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BDS4 CDS Restorative, Pros & Endo > SCR - Restorative > Flashcards

SCR - Restorative Flashcards

1
Q

What makes a tooth unrestorable ?

A

Root fracture (incomplete can be monitored, complete XLA).
Caries to or below the gingival margin (unable to achieve moisture control).
Grade III mobile teeth.

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2
Q

What are the three options for replacing edentulous spaces ?

A

Implant, bridge, RPD.

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3
Q

What are the three benefits of a cuspal coverage restoration ?

A

Coronal seal - prevents microleakage.
Prevents root fracture.
Prevents cuspal/restoration fracture.

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4
Q

For how long can GP be exposed before the tooth must be re-RCT’d ?

A

3 months.

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5
Q

How can microleakage be prevented in root treated teeth ?

A

Cuspal coverage restoration.
Trim GP to ACJ and placing RMGI lining over GP at pulp floor and RC openings.

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6
Q

What percentage of RCT’s fail due to coronal microleakage ?

A

60%

32% perio failure, 8% endo failure.

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7
Q

Define onlay and what materials can be used ?

A

Extra-coronal restoration with cuspal coverage.
Gold, porcelain or composite (lithium disilicate - EMAX).

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8
Q

What are the indications for an onlay ?

A

Sufficient coronal tooth substance loss with buccal and/or palatal cusps remaining - can be due to caries, toothwear, cusp fracture.
Remaining tooth substance is weakened - caries or large MOD.
Where higher strength material is required i.e. repeated amalgam failure.

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9
Q

Describe the tooth preparation for an onlay.

A

2mm working, 1.5mm non-working - porcelain and EMAX.
1mm working, 0.5mm non-working - metals.

4-6 degree taper, flat pulpal floor, no undercuts, margins should be clear of contact points, at least 1.5mm depth.

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10
Q

How should ceramic and EMAX onlays be cemented ?

A

Using NEXUS - dual cure composite with DBA (or RelyX Unicem - self adhesive resin cement).

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11
Q

How should metal onlays be cemented ?

A

Aquacem (GIC) (or RelyX RMGI).

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12
Q

What are the alternative options rather than doing an onlay ?

A

Large direct restoration - amalgam, composite, GI.
Crowns - 3/4 or full crowns.
Extraction.

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13
Q

What is an inlay and what materials can they be made from ?

A

Intra-coronal restoration.
Gold, composite (EMAX) or porcelain.

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14
Q

What are the advantages of an inlay vs. direct restoration ?

A

Superior material and margins, don’t deteriorate.

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15
Q

What are the disadvantages of an inlay vs. direct restoration ?

A

Time and cost.

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16
Q

What are indications for an inlay ?

A

MOD, DO, MO, O restorations with narrow isthmus.
Low caries rate.
Replace failed extractions.

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17
Q

How should a preparation for an onlay and inlay be temporised between appointments ?

A

Kalzinol or Clip (composite) - easy to remove.

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18
Q

What luting cement should be used to cement a ceramic or composite inlay ?

A

NEXUS (dual cure composite with DBA) (or RelyX Unicem - self adhesive resin cement).

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19
Q

What luting cement should be used to cement a metal inlay ?

A

Aquacem GIC (or RelyX RMGI).

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20
Q

What records might have to be taken for the lab to use for construction of an onlay or inlay ?

A

Interocclusal record. Alginate impression with Impregum wash. Facebow.

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21
Q

What makes a favourable temporary restoration ?

A

Good fit - no plaque accumulation which can cause gingival irritation and can compromise moisture control at final cementation.
Avoid preformed temporary crowns for this reason - usually not a great fit.

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22
Q

How can you temporise a veneer preparation ?

A

Spot bond composite.

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23
Q

What special tests can be used prior to deciding whether to re-RCT a tooth ?

A

Frac finder, tooth slouth, test cavity, staining/transillumination, selective anaesthesia, CBT, PA.

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24
Q

What is the survival rate of endodontic treatments ?

A

7-10 years - consent.

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25
Q

A already root treated tooth has became symptomatic again, what are the possible treatment options ?

A

XLA, re-RCT, peri-radicular surgery, monitor (if asymptomatic).

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26
Q

What should you include in your consent process for re-RCTing a tooth ?

A

Risk of reinfection, cost, possibility of tooth being unrestorable after removal of restoration (lack or no ferrule), time in chair, aesthetics, expected survival 7-10 years, perforation, instrument fracture, root fracture, importance of OH if cuspal coverage restoration.

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27
Q

What are indications for re-RCT treatment (ESE guidelines) ?

A

Teeth with inadequate RCT with PA pathology and/or symptoms.
Teeth with inadequate RCT and coronal restoration requires replacement or coronal tissue is breached.
GP is exposed >3 months.

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28
Q

What are the radiographic features you should assess on deciding whether to re-RCT a tooth ?

A

Unfilled canals.
Root filling and shaping of canal - voids, length.
Patency - fractured instruments, posts, sclerosis.
Bone support - mild, moderate, severe loss.
Crown to root ratio (1:1.5).
Pathology - perforations, resorption, PA radiolucency.

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29
Q

Why does tooth migration occur in periodontally involved teeth ?

A

Loss of PD attachment, unfavourable occlusal forces, unfavourable soft tissue profile.

30
Q

How should tooth migration be treated ?

A

Treat perio, correct occlusion, accept position or orthodontics (with stabilisation).

31
Q

Describe secondary occlusal trauma.

A

Injury from normal/excessive occlusal forces on periodontally compromised teeth.

32
Q

Describe primary occlusal trauma.

A

Injury resulting from excessive occlusal forces applied to teeth with normal PD support.
Normal clinical attachment, bone levels, excessive occlusal forces with no increased probing. Physiological adaptive widening of PDL to dissipate forces

33
Q

What are the radiographic signs of primary occlusal trauma ?

A

Physiological adaptive widening of PDL to dissipate forces, PDL should return to normal if occlusion is corrected.

34
Q

How can occlusion be corrected for teeth which are showing signs of physiological adaptive widening of PDL (primary occlusal trauma) ?

A

Selective grinding (occlusal adjustment), restorations, orthodontics.

35
Q

How should internal inflammatory root resorption be treated ?

A

Orthograde endodontic tx - coronal pulp necrotic, apical pulp vital causing ballooning of RC system.

36
Q

What radiographs would you request for a tooth with internal inflammatory root resorption ?

A

2x PAs 30 degrees from each other.

37
Q

How should external inflammatory root resorption be treated ?

A

Orthograde endodontic tx or XLA - necrotic pulp.

38
Q

Describe STAGE 1 NHS procedure for complaints handling.

A

Handled by dentist or practice.
Should respond to complaint within 5 days - verbal or written.
Special circumstances - no more than 5 day extension.
Apology should be given and explain the changes you will make to prevent this happening again.

39
Q

Describe STAGE 2 NHS procedure for complaints handling.

A

Handled by NHS complaints board.
Acknowledge within 3 days via written - including contact details of complaints officer at NHS, details of advice and support (PASS), info on role and contact details of SPSO.
Full response within 20 days.

40
Q

Describe STAGE 3 NHS procedure for complaints handling.

A

Handled by SPSO.
Can raise complaints within 10 days of response of NHS complaints board.
Acknowledge receipt within 5 days.
Decide whether to carry out review within 10 days.
Outcome within 20 days.

41
Q

What measures can be taken in practice to reduce complaints ?

A

Patient-specific post-operative instructions and consent.
Patient specific preparation before treatment.
Listen to patient.
Record complaints.
Know waiting times for referrals.
Have open door policy with staff and patients.
Ask colleagues for help.
Communication !

42
Q

How should a complaint be managed in general practice ?

A

Acknowledge issue and patient’s feelings. Apologise. Manage the issue. Record issue (separate to patient notes). Provide solution.

43
Q

What are the GDC expectations with regard to complaints handling for GDPs (Principle 5) ?

A

Have complaints procedure available to patients in practice.
You follow the complaints procedure.
Must get prompt and constructive response within 5 days.
Verbal or writing.
Resolve complaints efficiently, effectively and politely.
Can contact indemnity organisation for professional and confidential advice - to get independent view.
Use records of complaints to monitor performance in handling complaints.
Sign post to other avenues for dissatisfied patients.

44
Q

Why is the data protection act relevant to dentists ?

A

Patients have right to a copy of their clinical records without any fee.

45
Q

What does the Apologies Act 2016 state ?

A

Apology is not an omission of liability or negligence.

46
Q

What is some relevant legislation relating to complaints handling ?

A

Apologies Act 2016.
Data Protection Act.
Patient’s Rights Charter 2011.

47
Q

What material can be used for cores ?

A

Composite, amalgam, GI.

48
Q

What is the problem with using GI as a core ?

A

Expansion in water - poor fit.

49
Q

What is the problem with using amalgam as a core ?

A

Poor aesthetics, cannot prepare straight away - requires 24 hours to set.

50
Q

What is the benefits of using composite as a core material ?

A

Bonds to the tooth, aesthetics, command set.
Used for fibreposts.
Requires moisture control.

51
Q

Describe a Nayaar core.

A

Amalgam packed into root canals and tooth built up.
Risk of perforation during preparation.

52
Q

What degree of taper should a core have ?

A

6 degrees

53
Q

What occlusal clearance should a core have for a MCC ?

A

2mm - allows forces to be transmitted down long axis of the tooth.

54
Q

What height should a core be ?

A

3.5mm

55
Q

What are the guidelines for post placement ?

A

4-5mm GP remaining apically.
Post width no > 1/3 of root width.
Sufficient alveolar bone height (half post length).
Minimum 1:1 crown post ration.
At least 2mm ferule (collar of remaining coronal dentine).
Core should be 1.5mm superior to 2mm ferrule (=3.5mm prep length).

56
Q

What is the function of a ferrule ?

A

Vertical axial remaining collar of dentine.
Prevents tooth fracture and crown debonding.

57
Q

What makes an ideal post ?

A

Parallel sided, non-threaded, cement retained.

58
Q

What is the benefit and disadvantages of using pre-fabricated post ?

A

Benefits - one visit, chairside core build up.
Disadvantages - requires sufficient tooth tissue remaining i.e. 2mm ferrule is necessary.

59
Q

What is the benefit and disadvantage of using custom post ?

A

Benefit - unified post, risk of debonding unlikely, less tooth tissue required (no ferrule).
Disadvantage - requires two visits.

60
Q

What are the risks of post placement ? You must consent your patient with this before treatment.

A

Perforation, root fracture, core fracture, post fracture, debonding, irretrievable, risk of making future re-RCT much more complicated.

61
Q

What is the benefits of providing your patient with a temporary restoration between appointments for indirect restorative ?

A

Aesthetics, tooth function, stabilises occlusion, covers exposed GP (coronal seal), reduces sensitivity.

62
Q

What guidance is available for management of acute dental problems (includes endodontics and perio) ?

A

Management of Acute Dental Problems SDCEP 2013.

63
Q

What guidance is available for managing dental trauma ?

A

IADT 2013 Dental Trauma guidelines.

64
Q

What guidance is available for endodontic treatment ?

A

American Association of Endodontics - Guide to Clinical Endodontics.
ESE for re-RCT - European Society of Endodontics.

65
Q

What guidance is available for periodontal treatment ?

A

BSP - Diagnosis, Management, Periodontal Staged Treatment.

66
Q

What guidance is available for prescribing ?

A

BNF Dental Formulary.
SDCEP Drug Prescribing in Dentistry.

67
Q

What impression material should be used for taking impressions for indirect restorations ?

A

Impregum - light body polyether impression material.

68
Q

When should you record a patient’s interocclusal relationship in ICP ?

A

Sufficient index teeth, stable occlusion.
Tooth position (not a condylar position).

69
Q

When should you record a patient’s interocclusal relationship in RCP ?

A

Insufficient index teeth, unstable occlusion, changing OVD.
Use guided manipulation into RCP - condylar position (not tooth position) - most reproducible mandibular position (condyle in the most superior anterior position in mandibular fossa).

70
Q

What impression material should be used for taking interocclusal record ?

A

JetBite - PVS paste.
Wax wafer - modelling wax or Alminax - aluminium reinforced wax.

71
Q

When are record blocks required ?

A

Insufficient index teeth and casts cannot be hand articulated.
On wax, wire strengthened, CoCr or shellac base.
Modify with hot plate, bunsen, wax knife.

BDS4 CDS Restorative, Pros & Endo (13 decks)

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