Advanced restorative dentistry

The aim of this chapter is to cover the management of more complicated clinical problems associated with children and adolescents: tooth discolouration, inherited enamel and dentine defects, hypodontia, and tooth surface loss. As there is considerable overlap in the application of the various restorative techniques, the chapter is divided into two parts. The first outlines the clinical steps involved in the various procedures, while the second covers the more general principles of management of particular dental problems. It is not the remit of this chapter to cover advanced restorative dentistry in detail, but many of the techniques and indications used in children are the same as those for adults (Boxes 11.1 and 11.2). With the aid of some clinical examples, eight of the restorative procedures will be described in simple stages. Omitted from this list are the stages involved in the provision of full crown restorations and bridgework, which are the specific remit of a restorative dentistry textbook. However, the provision of porcelain veneers, more commonly associated with adult patients, will be mentioned briefly. This technique involves the daily placement of carbamide peroxide gel into a custom-fitted tray on either the upper or the lower arch. As the name suggests, it is carried out by the patient at home and is initially done on a daily basis. • Mild fluorosis. • Moderate fluorosis as an adjunct to hydrochloric acid–pumice micro-abrasion. • Yellowing of ageing. • Single teeth with sclerosed pulp chambers and canals. • Selective bleaching for aesthetic purposes. • Upper impression and working model. • Soft mouthguard—avoiding the gingival tissues. • 10% carbamide peroxide gel. 1. Take an alginate impression of the arch to be treated and cast a working model in stone. 2. Relieve the labial surfaces of the teeth by about 0.5mm and make an acrylic pull-down vacuum-formed splint as a mouthguard with or without reservoirs for bleaching agent on the teeth requiring lightening. The splint should be no more than 2mm thick and should not cover the gingival tissues. It is only a vehicle for the bleaching gel and is not intended to protect the gingivae.