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C A D > Aesthetics > Flashcards

Aesthetics Flashcards

1
Q
  1. What are the main problems with Aesthetics?
A
  • Colour
  • Surface texture
  • Symmetry
  • Spaces
  • Shape
  • Arrangement
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2
Q
  1. How can surface texture be a problem?
A
  • Enamel defect can pick up staining
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3
Q
  1. How can we manage the colour or shape problems?
A
  • Whitening
  • Micro-abrasion
  • Composite
  • Veneers
  • Crowns
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4
Q
  1. Whitening/ bleaching can be carried out….
A
  • To all of the teeth
  • To an individual tooth
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5
Q
  1. Methods for whitening all the teeth:
A
  • Chairside in the surgery
  • At home (nightguard vital bleaching)
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6
Q
  1. Methods for whitening individual tooth:
A
  • Internal bleaching
  • Inside / outside bleaching
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7
Q
  1. What aesthetic problem can happen if a tooth becomes non-vital? How to manage that?
A
  • becomes dark
  • whitening/ bleaching for an individual tooth methods: a) internal bleaching b) inside/ outside bleaching
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8
Q
  1. pros of whitening:
A
  • minimally invasive
  • improves tooth shade
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9
Q
  1. what is the chemical compound that is used for bleaching in the Nightguard Vital Bleaching?
A
  • Hydrogen peroxide
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10
Q
  1. Nightguard Vital Bleaching requires bleaching tray that has to be done by a dentist. How much does the current legislation allows for the maximum strength for Hydrogen peroxide
A
  • 6%
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11
Q
  1. What does the Typical home bleaching contain?
A
  • 10% Carbamide peroxide which released 3.6 % H2O2
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12
Q
  1. The ……. you go with hydrogen peroxide, the faster it will work
A
  • Stronger
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13
Q
  1. Nightguard Vital Bleaching using method:
A
  • 1st application – must be carried out under observation in the surgery (dispense the whitening into the tray and put it in and use it properly)
  • Then patient applies bleaching gel to the tray each night
  • The patient should be reviewed regularly i.e. after 1 or 2 weeks to assess change to shade and deal with any problems e.g., sensitivity
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14
Q
  1. What effects could happen on enamel surface morphology?
A
  • Enamel pores, depressions, and erosive surface alterations seen following two weeks of treatment
  • Transient sensitivity
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15
Q
  1. Do these effects last forever?
A
  • All effects completely reversed at three months following treatment
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16
Q
  1. What recommendations can be given following whitening?
A
  • fluoride mouth rinse/ varnish should be used to improve remineralisation of enamel
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17
Q
  1. how can bleaching affect dentine bonding? How to manage that?
A
  • Significant reduction in dentine bond strengths with 35% Hydrogen Peroxide, 35% Carbamide Peroxide and 10% Carbamide Peroxide immediately after bleaching.
  • At least 2 weeks allowed post bleaching prior to bonding
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18
Q
  1. Is veneer good option for managing the colour of non-vital teeth? how can we manage this problem?
A
  • Veneer is too thin and can show the colour underneath it
  • Do bleaching first then place veneer
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19
Q
  1. Root filled teeth often darken due to??
A
  • Pulpal remnants breaking down (bilirubin / biliverdin) – usually there are some blood products in the tooth that is now breaking down  haemoglobin breaks down into bilirubin/ biliverdin (both of which stained badly)
  • Pigmented bacteria
  • Caries
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20
Q
  1. 2 ways of treating
A
  • Internal bleaching
  • Inside/outside bleaching
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21
Q
  1. Internal bleaching stages:
A

a. Remove coronal restoration
b. Take GP down to 2mm below level of CEJ
c. Clean walls with ultrasonic
d. Place 1mm RMGIC over GP (not on walls)
e. Acid etch for 30 seconds wash / dry
f. Place pledget of cotton wool soaked in 10% carbamide peroxide
g. Temporary restoration with high contrast material such as Poly F or Chemfil Rock
h. Review on weekly basis and refresh the cotton

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22
Q
  1. Inside / outside bleaching
A
  • Tooth prepared as per internal bleaching, but after RMGIC lining leave open and provide tray as per vital nightguard bleaching
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23
Q
  1. Which one is more effective internal bleaching or Inside / outside bleaching
A
  • Inside / outside bleaching
24
Q
  1. Micro abrasion
A
  • The use of acid etching and pumice to remove surface stains and superficial enamel defects
25
Q
  1. In which cases micro abrasion is suitable?
A
  • mild fluorosis
26
Q
  1. what other regimens can micro-abrasion be used in conjunction with to get better straining point:
A
  • composite veneers or bleaching
27
Q
  1. micro-abrasion technique:
A
  • Rubber dam, Clean teeth to be treated with pumice and water, wash and dry.
  • Apply phosphoric acid 37% to enamel surface for 30 secs, wash and dry.
  • Clean teeth with a further pumice and water slurry in a slowly rotating rubber prophylaxis cup, and then wash again.
  • Repeat if necessary up to 3 applications in total
  • Review at one month and repeat above stages. Up to 3 visits for treatment
28
Q
  1. What to do after micro-abrasion?
A
  • Apply fluoride varnish
29
Q
  1. What can you do with composite for cosmetic improvement?
A
  • Change shade with a composite veneer
  • Change the shape of teeth
    o Close Diastemas
    o Make teeth longer
    o Make teeth wider
30
Q
  1. Composite – advantages:
A
  • Non-destructive
  • No lab fees
  • Can alter the shape
31
Q
  1. Composite – disadvantages:
A
  • Not Irreversible
  • Stains over time, loses aesthetics, needs maintenance
  • Challenging to get aesthetics right
32
Q
  1. To try to get the appearance better:
A
  • Diagnostic Wax up
  • Discuss with patient
  • Impression of this
  • Build up
33
Q
  1. Porcelain Veneers
A
  • A more conservative approach than crowns
34
Q
  1. Veneers disadvantages:
A
  • Veneers don’t last forever (They are going to chip/ come off/ need replacing, repairing, and maintaining)
  • PRF – They go right-up to the gingival margins. You need to have a patient with a good OH to do this kind of treatment
35
Q
  1. Cementation of veneers – Luting cement needs to;
A
  • Be Dual-curing
    o As light won’t properly penetrate the veneer to polymerise it enough
  • Have matching shades
    o As veneers are so thin the shade of the cement can affect the outcome
  • Contain a Silane-coupling Agent – this is a chemical that bonds to porcelain and resin
    o This allows a chemical bond to the porcelain
36
Q
  1. How does the resin cement adhere to tooth or porcelain
A
  • Silane coupling and adhesives are required to help it adhere
    o HEMA - bifunctional monomer bonds to tooth at one end and resin in the other end
    o Saline coupling agent – bonds to resin and bonds to porcelain
37
Q
  1. What are the indications of (Rely-X Ultimate + Scotchbond Universal)
A
  • Full Crowns
  • Conventional Bridges
  • Inlays/onlays
  • Resin retained bridges
  • Veneers Posts
38
Q
  1. What are the prosperities of (Rely-X Ultimate + Scotchbond Universal)
A
  • Self-adhesive dual-cure resin composite
  • Very high bond strength to tooth and metal alloys
  • High compressive strength
  • Acceptably low film thickness
  • Low solubility
  • Built in metal and ceramic primers (silane coupling)
39
Q
  1. Cementation of Porcelain Veneers (Rely-x) steps:
A
  • Apply etch for 15 seconds
  • Rinse for 10 seconds
  • Dry with cotton pellets
  • Apply bond – rub it in for 20 seconds
  • Gently air dry for 5 seconds
  • DO NOT LIGHT CURE
  • Apply Scotchbond adhesive to the hydrofluoric acid etched veneer surface
  • Gently air dry for 5 seconds
  • DO NOT LIGHT CURE
  • Cement the veneer with RelyX veneer cement or RelyX ultimate cement
  • Seat the veneer into place (gentle pressure)
  • Spot cure the veneer into place on the facial surface away from the margins using a small diameter light guide for 20 seconds to secure it in place.
  • Remove the excess cement from the margins using a blunt instrument or dry brush
  • Light cure the gingival edges first for 30 seconds, followed by light curing the middle and incisal edges each for 30 seconds
40
Q
  1. Why we need 1.2-1.5mm for MCC prep?
A
  • To fit metal layer then opaquing layer then 0.5 to get the right texture and shade
41
Q
  1. What can under-prep of a crown have as a consequence
A
  • Colour can be affected
42
Q
  1. Why can you not bend porcelain without breaking it?
A
  • As it is highly brittle and has got 0.1% strain to failure ration
43
Q
  1. How can porcelain be strong enough for a crown?
A
  • it needs to be at least 1mm thick
44
Q
  1. Compare between MCC and PJC?
A
  • PJC (porcelain jacket crown) – only suitable for anterior teeth + short live span + made of porcelain (same porcelain in the MCC) + There is no metal + thicker amount of porcelain to be a bit stronger underneath the PJC + but, not suitable for posterior teeth
  • MCC (metal ceramic crown) – the metal that gives it the strength + can be used for posterior teeth
45
Q
  1. To prepare a tooth for MCC we need to be too destructive, to give space for the technician to get the right measurements otherwise colour would be affected. The same for the PJC and if there wasn’t enough tooth prep, the crown would fracture as it is too brittle. Mention 2 historic ways to overcome the problem:
A
  • Dentine bonded crowns and it is called feldspathic porcelain (not strong enough for posterior teeth)
  • Alumina / Zirconia cored crowns (made for posterior teeth) – very opaquely coloured (The alumina is almost pure white; zirconia is dark yellow colour)
46
Q
  1. Which one is better for anterior teeth in terms of translucency? Why? (Feldspathic or Zirconia)
A
  • Feldspathic as it is very translucent opposite to the zirconia which is too opaque
47
Q
  1. Which one is better in terms of strength? (Feldspathic or Zirconia)
A
  • Zirconia
48
Q
  1. What do you know about Dentine Bonded Crown
A
  • Less destructive than PJC (similar reduction to FVC)
  • Gained strength from being bonded to the tooth
  • High abrasivity (due to feldspathic porcelain)
  • Poor longevity compared to MCC - 6% failure in 4 years
  • Requires plenty of sound tooth tissue to bond to
  • Must be supragingival
  • Cannot hide dark discolouration
49
Q
  1. Alumina / Zirconia Core (Procera)
A
  • Feldspathic porcelain that gains its strength from being bonded firmly to a ceramic core
  • 4 – 5 % failure in 5 years
  • More destructive than DBC or MCC
  • Can hide severe discolouration
  • Does not rely on bonding to tooth so may be subgingival
  • Ceramic core may be zirconia or aluminam
50
Q
  1. Mention 2 modern materials that can be used for crowns:
A
  • Lithium Disilicate (Emax)
  • Monolithic (translucent) Zirconia
51
Q
  1. Lithium Disilicate (Emax) indications:
A
  • Crowns
  • Veneers
  • Inlays
  • Anterior bridges (3-unit)
52
Q
  1. What do you know about Lithium Disilicate (Emax)?
A
  • Minimal Wear of opposing teeth
  • Manufactured in 2 ways
    o CAD/CAM (Presintered)
    o Pressed (Lost wax technique)
  • Recommend for Anterior Crowns including premolars
  • Success rate 98% over 5 years
  • Need to take shade of prep as well as desired crown due to translucency (Stump shade)
53
Q
  1. What is Stump shade?
A
  • Taking 2 shades (the shade of the tooth prep + the shade that we want the crown to be like
54
Q
  1. MCC or Emax?
A
  • Emax is better than the MCC as there is not metal involved in it + less destructive preps than MCC prep, it is much more like FVC prep
  • But it is much harder for the technician to make it match with the adjacent teeth in anyway as it tends to come in 1 colour whereas in MCC, they can use different colours in the crown
55
Q
  1. What do you know about Monolithic (translucent) Zirconia
A
  • New material – little data
  • Manufactured by CAD/CAM (Pre-sintered)
  • Strong so, can be used for crowns / bridges anywhere in mouth
  • Currently we are recommending them for posterior crowns
  • Prep similar to FVC, but 1mm extra occlusally
  • The downside: lack of translucency (too opaque)

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