Composite Restorations in

the Primary Dentition

Kenzie Tingle
Melody Ferzacca
Leslie Clark
DH 277
May 7th, 2016

Childhood caries affects many children, and although the primary teeth will
exfoliate with time, a restoration must be placed to ensure the longevity of the tooth.
When primary teeth are lost prematurely an unnatural space remains that causes
future problems for eruption of the permanent dentition (Turgut, Genc, Basar, and
Tekcicek, 870) . While resin-based composite restorative material remains a
popular choice among patients, its use in the primary dentition is limited. The
restorative material of choice for primary teeth is dependent on multiple factors
that should be considered on an individual basis.
Besides composite resins there are multiple other restorative materials that
have a beneficial use in dentistry. Amalgam has been used in dentistry for restoring
teeth for over 100 years. Although its not as esthetically pleasing as composite, its
durability, low cost, and ease of technique compared to other restorative materials
make it a desirable choice among dental practitioners (Burke, 193). However
amalgam restorations require a more extensive prep that involves removal of
healthy tooth structure to achieve adequate resistance and retention.
Characteristically primary teeth have thinner enamel and larger pulp chambers,
which is not accommodating to the larger prep size of amalgams.
Glass ionomers are a fluoride-releasing restorative material that, unlike
resin-based composites, can tolerate a moist environment. Although they are also
tooth-colored, they did not possess the same esthetic quality that composites do. Its
fluoride-releasing capabilities make this an excellent choice for patients exhibiting a
high caries rate or multiple areas of demineralization. Glass ionomers are also used
for interim therapeutic restorations (ITR). These types of restorations are placed

when traditional dental restorations are not possible such as in cases involving very
young children, uncooperative patients, or patients with special health care needs.
Stainless steel crowns are another restorative option commonly used in the
primary dentition. These are prefabricated crowns that are adapted to individual
teeth and cemented on to provide full coverage for the entire tooth structure.
Stainless steel crowns are typically placed in situations where failure of other
restorative materials is likely, teeth with extensive decay or multiple-surface
lesions, or following a pulpotomy procedure. One study found that in high cariesrisk children, definitive treatment of primary teeth with stainless steel crowns is
better over time than multi-surface intra-coronal restorations (Donly and GarciaGodoy, 483).
Resin-based composite is a tooth-colored restorative material used for
posterior and anterior teeth. It has gained popularity in recent years due to its
esthetic appeal. One benefit of using composite restorations is that the dentist can
be more conservative with the tooth preparation. However, the procedure for resinbased composites is more technique sensitive than other restorative materials and
requires longer time for placement (Donly and Garcia-Godoy, 485). In addition,
complete isolation must be obtained for proper bonding to be achieved. Composite
resins in primary teeth are indicated when the patient presents with minimal
carious lesions, has good oral hygiene, the patient can tolerate the procedure and
isolation can be obtained.
Although composite resins are an excellent restorative material choice, there
are some situations in which they are contraindicated in the primary dentition. The

placement time for resin-based composites is significantly longer than the

placement of other restorations. If there is lack of cooperation this procedure is not
likely to be tolerated by the patient (McMillan, 11). Additionally, isolation of the
tooth to prevent contamination by fluids is critical during the placement of
composite. If contamination does occur, there is the potential for the restoration to
result in microleakage from inadequate bonding and subsequent failure.
The patients current oral hygiene care must also be taken into consideration.
The longevity of the composite restoration is compromised when poor home care is
present. The clinician should assess the patients history of caries, number of white
spot lesions, presence of demineralization, and number of carious lesions present
(Donly and Garcia-Godoy, 484). Parental compliance should also be considered and
the likelihood of the patient returning for routine preventative care. In these
situations, other restorative materials may be the better option for the patient.
While resin-based composites have proven to be a functional restorative
material in dentistry, its use in primary teeth is limited. Pediatric patient behavior is
less predictable compared to adults and the technique sensitive placement of
composites may not be the best treatment option. There are many other restorative
materials that may provide the pediatric patient with better prevention from future
carious lesions. The provider must make a decision on which restorative material
to use on an individual basis and take into consideration the patients caries risk,
compliance, and the developmental status of the dentition.

References
Burke, T. (2005). PRIMARY CARE DENTISTRY. Surgeon (Edinburgh University Press),
3(3), 192-195.
Donly, K. J., DDS, MS, & Garcia-Godoy, F., DDS, MS. (2002). The use of resin-based
composite in children. Pediatric Dentistry, 24(5), 480-488. Retrieved May 7,
2016.
Guideline on Pediatric Restorative Dentistry. (2008). Retrieved May 7, 2016, from
http://www.aapd.org/assets/1/7/G_Restorative.pdf
McMillan, J. (2008). Caries in primary teeth. Contemporary Pediatrics, 25(9), 11-11
1p.
Turgut, M. D., Gen, G. A., Baar, F., & Tekiek, M. U. (2012). The effect of early loss
of anterior primary tooth on speech production in preschool children.
Turkish Journal Of Medical Sciences, 42(5), 867-875. doi:10.3906/sag-110441