Restoration of the central incisors in sleep

Course of treatment

On the first visit, we carried out and an examination and came up with a treatment plan. Of course, at this age, any treatment is possible only under the conditions of medical sleep with the sensitive and professional supervision of an anesthesiologist who specializes in dealing with younger children.

Egor fell asleep and we, fortunately, restored his teeth.

Under the conditions of medical sleep, we made the following:

1. Photo protocol, spot X-ray.

2. Professional oral hygiene using the Prophyflex apparatus, teeth polishing with a rubber cup.

3. Anesthesia using fluid Ultracaine DS 1:200,000 0.4 ml for the area of the central teeth – to reduce the likelihood of pain sensitivity even in sleep, because all the 4 teeth, unfortunately, had a diagnosis of pulpitis (and this is a complicated caries, work is done with pulp, i.e., nerve).

4. Teeth 5.4, 6.4,7.4,8.4 were treated with the KAVO Rondoflex apparatus, 27 µm powder for a complete cleaning of fissures from plaque and minimally changed enamel. The fissures were then sealed with Clinpro Sealant, which was carefully lapped with a microbrush for a better fixation.

5. Insulation with the dental rubber dam. In this case, there were difficulties with isolation, because after the removal of all the carious tissues from the teeth, only a part of the hard tissues remained almost at the gum level. However, we completed the isolation successfully. We started with the OptiDam system, but in the course of work it turned out that the dam was too hard for this clinical case, and we replaced it with a standard rubber dam.

6. Treatment of teeth 5.2, 5.1, 6.1, and 6.2 diagnosed as chronic reversible pulpitis. Reversible means that the pulp was affected only in the area adjacent to the carious cavity, so the pulp was not completely removed from the canal, but only the infected part was “cut off”. Biodentine, a bioinert calcium-containing medication was applied to the orifices of the canals. We isolated the material with Fuji IX special cement and then proceeded to the direct restoration. If the crowns are fixed on what remains after the removal of caries, there is a high risk of depressurization and loss of the crown.

Therefore, we, first, restored the tooth stumps using SDR, a special composite material, in accordance with an adhesive protocol with a 2-component bond OptiBond FL. Then the stumps were processed for the crowns. Zirconium dioxide crowns (ZOC) were selected according to the size, shape, and height of the teeth.

One of the important criterium for the long life of crowns is their passive fixation. This means that before cementing the crowns, we make sure that the crown “sits” well on the stump so that it cannot be blown off with a stream of air from the chip-blower. This technique has just recently come into practice but showed itself in the best way possible. The crowns were fixed with Fuji I glass ionomer cement. We performed a mandatory X-ray quality control for the treatment of pulpitis and fixation of the crowns.

After еру treatment, the mother was given recommendations on: 

• care of teeth covered with crowns; 
• means of hygiene and remineralization. 

And it was also recommended to give up on, at least, night breastfeeding (BF), since it is not yet possible to completely remove BF because of the baby’s temper. This recommendation is important as BF at this age is one of the risk factors for caries. Constant snacks reduce the acidity of the oral cavity, and newly erupted teeth are not yet mineralized enough and are very sensitive to external factors. It is also important in terms of preventing the appearance of carious lesions on the teeth, which will soon appear in the baby’s oral cavity. 

We hope for the consciousness of the parents, who will certainly make every effort to prevent the further spread of caries for Egorka. Waiting for a follow-up examination in 3 months and then we will invite them to further preventive meetings. 

Duration and cost of treatment

Treatment time: 2 hours 30 minutes 

Cost of treatment:

• the cost of medical sleep ~ 30 000 RUB;
• the cost of dental treatment ~ 88 000 RUR.