

• Two bitewing radiographs (Figure2.7.3)

F. Dental History

• Patient has never been to the dentist

• Parents have just recently initiated brushing child’s teeth once daily

Figure 2.7.2 (A–C) Preoperative right, left, and maxillary views.

Clinical Cases inPediatric Dentistry 67

t.me/Dr_Mouayyad_AlbtousH

CHAPTER 2

https://t.me/medicina_free

Figure 2.7.3 (A, B) Right and left bitewing radiographs.

Figure 2.7.4 (A, B) Maxillary and mandibular occlusal radiographs.

• Maxillary and mandibular occlusal radiographs (Figure2.7.4)

• Radiographs were obtained while patient was under general anesthesia

• Radiographs show multiple carious lesions

J. Differential Diagnosis

• Not applicable

• Three‐month recall: re‐evaluate caries risk, re‐evaluate oral hygiene status, review oral hygiene and diet with parent and child

M. Treatment (Figures2.7.5–2.7.9 andFundamentalPoint 1)

Figure 2.7.5 Absolute isolation before starting procedure.

Figure 2.7.6 Preparation for strip crowns with a tapered diamond bur. Approximately 1.5

mm reduction is necessary.

K. Diagnosis andProblem List

Diagnosis

• Early childhood caries

Problem List

• Moderate to high caries risk due to moderate plaque accumulation, poor oral hygiene, poor diet, and carieshistory

Multiple dental caries

•

• Very uncooperative and combative; patient requires general anesthesia for treatment

L. Comprehensive Treatment Plan

• Establish a dental home

• Dental prophylaxis

• Fluoride treatment

• Maxillary incisor strip crowns, stainless steel crown on maxillary right first primary molar

• Consider sealants on all primary molar occlusal surfaces

• Prescribe a remineralizing product such as those containing amorphous calcium phosphate

• Diet modification

Figure 2.7.7 Fitting the strip crowns.

Figure 2.7.8 Etching of the teeth.

Figure 2.7.9 Strip crowns completed.

68 Clinical Cases inPediatric Dentistry

t.me/Dr_Mouayyad_AlbtousH

N. Prognosis andDiscussion

https://t.me/medicina_free

• If there is good compliance with the proposed prevention plan, then the prognosis for avoiding further caries is good

FUNDAMENTAL POINT 1

RESTORATIVE DENTISTRY

Strip Crowns

• The isolation of teeth is critical when placing strip crowns. Any contamination will have a negative effect on the acid‐etch effectiveness, as well as the ability to obtain an adequate bond of resin to the tooth structure. When possible, ligation of a rubber dam around teeth to be treated can be achieved with dental oss or dental tape (Figure2.7.5). Preparation of teeth for a strip crown involves incisal reduction of approximately 1.5 mm with mesial and distal tooth reduction, which obtains adequate proximal space to t strip crowns. Beveling of the facial and lingual incisal preparation provides the reduction necessary to t strip crowns. Atapered diamond bur is ideal for preparing teeth for strip crowns. Following this general preparation, any decay that remains should be removed with a round bur (Figure2.7.6)

• After the strip crown preparation is completed, a glass ionomer cement liner/base can be placed in areas where the preparation extends well into the dentin. At this time, strip crowns are selected, choosing the size that most closely replaces the original tooth dimensions. The gingival margin of the strip crown should be cut with scissors so that the original incisal height of the tooth is achieved and the gingival margin of the strip crown adapts to the

remaining tooth structure (Figure2.7.7). All of the tooth structure and the glass ionomer liner/base is then acid etched with 37% phosphoric acid for approximately 30 seconds (Figure2.7.8). The etchant is rinsed away with a water spray and the tooth is thoroughly air dried. An adhesive is applied, according to manufacturer instructions, and light cured. It is helpful to place a small hole in the incisal edge of the strip crown so that composite can extrude when the crown is pushed into place over the prepared tooth. This relieves the potential for air voids to be created. Resin‐based composite is placed into the strip crown. (Highly lled resins provide excellent esthetics where margins of the preparation are not apparent through the restorative material.) The excess resin that extrudes through the hole can be easily removed when nishing and polishing. When the strip crown is t into place, excess resin at the gingival margin can be removed with the tip of an explorer prior to photo‐polymerization of the resin. The resin can then be light‐cured from both the facial and lingual surfaces. Following polymerization, the strip crown is cut away and the resin surface is nished and

polished (Figure2.7.9) (Lee 2002; Waggoner 2002; Donly and García-Godoy 2015; Waggoner 2015)

Self‐Study Questions

1. What indicates the use of crowns rather thanplacing composites on anterior teeth in children?

2. List the different types of crowns for children

3. What type of radiographs are indicated for a patient with an early mixed dentition?

4. What are the three categories of information used to make a caries risk assessment as dened by the American Academy of Pediatric Dentistry?

5. Why is a hole placed in the incisal edge of the strip crown prior to the placement of the resin‐ based composite?

Answers are located at the end of the case

Clinical Cases inPediatric Dentistry 69

t.me/Dr_Mouayyad_AlbtousH

<<< < Предыдущая 1 2 3 4 5 6 7 89 / 439 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 > Следующая >>>

Соседние файлы в папке Библиотека им академика М.И. Перельмана

#
31.08.202630 Мб0Книга_195_библиотеки_им_акад_М_И_Перельмана.pdf
#
31.08.202628 Мб0Книга_196_библиотеки_им_акад_М_И_Перельмана.pdf
#
31.08.202626 Мб0Книга_197_библиотеки_им_акад_М_И_Перельмана.pdf
#
31.08.202622 Мб0Книга_198_библиотеки_им_акад_М_И_Перельмана.pdf
#
31.08.202621 Мб0Книга_199_библиотеки_им_акад_М_И_Перельмана.pdf
#
30.08.202653 Мб0Книга_20_библиотеки_им_акад_М_И_Перельмана.pdf
#
30.08.202648 Мб0Книга_21_библиотеки_им_акад_М_И_Перельмана.pdf
#
30.08.202645 Мб0Книга_22_библиотеки_им_акад_М_И_Перельмана.pdf
#
30.08.202642 Мб0Книга_23_библиотеки_им_акад_М_И_Перельмана.pdf
#
31.08.202640 Мб0Книга_24_библиотеки_им_акад_М_И_Перельмана.pdf
#
31.08.202631 Мб0Книга_25_библиотеки_им_акад_М_И_Перельмана.pdf