DESIREE DUNCAN 1103671RESTORATIVE MATERIALS IN PEDIATRIC DENTISTRYThere are many options obtainable to dentists for pediatric restorative dentistry. There are numerous new classes of restorative materials being found, which makes it difficult to choose the correct materials. When choosing a treatment for pediatric dental patients, each patient and restorative material needs to be evaluated individually. This is to ensure appropriate care within each material's limits because each restorative material has its advantages and disadvantages. Risk assessment is an important factor when any restorative material is chosen.Factors affecting material choice:1. The age of the child2. Caries risk3. Cooperation of child4. Type of material5. Type of tooth

AMALGAMSilver amalgam is the standard which the success of alternative materials is often judged; its been used for over 150 years in dentistry. Amalgam alloys vary in composition and is continuously being altered to have better results. Amalgam is an alloy with the composition of silver, tin, gold, and zinc. Amalgam restorations follow G.V. Blacks principles of cavity preparation which is less conservative and more forgiving in terms of moisture control.

Recommended for:1. Class I restorations in primary and permanent teeth; 2. Two-surface Class II restorations in primary molars where the preparation does not extend beyond the proximal line angles; 3. Class II restorations in permanent molars and premolars; 4. Class V restorations in primary and permanent posterior teeth.

In small class I restorations there's not much different between amalgam and composite preparations. The only difference is that undermine enamel must be removed from amalgam preparations. In both cases a resin sealant material should be placed over the restoration to prevent the restoration from failing. For proximal lesions, amalgam would be indicated for 2-surface Class II preparations that do not extend beyond the line angle. This recommendation is not for restoring first primary molars in children 4 years of age and younger. First primary molars are small, and the buccal and lingual walls of the proximal box become thin and weak with little remaining supporting dentin, leading to failure. In situations where caries are extensive, in high-risk patients or for restoring first primary molars in children 4 years of age(and younger) stainless steel crowns have demonstrated better longevity than amalgam fillings.

Currently, amalgam demonstrates the best clinical success for Class II restorations that extend beyond the proximal line angles of permanent molars.

Advantages: Good durability Lower cost than other restorations Easy to handle It has reducing micro leakage properties with time. It is less technique sensitive than other materials

Two main disadvantages: Contains mercury which is poisonous It is not aesthetically appealing.

There have been concerns about the toxicity and environmental pollutions but it is still continued to be used. Clinicians are concerned about patients inhaling mercury dust during amalgam placement, patients swallowing amalgam, mercury allergic reactions and the negative effects on the environment.

COMPOSITE RESINResin-based composites are very important in pediatric dentistry. Composite resins are most commonly composed of Bis-GMAand other dimethacrylate monomers and a filler material such assilica. They are recommended for resin restorations, along with moderate Class II restorations, Class III restorations, Class IV restorations, Class V restorations and strip crowns. Composite resins are ideal for anterior restoration as it resembles the tooth structure. In order to prevent contamination the tooth must be properly isolated with a rubber dam when composite is being placed. If proper isolation and patient compliance is not possible then composite is not recommended. The use of composite resin in high-risk children is also not recommended Advantages: Composites are strong and durable Tooth colored Single visit for fillings Resists breaking holds up well to biting forces Maximum tooth structure is preserved during cavity preparation Small risk of leakage if bonded only to enamel Does not corrode like amalgamDisadvantage: Composites are more expensive than amalgam fillings Restoration is more difficult and time consuming to place Baby teeth with cavities between the teeth are at risk for recurrent caries and may have to be replaced in the future.Contraindications: Where a tooth cannot be isolated to obtain moisture control then it cannot be used. When there are large multiple surface cavities in posterior primary dentition; Patients who have a high caries risk, and/or tooth demineralization Also if they have poor oral hygiene and have difficulty with daily oral hygiene then resin composites are not recommended. Resin polymerization shrinkage has been a problem associated with resin-based composite restorations since the development of bis-GMA resin

GLASS IONOMER-Glass ionomers are water based material formed by the reaction of Fluorosilicate glass powder and polyalkenoic acid, an ionomer which can be used as a liner, a luting cement, or a base/core material.Fluoride-releasing glass ionomers are appropriate for use as luting cements and as liners and bases. Adhesion of all GICs is enhanced by the use of enamel and dentine conditioning agents before placementAs a restorative material, glass ionomer has the benefit of being the only material with a true chemical bond to tooth structure. In addition, glass ionomer as cement has the least solubility in oral fluids and has the capability of inhibiting secondary caries. On the other hand, glass ionomer is a lot weaker than other filling materials and is prone to quick wear and tear.Also, GI is more technique sensitive than amalgam and less wear resistant which makes it only useful in nonload bearing area class three and five cavities.A number of GICs exist, each having its advantages and disadvantages: Conventional GICs have weak mechanical properties. The chemical setting reaction is complete within minutes but continues to become better over the following months. It is vital to keep these materials from salivary contamination in the hours following placement or the material may shrink, crack and even lose its bond.Resin-modified glass ionomers Resin-modified glass ionomers were developed to defeat moisture sensitivity and low initial mechanical strength. They consist of a GIC along with a water-based resin system which allows curing with light before the acidbase reaction of the glass ionomer takes place. The resins increase the fracture strength and wear resistance of the GIC. High-viscosity GIC High-viscosity GICs were developed for the atraumatic restorative technique (ART). These GICs have much better mechanical properties than the other materials. They do not set like resin-modified glass ionomers, but they are fast setting. None of the GIC has the ideal physical properties of a restorative material but the high-viscosity GIC have the best physical properties. For this reason it is recommended for use in posterior primary teeth when a GIC is being considered. Advantages:1. Physical and chemical bonds to tooth structure2. It is biocompatible and moisture forgiving3. A good dentin replacement material because it has similar thermal expansion. (sandwich technique)Disadvantages: Although the colour is close, it is not a perfect match to your original tooth colour. It takes a long time to complete Glass Ionomer, treatment as each layer has to be bonded individually.

Glass ionomer is best used in pediatrics in non load bearing areas, temporization of primary teeth with pre-cooperative children. Or in teeth that will fall out in a year or two.

COMPOMERCompomer is a poly acid modified resin based composite. These materials are combination of composite and glass inomer. They are not water-based, so no acidbase reaction can occur thats why they are not described as glass ionomers. They set by resin photopolymerization. The acidbase reaction does occur in the moist intra-oral environment and allows fluoride release from the material. In order for adhesion to be successful there must be use of dentin-bonding primers before placement.They have better esthetics than glass inomer but still have some fluoride releasing advantage. A big disadvantage is the loss of retention and gap formation between the material and tooth surface.The failure rate of GICs is higher than amalgam; the average survival time for a GIC has been reported as 33 months. The incidence of secondary caries is reduced around fluoride-releasing materials. The compomers show considerable potential, in terms of handling characteristics and radio-opacity but they have limited fluoride-leaching ability. In general, for small occlusal lesions, a conservative preventive resin restoration, using composite or compomer along with sealant, would be more appropriate than the classic Class I amalgam preparation.Advantages: Adhesive Aesthetic Command set Simple to handle Radio-opaque Disadvantages: Technique sensitive Less fluoride release than GICs

STAINLESS STEEL CROWNSStainless steel crowns are pre-fabricated which provides full coverage and adapts to the tooth. Stainless steel crowns provide the most durable restoration for the primary dentition having success for over 40 months. They are somewhat expensive in regards to both time and money in the short term. However, the rate of replacement of these restorations is low in comparison to amalgam. This makes them more economical in the long round. They may be considered unaesthetic and require a significant amount of tooth preparation, and requires local anesthesia.

Advantages Considered the strongest in comparison to amalgam and composite. Serves as a preventative measure against caries Can be adapted for space maintainer with a distal loop or shoe

Disadvantages Poor esthetics because of the silver metallic color There will be some discomfort after the crown is placed. Extensive tooth preparation Patient cooperation required

Indications Badly broken down teeth. Restoration of primary teeth after pulpotomy or pulpectomy procedures. Patients with hereditary anomalies or with special needs Primary molars that have undergone pulp therapy. Hypo-plastic primary or permanent teeth. Dentitions of children at high risk of caries, particularly children having treatment under general anesthesia. Class 2 lesions where the caries extend beyond the anatomic line angles. As an abutment for space maintainers or prosthetic appliances.

Permanent teeth in children: All permanent molars and premolars in children at medium or high risk of caries should be sealed. In children at low risk, only the fissures that are deep and retentive need to be sealed.

Conclusion: Dental materials continue to advance in durability, strength, esthetics, and resistance, because of this modern pediatric restorative dentistry has changed. The traditional principles of restorative dentistry remain sensible and relevant in the practice of dentistry but there is still room for improvement.