Primary Incisor Restoration

Early childhood caries (ECC) is usually seen in 18to 36-month-old children, although it can present even younger. Initially, the maxillary incisors develop a band of dull white demineralization along the gum line that goes undetected by the parents. As the condition progresses, the white lesions develop into cavities that girdle the necks of the teeth in a brown or black collar. Frequently, by the time the child is brought to the dentist, much of the anterior clinical crowns are decayed or lost. In advanced cases, the crowns of the four maxillary incisors may be destroyed completely, leaving decayed brownish-black root stumps (Ripa, 1988). The premature loss or unsightly appearance of grossly decayed primary anterior teeth may be initially of concern to parents; however, as the child matures, it may also affect the patient’s self-image. Treatment of these badly decayed teeth remains a challenge for the dentist. The toddler and preschooler, due to their young age and lack of cognitive abilities, are usually very uncooperative for dental treatment, and their behavior plays a big factor in the choice of restoration. Many appear with poor oral hygiene practices, presenting swollen, inflamed, and bleeding gingiva. Treatment plans advocated for grossly decayed primary anterior teeth include the following: restorations, crowns, or extractions followed by partial dentures. This chapter presents step-by-step procedures for the placement of bonded resin composite strip crowns, full coverage prefabricated crowns, and the anterior esthetic fixed appliance (modified Nance or Groper appliance).