Easy Isolation For Difficult Cases

Aesthetic pediatric dentistry is possible. Here’s how to overcome the difficulties to isolate and stratify in children.

Precise composite layering is the key of any good aesthetic restoration in anterior teeth: for this
purpose, we suggest making a silicone stent to establish the restoration shape and help the clinician during composite stratification,

The silicone stents have many other applications, for example, in pediatric cases, where the patient often does not tolerate the rubber dam or some of their semi-erupted teeth do not allow an optimal isolation.

The tips below allow the easy restoration of anterior teeth after a traumatic event.

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Fig.1
The patient comes to the office with fractures on the 11 and 21 after an accident at school: As an emergency treatment, the teeth are disinfected with 2% chlorhexidine for 1 minute and protected with a layer of bonding.

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Fig.2
After the emergency treatment, two impressions are taken and a wax-up of the fractured area is done in the laboratory.

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Fig.3

It is well known that in pediatric cases it is very difficult to isolate the field with the classical rubber dam, either because the fractures are deep, or because the adjacent teeth are semi-erupted or simply because the small patient does not tolerate the dental procedures well.

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Fig.4

In this case we use the silicone stent as a guide, while at the same time it is a simple solution to substitute the rubber dam. It also allows the young patient to close their mouth during the bonding and layering stages.

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Fig.5
The silicone stent is placed in the mouth at the next appointment.

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Fig.6
The silicone allows the patient to close their mouth in a comfortable position, as we can appreciate in this lateral view.

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Fig.7
The patient with the silicone stent. The fact of being able to close their mouth offers a relaxing sensation and comfort while allowing us to work precisely.

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Fig.8
The silicone guide must fit perfectly, sometimes small adjustments can be carried out with a scalpel blade to help the stent fit better. We can work through the specially designed windows.

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Fig.9
The patient does not needs to open their mouth during the procedures. We can etch and bond easily and with no risk through the windows.

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Fig.10
The palatal enamel placed and adapted precisely without moving the stent or the patient.

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Fig.11
Opaque dentins are placed and some white spots are carried out to immitate the nautral teeth.

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Fig.12
The case finished and polished shows a perfect integration with the other teeth thanks to the precision of the layering stage.

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Fig.13
The case before.

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Fig.14
The case after.

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Fig.15
Color and shape integration must also take place as well on the palatal walls to avoid occlusion issues and future filtration.

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Fig.16
A control one week later assures us that the colour is correct after teeth are re-hydratated.

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Fig.17
A follow up some months later with the child’s smile!!

Bibliography

Vanini L. Light and color in anterior composite restoration P.P.A.D. 1996; vol 8, n 7; 673-682

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