Esthetic restorations in pediatric dentistry: a recent case
What are esthetic restorations?
An esthetic restoration seeks to improve the appearance of the smile, while preserving oral health.
Therefore, one of the most common treatment options is an aesthetic dental treatment to:
a) recover dental structure lost by decay or severe traumatism.
b) improve functionality of affected teeth.
In addition, it recovers and even improves previous aesthetics at the same time.
What is aesthetic restorative dentistry?
The reasons that may cause the need for a smile restoration procedure are:
Dental fracture caused by a trauma.
Oral trauma is common in children and adolescents, mainly affecting anterior teeth.
For the younger ones, as they learn to walk, run and climb everywhere they can, it makes it easier for them to fall. Therefore, it is only necessary to go to a playground to witness blows and falls that affect the teeth.
In addition, as they get older, boys and girls have more sports accidents. The most common sports causing this problem are skiing, soccer, basketball, field hockey and falls in swimming centers.
Caries process.
Today, thanks to increased knowledge and better prevention practices, caries prevalence is less common than in the past century.
Daily hygiene fluoride toothpaste, preventive and treatment planning has decreased the amount of caries in incisor teeth. The use of dental floss and control of the sugar in the diet, have also helped. Cases of nursing caries are also less prevalent today.
What are the problems of the esthetic side of dentistry?
The esthetic restorations of teeth can be:
(a) alterations of color
Such as hypo-plasias or hypo-calcifications.
b) alterations of shape
For example, when the natural teeth have altered shape such as conical teeth, tooth fusion, gemination, among others.
c) alterations of size
These are clinical cases in which the teeth are smaller than they should be. They call them microdontic teeth if they are smaller or macrodontic teeth if they are larger.
d) alterations of structure
Structural defects such as in amelo-genesis imperfecta or in dentino-genesis imperfecta.
What is aesthetic dental treatment?
Health and function to the oral cavity is what provides this non-invasive treatment.
For instance, those that correct:
a) malposition and
b) alterations of shape and color
that sometimes are affected by pathologies and pre-existing alterations, such as:
a) hypo-mineralization,
b) amelo-genesis or
c) dentino-genesis.
In these cases, dentists perform most smile designs using esthetic composite resins as restorations to improve
a) dental esthetics and
b) preserve dental health.
They can reconstruct angles of damaged or fractured teeth, incisal edges, or even fractures that reach the gingival margin.
In more severe scenarios, pediatric dentists can use other materials to restore tooth structures.
a) zirconium,
b) porcelain composite veneers or
c) porcelain crowns.
These options are not as conservative as esthetic resin restorations. However, they can be the best choice for the patient’s oral health.
What aesthetic restorative materials are used in pediatric dentistry?
Composite Restorations
This material can be used to restore decayed teeth and/or provide dental esthetics. They come in different shades and consistencies. Therefore, one of the least invasive and immediate treatments in Dentistry.
Composite Veneers
Compared to porcelain veneers, composite veneers are less invasive. Your pediatric dentist will not need to remove as much tooth enamel as in the first case.
Furthermore, your dentist will sculpt it directly on the tooth. Also, you will have it applied in a single appointment.
Normally, dentists use them for permanent front teeth. However, they can also be used for primary incisors.
Porcelain Veneers
Nowadays, pediatric dentists hardly use porcelain veneers compared to previous decades.
We try to restore with composite veneers instead of porcelain veneers.
Interim therapeutic restoration (ITR)
Atraumatic/alternative restorative technique (ART) is a type of Interim Restoration (ITR).
We often use this technique in specific cases, focusing on:
a) the age of the patient because of dental replacement, and
b) the cooperation-behavior in the dental chair.
Resin infiltrations
Normally they are used to conceal minor enamel defects, such as mild hypomineralization.
Usually, people do not observe the results immediately, and although it is generally effective, it may require several applications.
Glass Ionomers
They are a great provisional and definitive restorative material because of their re-mineralizing effect.
Pediatric dentists widely use glass ionomers in primary and permanent teeth. Dentists can use them as a base and sometimes as cement for various dental procedures.
Among them we can use different types:
a) Conventional glass ionomers
b) Resin modified glass ionomers
c) Glass ionomer sealants
Pit and fissure sealants
We undoubtedly focus mainly on isolating the tooth to be sealed in this non-invasive procedure.
This material is great for preventing cavities and food from getting stuck in the teeth’s fissures.
You must check it every year or every six months, depending on the occlusal wear that the patient shows.
What is a full coverage restoration in pediatric dentistry?
A full restoration means a type of restoration that covers the hole tooth. Also, commonly known as a “dental cap”, it is a prosthetic restoration. Nevertheless, the technical name is a “dental crown”.
In Pediatric Dentistry the most common indication is for molars that have been severely damaged with caries causing a lot of tooth destruction.
The restoration of these molars weakens them because there is more restoration material than healthy tooth in the end. Then these teeth become more prone to break just with normal forces of occlusion and chewing. This is why we crown the molars after restoring them most times with composite resin.
Crowns for primary (temporary-baby) molars are mainly of two different types: stainless steel crowns or zirconia crowns (esthetic).
In permanent molars, we recommend the use of stainless steel crowns. Fortunately, the preparation needs the removal of only a thin layer of enamel. For children and adolescents it is a more conservative and non-invasive preparation. When children become young adults we substitute the metal crown for an esthetic crown.
What are the novel materials in pediatric dentistry?
Resin-modified glass ionomer is a new restorative material in pediatric dentistry. Manufacturers make this particular type of resin with different components, excluding Bisphenol A, which has become controversial. Nevertheless, the FDA (Food and Drug Administration) in the United States considers therapeutic dosages safe and approves its use.
New techniques improve the benefits of new composite materials for dental restorations.
New composites enhance anti-microbial effect and bio-compatibility. The manufacturing process also includes adding silver and titanium particles.
We also have new Bio-active materials to consider like:
a) Calcium Enriched Mixture (CEM),
b) Amorphous Calcium Phosphate (ACP),
c) Endo Sequence Root Repair Material (ERRM) and
d) Bone Morphogenic Protein (BMP).
How is a dental restoration performed?
Everything will depend on the type of problem we have and what we want to improve to be able to recover function and esthetics.
To achieve better long-term results, pediatric dentists must perform these esthetic restorations using a rubber dam. Dentists consider rubber dam one of the best methods of isolation.
For the treatment to be performed we must consider:
Steps to follow
These steps are:
1. Get detailed information about the patient´s dental experience, age and other treatments received.
2. Esthetic restoration techniques and materials to use:
a. Rubber dam
b. Estethic composites
c. Dental bonding agents
d. Opaquers
e. Dental burs
f. Materials for finishing and polishing
Materials to use
As explained earlier:
1. Dental composites
2. Interim therapeutic restorations (ITR)
3. Resin infiltrations
4. Glass ionomers
5. Pit and fissure sealants
6. Crowns
In worn teeth
When dealing with worn teeth, pediatric dentists must choose restorations that can withstand the forces of chewing. This way, we can focus more on function than in esthetics. Current materials are resistant to dental wear of enamel and dentin.
For an esthetic problem
If we are looking to solve esthetic problems, we can use resin restorations and composite veneer restorations.
All this, with the help of “opaquers” (or a resin flow material that hide a metallic color, stains and lack of color). This way, the layers of deeper dental tissue do not show through.
Undoubtedly, the minimally invasive materials and techniques will vary depending on the patient. Dentists can also use esthetic porcelain or zirconium crowns. Also, resin, porcelain, or composite veneers. Both veneers and crowns performed with the minimal preparations possible.
The important thing will always be to seek oral health as the primary objective. And, respecting this principle, to achieve the best esthetics.
Is cosmetic dentistry the same as restorative dentistry?
Clearly, the objective of restorative dentistry procedures is to improve both function and oral health issues. Pediatric dentists always need to address this type of esthetic restoration procedures. On the other hand, cosmetic dentistry aims to address the appearance of gums and teeth to create a pleasing smile. Clearly, a simple composite restoration may not involve a function problem or a health issue.
Examples of cosmetic dentistry: veneers, Invisalign, teeth whitening, esthetic crowns
Examples of restorative dentistry: bridges, implants, crowns over implants
What is an example of an esthetic restoration procedure?
In this case, the patient had a microdontic upper lateral incisor (smaller than the usual size of lateral incisors).
The lateral incisor is smaller than the central incisor, but it has to keep an esthetic and functional proportion. In the present case it is quite smaller than it should be. However, the natural tooth does not present a great alteration in shape. Its configuration is only slightly more rectangular than it should be.
After the orthodontic treatment, the pediatric dentist decided to use dental composite. In this way, we were able to give it the same proper shape as the tooth on the opposite side. Finally, this way, the patient obtained a harmonious, esthetic, and healthy smile.
As shown below, the difference between the teeth before and after esthetic dental restoration treatment is quite successful. Our professional experts at BOJ Pediatric Dentistry Clinic in Barcelona will achieve the most beautiful smile. This is synonymous of health and family well-being.
Photographs before and after the restoration of the lateral incisor, after previous orthodontic treatment, in our dental clinic:
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