Restoration of proximal incisal caries in primary anterior teeth

Date: 2015-10-07; view: 630.

One type of preparation used for the esthetic restoration of primary incisors provides for includes a proximal reduction and the establishment of a definitive cervical seat that extends to labial and lingual locks in the cervical third of the tooth. As with other operative procedures for the pediatric patient, the use of the rubber dam aids in maintenance of a dry field, provides better vision, and facilitates control of the lips and tongue. The preparation includes a proximal reduction through the incisal angle and the carious lesion, and ends at the established cervical seat. Labial and lingual locks are then prepared in the cervical third of the tooth. The remaining caries is removed, the tooth is etched, and a bonding agent is applied. A properly placed matrix tightly wedged at the cervical seat aids the operator in placing, shaping, and holding the composite resin during the curing process. A good matrix also simplifies the finishing procedures. The lock extends minimally across two thirds of the labial surface and may extend even farther to include decalcified enamel in the cervical area. We would also recommend slightly beveling the enamel margins before etching to further improve the marginal bonding of the restoration. Initial shaping of the restoration may be accomplished with a flame-shaped finishing bur. The excess resin is removed, and the contour of the restoration is established. The gingival margins may be finished with a sharp scalpel blade. Final polishing may be accomplished with the rubber cup and a fine, moist abrasive material or one of the composite polishing systems.

Webber et a1. have described a resin crown technique. According to this technique the tooth is restored with composite resin using a celluloid crown form as a matrix. They did not advocate preserving a portion of the incisal edge. They point out that very little finishing of the restoration is required when the celluloid crown has been properly fitted. Preservation of the incisal area of the tooth provides a greater surface area of etched enamel and greater length in the preparation, both of which will improve the retentive quality of the restoration.