Bioactive restorative selection in pediatric dentistry

Dr. Carla Cohn discusses her choice of restorative materials

Children should learn to practice oral hygiene from an early age, and dentists are specially trained to treat little ones and educate their parents on oral health care. Caries can develop as the primary teeth first begin to erupt, and maintaining healthy primary dentition is important for the growth and development of the arch, as well as the emotional well-being of the child.

The 5-year-old patient featured in this case study did not benefit from early oral care and had multiple carious lesions. Considering the young age, high caries risk, and the uncertainty of compliance with follow-up appointments, I wanted to restore and seal all teeth in one visit. One quadrant is shown in this case study. The carious lesion on tooth J (65) was cavitated and prepared, restored, and sealed. Tooth I (64) was non-carious and would only be sealed (Figure 1).

I chose Activa™ Kids Bioactive-Restorative and Activa Presto (Pulpdent) as restorative materials for this case because I have seen excellent clinical results over time with these bioactive materials. Continuous release and recharge of calcium, fluoride, and phosphate from these restoratives are beneficial in the fight against decay long into the future.

Choosing restoratives based on ease of use and the ability to work quickly was important in this case. All restorations were completed under general anesthesia in one appointment. There were wear facets on the occlusal surfaces of the molars, so it was important to use a material that would have some flexibility and resistance to fracture. The innovative composition of Activa Kids includes an elastomeric monomer or “rubberized” component that absorbs forces and was an ideal filling material. Activa Presto shares similar properties, and it was convenient to use as an occlusal surface sealant for this patient.

Tooth J (65) was prepared with a coarse tapered high-speed diamond bur allowing for some minor mechanical retention by incorporating minimal undercut in preparation. The occlusal surface of tooth I (64) was also lightly abraded with a diamond bur (Figure 2). The preparations were selectively etched with phosphoric acid, rinsed, and lightly dried (Figure 3). Bonding agent was applied to the entire occlusal surfaces of both teeth, air thinned, and light-cured (Figure 4).

Tooth J (65) was bulk-filled with Activa Kids. For this fast injection technique, I place the dispensing tip at the floor of the preparation and extrude the material without removing the tip until the preparation is completely filled (Figure 5). I like to do some minor manipulation of the filling material with hand instruments to create anatomy, as well as to ensure the material is flush with the surface of the preparation, and no air is trapped inside. Activa Kids is dual-cure, ideal for bulk filling, and can be cured with all lights. A thin topcoat of Activa Presto was placed as a sealant on the entire occlusal surface of teeth I and J (64 and 65) (Figure 6). Figure 7 shows the final clinical situation.

This information was provided by Pulpdent.