Restorative Endodontic Interface Flashcards

1
Q

What tooth material do you need for a direct post?

A

Need dentine remaining.

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2
Q

What are DT light posts?

A

The D.T. Light-Post, is an advanced fiber post that adapts to the contours of the prepared canal rather than forcing the dentist to adapt the canal to fit the post. Products. Fiber-reinforced Endodontic Posts. DT Light-Post® Exclusive Quartz fibers provide high Flexural Strength.

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3
Q

What do you need to consider when thinking about if a tooth needs a core?

A

Could you build up a core?

Does tooth need a post now?

Restorative cycle!

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4
Q

What is the restorative cycle?

A
Wee filling
Big filling
RCT
Crown
Post crown
ReRCT/re post crown
Extraction.
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5
Q

What are the 3 options for a post?

A

Build up core (anterior or posterior teeth)
Fibre post
Cast post.

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6
Q

What are the stages in cast post prep?

A
Assessment
Design of a new restoration
Provisional restoration
GP removal 
Post space prep and anti rotation features
Provisional construction
Impression
Lab prescription
Provisional placement
Try in
Fit.
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7
Q

What should you ask yourself when assessing a root canal?

A
Did you do the root treatment?
If not:
When was it done?
How was it done?
Is it acceptable?
Has it been leaking?

Top tip: was root filling done using dam and hypochlorite?
If not:
Redo!

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8
Q

What is a favourable post design?

A
Parallel sided (avoids wedging) 
Non-threaded (avoids incorporating stress)
Cement retained (buffer between masticatory forces post and tooth).
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9
Q

How does the masticatory load transfer?

A

Tapered posts act as wedges leading to root fracture
Parallel sided posts do not cause wedging
Posts retained solely by cement tend to distribute masticatory forces evenly to the supporting tooth, the cement acting as a bigger between post and the tooth.

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10
Q

How big (in mm) does a ferrule have to be?

A

1.5mm.

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11
Q

What is ferrule preparation?

A

Place crown margins on solid tooth tissue rather than restorative material and 1.5-2mm collar of dentine extending supra-gingivally 360 degrees of the circumference of where the post would be.

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12
Q

What is ferrule effect?

A

Occurs when you put a crown on that area and you get some bracing and coronal portion of the tooth where the crown meets the ferrule prep and cement the crown in place- gives resistance to rotational forces and microleakage.

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13
Q

What is the core design?

A

Core- length and taper important
6 degree taper
Length required- to allow 2mm clearance for MCC.

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14
Q

What are examples of a provisional restoration?

A

Provisional post core crown (temp bond)
Immediate denture
Dressing? Not aesthetic but might prevent leakage
Essex retainer.

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15
Q

What are different types of dressings?

A

Calzinol and Zinc Oxide Eugenol.

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16
Q

What problem might the denture sitting over the root face called?

A

Problems with gingival haemorrhage.

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17
Q

How do you remove GP?

A

Dental dams (pros and cons)
Soften (heat/solvent)
Gates Glidden to maximum size 3 (straight part of canal only)
Use working length and rubber stopper on gates Glidden
Essential to leave 3-5mm GP in apical third
Use magnification/microscope/peri-apical.

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18
Q

What tool can you use to soften GO?

A

Super endo alpha.

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19
Q

What size of para post XP is the same size in tip of a gates Glidden?

A

0.9mm.

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20
Q

What is the para post XP shift?

A

Universal post system for direct post and core build ups and all casting techniques.

21
Q

What measurement in mm does the gates Glidden burs go up in?

A

0.2mm.

22
Q

What are the para post components?

A

Provisional posts
Burn out post (not important)
Para post drill
Impression post.

23
Q

What is the anti rotation notch/groove?

A

If sufficient coronal structure is present rotation is prevented by a vertical coronal wall
If coronal dentine is absent then a small vertical groove in the canal serves as an anti rotational element. Located in the bulkiest area of the root, usually lingual.

24
Q

What do you write on a lab prescription?

A

Please construct cast post and core
Para post (colours)
Core 6 degree taper
Please leave 2mm space in occlusion for crown
Enclosed registration/opposing impression (shade).

25
Q

What do you do when trying in a post?

A
Check post space for temp bond
Irrigate chlorhexidine (0.2%)
Dry paper points
Ensure fits around preps
Do you have enough clearance?
Be careful not to fill post place with cement
You may prevent it searing
Use firm apical pressure
Get rid of excess
Can ask lab for provisional acrylic crown
Make sure no access around when taking crown impression/fitting MCC
Practice for sequence.
26
Q

What is NHS fee for post core?

A

Metal alloy- £39.95 (lab fee £31)

Non precious metal- £20.75 (lab fee £18.47).

27
Q

What are different methods of post removal?

A
Ultrasonic
Trephan eg Masseran
Eggler device
Moskito forceps (screw retained)
Sliding hammer
Anthogyr (safe relax).
28
Q

What does an anthogyr do?

A

Attachments that go underneath bridges. Tie it round Pontiac’s and juggles it out- knocks post crowns out.

29
Q

What does intact post/core removal cost?

A

£0.

30
Q

How much does a fractured post removal cost?

A

£18.20 (below dentine collar).

31
Q

What are some post removal problems?

A
You can’t remove it
Root fracture (immediate or delayed)
Render tooth unrest or able 
Post space too wide
You break post
  • tell patient this during consent process.
32
Q

*posts do NOT strengthen teeth.

A

*

33
Q

What are the core materials for posterior teeth?

A
Composite (most commonly used core material, tooth coloured so good aesthetics, bonds to tooth structure, technique sensitive, so moisture control required, used with fibre posts)
Amalgam (tends to avoid as retention is required, poor aesthetics, core cannot be prepared straight away, needs 24 hours to set, avoid pinned amalgams)
Glass ionomer (not really used as it absorbs water and core expands in size).
34
Q

What is bio dentine?

A

Biodentine is a calcium-silicate based material that has drawn attention in recent years and has been advocated to be used in various clinical applications, such as root perforations, apexification, resorptions, retrograde fillings, pulp capping procedures, and dentine replacement.

35
Q

What is the most common material to build up posterior with?

A

Para core.

36
Q

How can core retention be obtained in root treated posterior teeth?

A

From physical undercuts and dentine pins or preferably bonding agents.

37
Q

What is a disadvantage of post preparation in molar teeth?

A

May lead to a strip or lateral perforation in these teeth.

38
Q

What is the biggest/widest/longest root canal in a upper 6 and lower 6?

A

Upper 6- palatal root canal

Lower 6- distal root canal.

39
Q

What is a ferrule?

A

A dental ferrule is an encircling band of cast metal around the coronal surface of the tooth. It has been pro- posed that the use of a ferrule as part of the core or arti- ficial crown may be of benefit in reinforcing root-filled teeth.

40
Q

What length of ferrule in mm is required for a definite coronal restoration (unless all porcelain restoration)?

A

At least 1mm ferrule.

41
Q

What should you consider putting on a root canal treated posterior tooth?

A

Cuspal protection.

42
Q

What is the minimum treatment required for endodontically treated molar or premolar?

A

An MOD inlay (cast restoration with occlusal coverage).

43
Q

What percentage of endodontically treated molars receiving coronal coverage were successful?

A

94% (compared to 56% of occlusally unprotected teeth).

44
Q

Why do you need to put cuspal protection on posterior teeth?

A

Prevents catastrophic fracture
Maintains coronal seal
Prevents microbial ingress.

45
Q

In mm, how much should you consider reducing cusp height of posterior teeth prior to RCT if restorations involve greater than one surface?

A

1.5-2mm.

46
Q

What posts should be used in premolars?

A

Cuspal coverage restorations should be considered as first option
Posts should only be used if roots are adequately long, bulky and straight
Only one canal should be used
Radix Anker posts produce extreme stress on the root structure.

47
Q

What are the steps of post space prep?

A

Impression
Heat source to remove GP
Gates glidden to remove GP
Irrigation
GG
Repeat
Gates has non cutting tip
Bigger gates glidden
Parapose drill with rubber stopper- same length to GG
DON’T FORCE INTO TOOTH- risks perforation
Move up in sequence of the parapose drills
Try in matrix again
Fabricate provisional post crown
Cut titanium post from apical end if too long
Leave 2-3mm short of incisor edge of adjacent tooth
Inject protemp into matrix
Should be able to remove all in one place
Take definite master impression
Putty wash technique (light body wash around prep, all margins and making sure post is fully covered)
Place putty impression over the top
Post should be retained in impression
Lab- post and core need made.

48
Q

Extra notes:

A

Build up composite core material- if you think you don’t need a post
-paracore or composite (anterior tooth)

Bit of dentine remaining but not enough to build up a core then consider a fibre post- need a ferrule to do this though

Very little tooth structure or compromised ferrule- indirect cast post

Avoid post in posterior teeth
-think seriously about extraction if considering this

Learn sequencing of indirect cast post
Watch SDEO.