Restorative Flashcards
A 19-year-old patient attends your practise on Monday morning having sustained trauma to teeth 12 and 11 on
Saturday evening. Tooth 12 is completely missing the crown and has a sub-alveolar fracture. Tooth 11 has a pulpal exposure of 2 mm. Both teeth are experiencing sensitivity.
Discuss FOUR steps in the immediate management of tooth 11 (4)
- Locate the missing fragment of tooth 12
(a&e if we don’t know where the fragment is) - LA for pain relief and rubber dam
- Exposure = large and >24 hours and tooth is sensitive. Partial Pulpotomy
-Access
-Remove necrotic pulp
-Achieve haemostasis using cotton wool + saline
If we cannot achieve haemostasis full coronal pulpotomy.
If haemostasis is still not achieved- pulpectomy - Restore with CA(OH)2 in pulp. seal with GIC then Composite dentine bandage or definitive composite
A 19-year-old patient attends your practise on Monday morning having sustained trauma to teeth 12 and 11 on
Saturday evening. Tooth 12 is completely missing the crown and has a sub-alveolar fracture. Tooth 11 has a pulpal
exposure of 2 mm. Both teeth are experiencing sensitivity.Tooth 12 has a subalveolar fracture and is rendered Unrestorable.
Why is a subalveolar fracture important in
making the tooth Unrestorable? (4)
- Lack of coronal tissue to bond to/support restoration/retain restoration,
- Inability to achieve moisture control for restoration,
- Inability to take impression for indirect restoration,
- Hard to establish marginal integrity/difficulty cleaning
- Difficult to gain a suitable seal (leaving the tooth vulnerable to secondary caries)
A 19-year-old patient attends your practise on Monday morning having sustained trauma to teeth 12 and 11 on
Saturday evening. Tooth 12 is completely missing the crown and has a sub-alveolar fracture. Tooth 11 has a pulpal
exposure of 2 mm. Both teeth are experiencing sensitivity.
Name TWO alternatives to replace tooth 12 after extraction
Implant, Bridge, RPD
A new patient attends your practice complaining of pain from tooth 12 and a de-bonded bridge.
What is the likely design of the bridge?
And what types of bridges can you get anteriorly? (1).**
Adhesive fixed-fixed bridge (RRB)
- debonded from divergent guidance paths and forces being transmitted down the long axis of 2 teeth
Adhesive cantilever
Conventional spring cantilever for upper incisor teeth
A new patient attends your practice complaining of pain from tooth 12 and a de-bonded bridge.
The patient has caries on the palatal of 12. It is sensitive to sweet under the bridge.
What is a reasonable differential diagnosis for the pain from tooth 12? (1)
Reversible pulpitis
Discomfort on stimulus (cold/sweet) but this disapears after removal.
Not spontaneous pain.
A new patient attends your practice complaining of pain from tooth 12 and a de-bonded bridge.The bridge de-bonded on abutment tooth 12 but not on abutment tooth 21. The de-bonded wing on the 12became a plaque trap leading to caries and ultimately causing pain.
Name a better alternative bridge design for this patient and explain why your design would be better. (2)
Adhesive cantilever bridge from tooth 21
less likely to debond as it is only bonded to one tooth - doesn’t have 2 divergent guide paths
If this de-bonded it would fall out (so it wouldn’t become a plaque trap and wouldn’t lead to caries)
This is also less destructive than other bridge designs.
Name 4 factors that could cause an adhesive bridge to de-bond (4)
- Poor moisture control during cementation
- Unfavourable occlusion,
- Parafunction (bruxism),
- Trauma to front of face,
- Poor quality and surface area of enamel
- bonding to an old composite - needs to be replaced or roughened
A new patient attends your practice complaining of pain from tooth 12 and a de-bonded bridge.The bridge de-bonded on abutment tooth 12 but not on abutment tooth 21. The de-bonded wing on the 12
became a plaque trap leading to caries and ultimately causing pain.
How would you treat this tooth 12? (2)
Remove caries, Restore with composite, Review
A cast with upper Co/Cr framework in placed.
List methods of tooth borne support. (3)
Occlusal rests, Cingulum rests, incisal rests
A cast with upper Co/Cr framework in placed.
Where should the cobalt chrome denture base extend to?
2mm in front of palatine fovea (vibrating line)
A cast with upper Co/Cr framework in placed.
There is a rest seat on 12, what is it for?
Indirect retention
Rest seats are for indirect retention (located away from saddle area) or bracing- for suport of plates/ clasps/ major connectors.
Be able to identify if a clasp is Gingivally approaching or occlusally approaching.
A cast with upper Co/Cr framework in placed.
Why is the framework not extending to 11 and 23? What is the benefit of this? (1)
Less mucosal coverage: easier to clean
Two periapical radiographs showing lower anteriors 42, 41, 31 and 32. All treated endodontically with post and
core. You can see radiolucency in all the teeth affected. The patient is referred to you for periradicular surgery.
Three treatment options other than periradicular surgery. (3)
Monitor- If they aren’t causing pain/ patient doesn’t want anything done we monitor with radiographs incase radiolucency increases in size.
Extraction-
Re-RCT
Two criterias for valid consent. (Given sentences. Have to underline.) (2)
Informed, Voluntary, Not Manipulated, Not Coerced, With Capacity
To achieve informed consent prior to providing treatment what 6 things should you tell the patient (6)
- The treatment and what it involves,
- The risks of the treatment,
- The benefits of the treatment,
- The outcomes of the treatment,
- The risks if they do not undertake the treatment,
- Alternative Tx,
- Cost
A patient attends with a fractured 26 MOD amalgam which has also been root treated.
- What are the restorative options for this tooth?
- Crown = MCC
- Indirect restoration: inlay, onlay with cuspal coverage
cuspal coverage = gold standard
A patient attends with a fractured 26 MOD amalgam which has also been root treated.
The GP has been exposed for 6 months; what is your new treatment plan and why?
Re-RCT: Any exposed GP >3 months (to the oral environment (saliva/bacteria) .
The coronal seal has been compromised therefore there can be an ingress of micro-organisms from the oral environment into the root canal system where they can proliferate and cause further infection/PA pathology.
Replace the amalgam with a cuspal coverage restoration (gold standard) to prevent another fracture in the future e.g. onlay, crown
A patient attends with a fractured 26 MOD amalgam which has also been root treated.
Features of Nayyar Core. (3)
When amalgam is placed into the pulp chamber and 2-3mm into the canal.
- 2-4mm of GP is removed from the canal and replaced with amalgam.
- The undercuts in the divergent canals & pulp chamber provides retention for the amalgam.
- The tooth cannot be prepared for 24 hours until it sets.
Name two restorative materials in dentistry that can bond amalgam to tooth. (2)
RMGIC
GIC
Which bond strength is stronger? Amalgam or composite? (1)
Composite
amalgam doesn’t bond it needs mechanical retention
Be able to identify the types of tooth wear.
Attrition- Wear due to tooth to tooth contact
Location- occlusal and incisal contacting surfaces
Clinically- Facets / flattening of cusps. Flattened incisal edge. Loss of cusp height. Shortened incisors and canine teeth . Restorations show the same wear as the tooth substance.
Abrasion -wear by an abnormal mechanical process independent to occlusion (Habituali.e toothbrushing)
Location - Labial/ buccally/ cervical on canine & premolars
Clinical- V shape or rounded lesion. Sharp margin at the enamel edge where dentine is worn away.
Tongue stud- causing lingual wear.
Erosion - loss of tooth surface caused by chemical process that does not involve bacterial action (extrinsic or intrinisc acid)
Clinically -Early lesions-enamel affected. Loses surface detail & they become flat/smooth/shiny)
Loss of tooth thickness (increased translucency of incisor edges) Bilateral concave lesions-Base of the lesion does not contact opposing tooth (cupping) . Restoration sits proud of tooth (tooth has dissolved away)
Abfraction- Loss of hard tissues from eccentric occlusal forces leading to compressive and tensile stress at the cervical fulcrum areas.
Clinically- V shaped tooth loss where the tooth is under tension. Sharp rim at ACJ.
Use the BEWE Score to identify toothwear
Name 3 routes or ways the tooth could be desensitised? (3)
seal and protect- Duraphat Fluoride varnish
desensitizing toothpaste- e.g. colgate sensitive.
Tooth mousse (aids remineralisation)
What is the DAHL technique? (1)
A technique used to increase the available interocclusal space. This creates space to allow restorations of the upper anteriors without further tooth reduction.
Composite is added to build up the anterior teeth to the height we want them to be.
Think of this as build ups and an anterior bite plane to prop open the bite and increase OVD.
This leaves a posterior open bite causing the continued eruption of the posterior teeth to fill the gap (restablish occlusion)- we give it about 3-6 months.
.
How does the DAHL technique work (2)
- Build up maxillary incisor crowns AND incorporate a composite platform on palatal side of the upper incisors = increase interocclusal space
- allow dentoalveolar compensation (3-6 months) from posteriors over erupting to close posterior open bite
List 4 contraindications for use of DAHL appliance. (4)
Absolute contraindications:
* Patients with active periodontal disease
* Short roots
- Post orthodontic treatment
- TMJ problems
- Bisphosphonates- they have slow turnover of bone
- If they have implants
- If they have bridges,
You are about to restore the tooth wear with composite. Name 4 constituents of composite and give an example
for each of the constituent. (4)
Resin: bis-GMA,
glass particles: silica or quartz,
Low weight dimethacrylate: TEGDMA,
Light activator: camphorquinone
Silane coupling agent: Gamma-methacryoxypropyltrimothoxysilane
(bifunctional molecule binding resin and filler)
Cervical abrasion cavity. Why would you use RMGI instead of composite resin? (2)
- Moisture control
- Less polymerisation shrinkage
- lower modulus which has better flex strength
can also use flowable composite
Tooth 11 has a traumatic exposure of the pulp.
What 2 factors would influence your choice of treatment?
Size of exposure (<1mm)
time since exposure (24hrs)
Tooth 11 has a traumatic exposure of the pulp.How you would treat this in practice?
In young patients with immature, still developing teeth, it is advantageous to preserve pulp vitality by pulp capping or partial pulpotomy. Also, this treatment is the choice in young patients with completely formed teeth.
●Calcium hydroxide is a suitable material to
be placed on the pulp wound in such
procedures.
In patients with mature apical development, root canal treatment is usually the treatment of choice,
although pulp capping or partial pulpotomy also may be selected.
● If tooth fragment is available, it can be bonded to the tooth.
● Future treatment for the fractured crown may be restoration with other accepted dental restorative material
What are the options for replacement of central incisor crown fractured completely off to the root at short notice? (4)
- direct resin bonded bridge with fractured crown as pontic
- Provisional overdenture,
- Provisional post crown
- Vacuum formed splint with tooth
Name 3 post materials
- Cast metal (type 4 gold/ stainless steel)
- Ceramics (alumina /zirconia)
- Fibre (Carbon fibre/ glass fibre )
Carbon fibre is avoided in anterior teeth.
4 Indications for size of post (4)
- 4-5mm GP remaining
- post <1/3 root width
- post:crown >1:1, at least half of the post length into the subcrestal root,
- 1.5mm of circumferential remaining dentine
What may be used to cement the post? (2)
- GI luting cement
- dual cure comp resin luting cement
Give 6 methods for removing fractured post
- Ultrasonic vibration,
- Masseran kit,
- cut out for fibre posts,
- Stieglitz/moskito forceps,
- Eggler Post Remover,
- Sliding Hammer
- anthogry
What are the clinical signs of erosion? (6)
- Loss of surface detail,
- Surface becomes flat/smooth/shiny
- Typically bilateral concave lesions without a chalky appearance around the edges of caries (Bacterial acid decalcification)
- cupping (preferential dentine wear- base of lesion is not in contact with the opposing tooth.
- Restoration is sitting proud of the tooth.
- translucent incisal edges (due to loss of tooth thickness)
What are some causative factors of erosion?
- Extrinsic - diet (carbonated drinks & alcohol), alcohol containing MW, asthma inhaler.
- Intrinsic – GORD, bulimia nervosa, persistent vomiting.
How is erosion managed?
Harden up the tooth surface (High fluoride toothpaste/ mouthwash)
Relief of any symptoms (Desensitising toothpaste)
Cover any sensitive/ exposed dentine
Depedent on cause of erosion:
**extrinsic acid- **
Diet modification
Changing habits (Drinking with a straw/ Avoid swilling the drink round your mouth/ careful with sports drinks and gels)
Intrinsic acid
Refer to GP to treat medical cause (Controlling gastric acid- omeprazole/ Anorexia & bolemia )
What factors does an implantologist consider before placing an implant?
MH- Any conditions affecting success of treatment e.g. bisphosphonates/ poorly controlled diabetes.
SH- do they smoke? Can they afford treatment?
DH- Pt motivation? Oral hygiene ?
I.O-
Smile line (High Smile line is a greater aesthetic risk)
Periodontal health
Width of edentulous span
Anatomy (Bone height? Bone width? )
Root position of adjacent teeth
Soft tissue adequacy
Gingival biotype-Thin gingivae is more upredictable for aesthetic.
When placing an implant- What bone dimensions are required and how are they best measured? (5)
We want 7mm of space in the edentulous area.
The bone dimensions are measured using a CBCT.
Bone dimensions:
Mesiodistally- 1.5mm away from teeth.
Bucopalatally-2mm
Apico-coronal margin- 2mm away from the ACJ.
>5mm space for the papilla between the bone crest and contact point.
2mm away from adjacent structures (IAN/Maxillary sinus)
3mm between inplants (I.5mm mesiodistally of each implant)
Give 3 alternative treatment options to implants for a space
- Accept space 2. RPD 3. Bridge
close space with ortho?
How can you check that a bridge has been debonded? (5)
- Probe around the bridge abutments/pontic/wings
- visually inspect - You may see secondary caries or demineralisation
- mobility of the units
- push & check for air bubbles
- floss around the bridge.
What factors should be taken into consideration before placing a bridge? (5)
- Abutment teeth
—health (caries/ perio)
— enamel quality - Occlusion
—-Opposing dentition (contact points/ have the opposing teeth overerupted?)
—-Parafunction- e.g. bruxism - length of span you are replacing (longer= more likely to flex &break)
- OH- can the patient maintain the complex work?
- soft tissue/hard tissue - bridge cannot repalce as well as RPD
What alternatives are there to a bridge? (3)
Nothing, RPD, implant, overdenture
17-year-old patient presents with congenitally missing 22 and 23.
The patient wants implants, what other treatment options could you advise? (2 marks)
- Removable partial denture,
- Bridge (4 unit, fixed-fixed),
- Orthodontics,
- Combined orthodontics and restorative
17-year-old patient presents with congenitally missing 22 and 23.Give a problem relating to aesthetics (1 mark)
Spacing present = unaesthetic
Patient may be being teased due to gap in teeth
Patient may be psychologically affected by missing teeth
low self confidence
17-year-old patient presents with congenitally missing 22 and 23.Give a problem relating to function (1 mark)
Patient may have difficulty eating/incising foods
Problems with speech/saying certain words/letters
lack of canine guidance on that side
17-year-old patient presents with congenitally missing 22 and 23.The patient wants implants.
Give 3 things a dentist would check (generalised) before referral (3 marks)
MH- Diabete/ Osteoporosis/ Bisphosphonates/ Blood clotting disorder.
DH- Periodontal disease/ Motivation/ Oral hygiene
SH- Smoking/ ability to afford treatment
17-year-old patient presents with congenitally missing 22 and 23.The patient wants implants. Give 3 things an implantologist checks (local) (3 marks)
MH- Any conditions affecting success of treatment e.g. bisphosphonates/ poorly controlled diabetes.
SH- do they smoke? Can they afford treatment?
DH- Pt motivation? Oral hygiene ?
I.O-
Smile line (High Smile line is a greater aesthetic risk)
Periodontal health
Width of edentulous span
Bone Quality (Bone height? Bone width? )
Root position of adjacent teeth
Soft tissue adequacy
Gingival biotype-Thin gingivae is more upredictable for aesthetic.
What are the signs and symptoms of reversible pulpitis?
- Discomfort when stimulus (Cold/sweet) is applied but goes away after removal. (<30 seconds after)
- Not spontaenous
- Short, sharp pain (Aβ and Aδ fibres, hydrodynamic microleakage stimulation),
How is reversible pulpitis managed?
Find out the causative agent & treat (remove caries & restore)
Dietary management (change diet/ habits )
OHI- fluoride toothpaste/ mouthwash/ varnish .
Use desensitising agents if the teeth are sensitive.
What are the signs and symptoms of irreversible pulpitis?
- Lingering pain after removal of stimulus
- dull (C fibres)
- spontaneous
- wakened at night
- pain with heat
- poorlylocalised
How is irreversible pulpitis managed?
RCT / XLA
A patient is referred to have a large MOD amalgam in their 46 replaced as it was causing a Lichenoid Type Reaction. You replace it with composite and take radiograph to ensure there is no secondary caries or pathology.
The patient then attends 5 days later complaining on pain when biting and to transient thermal stimuli.
Give 5 causes of the transient sensitivity to thermal stimuli and pain on biting that they are experiencing (5 marks)
- Deep cavity (without a liner placed)
- Insufficient coolant on prep (damaging the pulp)
- Uncured resin monomer entering the pulp and causing irritation (Soggy bottom due to >2mm curing increments)
- Polymerisation contraction shrinkage- causing gaps below the composite restoration.
—This causes the force to not spread evenly (lots of stress making fracture more likely)
— Gaps can fill with Dentinal Fluid from the tubules- (allowing bacterial ingress) - High in occlusion- more pressure as tooth is the first to contact
- Pulpal exposure
- fractured tooth syndrome
- Gingival recession
- Dental abrasion
- Periodontal disease
- Acid erosion - GORD, Dental bleaching, Bruxism,
A patient is referred to have a large MOD amalgam in their 46 replaced as it was causing a Lichenoid Type Reaction. You replace it with composite and take radiograph to ensure there is no secondary caries or pathology.
The patient then attends 5 days later complaining on pain when biting and to transient thermal stimuli.
Give 5 restorative management features that could prevent this from occurring (5 marks)
Occlusion → check with articulating paper.
Deep restoration →
- High speed with water/ slow speed & careful caries removal at pulpal floor- consider excavator for deep caries
- Place lining (CaOH/RMGIC)
Composite
* Debonded- use dental dam to prevent moisture contamination & ensure correct bonding procedure
* Polymerisation contraction stress → incremental placement keeping configuration factor low.
* Soggy bottom → <2mm increments and ensure correct curing regime.
Cracked tooth syndrome→ difficult to diagnose but can use tooth sleuth. Consider cuspal coverage with an indirect restoration
If fracture caused by parafunction= Provide patient with splint- if they have bruxism or toothwear to attempt to protect the restoration.
* Application of duraphat varnish 22600 ppm,
How does local anaesthetic work? (2)
This temporarily stops nerve conduction by temporarily blocking voltage gated sodium channels.
Preventing Na+ influx and Action potential generation.
(Action potentials travel along the axon)
Name 1 ester and 3 amide local anaesthetics
Ester – benzocaine.
Amide – Lignocaine, articaine, prilocaine, bupivicaine
What is in a cartridge of local anaesthetic? (5)
-Base (lidocaine) hydrochloride - anaesthetic agent + aromatic region (Hydrophobic)
-Ester or amide bond
-Amine side chain (hydrophillic)
reducing agent: sodium metabisulfide,
preservative: propylparaban.
fungicide
+/- vasoconstrictor
What is the maximum dose of lignocaine?
4.4mg/kg → for most LA it is roughly 1 cartridge/10kg
5.→ 1% = 1g/100ml = 10g/L →
e.g. 2.2ml cartridge of 2% =
2g/100ml = 20g/Lx2.2 = 44mg/ml
Lidocaine w/ adrenaline: 4.4mg/kg (44ml)
Prilocaine w/ felypressin 6.6mg/kg (66ml)
Articaine w/ adrenaline: 5.0mg/kg (72ml)
What are the characteristics of an ideal post? (3)
Parallel (more retentive than a tapered post & avoids wedging into the root)
non-threaded - a smooth surface encorporates less stress to the remaining tooth and prevents transmission of occlusal biting force within the root
(Posts with grooves are active therefore there is more force and more stress = greater chance of root fracture)
cement retained- cement acts as a buffer between the masticatory forces and the post/tooth.
How can a post be assessed for suitability?
Tooth suitable e.g. molars better w/pulp chamber retention instead –
Length – 4-5mm GP remaining –
Width - <1/3 root
Ferrule – 1.5mm dentine encircling tooth
Bone - >half post length into tooth –
Ratio – crown:root >1:1
Give 3 post materials
- fibre e.g. glass fibre, quartz, carbon fibre
- Metal e.g. cast gold, NiCr, stainless steel
- Ceramic e.g. zirconia, alumina
Give 3 core materials
- GIC
- composite,
- amalgam
Patient comes in with large MOD amalgam that is fractured along with both buccal cusps and has exposed GP.
Give two definitive treatment options (2 marks)
remove the fractured restoration and the fractured cusps and assess remaining healthy tooth tissue;
- Extraction under local anaesthetic
- Indirect restoration - onlay or crown
- Replace restoration-remove MOD amalgam and replace with an MODB amalgam
Patient comes in with large MOD amalgam that is fractured along with both buccal cusps and has exposed GP.
Patient says the fracture occurred 6 months ago, how would this change your treatment (2 marks)
Would need to remove the MOD amalgam, remove GP and perform a re-root canal procedure since coronal seal is a key element in prognosis of an RCT’d tooth
then assess restorability and place an indirect restoration for cuspal coverage
How would you bond composite to a tooth? Give two dental materials and examples (2 marks)
- Conditioner- acid etch 37% phosphoric acid
Used to: remove the smear layer, roughen the surface and allow micromechanical interlocking - Primer and adhesive can be separate or together
Combination = prime and bond
use: allows wetting and sealing of the dentine simultaneously
mix of Hema and resin Bis-GMA with a solvent and camphorquinone for light curing.
Can also do 3 steps separately in the total etch dentine bonding agent technique
Patient has gold post and core that has debonded several times.
3 reasons why it has debonded (3 marks)
- Post fracture
- Core fracture
- Root fracture at post level when not attributed to trauma (stress release)
- Untreatable caries
- Traumatic fracture
- Furcation perforation (due to dentine pins),
- Parafunctional habits
- post size too small
- inadequate use of cement
- poor quality cement
Patient has gold post and core that has debonded several times.Fracture occurs at the junction of the post and core, give 3 reasons why? (3 marks)
- excessive lateral forces from clenching and grinding- Causing Traumatic fracture (e.g. stress/ bruxism )
- inadequate ferrule/solid tooth tissue for crown margin to be placed on (increased likely hood of fracture)
- Short/narrow/overtapered post
- Inadequate moisture control when bonding (Causing contamination).
- Bacterial interaction causing caries and thus decay of the tooth resulting in fracture.
What are the principles of cavity preparation?
- Identify and remove carious enamel
- Remove enamel to identify the maximal extent of the lesion at the amelodentinal junction
- Remove peripheral caries in dentine starting from the outside in.
- Only then remove deep caries over pulp
- Outline form modification:
Enamel finishing (removal of CSM)
Occlusion- ensure the occlusion is not over the CSM.
Requirements of the restorative material (Composite- remove any enamel overhangs. Amalgam cut the retentive shape. ) - Internal design modification: Internal line and point angles, Requirements of the restorative material (Composite- smooth internal anatomy. Amalgam-undercuts)
What is the hybrid layer?
A layer of dentine consisting of collagen and resin.
This is created by the prime and bond which bonds dentine to the resin. (Interface between dentine and the restorative material)
- The dentine is etched to remove the smear layer & open the dentinal tubules to expose the collagen layer.
- The primer is hydrophilic at one end to bond to the wet dentine surface & hydrophobic at the other end to bond to the resin.
- The resin penetrates the primed dentine (now hydrophobic) and forms a bond within the tubules & exposed collagen fibres- Forming the hybrid layer.
What are the different types of dentine and how do they affect bonding? (3)
Primary dentine laid down during development – open tubules and good for bonding.
Secondary dentine laid down during function. Ok for bond.
Tertiary dentine – Reactionary and is laid down due to mild stimuli and reparative due to intense stimuli. This has Poor bonding ability due to poorly organised tubules or sclerosed tubules.
What is the inorganic content percentage of dentine?
Calcium hydroxyapatite (70%)
Give three constituents of GP other than GP (4)
- zinc oxide - 65%
- radio-pacifiers - 10%
- plasticisers - 5%
- waxes.
Give the function of a sealer (3)
To fill the space between the GP & the root canal wall to provide a fluid tight seal
fills voids and irregularities
lubricates
Give 3 common sealers used
- epoxy resin (AH26 plus)
- Calcium hydroxide,
- ZOE
- calcium silicate
How do you assess obturation on a radiograph? (5)
- Check correct length within 2mm of radiographic apex
- Well compacted. (check density)
- All canals filled with GP and sealer
- tapered, cone shaped and continuously funnelling
- GP stopped at ACJ(anteriors) and orifice (posteriors)
no excess GP in pulp chamber
Drawn and Label posselt’s envelope
RCP (retruded contact position) = the first tooth contact where mandible in the retruded axis position
ICP (intercuspal position) = maximum interdigitation of teeth which is comfortable
E (edge to edge) = Translational movement when teeth slide from ICP guided by the palatal surface of the upper incisors
PR (protrusion) = condyle slides downward and forwards along the articular eminence
T (max opening) = full translation of the condyle over the articular eminence
R (retruded axis position) = where the condyle is in the most superior and anterior position in the glenoid fossa
What is the average supracrestal attachment ?
Distance between the junctional epithelium and the supracrestal connective tissue (it should be 2mm)
Approx.2mm from alveolar crest to sulcus of gingiva.
Draw the endodontic access cavities for maxillary and mandibular
-incisors
-canines
-Premolars
-Molars
