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PEDIATRIC DENTISTRY SECTION

A SHINING SOLUTION: COMBATING

EARLY CHILDHOOD CARIES – DIGITALLY,

MINIMALISTICALLY AND ESTHETICALLY

FUNCTIONING

Gaurav Gupta, D.K. Gupta, Priyanka Gupta

INTRODUCTION
In both developed and developing nations, early
childhood caries (ECC) is a widespread and complex
condition that poses a significant public health
concern [1,2] . The American Association of Pediatric
Dentistry (AAPD) defines ECC as the presence of one
or more carious tooth surfaces (with or without cavities)
or one or more deciduous teeth with caries-related
fillings in children under the age of six. Affecting 60%
to 90% of children worldwide, ECC is among the most
prevalent childhood ailments . Although primary
[3]
dental prevention, fluoridated toothpaste, and continued
fluoride application in various forms can help prevent
tooth decay, it remains a major issue .
[4]
The gold standard for treating caries in pediatric
dentistry is the stainless-steel crown (SSC), known for Fig 1: Pre-procedure digital examination of oral cavity
its strong clinical and radiological outcomes . SSCs
[5]
provide long-term durability and are widely indicated CASE REPORT
for teeth with developmental defects or extensive carious A 3-year-old girl visited the clinic with a chief complaint of decayed teeth in the
lesions involving multiple surfaces, where glass ionomer upper front region, as explained by her mother. The teeth were asymptomatic at
or composite fillings are likely to fail. They are also used the time of presentation. Her medical and dental history was unremarkable, with
for the restoration of fractured teeth . However, parents no known allergies or systemic conditions. A clinical examination revealed caries
[6]
often object to SSCs due to cosmetic concerns, leading in the maxillary arch without pulpal involvement. The child was non-cooperative,
to the growing popularity of more aesthetically pleasing so digital behavior modification techniques were employed, and impressions were
alternatives such as pediatric zirconia crowns [7,8] . taken. Based on clinical and radiological findings, a diagnosis of early childhood
Zirconia crowns are fabricated from a single sintered caries (ECC) was established. To enhance the pediatric patient experience, the
block of zirconia crystals, making them approximately procedural protocol was modified using digital dentistry. (Figure 1)
three times stronger than porcelain-fused-to-metal
crowns while offering superior translucency . TREATMENT PLAN
[9]
This case report highlights the successful management Given the severity of the child’s dental anxiety and phobia, it was decided that
of ECC using silver diamine fluoride (SDF) treatment the best course of action would be treatment under nitrous oxide inhalation
combined with the placement of hybrid zirconia crowns, sedation (NOIS). Digital behavior modification was employed through digital
providing long-lasting protection against future cavities. diagnosis. Since the patient was initially resistant, digital behavior modeling
In this particular case, prefabricated zirconia crowns was demonstrated on her elder sibling using a digital impression, which helped
were not the most suitable option due to minimal enamel her feel more comfortable. She then consented to a digital intraoral scan, and
preparation. Zirconia crowns typically require a thickness preparations were made under NOIS.
of approximately 2 mm around the subgingival margins, A minimally invasive treatment plan was developed to ensure long-term tooth
necessitating a procedure performed under local preservation and aesthetics while arresting the progression of caries. Informed
anesthesia, often for endodontically treated teeth. This consent was obtained from the child’s parents. A 38% silver diamine fluoride
case underscores the importance of early intervention (SDF) solution was applied to the affected proximal and occlusal surfaces of
and child-friendly restorative techniques in pediatric the teeth. The parents were informed about the expected outcome of the SDF
dentistry. application, including the potential dark discoloration of the carious lesions,

52 Dental Practice I January-February 2025 I Vol 21 No 1