Pedo class 2 preps ?

[Demeter]

I was taught not not break the buccal and lingual walls during a class 2 prep on a primary tooth. The following description is from Pinkham's book, Pediatric dentistry 3rd edition. Is this approach old school?


Class II Amalgam Restorations
GENERAL CONSIDERATIONS
The outline form for several Class II amalgam preparations is shown in Figure 21-6. The guidelines given for the Class I preparation should be followed during the preparation of the occlusal portion of the Class II preparation; additionally, there are several recommendations for the proximal box preparation. The proximal box should be broader at the cervical than at the occlusal aspect. The buccal, lingual, and gingival walls should all break contact with the adjacent tooth, just enough to allow the tip of an explorer to pass. The buccal and lingual walls should create a 90-degree angle with the enamel.
(Pinkham, J. R.. Pediatric Dentistry: Infancy Through Adolescence, 3rd Edition. Elsevier, 1999. 23.4.2).

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[Dr. Pedo]

I was taught not not break the buccal and lingual walls during a class 2 prep on a primary tooth. The following description is from Pinkham's book, Pediatric dentistry 3rd edition. Is this approach old school?


Class II Amalgam Restorations
GENERAL CONSIDERATIONS
The outline form for several Class II amalgam preparations is shown in Figure 21-6. The guidelines given for the Class I preparation should be followed during the preparation of the occlusal portion of the Class II preparation; additionally, there are several recommendations for the proximal box preparation. The proximal box should be broader at the cervical than at the occlusal aspect. The buccal, lingual, and gingival walls should all break contact with the adjacent tooth, just enough to allow the tip of an explorer to pass. The buccal and lingual walls should create a 90-degree angle with the enamel.
(Pinkham, J. R.. Pediatric Dentistry: Infancy Through Adolescence, 3rd Edition. Elsevier, 1999. 23.4.2).

Dr. Pinkham was my pedo. prof at Iowa---obviously you know how I was taught. I've actually never heard of not breaking contact. Was that in a text you used or a philosophy of your pedo prof./dept?

I think Dr. Pinkham's text is widely regarded as the standard in pediatric dentistry; however, I recently bought the, Handbook of Pediatric Dentistry, 2nd edition. Authors: Cameron and Widmer. It's a great 2nd pedo text and a quick reference which is imperative during my residency. I checked what they suggest/teach on class II amal; they too want all contact broken just enough to allow the tip of an explorer to pass.

Dr. B

 

[ItsGavinC]

The buccal, lingual, and gingival walls should all break contact with the adjacent tooth, just enough to allow the tip of an explorer to pass.

This is what I was taught, by a great professor from UOP, not that it matters what I was taught.

 

[toofache32]

I was taught to break the walls, too. But then again, I always had this strange itch to just pull it...

 

[lnn2]

The proximal box should be broader at the cervical than at the occlusal aspect.

That's for retention purpose.

The buccal, lingual, and gingival walls should all break contact with the adjacent tooth, just enough to allow the tip of an explorer to pass. The buccal and lingual walls should create a 90-degree angle with the enamel.
(Pinkham, J. R.. Pediatric Dentistry: Infancy Through Adolescence, 3rd Edition. Elsevier, 1999. 23.4.2).

That's how I was taught. It's a requirement for regional board exam, breaking all of those contacts. Also bevel the axiopupal line angle.

 

[herodontist]

That's for retention purpose.

Yes it is...but the gingival floor of the proximal box in pediatric class 2 preps is wider in comparison to a permanent prep, because the contact areas are broader in deciduous teeth. Margins for amalgam need to be placed in self-cleansable areas.

 

[Dr. Pedo]

That's for retention purpose.

Yes it is...but the gingival floor of the proximal box in pediatric class 2 preps is wider in comparison to a permanent prep, because the contact areas are broader in deciduous teeth. Margins for amalgam need to be placed in self-cleansable areas.

This is truly the bottom-line. There are other reasons---likely undermined enamel, ditched margins with poor adaptions, poor contour of contact or simply condensing amalg. the matrix band would be ^%$# to put on.