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Fixed Prostodontics > Restoration of extensively damaged vital teeth > Flashcards

Restoration of extensively damaged vital teeth Flashcards

1
Q

Pulp and — mm thick surrounding layer of dentin
should be preserved if possible

A

1

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2
Q

Retentive features should not be cut deeper than
— at cervical line or central fossa (—)

A

1.5mm
2mm

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3
Q

Auxiliary retentive features ideally kept in “—
zone”

A

safe

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4
Q

Caries removal: deeper areas filled with

A

base

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5
Q

Restoration of extensively damaged vital teeth
-Central Core Guidelines Central Core (Pulp Chamber) (2) as we age

A

shrinks and recedes

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6
Q

5 Categories involved in decision making:

A

-Deciding on the type of restoration to use
–Crown, Filling, or other
-Using defects as retentive features
–Do I need a build up?
-Pin placement and retention
–Will a build up stay put?
-Bases and Cores
–Do I need to protect the pulp?
-Tooth preparation procedures

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7
Q

Restoration of extensively damaged vital teeth
-Restoration selection
To determine the type of restoration to use when large decay has destroyed tooth structure:
(5)

A

Where is the decay?
How much tooth structure is remaining?
Where is the remaining tooth structure?
Can I restore this?
Should I restore this?

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8
Q

Isthmus destruction greater than ½
intercuspal width –

A

Crown or Onlay

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9
Q

More that 50% of tooth structure is gone
and loss of cuspal suport–

A

Crown (and
likely a core build up too)

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10
Q

Restoration of extensively damaged vital teeth
-Restoration selection
Combined Central and Peripheral destruction:
(2)

A

-Core Build up and Crown
-Possible RCT/Post/Core/Crown

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11
Q

When would you decide you needed
Root Canal Treatment?
(2)

A

If pulp is exposed
If post is needed for retention of
Build up

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12
Q

Restoration of extensively damaged vital teeth
-Retention
Often, a tooth preparation will need to be modified
by adding retentive features to increase retention
and improve the resistance form:
(4)

A

Re-orientation of sloping surfaces
Adding Grooves
Adding Box forms
Adding Pins with a Build up

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13
Q

*There are also times when leaving a crown
preparation without a Build up can help with
retention too. Sometimes,

A

you need to leave it
ugly.

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14
Q

What can we do to increase resistance form with less than ideal tooth structure
remaining?
(4)

A

-Reshape axial walls to reduce convergence
-Add grooves
-Add Box forms
-Increase wall height

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15
Q

-Increase wall height
(4)

A

-place finish line more apical
-Pin retained core
-Crown-lengthening
-Orthodontic extrusion

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16
Q

Reshape axial walls to reduce convergence
Increased axial reduction in the cervical 1/2 of the preparation wall will

A

reduce taper and create more retention and greater resistance form.

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17
Q

Restoration of extensively damaged vital teeth
-Retention – Sloped wall
Incorrect
Sloping surfaces left after cusp fracture or caries
removal need retention
(2)

A

Break slope into vertical and horizontal
components
Conversion into one large vertical wall
weakens tooth with too much removal
and endangers the vital core of the
tooth.

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18
Q

Restoration of extensively damaged vital teeth
-Retention – Sloped wall
Sloping surfaces left after cusp fracture or caries
removal need retention
If greater than 3mm of vertical wall length is apical to
the fractured cusp –

A

-A facial shoulder with axial wall reduction leaves
adequate wall length for resistance form.

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19
Q

Restoration of extensively damaged vital teeth
-Retention - Grooves
-Grooves placed parallel to the long axis of the tooth
(3)

A

-at least 1mm wide and deep
-0.5 to 1mm away from the finish line
-Spaced around the tooth

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20
Q

Restoration of extensively damaged vital teeth
-Retention - Grooves
Grooves used in short preparation walls
with minimal occlusal clearance:
(2)

A

-Proximal grooves shorten the radius
of the arc of rotation
-Walls of a groove or a box are best
placed perpendicular to the displacing
force

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21
Q

Restoration of extensively damaged vital teeth
-Retention – Box form
Box form can be used for retention
(4)

A

-Remove caries
-Convert caries removal into a box form by squaring walls
-Not needed on intact walls
-Box should be well into dentin (deep enough) to resist displacing forces

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22
Q

Restoration of extensively damaged vital teeth
-Retention – Box form
When two boxes are needed, less than 180 degrees of tooth
circumference remains.
(2)

A

-This poses a great risk for cuspal fracture
-Use a Build Up and full crown to protect against fracture

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23
Q

Restoration of extensively damaged vital teeth
-Retention – Sloping, Box form and Grooves
(6)

A

Sloping walls
Converging walls
Short wall height
Occlusal forces
Amalgam removed
Boxes and grooves placed
Axial walls prepared in apical ½ to reduce converging walls

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24
Q

Restoration of extensively damaged vital teeth
-Retention – Wall height
How can we get more Wall height?
(4)

A

-Place margin more apically. Often this is
below the gingiva. However, we must avoid
breaking into biological width.
-Add materials to “Build Up” the tooth. Core
build up can give more wall. Remember, the
finish line needs to be on tooth structure and
you still need at minimum 2-3mm of ferrel.
-Remove biological width restriction with
crown lengthening.
-Pull the tooth out of the bone with
orthodontic extrusion.

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25
Q

Core Build up
(3)

A

Replaces lost tooth structure to improve
retention of a crown
A core must be anchored firmly to the tooth
and not just placed to fill the void
Retention for a core is often with the use of
pins

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26
Q

Build Up is needed when more than
–% of the tooth structure is lost
Insurance companies add – a Build Up
is needed for — of a crown.

A

50
retention

27
Q

Build up Guidelines-
(2)

A

First reason for Build up – Short axial walls
Second reason for a Build up – Excessive
interocclusal distance (tall crown height)

28
Q

Amalgam Core Build Up

A

Not retentive, but strong

29
Q

Composite Resin materials

A

Retentive, but not as strong

30
Q

Use of pins recommended if

A

½ or more of the
clinical crown has been destroyed.

31
Q

Cusps thinner than ½ their height are

A

weak and
should either be shortened or removed.

32
Q

For amalgam core, the cavity floors and walls
should be —.

A

flattened

33
Q

Crown margins should be at minimum – mm
apical to build up material margin.

A

1

34
Q

Amalgam Core
Mechanical properties
(2)

A

Compressive strength
Dimensional stability

35
Q

Amalgam Core
— less technique sensitive

A

Isolation

36
Q

Amalgam Core
Matrix placement can be difficult
if tooth is severely

A

broken down.

37
Q

Amalgam Core
Often used in RCT teeth into
canal for —

A

strength

38
Q

Amalgam Core
Limitations:
(7)

A

Matrix placement can be difficult if
tooth is severely broken down
Slow setting material (10-15 minutes
before band removal)
No bonding or natural retention
Requires at least 2mm thickness
Color shows through some ceramic
crowns
Final crown prep occurs another day
Not used to a great extent
any longer.

39
Q

Composite Core
(5)

A

Mechanical properties
Bonds to tooth structure
Still needs help with pins
Quick setting
Tooth prep at same visit
Ease of manipulation
Can be thinner than 2mm
Color of material aids in crown
matching

40
Q

Composite Core
Limitations
(3)

A

Technique sensitive
Microleakage
possible as material
shrinks when cured
Isolation can be
challenging

41
Q

Build Up Guideline -
(2)

A

Crown margin (finish line) needs to be on
sound tooth structure or life of crown
restoration is compromised.
Rule is rarely broken, but some science
suggests it is possible to for this to occur
successfully.

42
Q

Pins are helpful to support the Build
Up material when residual tooth
structure

A

does not provide adequate
retention itself.

43
Q

Pins increase resistance for —
The resistance is both (2)
Pins should be placed —

A

Build up support
internally and apically
non-parallel

44
Q

Guidelines for Pin placement
(3)

A

-Place in sound, healthy dentin
-Do not damage or undermine nearby enamel
-Angulation can create problems. Avoid
perforations or pins into the pulp!

45
Q

-Place in sound, healthy dentin
(1)

A

-If the dentin is not sound, the threaded pin
will not “bite” and will just spin in the hole
and/or fall out

46
Q

-Do not damage or undermine nearby enamel
(3)

A

-Flat area of placement
-0.5 to 1mm from DEJ or axial wall
-at least 0.5 mm of dentin should surround
the pin

47
Q

Pins introduce dentin stresses creating —
Also introduces — around the pin
— dentin is a must!

A

micro fractures
microleakage
Solid

48
Q

Guidelines for Pin placement
-Best used in — of posterior
teeth to avoid furcations,
perforations and the pulp!
-1 pin per (3)
-At least — of space between pins
-Max of — pins per tooth

A

line angles
missing cusp, line angle, or
axial wall
5mm
4

49
Q

Pin Placement Procedure

A

-Use Pilot drill to make pilot hole. Depth gauge is
on the drill!
-Used with slow speed hand piece
-Watch angulation and position
-Using Filpin latch pin and slow speed
handpiece, place pin just in hole, then full
rheostat power.
-The pin will snap off at the area of the
shaft that has been scored.
-The teeth of the pin should “bite” in the
dentin.
-The pin should not be mobile or able to
be easily pulled out.
-If the pin is mobile or pulled out, the
dentin is either still decayed or too soft to
support a pin (can be the case in RCT
teeth).
Pins often then need to be bent to help
create non-parallelism and to create even
more retention
This instrument can be used to bend the pins
Pin should remain in dentin during bending

50
Q

Pins placed into dentin should:
-Be – mm deep into dentin
-Be – mm coronal into Build up
-Minimum – mm radius of Build up still
around pin after preparation is done

A

2
2
1

51
Q

Drills have a (2)

A

cutting tip and helical flutes

52
Q

Drill down in one motion without

A

additional
movement to create a tight perfect pilot hole
for the pin.

53
Q

Too much wobble or imperfect handpiece
technique creates a

A

pilot hole that is too
wide for the pin threads to properly bind into.

54
Q

Once the pins are placed and bent if necessary, a
— is placed around the prep

A

matrix

Then Build up can be placed using techniques
required of them
Matrix is removed and now crown prep can
proceed as normal

55
Q

Pin Complications-Pin into pulp –
-Pin exits tooth surface above bone –
-Stripped pin (threads don’t bite) –

A

RCT needed
flap and smooth to tooth contour
move to another location at least
1.5 mm away or use a larger sized pin

56
Q

Bases
Bases are used only to protect pulp in
teeth that are have —

A

excavations that
are deep and near the pulp.

57
Q

Bases can be used to fill in —
when an entire Build up is not needed.

A

undercuts

58
Q

Bases are weaker materials that do not
provide strength like a

A

Build up.

59
Q

Bases are not strong enough to support
(3)

A

grooves, boxes or other retentive
features.

60
Q

Base – material that protects the pulp.
Common Protocol:
(5)

A
  1. Gluma (Gluteraldehyde)
    -2x60 second coats
  2. Dycal / Calcium Hydroxide
  3. Vitrebond
  4. Glass Ionomer?
  5. Routine restoration steps
61
Q

Restoration of extensively damaged vital teeth
-Sequence of Treatment
*Prior to prep:
(2)

A

-Evaluate periodontal and endodontic health
-If non-vital, RCT is needed

62
Q

*Remove all caries. Often, but not always, you will remove
any prior materials like old restorations or previous bases.

A

**You may not need to remove all caries. If you determine that
the tooth is non-restorable, you may not need to excavate
everything prior to extraction or RCT. Case by case basis with
Faculty.

63
Q

Re-evaluate your prep.
(4)

A

-HOW MUCH TOOTH STRUCTURE IS REMAINING??
-Is there enough tooth to restore this tooth well?
-Can the defects made from caries removal be
incorporated into prep for retention?
-Do you need a Build Up? or Base? or Pins? or a Post?

Fixed Prostodontics (19 decks)

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