5. Preclinic Exercises
#K SSC, #L DO Composite #A SSC, #B Pulpotomy/SSC
#E SSC
Incisal/Lingual reduction
for 1 mm clearance
Interproximal reduction to
allow for close adaption
Similar to strip crown without
a groove
#F Strip Crown
7. Daily Clinical Protocols
• Students expected to arrive on time in the Pediatric
clinic.
• All patients are scheduled by the Pediatric clinic
assistant and students are not assigned pediatric
patients to their family of patients.
• The students should thoroughly review the chart
prior to treatment.
• The faculty hold seminars and discuss Tx planning,
behavior management, charting and Tx sequencing
among other topics.
8. Daily Clinical Protocols
Examination:
• Medical and dental Hx.
• Evaluation of hard and soft tissues.
• Radiographs are based upon individual need and
taken only when a diagnostic yield is expected.
• Caries Risk Assessment.
• Occlusal analysis and need for orthodontic
assessment.
• Other specialty consultations are requested, if
needed.
9. Daily Clinical Protocols
Tx Plan Formulation:
• “Worst first” approach
• Quadrant dentistry/arch dentistry
• Selective non-invasive procedures introduce the
patient to the dental environment
• Caries Risk assessment and Preventive follow-up
10. Daily Clinical Protocols
Behavior Management:
• Tell, Show, Do
• Positive Reinforcement/Ignoring Negative
• Nitrous Oxide
• Voice control
• Modeling
• Distraction
• Papoose board used as needed – parents may or
may not be in the operatory during procedures
11. Daily Clinical Protocols
Materials:
• Local Anesthetics – Lido 2% with epi (max single
dose 4.4 mg/kg/2mg/lb [300 mg], septo 4% w/ epi
• Amalgams – Dispersalloy
• Composites – Dyract, Esthet-X micro hybrid and
composite, Clinpro Sealant
• Matrix and Wedging – T bands, Palodent
matrix, Tofflemier matrix bands
12. Daily Clinical Protocols
Stainless Steel Crowns:
• Occlusal reduction, interproximal and B/L reduction
to allow for proper adaption of the crown
• 1 – 1.5 mm of occlusal clearance and no cervical
ledge to prevent seating
• Use 6888-012 flame diamond and 909-040 wheel
diamond, 330 and 169L
• Adapt 3M Ion primary molar crowns
• Crimping pliers/Howe pliers for contouring
• Cement with glass ionomer luting cement
13. Daily Clinical Protocols
Pulp Therapy for Primary/Immature Permanent Teeth:
• Protective base – Fuji GI liner
• Indirect pulp cap
• Direct pulp cap (permanent only) MTA or CaOH
14. Daily Clinical Protocols
Pulpotomy Primary:
• Access pulp chamber – 330 or 169 carbides
• Remove pulp tissue - #4 or #6 round burs
• Formocreosol or Ferric sulfate to fix tissue
• IRM or Tempit in pulp chamber
• Condense wet cotton pellet or amalgam condenser
• Pulpectomy Primary – 30+ Vitapex, ZOE
15. Daily Clinical Protocols
Space Maintainers:
• Band and Loop
• Lower lingual holding arch
• Transpalatal arch/Nance appliance
18. Pediatric Dentistry
Clinical Requirements
Essential Experiences = EE
• 100 Procedures to include at least 1 space main.
• 1 Pulpotomy
• 1 SSC
Competency Assessments = CA
• 1 Pediatric Class II composite or amalgam
• 2 Case-based Tx plans – 1 comprehensive exam and
1 dental emergency exam
19. Faculty Assessment of
Student Performance
• Faculty should consult the Clinical Procedure Guide Book
(CPGB) for the clinical technical criteria for assessing each
clinical procedure. Link to CPGB:
G:DentalCPAF's_CLINICAL GUIIDEBOOK
• On site faculty should utilize electronic CPAFs for pediatric
assessment. Electronic CPAF can be accessed at:
https://asd.icedentalsystems.com/
• External site faculty should utilize the daily CPAF. Link:
G:DentalCPAF's_CLINICAL GUIIDEBOOKCPAFS Versions 4.07
• Hard copy CPAF for pediatrics is also available. Link:
G:DentalCPAF's_CLINICAL GUIIDEBOOKCPAFS Versions 4.07
20. D1351 Sealant
D1351 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1
Procedure and Surface Appropriate sealant Failure to review Med Inappropriate
Preparation product selected. Tooth and Dent Hx. Failure to understanding of what is
surface clean and free clean surfaces in involved and how
from debris preparation for sealant procedure is done
Isolation Tooth is adequately Loss of isolation No isolation
isolated to prevent
contamination
Etch/rinse/isolate Tooth etched Incomplete etch or No etch
appropriately & rinsed contamination of site
Sealant placement/cure Appropriate amount of Inappropriate amount, Inability to complete
sealant applied and too much, too little, procedure
allowed to cure for requiring adjustment
appropriate amount of through further care
time
Sealant adhered Sealant checked for Incomplete retention of No retention of sealant
complete adherence. sealant material material
Tooth restored to ideal
occlusion w/o assistance
21. D2150 CL II Amalgam
D2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1
Outline Form and Outline does not weaken Over prepared or Grossly over prepared or
Extension the tooth, no extended when caries extended OR
demineralization and anatomy does not Preparation of wrong
dictate tooth
Proximal & gingival
extension is optimal
Optimal treatment of
fissures
Oblique ridge of upper
second primary or
permanent molar nor
transverse ridge of lower
are not crossed unless
undermined by caries
Proximal cavosurface
angles at 90 degrees
22. D2150 CL II Amalgam
D2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1
Internal Form Proximal walls are Over prepared or deeper Pulpal exposure when
convergent occlusally than necessary none should have
occurred
Portions of the prep that
extend into the buccal
and lingual grooves
should slightly diverge
Pulpal floor, 1mm, free
of defects, uniform
depth, internal line angle
slightly rounded, axio-
pulpal line angle is
rounded, gingival floor 1
– 1.5 mm wide – M-D
Retention features
(grooves) ideally placed,
if necessary
No fragile or
unsupported enamel
23. D2150 CL II Amalgam
D2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1
Operative Environment Rubber dam is optimal, Poorly adapted dam Failure to use dam
preparation is dry
Adjacent tooth contact is
not damaged
Amalgam material is
handled in a safe manner
Matrix band and wedge
used appropriately
Anatomical Form Restores harmonious
form of existing tooth
Proximal contour returns
proper shape and
position
Optimal contact will
allow lightly waxed floss
to pass with proper
resistance
24. D2150 CL II Amalgam
D2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1
Margins No excess or deficiency Excessive or deficient Excessive or deficient
at any margin margin that can be margin that requires new
improved without new restoration
restoration
Finish, Function & Smooth surface, no pits, Damage to adjacent Damage to adjacent
Damage voids or irregularities tooth which is noted but tooth causing loss of
is managed with minimal tooth structure and
involvement necessitating a
restoration
25. Examples of CL II Amalgam Preps
Proximal walls are convergent occlusally,
portions of the prep extend into buccal and
lingual grooves, pulpal floor is flat and
uniform depth, gingival floor is 1 – 1.5 mm
wide mesiodistally. Acceptable
Assuming a small
interproximal lesion, just
inside the DEJ. The size
and axial depth of the box
would rate this Improvable.
If there was a pulpal
exposure, it would be
Unacceptable
