Composite is the material of choice for the restoration of primary anterior teeth. An anterior strip crowns with composite resin provides an aesthetic and durable restoration.
Local anaesthesia and rubber-dam isolation should be used if possible. Alterna- tively, because of age and poor cooperation of younger children, the restorative work may be completed under general anaesthesia.
Select the correct celluloid crown form depending on the mesiodistal width of the teeth.
Remove the caries using a slow-speed round bur.
Using a high-speed tapered diamond or tungsten carbide bur, reduce the incisal height by around 2 mm, prepare interproximal slices and place a labial groove at the level of gingival and middle thirds of the crown.
Protect the exposed dentine with a glass ionomer lining cement.
Trim the crown form and make two holes in the incisal corners by piercing with a sharp explorer.
Etch the enamel for 20 seconds, and wash and dry.
Apply a thin layer of bonding resin and cure for 20 seconds, ensuring all surfaces are covered equally.
Fill the crown form with the appropriate shade of composite and seat with gentle, even pressure, allowing the excess to exit freely. The use of small wedges may be helpful in avoiding interproximal excess.
Light cure each aspect (labially, incisally and palatally) equally.
Remove the celluloid crown gently, and adjust the form and finish with either composite finishing burs or abrasive discs.
Check the occlusion after removing the rubber dam.
It is also called as ‘congenital teeth’, ‘fetal deciduous teeth’, ‘dentition proceox’ and ‘natal and neonatal teeth’. There is premature eruption of teeth or teeth like structures that are present at birth.
Natal teeth are the teeth which are present at the time of birth and neonatal teeth are the teeth which are present within 30 days after the birth.
Hereditary—superficial position of tooth germ.
Hormonal influence—eruption accelerated by febrileincident or hormonal stimulation.
Mature—they are fully developed in shape and comparable in morphology to the primary teeth. Prognosis is relatively good.
Immature—their structure and development is incomplete. Poor prognosis of teeth.
Appearance—teeth may be conical or may be normal in size and shape and opaque yellow-brownish in color.
Signs—they are hypermobile because of their limited root development. Within relatively short time, premature erupted tooth will become stabilized and other teeth of the arch are erupted. Teeth appear to be attached to a small mass of soft tissue.
Significance—some teeth are so much mobile that there is danger of displacement and possible aspiration and in this case, removal is indicated.
Riga fede ulcer—there is ulceration of the ventral surface of the tongue caused by the sharp incisal edges. It leads to interference with proper suckling and feeding and thus the neonate is at risk of nutritional deficiency.
Associated syndromes—it may associate with syndromes like Ellis-van Creveld syndrome and cleft palate.
Extraction—extraction of the teeth should be carried out if it is causing inconvenience during suckling, interference with breastfeeding and causing traumatic injury.
NOTE- Extraction should be done after 10th postpartum day due to the inability of the clotting but nowadays, it is no longer considered because of prophylactic administration of vitamin K as a standard procedure in most of the hospitals.
Rounding of sharp angle—the other option that may be used is rounding of the sharp angle of incisal edges of teeth.
Retaining the tooth—if not necessary, tooth should not be removed.The preferable approach, however, is to leave the tooth in place and to explain to the parents the desirability of maintaining this tooth in the mouth because of its importance in the growth and uncomplicated eruption of the adjacent teeth.
A retained natal or neonatal tooth may cause difficulty for a mother who wishes to breast-feed her infant. If breast-feeding is too painful for the mother initially, the use of a breast pump and bottling of the milk are recommended. However, the infant may be conditioned not to “bite” during suckling in a relatively short time if the mother persists with breast-feeding. It seems that the infant senses the mother’s discomfort and learns to avoid causing it.
REFERENCE- MC DONALD TEXTBOOK OF PEDODONTICS AND ANIL GHOM TEXTBOOK OF ORAL MEDICINE