Which of the following would u say is contraindicated for use of composite in the primary dentition?
ClassII
Class II
Class V
Extensive caries activity
Im thinking the answer here is extensive caries since ideally we want to keep direct occlusion off the composite and if caries are on more than one tooth it would be hard to get good isolation. Extensive caries on a primary tooth is typically stainless steal crown. any thoughts?
There is no hard and fast rule. I'm not quite sure I understand your reasoning that we cannot have opposing resins. I've never read or been taught that it's an issue.
Class IIs it depends on the tooth. For class IIs on the Ds many pediatric dentists will place SSCs. The anatomy of these teeth makes retention of composites a difficult proposition. Some may still do resins on these teeth, some will place a RMGI like Fuji so it just depends.
Any pulpally involved primary tooth should receive an SSC or other means of full coverage. That doesn't mean that some people won't restore with resin, but the issue is not with occlusion but moreso with leakage, recurrent decay and an incomplete seal. The fact remains that the standard of care is to place full coverage over pulpally involved teeth.
Class Vs I will place resins, but Fuji is a nice option because it has some flex to it. Class Vs are mostly on anterior teeth, but those restorations don't stay that well. More than likely I would resort to strip crowns in the anterior if there is excessive class Vs in the mouth. Typically, class Vs on D thru G will also have some interproximal or lingual decay which makes the decision to place crowns easier. The primary teeth where I commonly see class V decay on the facial is on the canines.
Extensive decay depends on your definition of extensive, which varies person to person. With that said, extensive decay in the anterior can be restored with strip crowns (resin), so that's not necessarily something that rules resin out.
In restoring teeth in either dentition, one must take into account the caries risk and other factors like OH to determine what is the most appropriate tx. What may be a watch in one childs mouth may be a class I in another, which may be an SSC in another. Not only does it depend on the patient, but it also depends on the treatment modality (chair vs sedation vs OR).
