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Part 4: Restorative Dentistry for Children

Anatomical Differences Between Primary and Permanent Teeth

1) Thinner enamel (1mm occlusally)
2) Pulp chamber larger
3) Pulp horns closer to surface
4) Enamel rods in gingival 1/3 slope occlusally instead of cervically
5) Crown shorter and has greater cervical constriction
6) Interproximal contacts broader and flatter
7) Enamel and dentin shades whiter
8) Occlusal table is narrower
9) Exaggerated buccal and lingual cervical ridges
10) Long, slender, and divergent roots w/ little trunk
11) Shallower anatomy
Primary Tooth Facts
1) Largest primary tooth is mand. 2nd molar
-largest permt tooth is max. 1st molar
2) Smallest primary tooth is mand. lateral incisor
-smallest permt tooth is mand. central incisor
3) Most common congenitally missing primary tooth is primary max. LI
4) Most common primary tooth to be retained is mand. 1 st molar
5) Max. 1M: intermediate btw PM and molar
6) Primary Max 2M resembles permt max. 1st molar and mand. 2M resembles permt mand. 1M
7) Primary max. canine have longer, sharper cusps and mesial cusp ridge longer than distal cusp ridge (opposite in
permt max. canines)
8) Primary max. CI is only ant. tooth in either dentition to have shorter inciso-cervical height than mesiodistal width
9) Primary mand. 1st molar has prominent transverse ridge
Characteristics of Primary Mand. First Molar
1) Resembles no other tooth
2) Wide mesiodistally w/ pronounced cervical ridge
3) No central fossa
4) Difficult class II preparation
Caries in Primary Teeth
1) Dental decay in primary teeth can affect development of adult teeth
2) Dental decay in primary teeth often means there will be decay in adult teeth
3) Primary teeth are slightly more opaque on radiographs than permt teeth due to higher inorganic content
4) Decay in primary teeth progresses more rapidly from initial surface demineralization to dentin involvement due to
thinner enamel layer
Restoring Primary Molars w/ Amalgam
1) Prep depth is 0.5mm into dentin or about 1.5mm total depth
2) No. 330 and 245 burs common (330 is 1.5mm depth and 245 is 3mm depth)
3) Rounded line angles decrease internal stresses and prevent breakage of primary teeth
4) Occlusal prep extends into susceptible pits/fissures
5) Buccal/lingual extensions for class II proximal box minimally break contact
6) Buccal/lingual walls converge occlusally
7) Gingival seat contact on box is broken
8) Isthmus width is 1/3 intercuspal distance
Restoring Primary Molars w/ Composite
1) Preps may be more conservative than amalgam
2) Class I preps may be limited to carious region if sealant is used as part of restoration
3) Class II preps for composite similar to amalgam if caries exists on occlusal and interproximal
4) Must maintain dry field for composites