Sealants
Local Anesthesia (Inferior Alveolar Nerve Block)
Class II Amalgam
Stainless Steel Crown and Formocresol Pulpotomy

The video segments listed above are short versions of some of the most commonly performed clinical procedures in pediatric dentistry. Once you select a procedure, please review the preparatory text before viewing the video.

Home computer users: To view the video segments, you must have the QuickTime plug-in which can be easily installed on most computers. If your computer does not have this plug-in, click the address below to go to that site and follow your system requirements for downloading. Please note that the average downloading time via standard modem is 45 minutes to 1 hour per video segment. For this reason, you may want to view this part of the course at the Dental Learning Resources Center.

http://www.apple.com/quicktime/download/index.html

Dental Learning Resources Center: As you might be aware, this facility is located on 8th floor of Moos Tower. The computers in this lab already contain the the QuickTime plug-in to view the video segments. They also have powerful ethernet connections which can download the video segments within two minutes. You will find computers with a comparable set up at the Bio-medical Library in Diehl Hall.

Sealants

Tooth sealed: #3-6

Armamentarium:

Procedure:
  1. Apply topical anesthetic and isolate the tooth with a rubber dam. (Use local anesthesia when restoring other teeth in the quadrant.)
  2. Clean the grooves of the tooth with a black bristle brush at slow speed. Rinse the tooth with water and dry.
  3. Apply etching solution to the enamel surface.
  4. Rinse enamel surface with water for 10-20 seconds and dry for an additional 10 seconds with an air syringe.
  5. Enamel is etched when the surface appears dull, frosty, and opaque.
  6. Dispense the sealant in a dappen dish and apply on the grooves using a dycal applicator or explorer. Disperse the sealant into all the grooves including the buccal surface for a mandibular molar and lingual surface for a maxillary molar.
  7. Light cure the sealant for 30 seconds.
  8. Check the sealant for any voids or incomplete coverage.
  9. Check the occlusion and remove any interferences.

Click the button to view the procedure (00:22).

(return to the top)

Local Anesthesia (Inferior Alveolar Nerve Block)

Area anesthetized: Right mandibular quadrant

Armamentarium:

Anesthetic agents: Technique and patient management: Inferior alveolar block: In the child, the ramus is shorter vertically and narrower anteroposteriorly than in the adult. The location of the mandibular foramen in the child is inferior to its site in older individuals; therefore, the injection plane relative to the plane of occlusion must be altered.


  1. Position the barrel of the anesthetic syringe parallel to the line of occlusion of the posterior teeth and directly over the primary mandibular molar or premolar of the opposite side.
  2. Initially, penetrate the needle 2-3 mm submucosally. After negative aspiration, deposit a small volume of solution.
  3. When the needle tip encounters the medial surface of the mandibular ramus, its hub should be about 3.0 mm from the mucosa. At this point, aspirate the area, followed by a slow deposition of 1.0 mL of anesthestic solution to affect the inferior alveolar nerve.
  4. Withdraw the needle half way and position the syringe over the primary molar teeth on the side being anesthetized. Deposit 0.5 mL of solution to anesthetize the lingual nerve.
  5. To anesthetize the buccal nerve, deposit a small amount (0.25 mL) of solution into the buccal soft tissues of the vestibule distal to the most posterior teeth in the mandibular arch.

Click the button to view the procedure (00:18).

(return to the top)

Class II Amalgam

Teeth restored:

#8-5 MO amalgam
#8-4 DO amalgam
Radiographic examination: Examination of bitewing radiographs is essential in determining the presence or absence of proximal caries. Caries on the proximal surfaces most often begins just below the contact area and initially spreads laterally, and then gingivally.

 

The outline forms for several class II amalgam preparations are illustrated in the following figures:


Armamentarium: Note: Anesthetize the teeth by inferior alveolar block and isolate the quadrant with a rubber dam.

Cavity preparation:
  1. Start by penetrating the occlusal surface with the #330 bur, going from distal to mesial surface.
  2. Include deep and defective grooves. Blend the outline to form smooth arcs and curves.
  3. Width: one-third the width of the occlusal table.
  4. Depth: 1.5 mm. Use the #330 bur as an indicator. The distance from bur tip to shank is approximately 1.5 mm. The periodontal probe can also be used as an indicator.
  5. Round the line angles and pulpal floor with the #330 bur.
  6. Proximal box: Use the #330 bur to extend the occlusal outline through the marginal ridge. Extend the bur into the proximal surfaces, keeping it parallel to the long axis of the tooth. Move the bur in a pendualting motion from lingual to buccal.
  7. Proximal box is wider cervically than occlusally. Buccal, lingual, and gingival walls should break all contact with adjacent tooth just enough to allow the tine of an explorer to pass.
  8. Gingival walls are flat and axial wall extends 0.5 mm into the dentine.
  9. Axiopulpal line angle is rounded.
  10. If active caries has not been removed during cavity preparation, use a #4 or #6 round bur in a slow-speed handpiece. A large spoon excavator also works well.

Matrix Placement: To form a T-band matrix, fold the band back on itself in a circle and fold over the extension wings of the T to make an adjustable loop. Position it on the tooth with the folded extension wings on the buccal surfaces. Draw the free end of the band until it fits snugly against the tooth. Place the wooden wedge with cotton pliers.

Condensing and Finishing:
  1. Condense the amalgam into the corners of the proximal box and against the matrix band, continuing to fill the cavity until the entire preparation is overfilled.
  2. Condense adjacent class II preparation alternatively.
  3. Use lateral condensers to contour amalgam.
  4. Burnish the amalgam from the occlusal surface.
  5. Remove the excess from the margins with an explorer.
  6. Carve occlusal detail with a cleoid-discoid or T-3 carver.
  7. Check occlusion and do appropriate adjustments prior to discharging the patient.

Click the button to view the procedure (01:40).

(return to the top)

Stainless Steel Crown and Formocresol Pulpotomy

Tooth restored: #8-4

Radiographic examination: Examination of bitewing radiograph gives essential information regarding the extent of decay and presence of pulpal involvement. It also helps rule out any interradicular radioluceny that indicates irreversible pulpitis.

 

Armamentarium:

Note: Anesthetize the teeth by inferior alveolar block and long buccal injection. Isolate the quadrant with a rubberdam.

Crown preparation:
  1. Occlusal reduction: Reduce occlusal surface by about 1.0 to 1.5 mm with #169L or #330.
  2. Circumferential reduction: Slice mesial and distal contacts, just breaking the gingival and buccogingival contacts. Use tapered diamond for mesial and distal reduction being careful not to leave any ledges or shoulders. Do not reduce buccal and lingual surfaces except where a large buccal bulge exists.
  3. Proximal tapering: Round off all sharp line angles and edges by creating a bevel all along the occlusal one-third of the preparation.
  4. Remove decay with #330 bur (high speed) and then with large round bur (slow speed).

Pulpotomy: (Perform this procedure if pulp exposure occurs after caries removal.)
  1. Identify pulp exposure.
  2. Remove the roof of the pulp chamber with #330 bur or large round bur.
  3. Remove coronal portion of vital pulp using large round bur in slow speed or spoon excavator.
  4. Control hemorrhage using dry cotton pellets in the chamber.
  5. Place cotton pellet dampened with formocresol for 5 minutes.
  6. Clinically assess the condition of the pulpal tissues. Pulp stump should appear blackish brown. If bleeding occurs, check for residual pulp tissue and reapply formocresol for 2 minutes.
  7. Fill pulp chamber to about half its volume with IRM.

Crown selection:
  1. Select smallest crown that can be inserted over the cervical convexity of the tooth with finger pressure.
  2. Check occlusion and contact with adjacent teeth.

Crown trimming, contouring, and crimping:
  1. Mark the gingival margin with a scaler or explorer. Trim the crown 1 mm beneath the scratch using crown and bridge scissors.
  2. Contour the crown with #114 pliers.
  3. Crimp the margins with crown-crimping pliers.
  4. When placing crowns in areas of space loss, mesio-distal adjustment is done by crimping proximal contact areas with Howe pliers.

Crown finishing and cementing:
  1. Smooth crown margins with heatless stone and rubber wheel.
  2. Rinse and dry the crown and the tooth.
  3. Lute with glassinomer cement.
  4. Seat from lingual towards buccal.
  5. Remove excess cement with wet gauze, q-tip, and an explorer.
  6. Floss proximal areas to remove excess cement.
  7. Recheck occlusion and gingivae.

Click the button to view the procedure (03:15).

(return to the top)