Beyond the Clinic: why new bioactive restorative materials have really changed Paediatric Dentistry

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ABSTRACT

Background

The aim of this paper is to remind how evidence-based paediatric dentistry should not only consider the best available scientific evidence relating to the patient’s oral conditions but it should also consider the patient’s needs beyond the clinic. In a child-family-oriented approach, the best restorative treatment for a primary tooth could not be the proper one for the child as a whole. Preservation of dental tissues as much as possible, without involving the pulp, is called minimal intervention dentistry (MID) and it is closely related to “selective caries removal” and “bioactive restorative materials”. To preserve the vitality of a tooth as much as possible, many tools are available on the market (i.e. silver diamine fluoride, ozone) and this could play an important role in a “tailored fit treatment plan” mindset.

Conclusion

Minimally invasive direct restorative strategies in paediatric dentistry, is a predictable evidence-based-restorative option for the treatment of vital primary teeth with no need of local anaesthesia and absolute isolation. Beyond the clinical aspect, the clinician expertise is crucial to evaluate the required materials and tools, not only to perform a minimal invasive paediatric dentistry in a safe, efficient and child-friendly way, but for the wellness of all parties involved. In this life-related paradigm new bioactive restorative materials are among the main protagonists.

Clinical Report

This approach requires a huge paradigm shift in which carious lesion is no longer viewed as an infection to be eradicated, but as an illness that can be controlled in terms of slowing down or stopping it. This could be achieved through SCR (Selective Caries Removal) procedures that can be performed with low-speed drills, hand excavators, chemo-mechanical solutions and no need for local anaesthesia or absolute isolation. To maximise the chances of remineralisation of the carious lesion, the coronal seal of the restoration is crucial and the choice of bioactive restorative materials — that can be used in the not-absolutely-dry field — contributes to the success of these minimally invasive direct restorative procedures.

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