Caries of primary teeth and its treatment -...

Caries of primary teeth and its Caries of primary teeth and its treatmenttreatment

Development of cariesDevelopment of caries

Predilection placesPredilection places

Earliest occurance of cariesEarliest occurance of caries

time:time:• 6 month– 1 year after tooth eruption6 month– 1 year after tooth eruption

primary incisors: about 1 year of ageprimary incisors: about 1 year of ageprimary molars: about 3 years of ageprimary molars: about 3 years of age

Caries frequencyCaries frequency

Caries intensityCaries intensityAge

(year) 22 33 44 55 66

dsds 1,15 2,93 4,47 6,52 6,94

mm 0,03 0,06 0,12 0,25 0,52

fsfs 0,00 0,07 0,24 0,50 0,68

dmfsdmfs 1,18 3,06 4,83 7,27 8,14

dmf-s

Caries in different tooth-groups (%)Caries in different tooth-groups (%)

5

25

70

0

10

20

30

40

50

60

70

C I M

Classification of cariesClassification of caries• according to quality:

- CARIES SICCACARIES SICCA –relatively hard, brown, broken surfaces –relatively hard, brown, broken surfacesslow progressionslow progression

- CARIES HUMIDACARIES HUMIDA – rapid desintegration of hard tissues – rapid desintegration of hard tissues

CIRCULAR CARIESCIRCULAR CARIES „rampant caries”„rampant caries”

•according to depth:according to depth:- CARIES SUPERFICIALIS CARIES SUPERFICIALIS

- - CARIES MEDIACARIES MEDIA

- CARIES PROFUNDA - CARIES PROFUNDA

Classification of cariesClassification of caries

• according to localizationaccording to localization:

- OCCLUSAL CARIES- OCCLUSAL CARIES – pit and fissure– pit and fissure

- APPROXIMAL CARIES- APPROXIMAL CARIES

- SMOOTH SURFACE CARIES- SMOOTH SURFACE CARIES

types of primary dentition according to types of primary dentition according to caries locationcaries location

Classification of cariesClassification of caries

CARIES OF ANTERIOR TEETHCARIES OF ANTERIOR TEETH

CIRCULAR CARIES CIRCULAR CARIES

NURSING BOTTLE CARIES /NURSING BOTTLE CARIES /BABY BOTTLE SYNDROME /BABY BOTTLE SYNDROME /EARLY CHILDHOOD CARIES (ECC)EARLY CHILDHOOD CARIES (ECC)

„„NORMAL CARIES”NORMAL CARIES”on the approximal surfaceson the approximal surfaces

ECC ECC

AETIOLOGY:AETIOLOGY:- - EXOGENEXOGEN: bottle-feeding with sweet : bottle-feeding with sweet drinks (e. g. tea, juice) drinks (e. g. tea, juice)

- - ENDOGENENDOGEN: premature birth, : premature birth, exudative diathesis, TBC, rachitis.exudative diathesis, TBC, rachitis.

- - this form of caries occures on the labial this form of caries occures on the labial surface of incisors near the gingiva and surface of incisors near the gingiva and spreads very fast in a circular patternspreads very fast in a circular pattern

-it may start in extreme cases -it may start in extreme cases at about 1 year of ageat about 1 year of age

ECCECC

Symmetrical appearance, Symmetrical appearance, The rapid caries may cut the crowns of The rapid caries may cut the crowns of incisors before the eruption of second incisors before the eruption of second primary molars;primary molars;

If the causes are persistant, the caries If the causes are persistant, the caries spreads on the canines and molars both in spreads on the canines and molars both in the upper and lower jaws;the upper and lower jaws;

For 2-3 years of age totally destroyed For 2-3 years of age totally destroyed primary teeth;primary teeth;

In saliva: Streptococcus mutans, In saliva: Streptococcus mutans, lactobacillus acidofiluslactobacillus acidofilus

ECCECC

Mixed dentitonMixed dentiton

Primary dentitionPrimary dentition

TREATMENT OF ECCTREATMENT OF ECC• stop cariogenic diet!stop cariogenic diet!

• in very early stages: fissure sealantin very early stages: fissure sealant

• filling, restoration (glassionomer, composite)filling, restoration (glassionomer, composite)

• crowncrown

• impregnationimpregnation

• extraction (space maintenance; speach-extraction (space maintenance; speach-pathologist!)pathologist!)

ECC referencesECC references

WETZEL WE.: WETZEL WE.: Das Nursing-Bottle-Syndrom – ein Das Nursing-Bottle-Syndrom – ein nationales Unglück der Deutschen. Znationales Unglück der Deutschen. Zahnahnäärztl. Mitt. rztl. Mitt. 1992; 82:26-30.;1992; 82:26-30.;

BEHRENDT A, KNOBLAUCH B, BEHRENDT A, KNOBLAUCH B, SCHLECHTRIEMEN M, WETZEL WE: SCHLECHTRIEMEN M, WETZEL WE: Problematische Begleitbefunde beim Nursing-Bottle-Problematische Begleitbefunde beim Nursing-Bottle-Syndrom. Syndrom. Monatsschr. Kinderheilk. 1998; 136:30-36.;Monatsschr. Kinderheilk. 1998; 136:30-36.;

HANISCH S, GRIEB A, WETZEL WE: HANISCH S, GRIEB A, WETZEL WE: Neue Neue Erkenntnisse zum Nursing-Bottle-Syndrom in Erkenntnisse zum Nursing-Bottle-Syndrom in Deutschland. Deutschland. Dtsch. ZahnDtsch. Zahnäärztl. Z. 1995; 50:210-213.;rztl. Z. 1995; 50:210-213.;

DAVIES GN: DAVIES GN: Early childhood caries – a synopsis. Early childhood caries – a synopsis. Community Dent. Oral Epidemiol. 1998; 26(1 Community Dent. Oral Epidemiol. 1998; 26(1 Suppl):106-16.;Suppl):106-16.;

DUPERON DF: DUPERON DF: Early childhood caries: a continuing Early childhood caries: a continuing dilemma. dilemma. J. Calif. Dent. Assoc. 1995; 23:15.J. Calif. Dent. Assoc. 1995; 23:15.

„ „NORMAL” CARIES OF ANTERIOR TEETHNORMAL” CARIES OF ANTERIOR TEETH

4-6 years of age;4-6 years of age; approximal surface;approximal surface;

„„NORMAL” CARIES OF ANTERIOR TEETH NORMAL” CARIES OF ANTERIOR TEETH Modern diagnosticsModern diagnostics

Cold light probeCold light probe Laser fluorescent Laser fluorescent lamplamp

„„NORMAL” CARIES OF ANTERIOR TEETH:NORMAL” CARIES OF ANTERIOR TEETH:TREATMENTTREATMENT

filling (glassionomer/composite)filling (glassionomer/composite) grinding, impregnation (compromise)grinding, impregnation (compromise) crowncrown

filling filling (glassionomer, composite)(glassionomer, composite)


Cavity preparationCavity preparation


grinding, impregnation:grinding, impregnation:- self-cleaning approximal surfaces,- self-cleaning approximal surfaces,- obliteration of dentin channels,- obliteration of dentin channels,- discoloration (brown, black).- discoloration (brown, black).


CARIES OF PRIMARY CARIES OF PRIMARY MOLARSMOLARS

All caries types can occur;All caries types can occur; Central, approximal caries Central, approximal caries

(different types of dentition);(different types of dentition); The lower primary molars decay The lower primary molars decay

earlier than the upper;earlier than the upper; 44thth year is the critical age year is the critical age

CARIES OF PRIMARY MOLARSCARIES OF PRIMARY MOLARS

Change in the rate of the central and Change in the rate of the central and approximal caries;approximal caries;

44thth year is the critical age year is the critical age

ageage

CARIES OF PRIMARY MOLARSCARIES OF PRIMARY MOLARS

Rate of central and approximal Rate of central and approximal

caries lesions at the age of 6caries lesions at the age of 6

35

65

0

10

20

30

40

50

60

70

C P

CARIES OF PRIMARY MOLARSCARIES OF PRIMARY MOLARSTREATMENTTREATMENT

Grinding, impregnationGrinding, impregnation::-self-cleaning approximal surfaces,-self-cleaning approximal surfaces,-obliteration of dentin channels,-obliteration of dentin channels,-discoloration (brown, black)-discoloration (brown, black)-combination with filling-combination with filling


isolation:isolation:-cotton-roll, saliva-ejector;-cotton-roll, saliva-ejector;- - rubber dam ??rubber dam ??


Cavity preparation:Cavity preparation:- minimal invazive technique;- minimal invazive technique;- chemomechanical caries - chemomechanical caries removal (Caridex, Cariosolv) removal (Caridex, Cariosolv) - modified Black principles- modified Black principles

Cavity preparation:Cavity preparation:- chemomechanical caries removal - chemomechanical caries removal

(e. g. Caridex, Cariosolv)(e. g. Caridex, Cariosolv)



Cavity preparation:Cavity preparation:-modified Black principles-modified Black principles



Occlusal cavity:Occlusal cavity:-follow the fissure;follow the fissure;-form the cassetteform the cassette

Occlusal-palatinal cavityOcclusal-palatinal cavity



Approximal-occlusal cavity:Approximal-occlusal cavity: - C-C = distance between the - C-C = distance between the cusps;cusps; - I-I = isthmus-width.- I-I = isthmus-width.

Approximal cassette:Approximal cassette:

-optimal width and contour-optimal width and contour

(anatomy of primary teeth) (anatomy of primary teeth)



Preparation of approximal cassette :Preparation of approximal cassette : -extension to gingival direction;-extension to gingival direction; -convergent cassette-walls-convergent cassette-walls

Pulp-horns!Pulp-horns!Anatomy of primary Anatomy of primary

teethteeth


Mistakes in the cavity preparation:Mistakes in the cavity preparation:

Exposure of pulp-hornExposure of pulp-horn

Too deep in the gingival Too deep in the gingival directiondirection

Not proper form; Not proper form;

Too big cavityToo big cavity

CARIES OF PRIMARY MOLARSCARIES OF PRIMARY MOLARSTREATMENTTREATMENT matrixmatrix


fillingfilling

• isolationisolation

• drying (cotton-pellets, benzine)drying (cotton-pellets, benzine)

• indirect pulp-capping: Ca(OH)indirect pulp-capping: Ca(OH)22

• base: glassionomer cementbase: glassionomer cement

• filling: amalgam, composite, filling: amalgam, composite, cermet cement, cermet cement,

• inlay inlay

• crowncrown


PREVENTIVE COMPOSITE:PREVENTIVE COMPOSITE:

=extension of fissure-sealant=extension of fissure-sealant

• combination of fissure-sealant with combination of fissure-sealant with fillingfilling

•indication:indication:

• small occlusal caries lesion+deep small occlusal caries lesion+deep fissurefissure


Filling material: amalgamFilling material: amalgam


Filling material: cermet cementFilling material: cermet cement


• INLAYINLAY

Filling materials in primary Filling materials in primary dentitiondentition

Filling materialFilling material advantageadvantage dis-dis-advantageadvantage indicationindication

AMALGAMAMALGAM long-lasting, long-lasting, easy to useeasy to use estheticsesthetics I, II I, II

COMPOSITECOMPOSITE estheticsesthetics cooperation cooperation neededneeded

I, II,I, II,III/IV, VIII/IV, V

COMPOMERCOMPOMER estheticsesthetics cooperation cooperation neededneeded

I, II,I, II,III/IV, VIII/IV, V

Filling materials in primary dentitionFilling materials in primary dentition

Glassionomer cementGlassionomer cement

Advantage: easy to handleAdvantage: easy to handle

fluoride emissionfluoride emission

Disadvantage: fragilityDisadvantage: fragility

gets drygets dry


restoration with „metal ring”restoration with „metal ring”


Preformed steel crownPreformed steel crown

• Stainless steel; Ni-CrStainless steel; Ni-Cr

• Restore the bite-function of destroyed Restore the bite-function of destroyed primary primary

molars;molars;

• Proper preparation and adaptation;Proper preparation and adaptation;

• Conventional cementation.Conventional cementation.


Preformed steel crownPreformed steel crown

• steelsteel crowncrown

• conventionalconventional cementationcementation


preparation of tooth for preformed steel crownpreparation of tooth for preformed steel crown


preparationpreparation

• a. before preparationa. before preparation

• b. after preparationb. after preparation

• approximal view of primary molarapproximal view of primary molar


preparationpreparation

• special forceps for the special forceps for the application of crownapplication of crown

• measuring of mesio-distal measuring of mesio-distal diameter helps to choose the diameter helps to choose the proper crownproper crown


Application of the preformed steel crownApplication of the preformed steel crown

• polishing the crown edgepolishing the crown edge

• shortening the crown lengthshortening the crown length


applicationapplication

• shaping the crown walls with shaping the crown walls with contour-forceps contour-forceps

• shaping the margin of the shaping the margin of the crown with forcepscrown with forceps

• shaping the shaping the contact pointcontact point


applicationapplication

• incorrect applicationincorrect application

• correct applicationcorrect application

PREVENTIVE VITAL AMPUTATIONPREVENTIVE VITAL AMPUTATIONIndication:Indication: caries profunda of first primary molar;caries profunda of first primary molar; exposed pulp (caries, cavity-preparation, exposed pulp (caries, cavity-preparation,

trauma).trauma).

Necessary materials and instruments:Necessary materials and instruments:

-Sterile drill (excavator);Sterile drill (excavator);

-Physiological saline;Physiological saline;

-Sterile cotton-pellets;Sterile cotton-pellets;

- Formocresol / Ca(OH)Formocresol / Ca(OH)22;/ MTA(mineral trioxide aggregat);/ MTA(mineral trioxide aggregat)

- ZnO-Eugenol / glassionomercement;ZnO-Eugenol / glassionomercement;

- filling (amalgam / composite)filling (amalgam / composite)

PROPHYLACTIC VITAL AMPUTIONPROPHYLACTIC VITAL AMPUTION

PROCESS: PROCESS: 1. local anaesthesia1. local anaesthesia

2. prepare the cavity2. prepare the cavity

3. remove coronal pulp3. remove coronal pulp

4. stop the bleeding4. stop the bleeding

5. dry5. dry

6. filling6. filling

Formocresol+ Formocresol+ ZnOeugenol, or ZnOeugenol, or Ca(OH)Ca(OH)2 2 or MTAor MTA

PROPHYLACTIC VITAL AMPUTIONPROPHYLACTIC VITAL AMPUTION

PROCESS:PROCESS:

After vital amputation:After vital amputation:

Glassionomer-cementGlassionomer-cement

Filling Filling

Stainless steel crown to protect the Stainless steel crown to protect the weak crownweak crown


What circumstances influence our choice of What circumstances influence our choice of the proper therapy?the proper therapy?

1.1. Caracteristics of caries lesion (quality, Caracteristics of caries lesion (quality, depth, localization)depth, localization)

2.2. Condition of the dentitionCondition of the dentition

3.3. Age of the patient (changes of dentition)Age of the patient (changes of dentition)

4.4. Cooperation of the childCooperation of the child

THANK YOU FOR YOUR ATTENTION!THANK YOU FOR YOUR ATTENTION!

Caries of primary teeth and its treatment -...

Documents

Transcript of Caries of primary teeth and its treatment -...