Dental demolition and managing failure in tooth wear part 2 L3

Question 1

what is radiographic washout?

Answer 1

crown or something obstructing view underneath so need to go in blind but warn patient

Question 2

basic technique for cutting indirects?

Answer 2

Porcelain cutting – Coarse diamond
Metal cutting – Gold cutting bur

Whole way up buccal surface use chisel
Remember operator(s) & patient safety
High volume suction – porcelain fragments

May have to cut onto occlusal or palatal surface
May need to section horizontally
Zirconia – very hard to cut through
*Non-precious metal harder to cut through than precious metal

Plan demolition with contingencies and communication to patient
Pre-op impression for temporary
Try vertical cuts first – if bridge keep as intact as possible as may be useful as temporary
Section abutments apart trying to keep intact useful ones
Critically appraise cores

Question 3

repeat endo instruments?

Answer 3

Conventional files, GT files, GG burs
Rubber dam
Eucalyptus/Turpentine oil

Problem cases:
Ultrasonic instruments/magnification
High risk of instrument fracture

Question 4

how to post removal?

Answer 4

Case assessment critical
Risk of fracture
Ease of removal
(Length/taper/surface)
Contingency plan for fracture
Other pathology with tooth

Question 5

how to remove fractured posts? and what is risk?

Answer 5

• counter clockwise using masseran kit or ultrasonics risk of root fracture

Question 6

what is a failing dentition?

Answer 6

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.

A failing dentition is sometimes a terminal dentition

Question 7

what are keys to success when managing failure?

Answer 7

• Comprehensive history and examination
• 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

Question 8

what is protocol for giving bad news?

Answer 8

SPIKES
S- set up interview
P- perception assess what pt knows about situation
I- invitation - ask how much they want to know
K- knowledge - give the medical facts
E- emotion - respond to pt emotions
S- strategy and summary - negotiate a concrete follow-up step