Dental Problems

Temporary Tooth Restorations -Indications and Factors

Temporary tooth restorations are done for a temporary purpose, but not for permanent. These temporary or semi-permanent restorations are generally recommended to restore the lost tooth structure and also to stabilize the broken tooth with these prefabricated crown. However, one must follow some indications of temporary tooth restorations and also consider factors before the procedure. Let us examine them.

Indications of temporary tooth restorations:

The following are the list of indications which are known for the use of temporary tooth restoration treatment.

  • Extensive decay in primary and young permanent teeth:

    • Primary teeth with caries on 3 or more surfaces or where caries extends beyond the anatomic line angles.
    • For example, caries on mesial surface of the maxillary and mandibular first molar.
    • The proximity of the pulp on the mesial side make placement of an acceptable amalgam restoration difficult.
    • Primary incisors with class 4 lesions occurring mesially and distally, along with a class 5 lesion on the same tooth i.e., the primary anterior teeth that are extensively decayed from the nursing bottle syndrome.
  • For teeth deformed by developmental defects or anomalies:

    • Such as enamel dysplasias or dentinogenesis imperfecta.
    • For teeth with hypoplastic defects:
    • They may be more susceptible to caries because retention of the plaque occurs in hypoplastic defects.
    • In the placement of stainless steel crowns on hypoplastic teeth, the treatment may involve the crowing of the teeth in all 4 quadrants (often all posterior teeth).
    • Thus, there is a danger of altering the vertical dimension by impinging on the freeway space.
    • Soothe crowns should be fitted quadrant wise.
    • Only when the previous crown is cemented, then proceed with the preparation of the tooth in the next quadrant.
    • If extensive abrasions have already resulted in a loss of the vertical dimension, then a slight (less then 2mm) opening of the bite is acceptable.
    • If the bite is opened more than 2mm, it will result in tenderness of the treated tooth and possibly in an adverse pulp response.
  • Following the pulp therapy:

    • In both the primary and permanent teeth as pulp therapy leaves the treated tooth more brittle because of fluid loss, it is likely to fracture.
  • As a preventive restoration:

    • If the patient has a high susceptibility to caries, manifesting it either by numerous gross carious lesions or by rampant caries and in a handicapped child whose lack of oral hygiene may encourage further decay.
    • For instance, developing class 5 lesion is a sign of poor oral hygiene and cariogenic diet.
    • When this occurs in the preschool age child who also has class 2 lesion in the same tooth, the stainless steel crown is indicated particularly in the first primary molar.
  • As an abutment:

    • For a space maintainer or prosthetic appliance, for example a restoration for a first primary molar when it is to be the abutment for a distal extension appliance.
  • Temporary restoration of a fractured tooth:

    • In severe cases of bruxism:

      • The teeth may be so abraded that stainless steel crowns are required to restore the interarch vertical dimension and prevent traumatic pulpal exposure.
      • In the mixed dentition phase, the stainless steel crown adapted to the primary molars will assist in preventing undue wear of the first permanent molars.
    • Single tooth crossbite:

      • In case where a lower mandibular incisor has been previously displaced labially, a reversed stainless steel crown or a banded metal incline on the inlocked incisor with a guide plane can be used.
      • With the use of stainless steel crown correction occurs in 1-2 weeks.
    • For replacing prematurely lost anterior teeth:

      • Double stainless steel crowns on abutment teeth can be used for replacing the lost maxillary anterior teeth.

Factors to be considered in pre-operative evaluation:

  • Dental age of the patient:

    • This is recorded by the root development of the underlying tooth.
    • When a primary tooth can be expected to exfoliate within 2 years of restoration, amalgam restoration can be done.
    • However, failure of extensive amalgam restoration in the primary teeth can be frustrating.
    • This can be overcome by an initial placement of stainless steel crown.
  • Co-operation of the patient:

    • If the patient is uncooperative, whether it is due to age (i.e., less than 3 years) or due to negative behavior.
    • If the child is stubborn and does not want to cooperate, first a positive behavior has to be instilled.
    • If the child is unable to co-operate because of age (less than 3 years) then a chair side GA may have to be considered.
    • In this case, since it is difficult to check the correct occlusion so it is always better to keep the stainless steel crown at the level or slightly below the level of the adjacent tooth.
    • So that the child does not have disturbed occlusal due to premature contact.
  • Motivation of the parents:

    • Whether the parents are willing to come for dental visits for the follow-up.
  • Medically compromised/delayed children:

    • For example, in children with a heart problem, prophylaxis has to be taken as in tooth reduction, subgingival procedure is done or in poor general condition of the child chair side GA has to be taken into account.

The above article discusses briefly about the temporary tooth restorations indications and factors to be considered in pre-operative evaluation. It is necessary to consider the about things as it make the treatment procedure easily accessible and effective. Thus, before opting for any treatment one must know the detailed condition of the problem and also about the treatment options.

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