Tanta University ‫جامعة طنطا‬

Faculty of ‫كلية طب األسنان‬

Dentistry

Cover
Page

Student Research Project

*Year/ Level :Level 4

*Course Name : pedodontics
* Course Code :8 – (7305)
*Research Topic : Restoration of Badly destructed Primary teeth
*Group Number : 65
*Students Name :
Student Student National E-mail
No Name ID
321 ‫محمود إبراهيم محمود محمد‬ 29801141600852 mahmoud_d30897035@dent.tanta.edu.eg
‫يونس‬
322 ‫محمود بكر عبد العليم تهامي‬ 29803221400717 mahmoud_d30896986@dent.tanta.edu.eg
‫محمد‬
323 ‫محمود تيسير محمد طه‬ 29805081700653 mahmoud_d30896939@dent.tanta.edu.eg
‫الحوفى‬
324 ‫محمود عصام عبدالهادى‬ 29807031600138 mahmoud_d30896954@dent.tanita.edu.eg
‫عبدالجليل‬
325 ‫محمود عصمت فتحي سعيد‬ 29808131402372 mahmoud_d30896883@dent.tanta.edu.eg
‫نصر‬

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 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

• Contents:

1. Introduction. 3

2. Dental caries and its effect on The Teeth. 4

3. Badly destructed Primary Teeth. 4

4. Pulp therapy of badly destructed primary teeth. 5

5. Posts and restoration of badly destructed primary teeth. 5

6. Crown and restoration of badly destructed primary teeth. 8

7. Reconstruction of severely damaged Primary anterior Teeth. 9

8. Reconstruction of severely damaged Primary posterior teeth. 10

9. Conclusion. 12

10. References. 13

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 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

• introduction

The aim of Pediatric operative dentistry is to maintain the healthy state of teeth in dental arch,
Prevent its loss before the Shedding time and to Prevent the development of subsequent problems as
malocclusion, space loss in mixed dentition and Preventing eruption of permanent Successor.

Deciduous teeth are important for Proper mastication, esthetic, speech, Phonation, occlusal function,
Play an important role during growth and development of the dental arch, important for development of
jaws and muscles of face and act as a guide for eruption of the Permanent teeth in Correct Pathway so it's
important to be maintained in its normal position until the normal time of exfoliation.

The deciduous teeth differ from Permanent teeth so it's important to understand The difference in
structures between Primary and Permanent Teeth before doing any Procedure.

Deciduous teeth have shorter crown, occlusal table is narrow, cervical Portion is constricted, enamel and
dentin layers are Thinner [so dental Caries reached The Pulp and Penetrated deep and earlier in primary
teeth), wider mesio-distally Than cervico-occlusally [ This feature is important during selection of
stainless steel crown] and lighter in Color.

Restoration of badly destructed primary teeth is a challenge for dentist. There is no clinical data to
suggest that one type of restoration is superior to another. Dentist preferences, esthetic demands by
parents, the behavior of child, and moisture and bleeding control are all factors which affect the decision
and result of chosen restoration.

The restorations introduced for management of badly destructed teeth are a lot beginning with post
and core system and ends with full coverage restorations. These restorations should restore function
,esthetics and speech of child.

In certain cases parents refuse to restore these badly destructed primary teeth of their children and
insist on extraction . In these cases after extraction we should use interceptive appliances to prevent
problems that will happen in permanent teeth.

Parent education is very important to prevent badly destruction of deciduous teeth of their children
and they are the first responsible on this problem .they should help their children clean their tooth from
the beginning of eruption until child are aware to protect their teeth .they should provide healthy food for

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 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

their children that is full of fibers and avoid sticky foods. By this way we can prevent badly destruction of
primary teeth.

• Dental caries and its effect on the Teeth:

Dental Caries are the most common dental disease among the children and caused by Streptococci
mutans that ferments Carbohydrate which present in diet to Produce acid which attack the teeth, as the
children eat large amounts of Candied food, drinks rich in carbohydrate with The lack of regular oral
examination and oral hygiene.

Effect of dental caries on Primary Teeth, dental caries usually causes demineralization of
inorganic Part and dissolves the organic Part of The tooth Tissue locally and may lead to some
Consequences as Pulpitis, Periapical Periodontitis (and if it's left untreated may lead to Tooth missing),
which causes the Patient to fell Pain and discomfort as the enamel of Primary teeth is less calcified and
more fragile so they are more susceptible to increase initiation and progression than the Permanent teeth.

Dental caries are classified according to severity into mild, moderate and sever, sever Conditions
of dental caries are considered badly destructed teeth which make the Patient feel of sever Pain .forms of
sever dental caries such as rampant caries and nursing bottle caries must be diagnosed and managed
early to avoid their bad effects on the teeth. Rampant caries are wide spread caries appear suddenly and
involved many teeth surfaces which considered to be at low risk of decay, with early pupal involvement
causing extensive cavitation if left untreated .Nursing bottle caries is a unique pattern of caries which
affects the very young children due to improper and prolonged feeding habits, nursing bottle can
effectively blocks the salivary access to the surfaces of the teeth which increases the cariogenicity of the
oral flora ,if it left untreated it leads to severely decayed teeth also. Many factors which affect the oral
health specially in children with the neglecting of parents, leading to badly destruction of the teeth, so
we should have knowledge about badly destructed tooth and how to manage it.

• Badly destructed teeth

A Tooth with extensive damage is one that has lost substantial structure as a result of Caries,
fracture or failure of Previous restoration it become weaken tooth so the clinician should have the
probability of restoring severely damaged teeth successfully.

The remaining tissues of the badly destructed tooth as well as several biological and occlusal factors

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 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

must be considered to establish the Correct Treatment Plan.

The reconstruction of these badly damaged teeth is difficult because of the small size of the crown,
big pulp chamber and the child age. Decrease of strength of restorations and consequently their fracture
are usually related to insufficient remaining sound tooth structure.

Treatment plan for restoration of badly destructed teeth, after careful examination and diagnosis,
treatment begin by Pulp therapy ,use of post_core system to promote retention and support of restoration
from root canal to increase durability and longevity of restoration till time of exfoliation.

• Pulp therapy in badly destructed primary teeth

Objectives of pulp therapy in primary teeth are the conservation of the primary teeth in healthy
state of function as an integral component of dentition to preserve the arch space, prevent any
deleterious effects on the succedaneous tooth and promote the functions of primary teeth till time of
exfoliation.
Pulp therapies included in pediatric dentistry are indirect pulp capping, direct pulp capping,
pulpotomy, pulpectomy, apexogensis, apexfication. For restoring badly destructed primary teeth
pulpectomy is highly recommended to provide retention and support of the final restoration.
Pulpectomy involves deroofing and removal of the pupal content from pulp chamber to gain
access to the root canals which are debrided, enlarged and disinfected then filled with resorbable
materials such as zinc oxide eugenol paste, iodoform paste, calcium hydroxide and iodoform mixture
which have specific requirements to accommodate physiological root resorption of primary teeth then
after finishing pulp therapy, we can use post_core system to get retention and support from root canal.

• Posts and restoration of badly destructed primary teeth

for pediatric dentists to reconstruct badly damaged teeth. The aim of dental treatment is the
restoration of lost tooth structure to preserve function and prohibit changes in mastication,
phonetics, developing of para-functional habits and psychological problems that will affect
negatively on child. Dentists have made many attempts to restore such grossly destroyed primary
teeth with different and proper root canal retentive post and core systems so that the primary teeth
can be maintained until their replacing by successors.

Ideal property of posts:

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 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

- An ideal post and core must produce adequate retention and resistance.
-Post should have good adaptation to the inner wall of canal
-Post should made from biocompatible and resorbable material.

Indication of using posts in Primary teeth:

_When ½ crown structure is lost.

_When At least 1 mm of tooth structure is left supragingivally
_In Reduced crown tooth structure.
_The most common reason for using a post is to restore the shape and form of a severely decayed or
fractured primary tooth crown as it gives support for the final restoration.
_In increasing the resistance of the restored teeth to mechanical forces.

Problems while placment of post in Primary teeth

primary teeth provide a less surface area for bond system, big pulp chamber, and aprismatic enamel
etching is difficult.
Destruction usually includes the entire crown leaving only the root for bonding of the restoration and
this will lead to increase the rate of failure.

Extension of post in Primary root canal

_ short retentive posts are used in primary dentition because of the physiological root resorption which
takes place in deciduous dentition, unlike the post and core used in permanent dentition.
_Intra-canal insertion is about 3mm that is the cervical one-third of the root canal in order not to
hinder deciduous tooth root resorption and permanent tooth eruption.

Classifications of post used in Primary teeth

Post which are used in primary teeth can be classified based on types of post space design, material
used, post design and fabrication
A) Based on post space design: -
It classified into Mushroom shaped, tapered shaped and Onion shaped.
B) Based on material used: -
It is classified into custom made posts and prefabricated posts.

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 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

C) Based on post design: -

It is classified into Threaded, Non-threaded, Alpha, Half omega shaped, Omega shaped ,Modified
anchor shaped and Gamma shaped
D) Based on fabrication method: -
It classified into direct and indirect methods
Direct method includes metallic and fiber posts.
Indirect method includes resin composite post and cast metal post.

Canal Preparation for post and core in Primary teeth

Around 4 mm of root canal obturation should be removed from the canal. 1 mm of cement is
put over the filling material of the canal. The other 3 mm canal space is used for the placing of post.
For this procedure we can use Glass Ionomer Cement and a 1 mm GIC is put over the filling material.
Zinc Polycarboxylate cement can also be used.

Luting agents
A lot of luting agents can be used for the cementation of post in canal of deciduous teeth. The
choice of luting agents relies on the type and material of the post being used.
Zinc phosphate cement is used for cementation of reverse metal post, glass ionomer cement is
used for cementation of Omega post, flowable composite is used for cementation of Metal as well as
Fiber posts and dual cure resin is used for cementation of Metal as well as Fiber posts.

Difficulties of post in primary teeth:

-Difficulty in inserting of post length because of short length of deciduous roots & deciduous tooth
roots can undergo resorption over a period of time .
-Retention is decreased due to short length.
- possibility of losing of crown because of trauma.

Coronal restorations after post placement:

Restoration of remaining coronal structure can be done with direct or indirect technique or with
single tooth prostheses such ad strip crowns, stainless steel crowns, porcelain veneers, polycarbonate
crowns and acrylic resin crowns.

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 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

Notes about post used in pediatric dentistry: -

-The most used posts in the primary teeth are omega post and its modifications
-During usage of composite post the inverted mushroom shaped canal preparation is most convenient
for the retention of this post.
- Fiber posts can also be used efficiently in deciduous teeth. Among all fiber posts, polyethylene fiber
post has proved to be proper.
-Biologic post can be used successfully in the deciduous teeth when tooth bank facilities are available.
- Coronal restoration can be done by usage of direct or indirect restorative techniques. Full coronal
restoration must be placed after insertion of post.

• Crown and restoration of badly destructed primary teeth:

Many options are available for using full coverage restoration in the primary dentition, with each
option having advantages and disadvantages. Commonly used full coverage crowns involve stainless steel
crowns and its modifications, polycarbonate crowns and strip crowns. Stainless steel crown (SSC) has
been used to reconstruct damaged primary and permanent posterior teeth for almost 50 years. They are
ready made crown forms that are adapted to individual teeth and by using a biocompatible luting agent it
can be cemented.

“The SSC is very durable, cheep, exposed to minimal technique sensitivity during placing in tooth
, and offers the advantage of complete coronal coverage. Many dentists support the success of SSCs to
restore badly decayed, pulpotomized or destructed deciduous molars. Despite the good properties
mentioned, SSCs have a main drawback which is the poor esthetics.

Open-face SSCs have been introduced as esthetic solution to stainless steel crowns, but they also
have several disadvantages like time consuming and their requirements for additional preparation and use
of multiple materials.

Excellent esthetic appearance with acceptable durability has been gained from resin-based crowns
(strip crowns) for badly decayed and/or destructed anterior primary incisors but they have main
disadvantage as they are technique-sensitive restorations.

Polycarbonate crowns are another solution for restoration and esthetics of anterior primary
decayed or destructed teeth. They have good esthetic appearance than stainless steel crowns, easy to trim

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 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

and adapt and needs less chair side time.

Each of previous methods has short comings but they can be used at some time. The search for the
ideal full coverage restorations in pediatric dentistry continues as we are in world full of technologies and
human always looks for better so new and new trends will be introduced.

• Reconstruction of severely damaged Primary anterior teeth:

Before restoration of badly destructed primary anterior teeth endodontic treatment and placement of
some retentive features is mandatory before reconstruction of the crown, To get retention for these crowns
and stability. It is mandatory To use intracanal retainers after endodontic Treatment.

Treatment options of badly destructed teeth will be affected by one of the most important
consideration in reconstruction of Primary Teeth which is the physiological root resorption [ There for the
dentist should Consider 3mm of the root for retention and resistance of restoration].

For example. The use of Conventional methods such as Prefabricated metal Posts, nickel
chromium cast Posts, The use of stainless steel orthodontic wire as intracanal post all of them not coincide
with the physiological root resorption and composite resin posts Provide satisfactory esthetic but loss of
retention due to polymerization shrinkage.

According to Previous studies the use of prefabricated non metallic Posts such Polyethylene
fibers, ribbons or tapes, carbon fibers and ceramic Posts have good adaptation by application of resin to
the canal wall, retention and stability, but have disadvantages such as high cost, sensitive technique and
time consuming.

The most recent techniques for reconstruction of severely destructed primary anterior teeth are
performed easily and friendly. For example [“reverse metal post- insertion technique” (RMPT) ] , IT's
Performed in child mouth directly without any additional laboratory Processes, It can be completed in one
visit, the Post_ initial stability in the canal attained through the quadrangle shape of the Post's core with
enough composite material around the core part of The post system. This technique has advantages such
as adaptation of the shade so it's more esthetic, disappear of metal through Composite, The Core length of

9
 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

the Post system occupies 3 mm only which is The recommended length for deciduous teeth it's not
interfere with physiological root resorption of primary teeth or eruption of Permanent teeth and it can be
used also with multiple sever decayed primary anterior teeth, but in children specially with heavy occlusal
force or para functional habits, there is possibility for root cracking with long term function.

Restoration of severely destructed anterior teeth has been a challenge to pediatric dentists.
Esthetically anterior crowns such as Polycarbonate crowns, Strip crowns, Art glass crowns, Veneered
stainless steel crown and other types were introduced which restore the destroyed teeth with sufficient
tooth structure. But in case of badly destructed crown structure, these crowns fail to resist the forces of
occlusion . So, post and core systems like omega loop, fiber post were introduced which give good
retentive properties for the success of coronal restoration.

Strip crown with omega loop is quick, cheap and proper option for reconstruction of badly
damaged anterior primary teeth. Fabricating of omega loops is very simple and easy , with 21 gauge
stainless steel wire. In this technique, extensions of omega loop wire are inserted at the depth of
about 3-4 mm in pulp chamber and the projection of the loop is used for retention of the coronal
restoration. The largest advantage is that the wire does not produce any internal stresses in the
root canal as it is incorporated in the restorative material mainly, and it can be completed with
the least chair side time.

• Reconstruction of badly destructed primary posterior teeth:

Primary molars with extensive destruction by caries or any other cause are frequently seen in
clinic. Their early loss may not only lead to neuro-muscular imbalance that decreases masticatory
efficiency but also phonetic and esthetic problems, development of parafunctional habits and
psychological problems. To restore them there are a lot of treatment options that available today like
stainless steel crowns, cheng crowns, dura crowns, strip crowns, glastech crowns, pedo jacket crowns and
others . Out of the different treatment options available to restore severely destroyed deciduous molar is
biologic restoration . Lots of authors suggested the use of tooth structure as a restorative material.

Santos and Bianchi in 1991 coined the term “biological restoration” while the first paper reporting
the usage of extracted teeth as dental restorative materials was published in 1964 by Chosak and Eidelman.
Ramires-Romito et al used teeth from the human tooth bank of Sao Paulo University Dental School and
they used them as natural posts and crowns to fit into the roots and restore the crowns as well. After that

10
 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

, Another reports have explained the advantages of this technique, such as good esthetics, arising from
enamel’s natural surface smoothness, anatomical contour and color matching , functional and masticatory
efficiency , maintenance of sound tooth structure, prevention of physiological wear, and no need of more
complex materials. The technique is performed by bonding sterile dental teeth with large coronal
destruction. The bonding materials maintain the tooth fragment in the non-retentive cavity which is
present as a result of extensive loss of tooth structure. We can obtain fragments from the patient or from
a tooth bank and can be used as a safe and easy alternative to restore dental anatomy and function with
Proper biomechanical characteristics.

Not only the simple the technique is, but it also the maintain sound tooth structure and have
excellent esthetics in comparison with composite resins and stainless steel crowns, especially translucent
appearance. In addition the clinical chair time for fragment bonding procedures is very little , which is
very interesting when treating children.

However, such as any indirect restorations, biological restorations need a laboratorial phase that
may become a critical step if it is not done properly. Hence, despite being simple, the technique needs
experience in order to prepare and adapt the natural crowns to the cavity adequately.

Disadvantages of the biological restoration technique involve difficulty in obtaining teeth with
the required coronal dimensions and characteristics, problems inherent to indirect restorations and
matching fragment color with patient teeth color. Also, getting fragments from other people's teeth in
their mouth is not an acceptable idea for some patients and a lot of them refuse to take this treatment.
However, all these factors cannot be contraindications of the technique.

It is very important that the parents should know that the tooth fragments used for biological
restoration are previously submitted to a perfect sterilization process that completely eliminates any
source of contamination or disease transmission to the child receiving the fragment. recently, safe
methods of sterilization and storage are available to assure the safety of teeth or tooth fragments coming
from tooth banks.

Many materials are used in bonding dental fragments to cavities, such as adhesive systems,
composite resins, glass ionomer cements and dual-cure resin cements and the choice for each bonding
material is depended on dimensions of fragment and thickness of bonding agent layer.

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 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

• Conclusion

"prevention is better than cure "prevention keep up with grazing and heedfulness, but with the
carelessness of the parents or the ignorance of the public and oral health rules, dental caries occur to their
children, then the situation turns from just a prevention by using fissure sealant or fluoride application
into worse situation which leads to loss of parts of vital tooth structure if dental caries was simple, but
with the Increase of carelessness it becomes worst situation, In which dental caries progress to reach the
pulp, when bacteria reach to the pulp the tooth lose its vitality and become brittle so crown fracture occur
turning the tooth from sound tooth into badly destructed tooth. In this research we spoke about this subject
in which we mentioned treatment of badly destructed primary anterior teeth by using "reserve metal post
insertion technique "it's simple, easy technique, maintain the most important consideration in
reconstruction of severely decayed primary teeth (physiological root resorption) and little time consuming,
as all procedure occur at one visit, with mentioning of some esthetic restorations and crowns to preserve
and maintain esthetic view and child psychology, then we mentioned the restoration of posterior teeth in
which pulpectomy is occurred then using post_core system and supporting the tooth by durable restoration
as stainless steel crown or crowns made of natural teeth fragments to maintain primary molars integrity
until their time of exfoliation.

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 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

• References

-Gupta P, Bhatnagar P, Bais PS, Bhatnagar A. Management of Mutilated Primary Anteriors: A Challenge
to Pediatric Dentist. Int J Oral Health Med Res 2017;4(1):45-47.

-De Castro, Alessandra de Maia, et al. "Importance of deciduous teeth: maternal perceptions and early
childhood caries."Pesquisa Brasileira em Odontopediatria e Clínica Integrada 17.1 (2017): 1-9.

- Suzan S, Kumar VAA, Divya G et al. Effectiveness of chemomechanical caries removal agents Papacar-
ieand Carie-CareTM in primary molars: an in vitro study. J Int Soc Prev Community Dent 2016; 6: 391.

- ESTEVES, Helder; CORREIA, André; ARAÚJO, Filipe. Classification of extensively damaged teeth to
evaluate prognosis. Journal of the Canadian Dental Association, 2011, 77.5: 305.

-Anil, Sukumaran, and Pradeep S. Anand. "Early childhood caries: prevalence, risk factors, and
prevention." Frontiers in pediatrics 5 (2017): 157.

-Vafaei, Ali, et al. "Survival of composite resin restorations of severely decayed primary anterior teeth
retained by glass fiber posts or reversed-orientated metal posts." International journal of clinical pediatric

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 Tanta University ‫جامعة طنطا‬
Faculty of ‫كلية طب األسنان‬
Dentistry

dentistry 9.2 (2016): 109.

-MOLAR, Decayed Deciduous Mandibular. Biological Restoration of a Grossly Decayed Deciduous

Mandibular Molar. Journal of Clinical and Diagnostic Research, 2012, 6.1: 139-141.

-GARG, Venika, et al. Crowns in pediatric dentistry: A review. Journal of Advanced Medical and
Dental Sciences Research, 2016, 4.2: 41.

-SERAJ, Bahman, et al. Fracture resistance of three different posts in restoration of severely damaged
primary anterior teeth: An in vitro study. Dental research journal, 2015, 12.4: 372.

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