10 - Tooth wear 3

Question 1

Why is dental demolition common in tooth wear cases?

Answer 1

• previous failure
• small teeth
• high occlusal loads

Question 2

What is involved in informed consent for dental demolition?

Answer 2

• benefits and risks for health and appearance
• longevity of restoration and restorative cycle
• advise that assessment may not be possible until restoration removed, prepare for worst
• when to refer

Question 3

What is involved with operator safety in dental demolition?

Answer 3

• adequate eye protection
• surgical glove wear
• appropriate handling of sharp fragments

Question 4

What is involved in patient safety in dental demolition?

Answer 4

• eye protection
• airway protection (super floss attached to bridge, throat pack, dental dam)
• suction

Question 5

What prevents radiographic assessment of crowns for caries?

Answer 5

Radiographic washout

Question 6

What do you use to remove a porcelain restoration?

Answer 6

Coarse diamond bur

Question 7

What do you use to remove a metal restoration?

Answer 7

Gold cutting bur

Question 8

Describe the basic technique for the demolition of an indirect restoration.

Answer 8

• cut up buccal surface
• use chisel to prise apart
• if struggling, cut up occlusal or lingual surfaces
• section horizontally if required

Question 9

What additional tools can be of assistance when demolishing indirect restorations?

Answer 9

• sliding hammer
• matrices
• enamel chisel

Question 10

What complication is common with a sliding hammer?

Answer 10

High risk of core fracture

Question 11

What equipment is required for re-RCT?

Answer 11

• conventional files
• gates-glidden burs
• rubber dam
• eucalyptus oil

Question 12

What can be used to remove posts from teeth?

Answer 12

Masseran kit or ultrasonic

Question 13

How can extractions be managed to aid healing?

Answer 13

• mattress suture
• coe comfort lining immediate denture

Question 14

Define a failing dentition.

Answer 14

A dentition where deteriorating teeth, restorations or oral health means a loss of adequate basic oral functions such as mastication and acceptable aesthetics is inevitable if untreated.

Question 15

What are the keys to success when managing failure?

Answer 15

• comprehensive history and exam
• thorough planning and seek advice when necessary
• prevention
• avoid overambitious treatment plans
• effective communication with patient

Question 16

How can prevention be tailored to a failing dentition?

Answer 16

• OHI
• diet advice
• fluoride regime
• information provision and recording everything in the notes
• assess response to prevention

Question 17

What simple treatment is recommended in a failing dentition?

Answer 17

• OHI
• caries management
• simple endodontics
• dentures
• additive composite

Question 18

What makes up effective communication with a patient with a failing dentition?

Answer 18

• honesty and transparency
• taking into account patient’s wishes
• address the difficult issues
• give patient reality check
• document all discussions
• avoid patient led treatment

Question 19

What is the protocol for giving bad news?

Answer 19

SPIKES
- set up interview
- perception of what patient knows
- invitation of what patient wants to know
- knowledge, give patient facts
- emotion, respond to emotion
- summarise