10.1 INTRODUCTION
The aim of this chapter is to cover the management of more complicated clinical
problems associated with children and adolescents; tooth discolouration, inherited
enamel and dentine defects, hypodontia and tooth surface loss. There is considerable
overlap in the application of the various restorative techniques; therefore the chapter
is divided into two parts: the first outlines the clinical steps involved in the various
procedures, while the second covers the more general principles of management of
the particular dental problems.
10.2 ADVANCED RESTORATIVE TECHNIQUES
10.2.0 Introduction
It is not the remit of this chapter to cover advanced restorative dentistry in detail, but
many of the techniques used in children are the same as those for adults (517HTables 10.1
and 518H10.2).
With the aid of some clinical examples, seven of the restorative procedures will be
described in simple stages. Omitted from this list are the stages involved in the
provision of full crown restorations and bridgework, which are the specific remit of a
restorative dentistry textbook. However, the provision of porcelain veneers, more
commonly associated with adult patients, will be mentioned briefly.
10.2.1 The hydrochloric acid-pumice microabrasion technique
This is a controlled method of removing surface enamel in order to improve
discolorations that are limited to the outer enamel layer. It is achieved by a
combination of abrasion and erosion⎯the term 'abrosion' is sometimes used. In the
clinical technique that will be described no more than 100 um of enamel are removed.
Once completed the procedure should not be repeated again in the future. Too much
enamel removal is potentially damaging to the pulp and cosmetically the underlying
dentine colour will become more evident.
Indications
(1) fluorosis;
(2) idiopathic speckling;
(3) postorthodontic treatment demineralization;
(4) prior to veneer placement for well-demarcated stains;
(5) white/brown surface staining, e.g. secondary to primary predecessor infection or
trauma (Turner teeth).
Armamentarium
(1) bicarbonate of soda/water;
(2) Copalite varnish or vaseline;
(3) fluoridated toothpaste;
(4) non-acidulated fluoride (0-2 years: drops);
(5) pumice;