RESTORATIVE OPTIONS FOR PRIMARY

MOLARS

Mirel Toma
WHY RESTORING PRIMARY TEETH?
Repair or limit the damage of dental caries
Protect and preserve remaining the pulp and remaining tooth structure
Ensure adequate function
Restore aesthetics (where applicable)
Provide ease in maintaining good oral hygiene
In addition restoring primary teeth ensures that the natural spaces in the
child’s
primary dentition are retained for the developing permanent dentition
1.Tinanoff, N, Douglass J.M. Clinical decision-making for caries management of primary teeth. J Dent Ed 2001;65(10):1133-42.
2.Sheiham A. Impact of dental treatment on the incidence of dental caries in children and adults. Community Dent Oral Epidemiol 1997;25(1):104-12.
3.American Academy of Pediatric Dentistry. Guideline on caries risk assessment and management for infants, children, and adolescents. Pediatr Dent 2014;36(special issue):127-34.
4.National Institute of Health. Consensus Development Statement: Diagnosis and management of dental caries throughout life. NIH Consensus Statement. J Am Dent Assoc 2001;132(8):1153-61

KEYWORDS: LEEWAY SPACE, FIRST MOLAR SHIFT, VERTICAL DIMENSION OF THE

FACE/occlusion (VDO)
 WHEN TO RESTORE

Decisions for when to restore carious lesions should include

at least clinical criteria of visual detection of enamel
cavitation, visual identification of shadowing of the enamel,
and/or radiographic recognition of enlargement of lesions
over time.

1.American Academy of Pediatric Dentistry. Guideline on caries risk assessment and management for infants, children, and adolescents. Pediatr Dent 2014;36(special issue):127-34.
2.Ismail AI, Sohn W, Tellez M, et al. The international caries detection and assessment system (ICDAS): An integrated system for measuring dental caries. Community Dent Oral Epidemiol
2007;35(3):170-8.
3.Beauchamp J, Caufield PW, Crall JJ, et al. Evidence-based clinical recommendations for the use of pit-and-fissure sealants: A report of the American Dental Association Council on Scientific Affairs. J
Am Dent Assoc 2008;139(3):257-68.
 WHEN TO RESTORE

It should include the identification of the child’s risk

for caries progression and active surveillance to assess
disease progression.

1.American Academy of Pediatric Dentistry. Guideline on caries risk assessment and management for infants, children, and adolescents. Pediatr Dent 2014;36(special issue):127-34.
2.Ismail AI, Sohn W, Tellez M, et al. The international caries detection and assessment system (ICDAS): An integrated system for measuring dental caries. Community Dent Oral Epidemiol
2007;35(3):170-8.
3.Beauchamp J, Caufield PW, Crall JJ, et al. Evidence-based clinical recommendations for the use of pit-and-fissure sealants: A report of the American Dental Association Council on Scientific Affairs. J
Am Dent Assoc 2008;139(3):257-68.
WE ALSO HAVE TO CONSIDER
1. AGE
2. CARIES RISK
3. COOPERATION OF THE CHILD (AGE
RELATED)
4. RESTORATIVE SITUATION
5. CHOICE OF MATERIALS
LET’S SEE WHAT THE OPTIONS ARE
PREVENTIVE METHODS
PIT AND FISSURE SEALANTS
Pit and fissure caries account for approximately 80 to 90
percent of all caries in permanent posterior teeth and 44
percent in primary teeth
placement of resin-based sealant in children and adolescent
reduces caries incidence of 86 percent after one year and 57
percent at 48 to 54 months
1.Beauchamp J, Caufield PW, Crall JJ, et al. Evidence-based clinical recommendations for the use of pit-and-fissure sealants: A report of the American Dental Association Council on
Scientific Affairs. J Am Dent Assoc 2008;139(3):257-68.
2.Simonsen RJ. Pit and fissure sealants. In: Clinical Applications of the Acid Etch Technique. Chicago, Ill.: Quintessence Publishing Co, Inc; 1978:19-42
 PIT AND FISSURE SEALANTS

1.Muller-Bolla M, Lupi-Pégurier L, Tardieu C, Velly AM, Antomarchi C. Retention of resin-based pit and fissure sealants: A systematic review. Community Dent Oral Epidemiol 2006;34(5):321-36.
2.Wood AJ, Saravia ME, Farrington FH. Cotton roll isolation vs Vac-Ejector isolation. J Dent Child 1989;56(6):438-41. 
3.Collette J, Wilson S, Sullivan D. A study of the Isolite system during sealant placement: Efficacy and patient acceptance. Pediatr Dent 2010;32(2):146-50. 
4.Griffin SO, Jones K, Gray SK, Malvitz DM, Gooch BF. Exploring four-handed delivery and retention of resinbased sealants. J Am Dent Assoc 2008;139(3):281-89. 
PIT AND FISSURE SEALANTS
PIT AND FISSURE SEALANTS
PIT AND FISSURE SEALANTS
PIT AND FISSURE SEALANTS
 RESIN INFILTRATION
Resin infiltration is an innovative approach primarily to
arrest the progression of non-cavitated proximal caries
lesions
An additional use of resin infiltration has been suggested to
restore white spot lesions formed during orthodontic
treatment
RESIN INFILTRATION
 RESIN INFILTRATION
Recommendation AAPD:

There is evidence in favor of resin infiltration as a treatment

option for small, noncavitated interproximal carious lesions in
permanent teeth

1.Tellez M, Gomez J, Kaur S; Pretty IA, Ellwood R, Ismail AI. Non-surgical management methods of noncavitated carious lesions. Community Dent Oral Epidemiol 2013;41(1):79-96.
2.Senestraro SV, Crowe JJ, Wang M, et al. Minimally invasive resin infiltration of arrested white-spot lesions. J Am Dent Assoc 2013;144(9):997-1005.
RESTORATIVE METHODS
 SDF (Silver Diamine Fluoride)
Silver topical products, such as silver nitrate and SDF have
been used in Japan, China, India and New Zeeland for over
50 years to arrest caries and reduce tooth hypersensitivity in
primary and permanent teeth.

SDF is a 38% silver diamine fluoride which is equivalent to

5% fluoride in a colorless liquid, with a pH of 10.
1.Rodica Luca, De la impregnarea neagra la folosirea SDF’ului in tratamentul cariei simple. Al XXII’lea Congres International de Medicina Dentara, UNAS, 3-6 octombrie 2018, Bucuresti
2.Mei ML, Zhao IS, Ito L, et al. Prevention of secondary caries by silver diamine fluoride. Int Dent J 2016;66(2):71-7.
3.Zhao IS, Gao SS, Hiraishi N, et al. Mechanisms of silver diamine fluoride on arresting caries: a literature review. Int Dent J 2018;68(2):67-76.
 SDF

Food and Drug Administration approved SDF as a device for

reducing tooth sensitivity, and off-label use for arresting
caries is now permissible and appropriate for patients.

1.Mei ML, Lo EC, Chu CH. Clinical use of silver diamine fluoride in dental treatment. Compend Contin Educ Dent 2016;37(2):93-8; quiz100.
2.Sharma G, Puranik MP, K RS. Approaches to arresting dental caries: An update. J Clin Diagn Res 2015;9(5):ZE08-11.
3.Gao SS, Zhang S, Mei ML, Lo EC, Chu CH. Caries remineralisation and arresting effect in children by professionally applied fluoride treatment – A systematic review. BMC Oral Health 2016;16:12.
4.Duangthip D, Jiang M, Chu CH, Lo EC. Restorative approaches to treat dentin caries in preschool children: Systematic review. Eur J Paediatr Dent 2016;17(2):113-21.
5.Duangthip D, Chu CH, Lo EC. A randomized clinical trial on arresting dentine caries in preschool children by topical fluorides–18 month results. J Dent 2016;44:57-63.
 SDF
Studies consistently conclude that SDF is more effective for
arresting caries than fluoride varnish.
ADV: easy to apply, quick, affordable and cost effective
DISADV: discoloration of demineralized or cavitated surfaces
(black staining of the lesions).
1.Rodica Luca, De la impregnarea neagra la folosirea SDF’ului in tratamentul cariei simple. Al XXII’lea Congres International de Medicina Dentara, UNAS, 3-6 octombrie
2018, Bucuresti
2.Fung MHT, Wong MCM, Lo ECM, Chu CH. Arresting early childhood caries with silver diamine fluoride – A literature review. J Oral Hyg Health 2013;1:117. Available at:
“https://www.omicsonline.org/open-access/arresting-early-childhood-caries-with-silver-diaminefluoridea-literature-review-2332-0702.
1000117.php?aid=21896”. Accessed September 25, 2017. (Archived by WebCite® at: “http://www.webcitation.org/6tkIYecuP”)
3.Gao SS, Zhang S, Mei ML, Lo EC, Chu CH. Caries remineralisation and arresting effect in children by professionally applied fluoride treatment – A systematic review. BMC
Oral Health 2016;16:12.
4.Duangthip D, Jiang M, Chu CH, Lo EC. Restorative approaches to treat dentin caries in preschool children: Systematic review. Eur J Paediatr Dent 2016;17(2):113-21.
5.Duangthip D, Chu CH, Lo EC. A randomized clinical trial on arresting dentine caries in preschool children by topical fluorides–18 month results. J Dent 2016;44:57-63.
 SDF

Pictures from internet

 SDF

Pictures from internet

DEEP CARIES EXCAVATION
AND RESTORATION
Remark: Selective caries removal IAPD

With regard to the treatment of deep caries, three methods of

caries removal have been compared to complete excavation:
 DEEP CARIES EXCAVATION
AND RESTORATION
-Stepwise excavation (a two-step caries removal - carious
dentin is partially removed at the first appointment. At the
second appointment, all remaining carious dentin is removed
and a final restoration is then placed.
-Partial, or one-step, caries excavation (infected dentin is
removed leaving only the affected one and a final restoration
with or without remineralization properties is then placed.
-No removal of caries before restoration (Hall technique)
 DEEP CARIES EXCAVATION
AND RESTORATION
Recommendations AAPD:
1. There is evidence from two systematic reviews that the rate of restoration
failure is no higher after incomplete rather than complete caries
excavation.

2. There is evidence that partial excavation (one-step) followed by

placement of final restoration leads to higher success in maintaining pulp
vitality in permanent teeth than stepwise (two-step) excavation.
1.Lula EC, Monteiro-Neto V, Alves CM, Ribeiro CC. Microbiological analysis after complete or partial removal of carious dentin in primary teeth: A randomized clinical trial. Caries Res
2009;43(5):354-8. 
2.Orhan AI, Oz FT, Orhan K. Pulp exposure occurrence and outcomes after 1- or 2-visit indirect pulp therapy vs. complete caries removal in primary and permanent molars. Pediatr Dent
2010;32(4):347-55
3.Ricketts D, Lamont T, Innes NPT, Kidd E, Clarkson JE. Operative caries management in adults and children (Review). Cochrane Database Syst Rev 2013;3:54.
DEEP CARIES EXCAVATION
AND RESTORATION
 DENTAL AMALGAM
Dental amalgam has been the most commonly used
restorative material in posterior teeth for over 150 years and
is still widely used throughout the world today
Dental amalgam has been declined in use over the past
decade, due to the controversy surrounding perceived health
effects of mercury vapor, environmental concerns from its
mercury content, and increased demand for esthetic
alternatives
1.Beazoglou T, Eklund S, Heffley D, Meiers, J, Brown LJ, Bailit H. Economic impact of regulating the use of amalgam restorations. Public Health Rep 2007;122(5):657-63. 
2.U.S. Department of Health and Human Services. Final Rule. Federal Register 75: Issue 112 (Friday, June 11, 2010). Available at:
“http://www.fda.gov/downloads/medicaldevices/productsandmedicalprocedures/dentalproducts/dentalamalgam/ucm174024.pdf ”. Accessed September 4, 2013.
3.American Dental Association Council on Scientific Affairs. Statement on Dental Amalgam, Revised 2009. Chicago, Ill.; 2009. Available at:
“http://www.ada.org/sections/professionalResources/pdfs/amalgam_literature_review_0907.pdf”. Accessed September 4, 2013.
 DENTAL AMALGAM
Recommendation AAPD: 

There is strong evidence that dental amalgam is efficacious in

the restoration of
Class I and Class II cavity restorations in primary and
permanent teeth.
 DENTAL AMALGAM- SAFETY
1. Comprehensive literature review of dental studies published between
2004 and 2008 found insufficient evidence of associations between
mercury release from dental amalgam and the various medical
complaints.
2. On July 28, 2009, the Food and Drug Administration (FDA) issued a
final rule that reclassified dental amalgam to a Class II device (having
some risk) and designated guidance that included warning labels
regarding:
 possible harm of mercury vapors
 disclosure of mercury content
 contraindications for persons with known mercury sensitivity
1.American Dental Association Council on Scientific Affairs. Statement on Dental Amalgam, Revised 2009. Chicago, Ill.; 2009. Available at:
“http://www.ada.org/sections/professionalResources/pdfs/amalgam_literature_review_0907.pdf”. Accessed September 4, 2013.
 DENTAL AMALGAM- SAFETY
3. Also in this final rule, the FDA noted that there is limited
information regarding dental amalgam and the long-term
health outcomes in pregnant women, developing fetuses, and
children under the age of six.

1.U.S. Department of Health and Human Services. Final Rule. Federal Register 75: Issue 112 (Friday, June 11, 2010). Available at:
“http://www.fda.gov/downloads/medicaldevices/productsandmedicalprocedures/dentalproducts/dentalamalgam/ucm174024.pdf ”. Accessed September 4, 2013.
DENTAL AMALGAM

Pictures from internet

 DENTAL AMALGAM
The Minamata Convention on Mercury is a multilateral environmental
agreement that addresses specific human activities which are contributing to
widespread mercury pollution.

140 countries on January 19th, 2013, after three years of negotiation.

In the European Union, starting July 1st 2018, dental amalgam

shall not be used in the treatment of deciduous teeth, children
younger than 15 years and pregnant or breastfeeding women.

1. http://www.mercuryconvention.org/Portals/11/documents/Booklets/COP1%20version/Minamata-Convention-booklet-eng-full.pdf
2. https://www.eumonitor.eu/9353000/1/j9vvik7m1c3gyxp/vkerepdhtuzg
3. https://sciencebasedmedicine.org/mercury-amalgam-fillings-and-you/
 DENTAL AMALGAM
The Minamata Convention on Mercury is a multilateral environmental
agreement that addresses specific human activities which are contributing to
widespread mercury pollution.

From January 1st 2019, dental amalgam shall only be used in pre-
dosed encapsulated form. The use of mercury in bulk form by the
practitioner is prohibited

The feasibility of a phase out of dental amalgam use in the long

term, and preferably by 2030.
1. http://www.mercuryconvention.org/Portals/11/documents/Booklets/COP1%20version/Minamata-Convention-booklet-eng-full.pdf
2. https://www.eumonitor.eu/9353000/1/j9vvik7m1c3gyxp/vkerepdhtuzg
3. https://sciencebasedmedicine.org/mercury-amalgam-fillings-and-you/
 COMPOSITES
Resin-based composite restorations were introduced in dentistry
about a half century ago as an esthetic restorative material.
They are more technique sensitive than amalgams and require
longer working time
Bisphenol A (BPA) and its derivatives are components of resin-
based dental sealants and composites. Trace amounts of BPA
derivatives are released from dental resins through salivary
enzymatic hydrolysis and may be detectable in saliva up to three
hours after resin placement
1.Bernardo M, Luis H, Martin MD, et al. Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial. J Am Dent Assoc 2007;138(6):775-83.
2.Antony K, Genser D, Hiebinger C, Windisch F. Longevity of dental amalgam in comparison to composite materials. GMS Health Technol Assess 2008;13(4):Doc12.
3.Fleisch AF, Sheffield PE, Chinn C, Edelstein BL, Landrigan PJ. Bisphenol A and related compounds in dental materials. Pediatrics 2010;126(4):760-8.
 COMPOSITES
On the basis of the proven benefits of resin-based dental materials
and the brevity of BPA exposure, AAPD recommends continued
use with strict adherence to precautionary application techniques.
 Use of these materials should be minimized during pregnancy
whenever possible.
Manufacturers should be required to report complete information
on the chemical composition of dental products and encouraged to
develop materials with less estrogenic potential.
1.Bernardo M, Luis H, Martin MD, et al. Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial. J Am Dent Assoc 2007;138(6):775-83.
2.Antony K, Genser D, Hiebinger C, Windisch F. Longevity of dental amalgam in comparison to composite materials. GMS Health Technol Assess 2008;13(4):Doc12.
3.Fleisch AF, Sheffield PE, Chinn C, Edelstein BL, Landrigan PJ. Bisphenol A and related compounds in dental materials. Pediatrics 2010;126(4):760-8.
 COMPOSITES
Recommendations AAPD: 
1. In primary molars, there is strong evidence that composite
resins are successful when used in Class I restorations
2. In permanent molars, there is strong evidence that composite
resins can be used successfully for Class I and II
restorations.
3. Enamel and dentin bonding agents decrease marginal
staining and detectable margins for the different types of
1.Soncini JA, Meserejian NN, Trachtenberg F, Tavares M, Hayes C. The longevity of amalgam versus compomer/ composite restorations in posterior primary and permanent teeth: Findings from the New

composites.
England Children’s Amalgam Trial. J Am Dent Assoc 2007;138(6):763-72.
2.Hickel R, Kaaden C, Paschos E, Buerkle V, García-Godoy F, Manhart J. Longevity of occlusally-stressed restorations in posterior primary teeth. Am J Dent 2005;8(3):198-211.
3.Fuks AB, Araujo FB, Osorio LB, Hadani PE, Pinto AS. Clinical and radiographic assessment of Class II esthetic restorations in primary molars. Pediatr Dent 2000;22(5):479-85.
4.Antony K, Genser D, Hiebinger C, Windisch F. Longevity of dental amalgam in comparison to composite materials. GMS Health Technol Assess 2008;13(4):Doc12.
COMPOSITES
 COMPOMERS

Polyacid-modified resin-based composites, or compomers,

were introduced into dentistry in the mid-1990s. 72% percent
(by weight) strontium fluorosilicate glass and the average
particle size is 2.5 micrometers
Considering the ability to release fluoride, esthetic value, and
simple handling properties of compomer, it can be useful in
pediatric dentistry
1.Nicholson JW. Polyacid-modified composite resins (‘compomers’) and their use in clinical dentistry. Dent Mater 2007;23(5):615-22.
2.Cildir SK, Sandalli N. Fluoride release/uptake of glassionomer cements and polyacid-modified composite resins. Dent Mater J 2005;24(1):92-7.
3.Peng D, Smales RJ, Yip HK, Shu M. In vitro fluoride release from aesthetic restorative materials following recharging with APF gel. Aust Dent J 2000;45(3):198-203.
 COMPOMERS

Recommendations AAPD:
Compomers can be an alternative to other restorative
materials in the primary dentition in Class I and Class II
restorations.

There is not enough data comparing compomers to other

restorative materials.
1.Nicholson JW. Polyacid-modified composite resins (‘compomers’) and their use in clinical dentistry. Dent Mater 2007;23(5):615-22.
2.Cildir SK, Sandalli N. Fluoride release/uptake of glassionomer cements and polyacid-modified composite resins. Dent Mater J 2005;24(1):92-7.
3.Peng D, Smales RJ, Yip HK, Shu M. In vitro fluoride release from aesthetic restorative materials following recharging with APF gel. Aust Dent J 2000;45(3):198-203.
 GLASS IONOMER CEMENTS 
Glass ionomers cements have been used in dentistry as
restorative cements, cavity liner/base, and luting cement since
the early 1970s

1.Wilson AD, Kent BE. A new translucent cement for dentistry. The glass ionomer cement. Br Dent J 1972;132(4):33-5. 
2.Mitra SB, Kedrowski BL. Long-term mechanical properties of glass ionomers. Dent Mater 1994;10(2):78-82.
3.Douglas WH, Lin CP. Strength of the new systems. In: Hunt PR, ed. Glass Ionomers: The Next Generation. Philadelphia, Pa.: International Symposia in Dentistry, PC; 1994:209-16. 
4.Tam LE, Chan GP, Yim D. In vitro caries inhibition effects by conventional and resin-modified glass ionomer restorations. Oper Dent 1997;22(1):4-14.
5. Tyas MJ. Cariostatic effect of glass ionomer cements: A 5-year clinical study. Aust Dent J 1991;36(3):236-9.
6.Swartz ML, Phillips RW, Clark HE. Long-term fluoride release from glass ionomer cements. J Dent Res 1984;63 (2):158-60.
 GLASS IONOMER CEMENTS 
All glass ionomers have several properties that make them
favorable for use in children including:
chemical bonding to both enamel and dentin;
thermal expansion similar to that of tooth structure;
biocompatibility; uptake and release of fluoride;
decreased moisture sensitivity when compared to resins
1.Wilson AD, Kent BE. A new translucent cement for dentistry. The glass ionomer cement. Br Dent J 1972;132(4):33-5. 
2.Mitra SB, Kedrowski BL. Long-term mechanical properties of glass ionomers. Dent Mater 1994;10(2):78-82.
3.Douglas WH, Lin CP. Strength of the new systems. In: Hunt PR, ed. Glass Ionomers: The Next Generation. Philadelphia, Pa.: International Symposia in Dentistry, PC; 1994:209-16. 
4.Tam LE, Chan GP, Yim D. In vitro caries inhibition effects by conventional and resin-modified glass ionomer restorations. Oper Dent 1997;22(1):4-14.
5. Tyas MJ. Cariostatic effect of glass ionomer cements: A 5-year clinical study. Aust Dent J 1991;36(3):236-9.
6.Swartz ML, Phillips RW, Clark HE. Long-term fluoride release from glass ionomer cements. J Dent Res 1984;63 (2):158-60.
 GLASS IONOMER CEMENTS 
GIC is the most biocompatible restorative material known to
these days and most suitable for applying in minimal
intervention dentistry (ART and ITR). These procedures have
similar techniques but different therapeutic goals
Resin modified glass ionomer cements (RMGIC), with the
acid-base polymerization supplemented by a second resin light
cure polymerization, has been shown to be efficacious in
primary teeth
1.Chadwick BL, Evans DJ. Restoration of Class II cavities in primary molar teeth with conventional and resin modified glass ionomer cements: A systematic review of the literature. Eur Arch Paediatr
Dent 2007;8(1):14-21. 
2.Toh SL, Messer LB. Evidence-based assessment of toothcolored restorations in proximal lesions of primary molars. Pediatr Dent 2007;29(1):8-15.
3.Daou MH, Tavernier B, Meyer JM. Two-year clinical evaluation of three restorative materials in primary molars. J Clin Pediatr Dent 2009;34(1):53-8
GLASS IONOMER CEMENTS 
To date, we have 3 GI delivery forms:
1. Encapsulated GIC
2. Compomers
3. RM-GIC
4. GIC powder + liquid
 GLASS IONOMER CEMENTS 

It is worth mentioning that all GI properties for

remineralization of caries lesions are based on the use of
polycarboxylic cement used decades ago, both for minimal
intervention dentistry and esthetic restoration, before
composite resins appear.
 GLASS IONOMER CEMENTS 
Recommendations AAPD:
There is evidence in favor of glass ionomer cements for Class I
restorations in primary teeth.
Resin-modified glass ionomer cements for Class I restorations are
efficacious, and expert opinion supports Class II restorations in
primary teeth.
Interim therapeutic restoration/atraumatic restorative technique
(ITR/ART) using high viscosity glass ionomer cements has value as
single surface temporary restoration for both primary and permanent
teeth.
GLASS IONOMER CEMENTS 
 GLASS IONOMER CEMENTS 

Hybrid
glassionomer
GLASS IONOMER CEMENTS 

Hybrid
glassionomer
 PREFORMED METAL CROWNS

Preformed metal crowns (also known as SSCs) are

prefabricated metal crown forms that are adapted to
individual teeth and cemented with a biocompatible luting
agent
As presented and demonstrated yesterday
PREFORMED METAL CROWNS
PREFORMED METAL CROWNS
PREFORMED METAL CROWNS
PREFORMED METAL CROWNS
 PREFORMED METAL CROWNS

Hall Technique (HT).  The Hall technique calls for

cementation of a crown over a caries-affected primary molar
without local anesthetic, caries removal or tooth
preparation, This technique was developed for use when
delivery of ideal treatment was not feasible
1.Innes NP, Stirrups DR, Evans DJ, Hall N, Leggate M. A novel technique using preformed metal crowns for managing carious primary molars in general practice – A retrospective analysis. Br Dent J
2006;200(8):451-4; discussion 444.
2.Roshan D, Curzon MEJ, Fairpo CG. Changes in dentists’ attitudes and practice in paediatric dentistry. Eur J Paediatr Dent 2003;4(1):21-7. 
3.Threlfall AG, Pilkington L, Milsom KM, Blinkhorn AS, Tickle M. General dental practitioners’ views on the use of stainless steel crowns to restore primary molars. Br Dent J 2005;199(7):435-5. 
4.Blinkhorn A, Zadeh-Kabir R. Dental care of a child in pain: A comparison of treatment planning options offered by GDPs in California and Northwest of England. Int J Paediatr Dent 2003;13(3):165-71. 
5.Maggs-Rapport FL, Treasure ET, Chadwick BL. Community dental officers’ use and knowledge of restorative techniques for primary molars: an audit of two trusts in Wales. Int J Paediatr Dent 2000;10(2):133-
9. 
ZIRCONIA CROWNS
ZIRCONIA CROWNS
ZIRCONIA CROWNS
ZIRCONIA CROWNS
ZIRCONIA CROWNS
ZIRCONIA CROWNS
ZIRCONIA CROWNS
ZIRCONIA CROWNS

BUT…
ZIRCONIA CROWNS
 CONCLUSIONS
The need for restoring and preserving of the deciduous
molars was clearly stated in this presentation.

Each case should be treated based on an accurate diagnosis

and a literature evidence based principle

Following behavioral management approach with children

is one of the key factors for successful long lasting
restoration.
Thank you / multumesc / ‫תודות‬

toma.mirel@gmail.com