8.7.4 Anterior teeth
The treatment of decayed primary incisors depends on the stage of decay and the age
and co-operation of the patient. In the preschool child, caries of the upper primary
incisors is usually as a result of 'nursing caries syndrome' due to the frequent or
prolonged consumption of fluids containing fermentable carbohydrate from a bottle or
feeder cup (368HChapter 6). The lower incisors are rarely affected as they are protected
during suckling by the tongue and directly bathed in secretions from the
submandibular and sublingual glands. In 'nursing caries' the progression of decay is
rapid, commencing on the labial surfaces and quickly encircling the teeth. It is
impossible to prepare satisfactory cavities for restoration and after a comprehensive
preventive programme the most suitable form of restoration is the 'strip crown
technique'. This utilizes celluloid crown forms and a light-cured composite resin to
restore crown morphology. Either calcium hydroxide or glass ionomer cement can be
used as a lining and the high polishability of modern hybrid composites make them
aesthetically, as well as physically, suitable for this task.
In older children over 3 or 4 years of age new lesions of primary incisors, although
not usually associated with the use of pacifiers, do indicate high caries activity (369HFig.
8.15). Such lesions do not progress so rapidly and usually appear on the mesial and
distal surfaces, here a glass ionomer cement or composite resin can be used for
restoration. Glass ionomer lacks the translucency of composite resin but has the useful
advantages of being adhesive and releasing fluoride.
Fractures of the incisal edges in primary teeth, as in permanent teeth, should be
restored with composite resin.
Strip Crowns (3M ESPEE) are a useful aid in the restoration of primary incisors.
Unfortunately, owing to their low sales in the United Kingdom and the rest of Europe,
the company has discontinued the sale of these crowns and now they are only
available on special request. They are however, freely available in the United States.
In the authors opinion, these crowns are excellent for building primary incisors where
extensive tooth tissue has been lost due to either caries or trauma. The technique for
their use is similar to that of such crowns used in permanent teeth; the crowns are
easily trimmed with sharp scissors, filled with composite, and seated on a prepared
and conditioned tooth. The celluloid crown form can be stripped off after the
composite has been cured. 370HFigure 8.16 (a) and (b) show that excellent results can be
obtained with the use of strip crowns.
371H
Fig. 8.15 Labial and approximal caries
in upper anterior primary teeth.