advanced restorative dentistry Flashcards
What is restorative dentistry?
Eliminate, prevent new and recurrent disease and restore function and aesthetics using the most appropriate materials and techniques
Why do restorations eventually fail?
STRUCTURAL DEGRADATION
Increased stress fields due to-
- fatigue effects
- change in physical properties
- other destructive lesions
- placement of adjacent restorations
+ in/direct loading forces= failure
(occlusal loading/reduced occlusal support, stress-induced parafunction)
+ environmental damage
(moist, thermal/pH changes, bacterial biofilm)
How can you have predictable restorations?
Choice of materials
- backed w good research data (lab and clinical trials)- in vitro
- read DFUs and follow
- price reflects quality
Clinical technique
- attention to detail
- care at every stage
- correct use of materials/tech
- maintain pulp vitality
- use protocols
- maintenance
What is the hierarchy of evidence?
1. Systematic reviews and meta analysis of RCTs
2. RCTs
3. Cohort studies
4. Case control studies
5. Cross sectional surveys
6. Case reports
7. Expert opinion
What is the rationale for evidence?
Support clinical decision making
Inform patient choice
Inform planning and commissioning of dental services
Support development of dentistry
How should you place a restoration?
Clean the tooth with a rotary brush (intra coronal bristle) and pumice paste (add water and remove excess with cotton wool roll)
Disinfect w chlorhexidine 0.2% by soaking
Etch enamel for 30s and dentine for 15s
Wash thoroughly
Rub scotch bone universal physically for 30s
Wait 30s for solvent to evaporate
Place small amount of flowable composite (SDR- lowest shrinkage stress) at base of cavity (avoids air entrapment)
Place composite in increments and using C factor theory
What are the consequences of loss of pulp vitality?
RCT- significant loss of structural integrity
Pain, discomfort, loss of function and aesthetics
Always compromised tooth
At best- restoration
At worst- extraction and inability to replace
What are the different types of burs?
Tungsten carbide
Diamond
Etc
Types, coatings, shapes, indications
What are the different types of handpiece?
Red (fast) - 350-400 000rpm
Green (slow)
Blue
Gearings
What are ultrasonic scalers?
PHYSICS
Magnetostrictive- 20-40kHz, elliptical stroke pattern, metal rod or stacks of metal sheets, all surfaces active
Piezoelectric- 29-50kHz, linear stroke pattern, crystals activated by ceramic handpiece, only active on lateral sides

CAVITATION
MAINTENANCE
What are curing lights?
To polymerise RBCs
LEDs
Intensity
Duration
What are scanners?
Intra oral and bench top
To obtain digital impressions
What is CAD-CAM?
To make ceramic crowns, bridges, inlays etc
What is selective laser sintering?
CoCr frameworks
