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CSB > Rest ops for root filled teeth > Flashcards

Rest ops for root filled teeth Flashcards

1
Q

What are the 2 main options when a patient has a tooth with pulpal disease

A
  1. Extract
  2. Consider endodontic treatment- pre-op assessment
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2
Q

What can be the outcomes of a pre-op assessment when considering endodontic treatment on a tooth

A
  1. insufficient tooth tissue for strength or to create ferrule
  2. sufficient tooth tissue for direct restoration
  3. greater tooth loss but ferrule possible
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3
Q

What are the options for a tooth that has insufficient tooth tissue for strength or to create ferrule

A

overdenture abutment
extract

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4
Q

What is an overdenture

A

a denture that goes on top of badly broken teeth

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5
Q

what is the ferrule of a tooth

what is its role

A

the portion of the crown that encircles the remaining dentine

binds to remaining tooth, prevents root from fracturing and provides resistance

pic

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6
Q

what should the height of the ferrule be
what should the width of the ferrule be
how much of an angle should the ferrule be encircling the tooth

A

atleast 2mm
atleast 1mm
360 degrees, but dependant on tooth as some surfaces are important than the other

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7
Q

what is the ferrule effect

A

during occlusion, the encircling of the crown on top of the sound dentine will transmit the forces in a more favourable way to the PDL and the bone, preventing fractures and dislodgement

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8
Q

What are the 3 sections of an assessment of a root filled tooth

A

endodontic assessment
periodontal assessment
coronal tissue assessment

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9
Q

Explain how to carry out a coronal tissue assessment

A
  1. remove existing restorations to evaluate remaining tooth tissue
    - assess quality of remaining healthy tooth tissue
    - height minimum 1.5-2mm for ferrule
    - thickness of tooth tissue
    - position of remaining healthy tooth tissue- B/L/M/D
  2. aesthetics
    - tooth/root discolouration
    - tooth shape
  3. occlusion
    - is the tooth in occlusion
    - does the tooth contribute to lateral or protrusive guidance
    - will the forces on the tooth be low or high during function
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10
Q

what are the 4 rationale principles of restoring root filled teeth

A
  1. to provide a biological seal (coronal seal) to prevent infection of the root canal system
  2. to protect remaining tooth tissue
  3. to maintain occlusal stability and proximal contacts to prevent over eruption or drifting
  4. to restore function
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11
Q

What is the option for when a tooth has pulpal disease and sufficient tooth tissue for direct restoration

A

restore with composite (or amalgam) with weak cusps reduce and onlayed

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12
Q

What is the option for when a tooth has pulpal disease and greater tooth loss but a ferrule is possible

A

direct amalgam or composite core
then, preparation for indirect restoration (crown or onlay)

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13
Q

What do you require for a tooth with pulpal disease, has greater tooth loss but a ferrule is possible and the core requires additional retention and support

A

a post

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14
Q

what type of core is used when the tooth requires retention

A

a composite nayyar-type core

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15
Q

what type of post is used when the tooth requires more retention

A

prefabricated post

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16
Q

what type of post is used when the tooth requires most retention

A

cast post and core

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17
Q

to place a direct restoration, after you have finished your root canal tx, what must you do

A

remove gp until level with CEJ
seal gp inside the canal

18
Q

what can be used to seal the gp in the canals

A

rmgic

19
Q

describe the Nayyar type core (corono-radicular dowel)

A

doesn’t use a post
relies on the shape of the root canal to go in to different root canals and gain retention (retention from coronal and radicular tooth tissue)
2-4mm GP removed from each canal using gates glidden

pic

20
Q

what are the 2 main types of posts

A

prefabricated post (chair-side)
cast post and core (lab involved)

21
Q

What is the only use of posts

A

to retain core

22
Q

what are some issues with posts

A

weaken teeth
can cause perforations

23
Q

what type of posts should you use

A

parallel, tapered, non metal, ready made/custom made post

24
Q

what types of posts should you avoid and why

A

threaded posts as they induce stress on the canals and can lead to fractures

25
Q

what length should the post be

A

post length at least equal to cornal length, whilst still keeping enough apical seal

26
Q

what is important when doing a post

A

the presence of a ferrule of 1.5-2mm is more important in fracture resistance than the post design or type

27
Q

what 3 materials can a prefabricated post be made from

A

stainless steel
titanium
fibre-reinforced composite ‘fibre posts’

28
Q

explain how to fit a prefabricated post

A
  1. use GG burs in order to remove GP- follow canal direction to desired length
  2. use parapost drills to prepare post channel
  3. try in matching fibre posts, ensure stability and fit to desired length (may need to move up drill size be aware of canal/root width)
29
Q

Advantages of fibre posts

A
  1. aesthetics- metal free
  2. bond with dual and self cure resin cements and composite core material - benefits of adhesive techniques
  3. flexural properties closer to those of dentine
  4. can be removed for revision of endodontic treatment
  5. claimed to reinforce tooth (evidence hasn’t confirmed)
  6. post more likely to fracture than root, decementation is commonest mode of failure but retrievable failures
30
Q

how do you make a cast post

A
  1. post channel is prepared in the tooth
  2. then a plastic impression post is used along with silicone impression material to record the shape of the post space within the canal
  3. a post is cast along with the core in the lab
  4. this single unit is then cemented into the tooth at a further visit
31
Q

for when a cast post is being made, what is needed between appts

A

a temporary post and core

32
Q

What are the 3 guidelines for post length

A
  1. As much as post as possible in root which is supported in bone
  2. Post length in bone at least as much as that above the boney crest level
  3. 4-5mm apical GP remaining
33
Q

What are the 2 guidelines for post stress distribution

A
  1. Force transmitted to core and onto post
  2. Force transmitted to dentine
34
Q

What are the 3 criteria for the post diameter

A
  1. Retain as much coronal and radicular dentine as possible
  2. Narrower diameter posts preserve more tooth structure and reduce risk of root fracture
  3. Too narrow a post may bend or fracture
35
Q

2 advantages of cast post and core

A

Can go subgingivally
Good if oval canal

36
Q

3 disadvantages of cast post and core

A
  1. Extra clinical visit
  2. Greater likelihood of discrepancies introduced by impressions, casting models, casting metal
  3. Temporisation difficult coronal seal
37
Q

4 advantages of prefabricated post

A

+ Immediate coronal seal
+ Crown prep can be done at same visit
+ Better aesthetics (fibre post)
+ Reduced number of stages therefore
reduce discrepancies

38
Q

1 disadvantage of prefabricated post

A
  • Core takes time to build
39
Q

3 options for cuspal protection

A
  • Extra-coronal Restorations
  • Inlays/ Onlays
  • Full coverage crowns
40
Q

3 guidelines for occlusion

A
  • Post-crowned canines should not provide canine guidance - planned change to group function needed
  • Post-crowned posterior teeth - ICP contact only
  • Post-crowned anterior teeth - incisal guidance should be shared across all anterior teeth
41
Q

4 ways root filled teeth can fail

A
  1. Perforations
  2. Poor coronal seal- reinfection of the root canal and apical pathology
  3. Root fracture
  4. Fractured post

CSB (8 decks)

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