CDS Restorative Flashcards

Question

Advantages of resin bonded bridgework

Answer 1

Minimal or no preparation No anaesthetic needed Less costly Less clinical time Can be used as provisional restorations (eg in children with hypodontia, as implants can't be provided until finished growing) If they fail, usually less destructive than alternatives

Answer 2

Rigorous clinical technique, due to being resin retained, moisture control very important Metal shine through Chipping porcelain Can debond Occlusal interferences No trial period possible

Answer 3

Young teeth (less destructive) Good enamel quality - for bonding Large abutment teeth surface area Minimal occlusal load Good for single tooth replacement Simplify partial denture design

Answer 4

Insufficient or poor quality enamel Long spans Excess soft or hard tissue loss Heavy occlusal contacts Bruxists Poorly aligned, tilted or spaced teeth Contact sports?

Answer 5

History - establish habits eg bruxism Examination - clinical, dynamic occlusal relationships should be examined as well as stationary, periodontal health, radiographic examination Study models - mounted on semi adjustable articulator and facebow registration, consider diagnostic wax up Consider abutment teeth, occlusion and aesthetics Patient cooperation and OH are important

Answer 6

Bruxists, some don't know - look for signs of attrition Consider opposing dentition, contact points, over-eruption Look at dynamic and stationary occlusal relationship clinically and on mounted study models

Answer 7

Done chairside, there and then Very useful in emergency situations, if a tooth requires immediate extraction or has been lost traumatically Can be done using the patient's tooth, acrylic denture pontic, polycarbonate crown or cellulose matrix filled with composite

Answer 8

Extract tooth Cut root off crown Remove pulp and fill hole with composite Etch contact points to adjacent teeth Bond and put in situ Apply small amounts of composite to the contact points TEMPORARY solution until pt can have implant, denture or indirect bridgework

Answer 9

Direct - done chairside, there and then Indirect - prostheses made in lab, requires impressions to be taken and lab work Can require no, minimal or heavy preparation

Answer 10

Need generous coverage on the palatal or lingual surface of abutment teeth - greater surface area of enamel covered = greater bond strength Need good quality enamel for good bond Should be kept supragingival, ideally 0.5mm Care must be taken with coverage at incisal edge considering enamel translucency and shine through

Answer 11

Generally cantilever

Answer 12

Fixed-fixed

Answer 13

One of the wings will often debond, ultimately resulting in caries underneath Divergent guidance pathways - occlusal forces are directed down each anterior tooth in a different way due to the shape of the anterior arch

Answer 14

Ideally sound enamel is needed to bond to Bonding to composite can be ok, however consider replacing with newer composite or roughening the old one with slow speed Amalgam will cause a compromised bond to chemically cured composite cement, consider replacing

Answer 15

Occlusal contact reduction (slight) especially if very heavy contact on abutment tooth Cingulum undercut removal only, helps with path of insertion Chamfer margin 0.5mm supragingivally

Answer 16

Rest seats/cingulum rests Proximal grooves Supra-gingival chamfer finish line ~0.5mm

Answer 17

0.5mm reduction of entire surface Cingulum rest +/- proximal grooves Chamfer margin (0.5mm supragingival)

Answer 18

First 2 years, 5 year survival and 10 year survival stats very similar

Answer 19

Useful tool for cleaning under bridge pontics Thinner and thicker parts

Answer 20

Dual cure composite resin luting cement Example Panavia21

Answer 21

Ideally pontic is smaller than abutment tooth

Answer 22

Try in by holding with finger Can request locating cleat on retainer, to check appearance and occlusion Small bit of composite can be used but then requires cleaned off the surface, may require sandblasting again

Answer 23

Used on fit surface of bridge retainer - cobalt chrome or nickel-chromium alloy has aluminium oxide particles of 50 micron thickness blasted at the surface Roughens surface for increased bond strength

Answer 24

Often none When required, occlusal rests ~2mm deep, 180 wraparound with chamfer finish line 0.5mm supragingivally, and occasionally proximal grooves

Answer 25

Direct bridgework RPD Essex retainer If prep remains within enamel, no real need for temporary, sensitive toothpaste/duraphat or a thin layer of dentine bonding agent can help with sensitivity

Answer 26

Not much occlusal contact such as class II incisor relationship

Answer 27

Robust design Maximum retention and strength Abutment teeth splinted together - good in cases of stable perio where still mobile Can use longer spans Lab construction is straightforward

Answer 28

Preparation can be difficult - common path of insertion required Removal of tooth tissue causes danger to pulp If preparation is over tapered, retention is reduced Problems when alignment of abutment teeth not parallel

Answer 29

5-7 degrees

Answer 30

More conservative tooth prep than fixed-fixed Lab construction straightforward No need to ensure multiple tooth preparations are parallel

Answer 31

Only for short span (one tooth) Rigid to avoid distortion - more prone to fracture Mesial cantilever preferred (pontic more anterior)

Answer 32

Solution for fixed-fixed designs where the abutment teeth are not aligned parallel to each other

Answer 33

Bridge comes in two components, pontic and one retainer with a dovetail in one path of insertion, then another crown for the other abutment tooth, with a slot. The two components have different paths of insertion but slot together.

Answer 34

Preparations don't require common path of insertion, allowing more conservative tooth preparation Each preparation is designed to be retentive independent of each other Allows minor tooth movement Can be cemented in two parts

Answer 35

Limits length of span Lab construction more complicated, can take longer Possible difficulty in cleaning beneath moveable joint, as they are slotted not cemented together Cant construct provisional bridge, could maybe do two provisional crowns on abutments and an essex retainer

Answer 36

One pontic added to the end of a metal arm that runs across the palate to a rigid connector on the palatal side of a retainer. This was designed to try to conserve anterior tooth tissue. No longer used.

Answer 37

Useful if spacing between upper anteriors present, where adjacent teeth are unrestored, and a posterior tooth would provide a suitable abutment, i.e. already has a crown or large restoration

Answer 38

Can only be used to replace upper incisors Difficult to clean beneath palatal connector May irritate palatal mucosa Difficult to control movement of pontic due to springiness of metal arm and displacement of palatal soft tissues

Answer 39

Must be able to withstand the forces previously directed to the missing teeth Supporting tissues should be healthy and free of inflammation Crown to root ratio - length of tooth coronal to alveolar crest to length of rooth embedded in bone - optimum 2:3, minimum 1:1

Answer 40

Leave space Denture Implants

Answer 41

Every restoration fails eventually

Answer 42

History - presenting complaint, MH, SH, PDH Clinical exam intra and extra oral - soft tissue, perio, caries, risk assessment, occlusion, parafunction Abutment evaluation - sensibility testing, remaining tooth structure, radiographs

Answer 43

Sensibility testing Remaining tooth structure Radiographs Healthy pulp or good RCT PA health Perio

Answer 44

Examine intraorally and using study casts - facebow mounted on a semi adjustable articulator Incisal classification, canine guidance vs group function Consider overerupted opposing teeth Parafunction? Will bridge interfere with occlusion?

Answer 45

Root configuration Angulation/rotation of abutment Periodontal health

Answer 46

Surface area for bonding and quality of enamel Risk of pulpal damage Quality of endodontics - consider re-RCT Remaining tooth structure - is there enough? Consider build up Core - remove and rebuild

Answer 47

Select abutment teeth - judge longevity of adjacent teeth Select retainer - no prep, minimal prep, regular prep for RBB or full crown prep for conventional Select pontic and connector Plan the occlusion Prescribe material

Answer 48

Restore appearance Stabilise occlusion Improve masticatory function

Answer 49

Should always be smooth with highly polished or glazed surface Surface should not harbour join of metal and porcelain Embrasure space smooth and cleansable

Answer 50

Longer the span, greater the thickness required to withstand occlusal forces

Answer 51

Should resemble those of the tooth it is replacing, narrower if possible to enable cleaning, should have sufficient occlusal contact

Answer 52

Connector strength ideally 2x2mm Embrasure space for cleansability

Answer 53

Also called sanitary or hygienic pontic Makes no contact with soft tissue, functional rather than aesthetic, consider in lower molar area

Answer 54

Also called torpedo or bullet shaped Useful in lower incisor, premolar and upper molar regions, acceptable aesthetically if occlusal 2/3 of buccal surface is visible, less suitable if gingival 1/3 is visible

Answer 55

Buccal surface looks as tooth like as possible, but lingual surface is cut away, can have problems with food packing on lingual surface, but is quite easily cleaned

Answer 56

Greatest contact with soft tissue, may cause temporary blanching, good for not allowing food packing Only for pts with good OH, care should be taken not to displace soft tissue

Answer 57

Good for good OH pts, best aesthetics Gingivae mould into a divot Sometimes need to initially prescribe an essex retainer with an ovate pontic in it

Answer 58

Gold - Great function, poor aesthetics Nickel/cobalt chromium - cheaper Stainless steel

Answer 59

Zirconia is very strong, less aesthetic Lithium disilicate is less strong, more aesthetic

Answer 60

Porcelain combined with composite Not used much any more Belleglass, vectris, targis

Answer 61

Lower posterior region Lots of occlusal forces and lower aesthetic demand

Answer 62

Metal ceramic Compromise of strength and aesthetics

Answer 63

The preparation no longer needs to be as destructive as it once was

Answer 64

Longer spans

Answer 65

Mounted study models Consider diagnostic wax up and custom impression tray Request lab to construct a vacuum formed stent - allows checking of reduction during tooth prep and allows construction of a temp bridge Select shade before tooth prep and have lab made stent made or make pre-operative putty impression for provisional bridge

Answer 66

Occlusal/incisal reduction Separation of teeth Aim for parallelism of tapered surface of each prep e.g. for 13 12 11 Mesial 11 then mesial 13 Distal 11 then distal 13 Labial 11 then labial 13

Answer 67

Direct vision with one eye closed Large mouth mirror for posteriors Use probe like a lab surveyor

Answer 68

Quick impression Pour model Use lab surveyor

Answer 69

Slots or grooves

Answer 70

Short clinical crown height Overtapered

Answer 71

Confirm parallelism Construct provisional bridge if using one Make impression and occlusal registration Temporary cement the provisional bridge Demo cleaning with superfloss Write/draw lab prescription, including pontic shape, shape, abutment teeth etc Final bridge cementation

Answer 72

Aquacem (GI luting cement) RelyX luting (RMGI luting cement)

Answer 73

Aquacem (GI luting cement) RelyX (RMGI luting cement)

Answer 74

Panavia 21

Answer 75

It is an anaerobic dual cure resin cement with 10-MDP which helps tooth stick to metal

Answer 76

Mesial cantilevers preferred Occlusal forces contact distally first, so if pontic is distal to cantilever retainer, this can mean that it is more likely to debond

Answer 77

Shortened dental arch Unopposed Opposed by denture

Answer 78

Caries Trauma Developmental problems Tooth wear

Answer 79

Normal wear associated with normal function and age 20-38um per annum

Answer 80

When the remaining tooth structure or pulpal health is compromised or the rate of tooth wear is in excess of what would be expected for the pts age Also considered pathological if the pt experiences a masticatory or aesthetic deficit

Answer 81

Attrition Erosion Abrasion Abfraction

Answer 82

The physiological wearing away of tooth structure as a result of tooth to tooth contact

Answer 83

Occlusal and incisal

Answer 84

Polished facet on a cusp or slight flattening of incisal edge

Answer 85

Reduction in cusp height and flattening of occlusal inclined planes Shortening of the clinical crown of the incisor and caning teeth

Answer 86

They show the same wear as tooth structure

Answer 87

Almost always

Answer 88

The physical wear of tooth substance through an abnormal mechanical process independent of occlusion. It involves a foreign object or substance repeatedly contacting the tooth

Answer 89

Site and pattern of tooth loss is related to the abrasive element Most common on labial/buccal surfaces, cervical on canine and premolar teeth V shaped or rounded lesions Sharp margin at enamel edges where dentine is worn away preferentially Can manifest as notching of incisal edges

Answer 90

Toothbrushing

Answer 91

The loss of tooth surface by a chemical process that does not involve bacterial action Caused by chronic exposure of teeth to acidic substances - intrinsic or extrinsic

Answer 92

Enamel is affected, loss of surface detail, surfaces become flat and smooth

Answer 93

Typically bilateral concave lesions without chalky appearance of bacterial acid decalcification Dentine later exposed Preferential wear of dentine leads to cupping Increased translucency of incisal edges, can appear dark

Answer 94

Source, type and frequency of acid exposure

Answer 95

Amalgam and composite restorations stand proud of the tooth

Answer 96

Loss of hard tissue from eccentric occlusal forces, leading to compressive and tensile stresses at the cervical fulcrum areas of the tooth Pathological loss of tooth substance at the cervical margin

Answer 97

Biomechanical loading forces result in flexure and failure of the enamel and dentine at a location away from the loading Disruption of the ordered crystalline structure of the enamel and dentine by cyclic fatigue Crack in tooth substance cause tooth substance to chip out

Answer 98

V shaped tooth loss where the tooth is under tension, classically sharp rim at the amelo-cemental junction

Answer 99

To help with prevention

Answer 100

Males (70% vs 60%)

Answer 101

Determine chief complaint - functional, aesthetic, pain? MH PDH SH

Answer 102

Can often give insight into the aetiology of wear, particularly erosion - Medications with low pH - Dry mouth - Eating disorders - Heartburn - Alcoholism - GORD - Hiatus hernia - Rumination - Pregnancy - Reflux

Answer 103

Lifestyle stress - bruxism Occupational details - abrasive habits Alcohol consumption Diet analysis Habits Sports

Answer 104

Buccal keratosis Lingual scalloping

Answer 105

No loss of enamel surface characteristics

Answer 106

Loss of enamel surface characteristics

Answer 107

Buccal, lingual and occlusal loss of enamel, exposing dentine for less than one third of the surface Incisal loss of enamel Minimal dentine exposure

Answer 108

Buccal, lingual and occlusal loss of enamel, exposing dentine for more than one third of the surface Incisal loss of enamel Substantial dentine exposure

Answer 109

Buccal, lingual and occlusal complete loss of enamel, pulpal exposure or exposure of secondary dentine Incisal pulp exposure or exposure of secondary dentine

Answer 110

0 No erosive wear 1 Initial loss of surface texture 2 Distinct defect, hard tissue loss <50% of surface 3 Hard tissue loss >50% of surface area

Answer 111

None - less than or equal to 2 Low - between 3 and 8 Medium - between 9 and 13 High - 14+

Answer 112

Sensibility testing Radiographs Articulated study models Intra-oral photos Salivary analysis Diagnostic wax up Diet analysis

Answer 113

Most severely affected surface in a sextant

Answer 114

Deal with pain - desensitising agents, fluorides, bonding agents, GIC coverage of exposed dentine Pulp extripation if wear has compromised pulp health Smooth sharp edges - prevent trauma to soft tissues Extraction - pain from unrestorable/non-functional tooth TMJ pain

Answer 115

Stabilise existing dentition Deal with caries Deal with perio Oro-mucosal Wear is important but treat the whole pt and whole mouth Once you have a diagnosis and have identified the primary causative factor, institute a preventative regime, no point treating an ongoing problem

Answer 116

BEWE Smith and Knight

Answer 117

Remove foreign object involved in causing the wear Change toothpaste, alter toothbrushing habits, change habits such as nail biting or pen chewing For toothbrushing abrasion use RMGIC (first choice), GIC, flowable composite or composite restorations placed with no tooth prep

Answer 118

Patient wears through the restoration rather than tooth

Answer 119

Ideally RMGIC as it has best survival rate Can use GIC, composite or flowable Composite may look better but higher modulus may compromise retention Balance aesthetics and retention

Answer 120

Generally more difficult to address as usually related to a parafunctional habit CBT or hypnosis can be useful to reduce parafunction as a stress response Splints - wear away instead of teeth, may break habit, soft ones can be used as a diagnostic aid

Answer 121

Soft - diagnostic device to show where wears faster Hard - more robust and can be used longer term

Answer 122

Popular hard splint providing ideal occlusion with even centric stops, has canine rise which provides disclussion in eccentric mandibular movements - canine guidance

Answer 123

Active perio TMJ problems Post orthodontics Bisphosphonates If implants present If existing conventional bridges

Answer 124

Localised anterior

Answer 125

Composite Better aesthetics, better compliance, easier to adjust, can be immediate definitive treatment

Answer 126

Method of gaining space in cases of localised tooth wear (Originally using a removable CoCr anterior bite plane) Palatal surfaces covered, allowing occlusion on raised cingulum, resulting in posterior disclusion and increase in OVD of 2-3mm Occlusal contacts only on anteriors Over 3-6 months you gain space between anteriors, anteriors intrude and posteriors erupt Results in space between upper and lower anteriors for restoration without occlusal reduction

Answer 127

Exposes more of the crown for retention of final restoration Repositioning of gingivae apically generally with removal of bone Sensitivity Still need occlusal reduction

Answer 128

Even when erosion is not the best fit diagnosis for a toothwear case, it is likely to be part of the problem so should be considered in all cases Dependent on the source of acid - intrinsic or extrinsic Desensitising agents for symptomatic relief Fluoride Diet management Habit changes Control xerostomia Anorexia/bulimia treatment Control GORD, reflux, hiatus hernia Discuss drugs with GMP

Answer 129

If pt has taken PPIs for several months + it is possible that they may have rebound acid secretion and symptoms may get worse for up to two weeks when PPIs are stopped This can easily be misinterpreted as a need for ongoing therapy

Answer 130

Assess occlusion on affected teeth - consider occlusal equilibration Fill cavities with a low modulus restorative material - RMGIC and flowable

Answer 131

Prevention and monitoring Should be the first part of any treatment of wear Most patients will be in this phase for at least 6 months For many patients this is all that is required

Answer 132

Intervention threshold - when to progress to active management Simple restorative intervention - covering exposed dentine, filling cupped defects in molars and incisors The requirements for more extensive definitive restoration are not always clear - wear that leads to further complications, aesthetics beyond patient acceptability, leaving intervention may require more complex tx

Answer 133

Preservation of remaining tooth structure Pragmatic improvement in aesthetics Functioning occlusion and stability

Answer 134

Pattern of the tooth wear Inter occlusal space Space required for the restorations being planned Quality and quantity of remaining tooth tissue, particularly enamel Aesthetic demands of the patient

Answer 135

Tooth wear limited to the palatal surfaces only Tooth wear involving the palatal and incisal edges with reduced clinical crown height Tooth wear limited to labial surfaces

Answer 136

If teeth wear rapidly and there is not time for alveolar compensation Where there is an AOB Where there is an increased overjet - in these cases there can be available space for restorations with no change in OVD

Answer 137

Thos with adequate inter-incisal space for restorations with no change in OVD

Answer 138

There is compensation for the loss of tooth substance by dento-alveolar bone growth

Answer 139

Maintains masticatory efficiency BUT leaves no space for restorations

Answer 140

Little tooth tissue to begin with Poor retention due to short axial walls Good chance of pulpal damage due to short clinical crowns New materials offer a better, more conservative approach in these cases

Answer 141

Increase OVD - multiple posterior extra-coronal restorations, reorganised approach, can be complex, destructive, expensive Occlusal reorganisation from ICP to RCP - complicated, can be destructive, specialist treatment Surgical crown lengthening - doesn't really create more space Elective RCT and post crowns - very destructive Conventional orthodontics - lengthy treatment

Answer 142

Short roots (increasing crown to root ratio could cause orthodontic movement) Reduced periodontal support due to periodontal disease Lack of remaining enamel reduces the success rate significantly due to bond strength of composite to enamel

Answer 143

Can be done with a high degree of confidence

Answer 144

Composite bonding - non invasive

Answer 145

Remaining ring of enamel on worn tooth surfaces which has a very positive influence on retention of composite bonding

Answer 146

Lower Less enamel, smaller bonding area, more difficult moisture control

Answer 147

Possible to improve aesthetics but do not increase OVD Do them before uppers Same techniques as uppers Wrap composite over and onto lingual surface

Answer 148

Fill with composite to protect dentine from erosion

Answer 149

Restorative care can be aimed at providing sufficient canine guidance to ensure posterior disclusion during lateral and protrusive movement Composite resin added to the palatal of upper canines Simple, effective and reversible technique, freehand or with diagnostic wax and template

Answer 150

Direct build up with putty matrix Clear vacuum formed matrix

Answer 151

Alginate imps Cast imps Wax up build up on the cast Take putty matrix of built up cast Use matrix as template when placing composite build ups

Answer 152

Alginate impression Wax up on cast impression Impression of this, cast in stone Vacuum formed clear plastic matrix formed on this Cut to size and use as mould for build up

Answer 153

Generally good pt satisfaction Posterior occlusion normally re-achieved Seldom TMJ problems No detrimental effect on pulp health No worsening of periodontal condition

Answer 154

Viable medium term option Requires repair and maintenance Maxillary restorations last better No definitive figures, around 70% over 10 years If they fail they can be replaced or repaired and no tooth destruction occurred during their placement

Answer 155

Increased bonding area, lower occlusal load, although tongue and saliva protect lowers

Answer 156

Your front teeth will receive tooth coloured fillings to cover the exposed and worn tooth surface, preventing more wear No, or minimal drilling, maybe LA Add to tooth, no removal of tooth Improved appearance should be possible Bite will feel strange and might lisp or bite your tongue for a few days, chewing can be difficult Only front teeth will meet, back ones will come together over 3-6 months It is likely that posterior crowns, bridges or dentures will need replaced Potential for debonding, replacement causes no damage Maintenance will be required and will not be free forever

Answer 157

Excessive wear with loss of OVD Excessive wear without loss of OVD but with available space Excessive wear without loss of OVD and with no space available

Answer 158

Adhesive approach first if possible These can be used to asses the pts tolerance of a new occlusal scheme as a medium term restoration If conventional preps are required later, these adhesive additions may form the bulk of the removed material, preserving tooth structure

Answer 159

Easiest but also least common A splint can be used to assess the pts tolerance of the new face height - may not be necessary if adhesive approach used you can go straight in Ideally half the OVD increase maxillary and half mandibular Often a mixture of adhesive and conventional is required Dentures may be required to provide posterior support at the new OVD

Answer 160

More complicated than loss of OVD to treat Can involve occlusal reorganisation A splint should be considered as an increase in occlusal face height is necessary Most pt accommodate the increase Restoration of anterior and posterior teeth then carried out at the new face height If possible should involve minimal prep adhesive restorations

Answer 161

Most severe and difficult to treat Specialist opinion before treating Attempt to increase OVD with splints or dentures if lack of posterior support Crown lengthening surgery Elective endodontics - destructive and post and cores do not go together with attrition Ortho Overdentures can be an option for these pts

Answer 162

Used to increase coronal tooth substance available May result in black triangles between teeth where ID papilla is further down Can lead to unfavourable crown to root ratio increasing chance of loosening or tooth movement if tooth loaded subsequently Often post op sensitivity Any subsequent conventional crown prep will be further down the root - problem if the tooth has a significant coronal-cervical taper, greater chance of pulpal damage

Answer 163

Preserve tooth substance and bone for support of denture when teeth are so worn down that restoration is impossible Can be bulky for pt Difficulties with keeping teeth and gingivae healthy underneath prosthesis

Answer 164

Where wear has been present for some time and not progressing, it is sufficient in most cases to record that it has been recognised, pointed out to pt and is being monitored Advice must be recorded If pt is not compliant, reluctant or unwilling to follow recommended course of action this must be recorded Surface treatments such as topical fluoride must be recorded - important to record if pt complied with repeat applications Discussions on consent must be recorded - pt must understand the proposed treatment, including passive prevention, as well as their part and how it is integral to a favourable outcome, must understand consequences of not following advice Discussions on temporary treatment and this being explained, as well as the reason for not providing definitive at that time Any referral documentation

Answer 165

Kayser 1981 A dentition where most posterior teeth are missing Satisfactory oral function without use of RPD Priority given to maintaining an anterior and premolar dentition in one or both jaws In the right circumstances, non replacement of posterior missing teeth can provide a stable and acceptable dentition

Answer 166

A pair of occluding premolars = one unit A pair of occluding molars = two units

Answer 167

The retention, throughout life of a functional, aesthetic, natural dentition of not less than 20 teeth and not requiring recourse to prostheses

Answer 168

Missing posterior teeth with 3-5 occluding units available Sufficient occlusal contacts to provide a large enough occlusal table Favourable prognosis for remaining anterior and premolar teeth Patient not motivated to pursue complex restorative plan Limited financial resources for dental care This strategy will only work long term if the remaining natural dentition can be preserved for the remainder of the lifetime of the patient

Answer 169

If there is a poor prognosis for remaining dentition Untreated or advanced perio Pre existing TMJDS Signs of pathological tooth wear The patient has significant malocclusion (severe class II or III)

Answer 170

28 teeth, more complicated treatment at high cost, treatment results may be better 20-24 teeth, less complicated lower cost treatment, treatment results may be worse?

Answer 171

Does pt have problems chewing? Does pt have appearance concerns? Does pt have discomfort such as traumatising gingivae? Is there any evidence of occlusal instability as a result of the missing teeth?

Answer 172

TMJ - click, crepitus, deviation, pain Hypertrophy Check skeletal relationship

Answer 173

Check for signs of bruxism such as buccal keratosis, scalloping, trauma, wear facets, fractured restorations Periodontal assessment Occlusal assessment Teeth of poor prognosis

Answer 174

Not sufficient occlusal contact

Answer 175

A course of non-surgical periodontal management should be planned if active disease Therapy aimed at stabilising the periodontal condition of all remaining teeth Evaluate response Must be able to maintain perio health

Answer 176

Drifting of periodontally compromised teeth under occlusal load Loss of alveolar bone leading to a compromised denture bearing area in the long term Loss of space (neutral zone) for denture teeth in the long term

Answer 177

Increases anterior load Increases number and intensity of anterior occlusal contacts Increased interdental spacing This is exacerbated by inadequate perio support

Answer 178

The long term threat this poses to survival of teeth Gradual loss of occluding contacts and occlusal stability

Answer 179

The stability of tooth positioning relative to its spatial relationship in the occluding dental arches or The absence of the tendency for teeth to migrate other than the normal

Answer 180

Periodontal support Number of teeth in the arches Interdental spacing Occlusal contacts Tooth wear

Answer 181

Tooth mobility Tooth migration Supra-eruption of unopposed teeth

Answer 182

Increased anterior load, in turn increasing the number and intensity of anterior occlusal contacts as well as the interdental spacing Exacerbated when unopposed teeth and lone standing teeth have inadequate perio support

Answer 183

Stable contacts on all teeth of equal intensity in centric relation Anterior guidance in harmony with the envelope of function Disclusion of all posterior teeth during mandibular protrusive movement Disclusion of all posterior teeth on the non-working side during mandibular lateral movement Disclusion of posterior teeth on the working side during mandibular lateral movement

Answer 184

Fracture of restorations and/or teeth Tooth mobility Dental pain not explained by infection Tooth wear A traumatic occlusion may also be a contributing factor to TMJDS

Answer 185

Does the pt have existing TMJDS? Is this associated with tooth wear? Loss of posterior support may be contributing to TMD Replacement of missing teeth and correction of occlusal derangement may reduce TMD symptoms Little evidence to support increased TMD problems with SDA

Answer 186

Distal cantilever Max one unit on each side of the arch Light contact on cantilevered pontics in ICP Minimal contact in excursive movements Heavy contacts may lead to failure

Answer 187

Bilateral free end saddle RPI design Consider with CU Non-compliance

Answer 188

Distal cantilever One unit max on each side of arch Light contact on cantilevered pontics in ICP Minimal contact in excursive movements Heavy contacts may lead to failure Consider RPD

Answer 189

Single tooth in molar/premolar region with cantilever bridge

Answer 190

RBB Removeable retainer with pontics Implants

Answer 191

Oral hygiene Cost Smoking Amount of bone available Perio history That the patient understands what is likely to be included and is willing to comply

Answer 192

Width of alveolar bone Space available between adjacent teeth Bone height Local perio Smile line Soft tissue adequacy Gingival biotype Plaque control

Answer 193

Peri-implantitis or implant mucositis Implant failure Screw fracture Crown or porcelain chip or fracture Recession Need for replacement

Answer 194

Toothbrush abrasion

Answer 195

Allows attempt to reduce further wear Plan for problems, contingencies and failure Allows you and pt to be realistic Identifies wider medical and wellbeing issues and allows signpositng Prognostic indicator Enhances consent process Aids clinical diagnosis and treatment planning

Answer 196

Normal amount of wear for the patients age

Answer 197

Lack of posterior teeth Occlusion - deep OB or edge to edge Restorations Erosion and abrasion Stress and anxiety

Answer 198

Deep OB - lower incisors Edge to edge - localised wear

Answer 199

Significant wear throughout dentition Repeated restoration failure Root fractures Often onset in early adulthood Progressive

Answer 200

Often more rapidly progressive Advise pts to wear a RPD

Answer 201

Porcelain, especially if unglazed/unpolished

Answer 202

Multiple cusp fractures on heavily restored teeth Multiple cracks around restorations Root fractures in unrestored teeth Soft tissue trauma

Answer 203

Lifestyle Multiple factors Amount and frequency Level of control Psychosocial

Answer 204

Eating disorders GORD Other medical conditions

Answer 205

Carbonated drinks Sports drinks Alcoholic acidic drinks Citrus drinks Acidic fruits Acidic sweets Pickles Drugs - methamphetamines

Answer 206

Incisal erosion on upper central Cupping on lower molars Palatal erosion on upper incisors Sensitivity Interproximal caries and buccal white spot/brown spot caries

Answer 207

Palatal erosion on upper teeth Polished restorations - esp amalgam Erosion around restorations Sensitivity Caries Altered taste sometimes Halitosis sometimes Soft tissue changes

Answer 208

Toothbrush abrasion Oral self harm (less common) Tongue studs Occupational Unusual habits

Answer 209

Localised or generalised Frequency and duration Bristle and toothpaste abrasiveness Electric v manual Part of a combination wear problem eg eating disorder? Part of a stress/anxiety related problem?

Answer 210

Synergistic

Answer 211

Erosion (extrinsic and intrinsic) attrition and abrasion Erosion (extrinsic) and attrition Erosion (intrinsic and extrinsic) and attrition

Answer 212

Alcoholism and drug abuse Eating disorder

Answer 213

Bruxist with a poor diet

Answer 214

Bruxist with poor diet and GORD

Answer 215

Erosion (intrinsic and extrinsic), attrition and abrasion

Answer 216

Erosion (extrinsic) and attrition

Answer 217

Erosion (intrinsic and extrinsic) and attrition

Answer 218

Communicate a guarded prognosis

Answer 219

ED Mental health issues Abuse/harm/addiction Vulnerable adult/child

Answer 220

Comprehensive Use of indices ? Try relate findings to aetiology Remember tooth wear patients also have caries and perio disease

Answer 221

BEWE - erosion Smith and Knight

Answer 222

Make an individualised preventative plan Reinforce the key messages Signpost and refer to other health and social care Review the aetiology control before definitive plan

Answer 223

Fluoride - high dose tp, alcohol free mw Diet modification - frequency and quantity, method of delivery, elimination and addition Remineralisation - tooth mousse

Answer 224

Toothbrushing instruction Splint therapy Signposting - CBT or hypnotherapy Refer - GMP, psychiatrist, social services

Answer 225

High failure rates

Answer 226

What can you see - Translucent central incisor edge, cupping defects cervical third central incisors labial aspect (looks like erosion), caries 22m, 26 large cracking amalgam, wear into dentine U3-3, combination attrition and erosion? L6s occlusal enamel lost, wear on premolars and anteriors through to dentine, tongue stud What will you ask - fizzy drinks, symptoms - sensitivity, history of sensitivity, medical history - acid reflux, ED

Answer 227

Denture intolerance Denture refusal Supervised neglect

Answer 228

Bruxism does not stop, so - Fractured dentures - Ridge resorption - Pain and ulceration under complete denture (complete overdentures can be ok)

Answer 229

Any removeable prosthesis that rests on one or more remaining natural teeth, the roots of natural teeth and/or dental implants

Answer 230

Correction of occlusion and aesthetics Support Tooth wear management Preservation of ridge form Proprioception - keeping PDL Denture retention Can be used with precision attachments Avoids extractions - MRONJ and ORN risk Psychological benefits -still have natural teeth Useful in elderly patients on polypharmacy Eases transition to edentulism

Answer 231

Need for good oral hygiene Increased caries and perio risk Care homes - poor OH Denture fracture - thinner acrylic Discomfort/infection of roots Medical history Potentially more traumatic extractions of roots than whole teeth

Answer 232

Good oral hygiene Fluoride toothpaste application to roots Regular examination and radiographs of the roots Denture hygiene particularly important

Answer 233

Can be used to increase OVD in cases of poor posterior support to create space for restorations

Answer 234

Transitional denture which increases OVD worn for a few months, if pt copes with transitional dentures AND increased OVD 1. Get rid of impossible teeth 2. Crowns with rest seats and undercuts 3. Definitive dentures with same OVD as transitional

Answer 235

High occlusal forces

Answer 236

Teeth will fall off the saddle areas Co/Cr backing so teeth occlude with metal (must do wax trial before CoCr made)

Answer 237

Bridgework

Answer 238

In a stable occlusion, with sufficient index teeth (Ensure your prosthesis/restoration does not alter the occlusion)

Answer 239

Occlusion is unstable and there is a lack of sufficient index teeth Usually more challenging to record occlusion Decision on how much to increase OVD

Answer 240

Crowns are more destructive to tooth tissue and have a higher rate of failure

Answer 241

Impressions and facebow Mounted articulated casts on semi adjustable articulator (+/- surveying if making a denture) High quality interocclusal record Diagnostic wax ups Stents - mock up - temporaries (if indirect) Temporary (transitional) dentures Clinical photographs (radiographs)

Answer 242

For severe anterior tooth wear Upper 3-3 built up with composite to disclude the posteriors Over a course of months the posteriors with over erupt and come back into occlusion

Answer 243

Generally consider adhesive minimally invasive dentistry first

Answer 244

Usually 50% tooth structure remaining above gingival margin

Answer 245

Usually very difficult due to lack of occluso-gingival height Lack of occlusal space Severely compromised tooth

Answer 246

Materials Grooves Inlays Ferrule Parallel preps Margins and occluding surfaces Cores Electrosurgery Surgical crown lengthening

Answer 247

Metal is more ductile, porcelain more brittle BUT consider aesthetics Metal on biting surfaces wherever possible

Answer 248

Enhance resistance form and retention by reduction in radius of rotation

Answer 249

Assessing restorability of teeth

Answer 250

Improve retention

Answer 251

electric current is precisely applied to the soft tissues by electrodes to obtain cutting of tissues Can be used to cut back gingivae in order to ensure accuracy of an impression for a crown

Answer 252

Metal palatal surfaces - teeth should occlude with metal because there is not sufficient space

Answer 253

To not increase crack propagation through porcelain, and porcelain splitting off metal

Answer 254

Less destructive, further away from the pulp Chamfer finish helps retention

Answer 255

Surgical crown lengthening

Answer 256

Around 3 months

Answer 257

Avoids shear forces in lateral excursions

Answer 258

To spread the load

Answer 259

Lots of failure - many teeth involved are heavily restored, with very small occluso-gingival height and subject to high occlusal loads e.g. in bruxists

Answer 260

Be clear on benefits - health appearance or both Be clear on risks - health appearance or both Clarity and honesty about longevity and cycles of replacement Adequate dental health risk assessment Can you achieve health and aesthetic objectives Balance risks v benefits Appropriate information provision Valid consent Learn to say no and to refer

Answer 261

Visor for eye protection ESSENTIAL - porcelain fragments etc Consider surgical glove wear and appropriate handling - potential sharp metal edges/failed posts

Answer 262

Eye protection Airway protection - dental dam, or tie floss around long span bridges if dam not possible Comfort - suction

Answer 263

Fractured instrument and post perforating canal

Answer 264

Bridge Two poorly root filled teeth Apical radiolucencies

Answer 265

Silver points

Answer 266

Coarse diamond

Answer 267

Gold cutting bur

Answer 268

Porcelain - coarse diamond Metal - gold cutting bur Cut the whole way up the buccal surface then use chisel to remove bridge High volume suction for porcelain fragments May have to cut onto occlusal or palatal if wont break off May need to section horizontally Zirconia - very hard to cut through

Answer 269

Eucalyptus oil Turpentine

Answer 270

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

Answer 271

Basic oral health messages Individualised oral hygiene instruction Individualised dietary advice Individualised fluoride regime Individualised habit advice and management Information provision and documentation in records Referral to other health and social care professionals Assess response to preventative and oral health measures before embarking on advanced treatment

Answer 272

Set up the interview - mental and physical preparation Perception - assess what the patient knows about the medical situation Invitation - ask how much they want to know Knowledge - give the medical facts Emotion - respond to patients emotions Strategy and summary - negotiate a concrete follow-up step

Answer 273

Comprehensive history and exam Thorough planning Seek advice if needed Prevention Avoid overambitious treatment Effective communication Decision making and treatment planning around basic principles Keep plans simple Have an effective maintenance strategy and regularly reassess the situation

Answer 274

Dental nurse chair has a ring to provide support and stability for the feet, allowing the nurse to sit higher and see over potential obstructions

Answer 275

Neutral or balanced - back upright Feet on the floor Thighs roughly parallel with the floor Approx 90 degree angle at hip and knee Shoulders relaxed Move with the chair, do not bend, twist or stoop

Answer 276

Not using back support Stooping forward Rounded shoulders Feet balancing on the legs of the chair DANGEROUS and UNSTABLE

Answer 277

Using back support Straight back with relaxed shoulders Thighs parallel to the floor Feet supported by the ring providing stability Hip should be parallel with patients shoulder

Answer 278

2-4 inches higher This enables them to see over obstructions

Answer 279

7-11 o clock

Answer 280

11-2 This area is across the top of the patients face so should be kept clear

Answer 281

4-7 Instruments and medicaments are passed in this area which is across the patients chest

Answer 282

Access for the aspirator is limited or the aspirator obscures the view of the operator

Answer 283

Adjacent to the tooth/teeth being treated Aspirator is best placed slightly distal to the toth to remove water/debris Bevel should be adjacent to the tooth being treated Remember to removed any excess fluid and debris gathering at the back but do NOT go over the centre of the tongue to access this area

Answer 284

When working in the upper anterior region palatal aspect

Answer 285

Gold type III alloy

Answer 286

7-15 degrees

Answer 287

To avoid acceleration of irreversible periodontal tissue damage and recession

Answer 288

Use of an atraumatic preparation technique Optimal retention and resistance form Control of the path of insertion Conservation of tooth tissue

Answer 289

To protect weakened tooth structure To improve or restore aesthetics For use as a retainer for fixed bridgework When indicated by the design for an RPD To restore tooth function - occlusion

Answer 290

Rest seats Clasps Guide planes

Answer 291

Preservation of tooth structure Retention and resistance Structural durability Marginal integrity Preservation of the periodontium Aesthetic considerations

Answer 292

To avoid weakening the tooth structure unnecessarily To avoid damage to the pulp

Answer 293

Poor aesthetics Over built crown with periodontal and occlusal consequences

Answer 294

Pulp and tooth strength being compromised

Answer 295

Prevents removal of the restoration along the path of insertion or the long axis of the tooth prep

Answer 296

Prevents dislodgement of the restoration by forces directed in an apical or oblique direction and prevents any movement of the restoration under occlusal forces

Answer 297

Taper Length of walls Extra means of retention such as grooves or slots Path of insertion

Answer 298

Ideal inclination of opposing walls 6 degrees

Answer 299

Longer walls help prevent tipping displacement

Answer 300

Imaginary line along which the restoration will be placed onto or removed from the prep Set before the preparation is begun and all the features of the prep must coincide with that line

Answer 301

Retention is improved by limiting the number of paths of insertion

Answer 302

Restoration must contain a bulk of material that is adequate to withstand the forces of occlusion Achieved through - Occlusal reduction - Functional cusp bevel - Axial reduction

Answer 303

Crown prep with functional cusp bevel

Answer 304

Knife edge Bevel Chamfer Shoulder Bevelled shoulder

Answer 305

Smooth and fully exposed to cleansing action Placed where the dentist can finish them and the patient can clean them Placed at gingival margin wherever possible

Answer 306

Distance established from the junctional epithelium and connective tissue attachment to the root surface of a tooth Acts as a natural seal protecting the tooth from infections and diseases

Answer 307

Aesthetics Destructive prep Destructive to opposing teeth (bruxists?)

Answer 308

Functional cusps 1.5mm Non functional cusps 0.5mm

Answer 309

1.5mm functional cusps 0.5mm non functional cusps

Answer 310

1.5mm functional cusps 1mm non functional cusps

Answer 311

1.8mm functional cusps 1.3mm non functional cusps

Answer 312

Functional cusps 2mm Non functional cusps 1.5mm

Answer 313

Chamfer 0.5mm

Answer 314

Shoulder 1mm

Answer 315

0.5mm chamfer where only metal required 1.3mm shoulder where both metal (0.4mm) and porcelain (0.9mm)

Answer 316

Chamfer 1-1.5mm

Answer 317

Occlusal reduction Separation Buccal reduction Palatal or lingual reduction Shoulder and chamfer finish Check occlusal surface and clearance

Answer 318

Retain some occlusal morphology - cusps and marginal ridges Use diamond tapered fissure bur, round or rugby ball shape bur

Answer 319

Use long tapered diamond bur with 5-10 degree taper Interproximal margin follows gingival contour

Answer 320

Use diamond tapered shoulder bur for first reduction plane Fissure bur 2nd reduction plane - avoid buccal pulp horn

Answer 321

1 plane for posteriors Follow palatal contour for anteriors Use diamond chamfer bur

Answer 322

Tungsten carbide tapered shoulder bur or fine diamond parallel should bur Finish palatal chamfer margins to remove any lips of dentine

Answer 323

Insufficient occlusal clearance

Answer 324

In ICP and in excursive movements

Answer 325

Presence of clinical signs/symptoms Enlargement of existing periradicular lesion Development of a new periradicular Persistence of periradicular radiolucent lesion associated with a tooth that had RCT at least 4 years previously

Answer 326

Monitor Orthograde retreatment Periradicular surgery Extract +/- prosthesis

Answer 327

Clinical factors Patient factors

Answer 328

Intra radicular infection New complex restoration with technically poor RCT Loss of coronal seal

Answer 329

Remove restorative Assess restorability Remove all root filling Assess anatomy Refine/modify preparation Complete treatment as with new case

Answer 330

Ultrasonics

Answer 331

Handfiles +/- solvent Reciproc

Answer 332

Chloroform Eucalyptus oil

Answer 333

R25 for narrow canals R40 for medium R50 for large canals

Answer 334

Results in much cleaner dentinal tubules

Answer 335

Bite fork Transfer jig assembly Reference plane locator Earbow

Answer 336

Approximate position of the infraorbital foramen 43mm apical to anterior incisal edge (ideally 12)

Answer 337

With bite reg paste or rigid wax

Answer 338

Increase in vertical height is needed to make space for restorations Tooth/teeth significantly out of position ie overerupted, tilted or rotated A significant change in appearance is wanted There is a history of occlusally related failure or fracture of restorations

Answer 339

Prep Temporise Impressions and registration Cementation

Answer 340

Compromises aesthetics Degrades tooth function - occlusal reduction, destabilises occlusion Due to occlusal and interproximal reduction - sensitivity (exposed dentine), compromised coronal seal in RCT teeth

Answer 341

Aesthetics Stabilise occlusion Prevent sensitivity from exposed dentine Protect coronal seal of RCT teeth Prevent microleakage/bacterial leakage

Answer 342

Patient is unable to clean - caries and gingival inflammation Poor moisture control Gingival overgrowth

Answer 343

Non irritant - to pulp or PDL Low temp rise during setting Dimensionally stable Adequate working time and setting time Adequate strength and wear resistance Good aesthetics

Answer 344

Custom formed - bespoke, preferable, can be technically demanding Preformed - standard shapes and sizes, adjust to fit chairside

Answer 345

Chemically cured bis-acrylic composite resin - protemp

Answer 346

To check that the prep is satisfactory - Undercuts - Sufficient reduction

Answer 347

Polycarbonate Clear plastic crown forms - filled with composite Aluminium Stainless steel

Answer 348

Unlikely to fit accurately - cervically, occlusally, interdentally Large bank of crowns needed to accommodate variation - expensive

Answer 349

When no impression is taken before tooth prep e.g. trauma

Answer 350

The area of prosthodontics focused on permanently attached dental prostheses Such dental restorations are also referred to as indirect restorations Veneers Onlays and inlays Crowns Bridgework

Answer 351

Smile line

Answer 352

Incisor relationship Excursions of the mandible Canine guidance/group function

Answer 353

Improve aesthetics Change teeth shape and/or contour Correct peg laterals Reduce or close proximal spaces and diastemas Align labial surfaces of instanding teeth

Answer 354

Minimal prep for veneers Wax up Stend Intra-oral mock up Preparation into mock up (can use depth cut burs)

Answer 355

Poor OH High caries rate Interproximal caries and/or unsound restorations Gingival recession Root exposure High lip lines If extensive prep needed (>50% of surface area no longer in enamel) Labially positioned, severely rotated, overlapping Extensive TSL/insufficient bonding area Heavy occlusal contacts Severe discolouration

Answer 356

Toot wear cases - increaseOVD Fractured cusps Restoration of RCT tooth - onlays provide cuspal coverage Replace failed direct restorations Minor bridge retainers (not recommended

Answer 357

Active caries or perio Time - tooth prep and lab fabrication required Cost

Answer 358

To protect weakened tooth structure To improve or restore aesthetics For use as a retainer for fixed bridgework When indicated by RPD design To restore tooth function - eg restore in OVD

Answer 359

Active caries/perio More conservative options available Lack of tooth tissue for prep Unable to provide post and core Unfavourable occlusion

Answer 360

Aesthetics Occlusal stability - prevent tilting and overeruption of adjacent/opposing teeth Function - mastication, speech Periodontal splinting Restoring OVD Patient preference

Answer 361

Damage to tooth and pulp Secondary caries Effect on the periodontium Cost Failure

Answer 362

Coronal seal - restoration/crown - leakage/caries? Amount of remaining tooth structure Is the tooth restorable? Can you isolate tooth with rubber dam? Swelling Sinus TTP Buccal sulcus - ttpalpation? Mobility Increased pocketing - perio and root fractures

Answer 363

Root filling - length, obturation quality, voids Unfilled/missed canals Shape of canal Patency - fractured instruments, posts, sclerosis Bone support Crown to root ratio (1:1.5) Pathology - PA radiolucency, healing, resorption, perforations

Answer 364

Amount of remaining tooth structure - externally and internally Lack of ferrule Wide post holes Endo complications - fractured instruments, perforations, short/extruded root fillings Teeth more brittle after RCT Coronal microleakage

Answer 365

Ingress of oral microorganisms into the root canal system Cause of RCT failure Root filled teeth unrestored for 3months + should generally be re-root treated Trim GP to ACJ and place RMGI over pulp floor and root canal openings Lining should not be too thick, allowing remainder of pulp chamber for retention and restoration

Answer 366

No ferrule

Answer 367

Gains intraradicular support for a definitive restoration Core provides retention for crown Post retains the core Posts do NOT strengthen or reinforce teeth Prep of the root canal for a post weakens tooth

Answer 368

Thin/tapering/narrow mesiodistal roots

Answer 369

4-5mm apically

Answer 370

No more than 1/3rd of root width at narrowest point and 1mm of remaining circumferential coronal dentine

Answer 371

At least half of post length into the root in bone

Answer 372

A dentine collar - encirclement of 1-2mm of vertical axial tooth structure within walls of a crown Helps prevent tooth fracture (orthodontic extrusion or crown lengthening may be necessary to achieve this)

Answer 373

Parallel sides Non threaded Cement retained

Answer 374

Avoids wedging More retentive

Answer 375

Incorporates less stress to remaining tooth than threaded

Answer 376

Less retentive than threaded but cement acts as a buffer between masticatory forces and post/tooth

Answer 377

Only 1 visit required No impressions and lab visit required Chairside core build up Immediate preparation of core Large selection of designs and materials

Answer 378

Post designs Tapered smooth Tapered serrated Tapered threaded Parallel smooth Parallel serrated Parallel threaded

Answer 379

Metals - cast gold, SS, brass, titaniu, Ceramics - alumina, zirconia Fibre - glass, quartz, carbon

Answer 380

Poor aesthetics Root fracture risk Corrosion Nickel sensitivity Radiopaque

Answer 381

High flexural strength and fracture toughness Favourable aesthetics Difficult retrievability Root fracture common

Answer 382

Flexible Similar qualities to dentine and bond to dentine with DBAs Aesthetic Retrievable Radiolucent

Answer 383

Conservative High strength High stiffness

Answer 384

Less retentive than parallel or threaded

Answer 385

Small circular canals

Answer 386

Avoid excessively flared canals

Answer 387

Good retention High strength Comprehensive system

Answer 388

Precious metal post expensive Corrosion of SS Less conservative

Answer 389

Small circular canals

Answer 390

Take care during prep

Answer 391

High retention

Answer 392

Stresses generated in canal may cause fracture

Answer 393

Only when max retention is essential

Answer 394

Take care to avoid fracture during seating

Answer 395

High strength Better than prefab

Answer 396

Less stiff than wrought Multiple appts Complex

Answer 397

Elliptical or flared canals (non circular or extreme taper)

Answer 398

Care to remove nodules before insertion

Answer 399

Crown or onlay Coronal seal Prevention of fracture

Answer 400

The internal part of the tooth is built up with restorative material to replace the lost tooth tissue The core is prepared It provides retention and resistance for definitive restorations

Answer 401

Composite - most common Amalgam Glass ionomer

Answer 402

Good aesthetics Bonds to tooth structure Technique sensitive - moisture control required Used with fibre posts

Answer 403

Tend to avoid as retention required Poor aesthetics Core cannot be prepared straightaway needs 24 hr to set Avoid pinned amaglams

Answer 404

Not really used as it absorbs water and core expands in size

Answer 405

Root treatment removed from the root canals Amalgam packed into the canals and tooth built up This provides retention for the amalgam Cannot be prepared for 24 hours until amalgam sets

Answer 406

Masseran Ultrasonic Eggler device Moskito forceps Sliding hammer Anthogyr

Answer 407

Cant remove it Root fracture - immediate or delayed Render tooth unrestorable Post space too wide Break post

Answer 408

Perforation Core fracture Root fracture Post fracture

Answer 409

Repair - internal or external (periradicular surgery) Extract

Answer 410

60% restorative reasons 32% periodontal 8% due to endodontic reasons

Answer 411

One less material interface

Answer 412

How long will the post be? Is there a ferrule? How wide? 3-5mm remaining GP Is canal straight? How much space for the core? - need to factor in the type of crown to be placed

Answer 413

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

Answer 414

Provisional post core crown - temp bond Immediate denture? Dressing - not aesthetic but might prevent leakage Essix retainer Para post - provisional post and para post drill and impression post

Answer 415

Dental dam Soft - solvent or heat Glades gliddens to minimum size 3 (straight part of the canal only) Use working length and rubber stopper on the gg Essential to leave 3-5mm GP apical third Check GP plug remains

Answer 416

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

Answer 417

Check post space for temp bond Irrigate 0.2% chlorhexidine Dry paper points Ensure fits around prep Do you have enough occlusal clearance?

Answer 418

Be careful not to fill post space with cement - may prevent seating Use firm apical pressure Get rid of excess Can ask lab for provisional acrylic crown Make sure no excess around when taking crown impression/fitting MCC

Answer 419

A direct functional and structural connection between a load bearing dental implant and living (organised) bone Primary and secondary

Answer 420

Implant is anchored in bone due to frictional forces provided between osteotomy and dental implant design features

Answer 421

The process of a functional connection between bone and dental implant Living bone grows onto the surface of a dental implant

Answer 422

Days - granulation tissue in wound chamber Weeks - immature (woven bone) 4w - collagen orientation 6-8w - mature tissue attachment Months - mature lamellar bone

Answer 423

Tooth has more fibroblasts, less collagen and the collagen fibres are orientated perpendicular to root surface Implant has less fibroblasts, more collage and the collagen fibres are orientated parallel to implant crown

Answer 424

Tooth anchored to bone by periodontal complex bone/PDL/cementum and is capable of physiologic adaption - resilient tissue attachment Implant anchored to bone by direct functional contact, no physiologic adaption present, rigid connection

Answer 425

Ti TiZr - increased strenght Ceramic - Y-TZP yittra stabilised zirconia

Answer 426

Aesthetic zone Upper anteriors

Answer 427

Where aesthetic demand less high Posteriors

Answer 428

Material Bone/tissue level Tapered/parallel Length and diameter

Answer 429

Tapered may provide increased primary stability in immediate placed Tapered may be used where there is root convergence apically

Answer 430

Site Indication Local anatomy

Answer 431

High survival of narrow diameter and short <10mm implants

Answer 432

To create roughness Sand blasting/acid etch/plasma spray

Answer 433

Smooth 0-0.5um Mild 0.5-1um Moderate 1-2um Rough >2um

Answer 434

Replace missing teeth with aesthetic, functional and predictable restoration Low rate of complications during healing and maintenance Long term stability

Answer 435

SSRIs PPIs Bisphosphonates Steroids Radiotherapy (poorly controlled diabetes)

Answer 436

Medium risk

Answer 437

Reduces vascularity Fibroblast/osteoblast function PMN function polymorphic neutrophils

Answer 438

Polymorphic neutrophils The most abundant innate immune cells, first defence against infection

Answer 439

Relative infra occlusion Suboptimal aesthetics Occlusal disharmony Implant fenestration

Answer 440

>2mm ST show

Answer 441

lip covers >25% of teeth

Answer 442

Thick/thin Flat/scalloped (low scalloped, medium scalloped, high scalloped)

Answer 443

Probe visibility

Answer 444

Risk of recession, risk of implant visibility through tissues Thick tissue more likely to scar and less likely to develop papilla

Answer 445

M-D papilla Gingival zenith Mucosal colour/deficiency ST colour and texture

Answer 446

Distance from the bone crest to the adjacent contact point

Answer 447

Maxillary sinus Nasal floor Naso-palatine canal Infraorbital nerve

Answer 448

Inferior alveolar canal Mental foramen Incisive canal Lingual perforating vessels Submandibular fossa

Answer 449

Implants should be planned starting form the final planned prosthesis position This should be taken into account when requesting special tests

Answer 450

Implant system Proposed gingival margin Local anatomy Prosthetic plan - cement vs screw

Answer 451

Minimum 1.5mm

Answer 452

To lower risk of damage to the adjacent tooth and lower risk of bone necrosis and ST defect inbetween the implant and the tooth

Answer 453

Aim for >1mm bone or >2mm bone and soft tissue

Answer 454

Thick low scalloped

Answer 455

Medium thick medium scalloped

Answer 456

Thin high scalloped

Answer 457

Rectangular

Answer 458

Triangular

Answer 459

5.5-6.5 mm to contact point

Answer 460

>/= 7mm to contact point

Answer 461

12-16 weeks

Answer 462

6 months +

Answer 463

Study models Diagnostic wax up Surgical template Clinical photos CBCT Surgical guide Essix (provisional)

Answer 464

Fixed - single/multi unit/full arch screw or cement retained Removeable - stud, bar, ball, magnet retained

Answer 465

Open tray impression Closed tray impression The choice depends on use preference and the clinical situation

Answer 466

Impression post Guide screw

Answer 467

Cap Post Screw

Answer 468

Colour coded components correspond to prosthetic connection High precision impression Clear cut tactile response for accurate positioning Guide screw can be tightened by hand or with the SCS screwdriver

Answer 469

Colour coded components correspond to prosthetic connection No additional prep of tray Cheaper High precision impression Clear cut tactile response for accurate positioning

Answer 470

More susceptible to porcelain fracture and screw fractures or loosening

Answer 471

Peri implant inflammation - often due to excess cement

Answer 472

Post extraction defects Trauma Hypodontia Periodontal disease Thin biotype

Answer 473

Bone volume and morphology Space dimensions 3D implant position Biotype Operator skill and experience

Answer 474

Smoking Tannins - tea coffee red wine guinnes Chromogenic bacteria Chlorhexidine Iron supplements

Answer 475

Fluorosis Tetracycline Non vitality - blood products Physiological (age changes) Dental materials - amalgam, root filling materials Porphyria - red primary teeth Cystic fibrosis - grey Thalassemia, sickle cell anaemia (blue, green, brown) Hyperbilirubinaemia (green teeth)

Answer 476

External vital bleaching Internal non vital bleaching (can be used together in non vital teeth)

Answer 477

Hydrogen peroxide H2O2 Forms an acidic solution in water, breaks down to form water and oxygen Free radical HO2 hydroperoxyl is formed - this is the active oxidising agent Fast reacting oxidising agent

Answer 478

Free radical HO2

Answer 479

Carbamide peroxide Urea Surfactant Calcium phosphate Fluoride Potassium nitrate Flavour Preservative Pigment disperses Carbopol

Answer 480

Carbamide peroxide Breaks down to produce hydrogen peroxide and urea

Answer 481

Thickening agent Slows the release of oxygen Increases gel viscosity - stays where you put it Slows diffusion into enamel

Answer 482

Raises pH Stabilises hydrogen peroxide

Answer 483

Allows the gel to wet the tooth surface

Answer 484

Tooth desensitising agents

Answer 485

Desensitises tooth Prevents erosion

Answer 486

Time - more time more effect Cleanliness of tooth surface - cleaner better effect Concentration of solution - higher con more and quicker effect Temperature - higher temp quicker effect

Answer 487

Always check patient is dentally fit Any leakage around carious cavity margins will lead to pulpal damage

Answer 488

Take an initial shade and agree it with the patient to record in the notes Check that the patient is dentally fit

Answer 489

Sensitivity Relapse Restoration colour Allergy Might not work Compliance with regime

Answer 490

Chair side Home

Answer 491

Controlled by dentist Can use heat/light Quick results for patient

Answer 492

Time for dentist Can be uncomfortable Results tend to wear off quicker Expensive

Answer 493

Thorough cleaning of teeth Rubber dam (at least gingival mask) Apply bleaching gel to tooth Apply heat/light Wash/dry/repeat Takes 30-60 min

Answer 494

Gingival protection

Answer 495

10-15% carbamide peroxide (16.7% carbamide peroxide equates to 6% hydrogen peroxide which is the max legal strength)

Answer 496

0.5mm thick soft acrylic vacuum formed soft splint Stopping 1mm short of gingival margin Buccal spacer to allow for placement of gel

Answer 497

Full mouth cleaning/polishing Fit trays and check extension and comfort Instructions: Brush and floss teeth Load tray 1mm2 dot buccally on each tooth Fit tray in mouth for at least 2 hours, ideally overnight Give written instructions Review at 1 week

Answer 498

Most see a result 2-3 days Normally reached maximum 3-4weeks If no change in 2 weeks it is not going to work

Answer 499

Yellow/orange discolouration respond better than bluish/greyish

Answer 500

Age related darkening Mild fluorosis Post smoking cessation Tetracycline staining?

Answer 501

Sensitivity Wears off Cytotoxicity Gingival irritation Problems with bonding to tooth

Answer 502

Common 60%+ Worse initially, resolves 2-3 days post bleaching

Answer 503

Pre-existing sensitivity High conc bleaching agent Frequency of change Bleaching method Gingival recession

Answer 504

Residual oxygen from the peroxide remains within the enamel structure initially Dissipates over a short time, ideally delay restorative procedures for a week after bleaching

Answer 505

Dead pulp -> bleeding into dentine Blood products diffuse and darken leading to grey discolouration

Answer 506

Non vital tooth Adequate RCT No apical path

Answer 507

Heavily restored tooth Staining due to amalgam

Answer 508

Easy Conservative Patient satisfaction good

Answer 509

External cervical resorption dur to diffusion of H2O2 through dentine into periodontal tissues (High conc H2O2 and heat, history of trauma)

Answer 510

Record initial shade Rubber dam Remove filling from access cavity Remove GP from pulp chamber and 1mm below AGJ Place 1mm RMGIC over GP to seal canal Remove any very dark dentine Etch internal surface 37% phosphoric acid 10% carbamide peroxide gel in cavity Seal cotton wool over this Seal with GIC Repeat weekly Until shade achieved or no change after 4 visits

Answer 511

After removing GP to 1mm above the ACJ, place 1mm RMGIC over it to seal dentine

Answer 512

Variable ~4-5 years

Answer 513

Restore palatal cavity Place white GP or similar Restore with a light shade of composite

Answer 514

Inside-outside bleaching Removed GP and cover with RMGIC Make bleaching tray with palatal reservoir (instead of buccal) Bleach placed in access cavity and in tray Replaced frequently over about a week Must wear tray whole time

Answer 515

Removes discolouration limited to the outer layers of enamel Combination of erosion (acid) and abrasion (pumice)

Answer 516

Fluorosis Post ortho demineralisation Demineralisation with staining Prior to veneering if dark staining present

Answer 517

Clean teeth thoroughly Rubber dam Mix 18% HCl and pumice Apply to teeth Gently rub with prophy cup 5 seconds/tooth Wash Repeat up to 10x Remove dam Polish teeth with fluoride prophy paste Apply fluoride gel or varnish to help reharden and decrease sensitivity RV 1 month

Answer 518

Quick Easy No long term problems

Answer 519

Acid Sensitivity Only works for superficial staining Works much better for brown staining than white marks

Answer 520

37% phosphoric acid or 18% HCl (HCl removes 100 microns, phosphoric only 10 microns)

Answer 521

Very rare Glucose 6 phosphate dehydrogenase deficiency Acatalasemia (Because neither can metabolise hydrogen peroxide)

Answer 522

Products containing or releasing between 0.1% and 6% hydrogen peroxide cannot be used on any person U18 except where such use is intended wholly for the purpose of preventing disease

Answer 523

6% (16.7% carbamide peroxide)

Answer 524

Formation of chemically stable, chromogenic products within tooth substance These are long chain organic molecules Bleaching oxidises these compounds into smaller molecules which are often not pigmented

Answer 525

Treatment for discolouration Doesn't remove surface layer Infiltrate the white area with resin Changes the refractive index of the white area Masks it and makes it look like surrounding enamel Hydrophilic resin impregnation of the porous enamel surface

CDS Restorative Flashcards

(582 cards)