PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

Armamentarium


(1) rubber dam;
(2) zinc phosphate or IRM cement;
(3) 37% phosphoric acid;
(4) bleaching agent, for example, hydrogen peroxide, carbamide peroxide, or sodium
perborate;
(5) cotton wool;
(6) glass ionomer cement;
(7) white gutta percha temporary restorative;
(8) composite resin;
(9) non-setting calcium hydroxide.


Technique



  1. Take preoperative periapical radiographs; these are essential to check for an
    adequate root filling (524HFig. 10.2 (a)).

  2. Clean the teeth with pumice and make a note of the shade of the discoloured tooth.

  3. Place rubber dam, isolating the single tooth. Ensure adequate eye and clothing
    protection for the patient, operator, and dental nurse.

  4. Remove palatal restoration and pulp chamber restoration.

  5. Remove root filling to the level of the dentogingival junction⎯you may need to
    use adult burs in a mini-head (525HFig. 10.2 (b) and (c)).

  6. Place 1 mm of cement over the gutta percha.

  7. Freshen dentine with a round bur. Do not remove excessively.

  8. Etch the pulp chamber with 37% phosphoric acid for 30-60 s, wash, and dry⎯this
    will facilitate the ingress of the hydrogen peroxide.

  9. Place the bleaching agent, either alone or on a cotton wool pledget into the pulp
    chamber. Place into the tooth, either alone with a flat plastic instrument or on a
    cotton-wool pledget.

  10. Place a dry piece of cotton wool over the mixture.

  11. Seal the cavity with glass ionomer cement.

  12. Repeat the process at weekly intervals until the tooth is slightly overbleached.

  13. Place non-setting calcium hydroxide into the pulp chamber for 2 weeks. Seal with
    glass ionomer cement.

  14. Finally, restore the tooth with white gutta percha (to facilitate reopening the pulp
    chamber again, if necessary, at a later date) and composite resin.

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