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exam 1 Flashcards

1
Q

current view of dental caries

A

a transmissable bacterial, chronic, multifactorial disease that starts with microbiological shifts within the complex biofilm, characterized by a continuum resulting from many cycles of demineralization and remineralization (dynamic)

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2
Q

can dental caries be eradicated

A

no

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3
Q

who is susceptible to caries

A

all ages

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4
Q

strategies to deter caries development

A

control the necessary and determining causal factors: dental biofilm and diet in addition to the use of fluorides

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5
Q

dental plaque

A

colorless, soft, sticky coating that adheres to the teeth = oral biofilm

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6
Q

1960s model

A

bacteria; diet; host factor: tooth, saliva; time

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7
Q

non-specific plaque hypothesis

A

(1900s) idea that the accumulation of dental plaque was responsible for oral disease without discriminating between levels of virulence of bacteria

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8
Q

specific plaque hypothesis

A

(1976) = idea that only a few speices of the total microflora are actively involved in disease

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9
Q

ecological plaque hypothesis

A

(1994) = result of an imbalance in the microflora by ecological stress resulting in an enrichment of certain disease-related micro-organisms

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10
Q

keystone-pathogen hypothesis

A

(2012) = certain low-abundance microbial pathogens can cause trigger (virulence factor) the process by interfering with the host and remodeling the microbiota

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11
Q

true of false: caries is not a classical infectious disease

A

true

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12
Q

acidogenic

A

acid-producing

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13
Q

aciduric

A

acid-tolerating

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14
Q

non-mutans streptococci

A

can metabolize sugars in comparable way to S. mutans

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15
Q

phenotypica heterogeneity among different S. mutans strains

A

determines the rate of the carbohydrate fermentation and thus their cariogenic potential

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16
Q

demineralization

A

faster than RE
dentin more vulnerable than enamel
primary enamel is less mineralized
pH < 5.5

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17
Q

remineralization

A

slower process than DE
can reverse the DE process
pH > 5.5

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18
Q

net mineral loss

A

lesion initiation/progression

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19
Q

surface feature of net mineral loss

A

dull/rough (enamel)

dull/soft (dentin)

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20
Q

net mineral gain

A

lesion regression/arrest

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21
Q

surface feature of net mineral gain

A

shine/smooth (enamel)

shine/hard (dentin)

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22
Q

does a “caries-free” patient exist

A

controlled the physiologic balance of the intra-oral environment

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23
Q

how long do drops in pH last

A

approx 30 min

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24
Q

stickiness of foods

A

is relevant in their cariogenicity

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25
Q

how fluoride controls dental caries

A

reduces demineralization and enhances remineralization

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26
Q

main effect of fluoride

A

to interfere phsyiochemically with caries development by reducing demineralization and enhancing remineralization of dental enamel without significantly promoting antimicrobial effect on dental plaques

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27
Q

fluoride uptake

A

a consequence of the effect of fluoride on caries process more then that causes caries lesions reduction

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28
Q

what causes demineralization

A

dietary sugars (intake, amount, type) must be present for a sufficient length of time to cause demineralizaiton

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29
Q

true or false: it takes years to break in the enamel and form the cavitation

A

true

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30
Q

biological determinants of caries

A

fluoride; saliva/biofilm characteristics; antimicrobial agents; etc.

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31
Q

primary determinants of caries

A

diet, bacteria, susceptible tooth, time

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32
Q

environmental determinants of caries

A

behavior; education; knowledge; attitudes; etc.

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33
Q

% of adults (20-64 yo) that have had dental caries in their permanent teeth

A

92%

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34
Q

% of adults 20 to 64 yo that have untreated decay

A

23%

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35
Q

main reason for replacing existing restorations

A

recurrent caries

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36
Q

prevalence of root caries

A

positively associated with older age

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37
Q

most common complication for prosthodontic patient

A

caries

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38
Q

20th century beliefs

A

caries are symptoms and disease; infectious and transmissable; systemic fluoride is essential

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39
Q

21st century beliefs

A

detection and diagnosis; biofilm-sugar dependent disease; fluoride interferes with de-remineralization

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40
Q

where biofilms can accumulate

A

at occlusal surfaces (being particularly at risk during the long-lasting eruptive process); non-functional occlusion

in the interproximal areas below contact area

along marginal gingiva

on enamel-cementum junction, when exposed

adjacent to dental surfaces sealed or restored with dental materials

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41
Q

ICDAS

A

international caries detection and assessment system

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42
Q

severe decay

A

pulpal decay

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43
Q

established decay

A

visible dentine decay

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44
Q

early stage decay

A

visible enamel decay

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45
Q

very early stage decay

A

sub-clinical decay

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46
Q

NDIP detailed inspection

A

% with no obvious decay and number of decayed, missing and filled teeth

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47
Q

secondary caries

A

reccurent caries

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48
Q

CARS

A

caries lesions associated with restorations and sealants

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49
Q

caries detection

A

a process involving the recognition (and/or recording) traditionally by optical or physical means of changes in enamel and/or dentin and/or cementum, which are consistent with having been caused by the caries

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50
Q

caries lesion assessment

A

the evaluation of the characteristics of a caries lesion once it has been detected; these characteristics may include optical, physical, chemical or biochemical parameters, such as color, size, or surface integrity

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51
Q

visual caries lesion assessment

A

the clinical evaluation of the characteristics of a caries lesion that relies on visual signs (changes in color, cavitation), which represent manifestations of a relatively advanced caries process

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52
Q

occlusal surface lesion

A

pits and fissures caries lesion

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53
Q

interproximal lesion

A

approximal lesion

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54
Q

root caries lesion

A

radicular dentin caries leison

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55
Q

localization of caries

A

pits and fissures caries lesion; smooth surface lesion; cervical lesion; approximal lesion; radicular dentin caries lesion

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56
Q

primary caries

A

first lesion developed in a tooth

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57
Q

secondary caries

A

recurrent caries; occurs in areas of plaque stagnation; the cervical margins of restorations are commonly affected;

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58
Q

how can caries lesions be described

A

according to location, extent, order of development and activity

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59
Q

extent of caries

A

= degree of severity = level of progression

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60
Q

incipient

A

reversible = initial stage = early caries lesion

can be remineralized if immediate corrective non-invasive approach after the stage

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61
Q

cavitated

A

= irreversible

in this condition the enamel surface is broken and usually an invasive procedure (restoration) is indivated

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62
Q

active lesions

A

tend to be whitish or yellowish in color and opaque (non-glossy)

feel rough when the tip of the explorer is moved gently across their surface; usually presents biofilm acculumation

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63
Q

inactive lesions

A

can be whitish or yellowish in color but tend to be shiny or glossy

feel hard and smooth when the tip of the explorer is moved gently across their surface

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64
Q

tooth-cavity prepartion

A

mechanical alteration of caries lesion to receive a restorative material that reestablish form and function

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65
Q

simple

A

1 surface

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66
Q

compound

A

2 surfaces

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67
Q

complex

A

more than 3 surfaces

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68
Q

O

A

occlusal surface

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69
Q

MO

A

involving mesial and occlusal

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70
Q

MOD

A

involving

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71
Q

dental cavity

A

lost of tooth structure (defect) in enamel or E/D due to dental caries disease progression

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72
Q

caries detection

A

is a process involving the recognition (and/or recording), traditionally by optical or physical means, of changes in enamel and/or dentin and/or cementum, which are consistent with having been caused by the caries

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73
Q

caries lesion assessment

A

is the evaluation of the characteristics of a caries lesion once it has been detected; these characteristics may include optical, physical, chemical, or biochemical parameters, such as color, size, or surface integrity

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74
Q

caries lesion diagnosis

A

an integration of information obtained by clinicial examination, use of caries diagnosis aids, conversation with the patient and biological knowledge of the caries process

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75
Q

ICDAS

A

a clinical visual caries scoring system for use in clinical practice, dental education, research and epidemiology; it provides a framework to support and enable personalized comprehensive caries management for improved long-term health outcomes; it is designed to lead better-quality information to inform decisions about appropriate diagnosis, prognosis and clinical management at both the individual and public health levels

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76
Q

important parts of caries detection

A

removal of plaque from the tooth surface; appropriately lit surface; appropriately dried area

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77
Q

use of a sharp explorer

A

not necessary because it does not add to accuracy of the detection and may damage the enamel surface covering early carious lesions

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78
Q

ball-ended explorer

A

may be used in order to remove any remaining plaque and debris, to check for surface contour and minor cavitation and to confirm the presence of tooth-coloured restorations and sealants

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79
Q

restoration and sealant code 0

A

not sealed or restored

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80
Q

restoration and sealant code 1

A

sealant, partial

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81
Q

restoration and sealant code 2

A

sealant, full

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82
Q

restoration and sealant code 3

A

tooth-colored restoration

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83
Q

restoration and sealant code 4

A

amalgam restoration

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84
Q

restoration and sealant code 5

A

stainless steel crown

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85
Q

restoration and sealant code 6

A

porcelain, gold, PFM crown or veneer

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86
Q

restoration and sealant code 7

A

lost or broken restoration

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87
Q

restoration and sealant code 8

A

temporary restoration

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88
Q

carious lesion code 0

A

sound tooth surface, no or slight change after prolonged air drying

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89
Q

carious lesion code 1

A

first visual change in enamel seen after prolonged air drying

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90
Q

carious lesion code 2

A

distinct visual changes in enamel

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91
Q

carious lesion code 3

A

localize enamel breakdown, no dentin involvement

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92
Q

carious lesion code 4

A

underlying dark shadow from dentin (not cavitated into dentin)

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93
Q

carious lesion code 5

A

distinct cavity with visible dentin

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94
Q

carious lesion code 6

A

extensive distinct cavity with visible dentin

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95
Q

ICDAS code 1 wet and dry

A

wet: no evidence
dry: suggested carious opacity or discoloration (white or brown lesion) is visible/ not consistent with sound enamel

when seen wet or dry: suggested carious opacity or discoloration (white or brown lesion) is visible / not consistent with sound enamel and is limited to the confines of the pit and fissure area

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96
Q

ICDAS code 2 wet and dry

A

wet: suggested carious opacity or discoloration (white or brown lesion) is visible / not consistent with sound enamel
dry: the lesion must still be visible

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97
Q

ICDAS code 3 wet and dry

A

wet: suggested carious opacity or discoloration (white or brown lesion) is visible / not consistent with sound enamel
dry: localized enamel breakdown due to caries with no visible dentin or underlying shadow

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98
Q

ICDAS code 3 for a restored tooth

A

a gap between a restoration and the tooth of less than 0.5 mm but associated with an opacity or discoloration consistent with demineralization

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99
Q

ICDAS code 4 wet and dry

A

wet: appear as shadows (may appear as grey, blue or brown) of discoloured dentine visible through apparently intact enamel which may or may not exhibit localized breakdown
dry: more clear visualization of shadows

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100
Q

ICDAS code 5 wet and dry

A

wet: may have darkening of the dentin through the enamel
dry: visual evidence of loss of tooth structure at the entrance to or within the pit and fissure - frank cavitation; there is visual evidence of demineralizaiton (opaque (white), brown or dark brown walls) at the entrance to or within the pit or fissure and the dentin is exposed

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101
Q

ICDAS code 6 wet and dry

A

wet: obvious loss of tooth structure
dry: dentin is clearly visible on the walls and at the base in a cavity that involves at least half of a tooth surface. the marginal ridge may or may not be present.

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102
Q

root caries ICDAS E

A

if the root surface cannot be visualized directly as a result of gingival recession or by gentle air-drying, then it is excluded

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103
Q

root caries ICDAS 0

A

the root surface does not exhibit any unusual discoloration that distinguishes it from the surrounding or adjacent root areas

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104
Q

root caries ICDAS 1

A

there is a clearly demarcated area on the root surface or at the cemento-enamel junction

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105
Q

root caries ICDAS 2

A

there is a clearly demarcated are on the root surface or at the cemento-enamel junction that is discoloured (light/dark brown, black) and there is cavitation

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106
Q

lesion activity assessment (LAA) Nyvad’s system

A

based on the combined knowledge of clinical appearance (ICDAS) of the lesion, whether or not the lesion is in a plaque stagnation area, and the tactile sensation when a ball-ended WHO probe is gently drawn across the surface of the tooth

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107
Q

additional methods to detect caries lesions

A

radiographic methods; fluorescence-based methods; visible light methods

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108
Q

radiographic exam

A

relevant tool to diagnose approximal caries lesions; for occlusal surface, add a minimal diagnostic value because of large amounts of surround sound enamel; about 60% of lesions seen as radiolucencies in the outer half of enamel are usually noncavitated and remineralizable

109
Q

bitewing radiography

A

the process of creating radiograph images of the posterior teeth with the specific objective of identifying carious lesions on the proximal surface that may be inaccessible to visual and tactile examination

110
Q

Clinical Decision Support (CDS)

A

process for enhanving health-related decision and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery

provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times to enhance health care

avoid overtreatment, improve outcomes and clinical workflow

111
Q

what does conservative dentistry advocate

A

the detection of the carious lesion at the earliest possible stage so the progression of lesion can be reversed before cavitation

112
Q

tooth-cavity preparation

A

mechanical alteration of caries lesion to receive a restorative material that re-establish form and funciton

113
Q

simple

A

1 surface

114
Q

compound

A

2 surfaces

115
Q

complex

A

more than 3 surfaces

116
Q

dental cavity

A

loss of tooth structure (defect) in enamel or E/D due to dental caries disease progression

117
Q

when should you prep a cavity

A

there is a cavitated caries lesion where a restorative procedure is indicated

118
Q

should i prep to restore non-cavitated early caries lesion

A

no

119
Q

GV Black

A

standardized the rules of cavity preparation; developed the principles of “extension for prevention;” he wrote more than 500 articles and several books; established the scientific foundation for operative dentistry

120
Q

extension for prevention

A

to provide extension of the preparation to the facial and lingual line angles in order to bring about “self-cleaning” margins via food excursion; it was done to prevent the secondary caries at margins of restorations

121
Q

G.V. black’s principles for cavity preparation

A

to gain access and visibility; removal of all traces of demineralized enamel and dentin; room for restorative material; extension for prevention = cavosurface margins self cleaning areas; mechanical interlocking retentive designs

122
Q

class I surfaces

A 
distal wall
lingual wall
pulpal wall
buccal wall
mesial wall
123
Q

class II

A

proximal surface of posterior teeth with access established from occlusal surface

124
Q

class II walls

A 
lingual wall
buccal wall
axial wall
pulpa wall
gingival wall

bucco axial line angle
lingual axial line angle
bucco-axial-gingival point angle

125
Q

class III

A

proximal surfaces of anterior teeth which may or may not involve a facial or lingual access and do not involve the incisal edge

126
Q

class IV

A

proximal surfaces of anterior teeth involve incisal edge

127
Q

class V

A

lesions involving the cervical third of all teeth

128
Q

class VI

A

lesions involving the incisal edge of anterior and cusp tips of posterior teeth without involving any ohter surface

129
Q

class I is similar to

A

occlusal O

130
Q

class II can be

A

DO, MOD, or MODB

compound, complex

131
Q

classical principles of cavity preparation

A

fulfill the mechanical requirements of amalgam; approach carried out at the expense of removal of sound dental tissue; standardized preps even for lesion with different sizes

132
Q

current principles for cavity prep

A

based on maximum conservation of sound dental tissue and clinical judgement of each lesion; bonding materials will help to preserve tooth structure; prep guided by the size of the lesion

133
Q

classical principle steps

A
  1. establishing out line form
  2. obtaining convenience from
  3. removing the remaining caries lesion
  4. obtaining resistance from
  5. obtaining retention from
  6. finshing enamel walls
  7. performing toilet of the cavity
134
Q

establishing outline form

A

shape of a cavity which is dictated by the anatmical form of the tooth and based one localization and extent of caries lesion

135
Q

extent of caries lesion in dentin

A

primary determinant of the outline form

136
Q

final outline

A

when all caries, dentin and usually the overlying unsupported enamel have been removed

137
Q

obtaining convenience form

A

shape of a cavity which allows adequeate observation, access ability and ease of operation in prepartion and restoration restoring the cavity

138
Q

when involving removal of sound structure

A

should be limited to what is necessary

139
Q

removing caries lesion

A

if caries is minimal, carious tissue is removed during step of cavity preparation, if deep, we remove the carious lesion by large round bur rotation at slow speed

140
Q

obtaining resistance form

A

design that prevents fracture of both tooth and restoration

141
Q

obtaining retention form

A

approaches to avoid the displacement of the restoration

142
Q

how to avoid displacement of the restoration

A

mechanical shaping of the prep (non-adhering restorative materials)

bonding procedures - adhering restorative materials that attach to tooth structure (i.e. composites and glass ionomers)

143
Q

finishing enamel walls and cavorsurface margins

A

to promote smoothness and uniformity:
non-adhering restorative materials –> remove unsupported enamel, make the cavosurface margin smooth

adhering restorative materials that attach to strucutre (i.e. compositives and glass ionomers) - make the cavosurface margin smooth

144
Q

performing toilet of the cavity

A

involves washing the cavity of debris and final inspection; check if all prep is appropriated before start the restorative procedures

145
Q

hand cutting instruments

A

rotary instruments

146
Q

hand non-cutting instruments

A

restoring instruments

147
Q

explorer #23

A

important tactile instrument; use gently and without pressure; use to check the carious dentin consistency; should not be used in demineralized area; apply composite in layering technique in posterior restorations

148
Q

excavators

A

denomination by GV black from hand cutting instruments

149
Q

cleoid

A

discoid

150
Q

chisels

A

straight chisel

151
Q

hatchet

A

excavator

152
Q

how are hand cutting instruments classified

A

design
angle
formula

153
Q

hatchet

A

used for cutting enamel, and to smooth the walls and floors of the tooth preparation, especially class II

154
Q

hoe

A

blades and cutting edge are perpendicular to the long axis of the handle; used with a pulling motion; more angulated than chisel

155
Q

wedelstaedts chisel

A

slightly curved shanks and are used primarily on anterior teeth

156
Q

biangle chisels

A

have two distinct angles - one at the shank and one at the working end

157
Q

chisels

A

are used to cleave (split) tooth enamel, to smooth cavity walls, and to sharpen cavity preparations

158
Q

gingival marginal trimmer

A

it has a curved angle and a shank for use either on the right or left sides and on the mesial or distal surfaces; used to trim, smooth and shape along the gingival enamel margins of the preparation

159
Q

restoring instruments

A

condensing instruments
carvers
burnishers
plastic instruments

160
Q

condensing instruments

A

used to condense material into the cavity after preparation

161
Q

PFI

A

not necessarily made of plastic material; name refers to their function of carrying/handling restorative materials after mixing while the material is still in “plastic”

162
Q

carvers

A

used to carve anatomy into the restorative material (unset amalgam); common types: cleoid/discoid

163
Q

discoid

A

circular edge

164
Q

cleoid

A

clawlike blade

165
Q

to determine whether the instrument is right or left bevel

A

he primary cutting edge is held down and pointing away; if the bevel appears on the right side of the blade, it is the right instrument of the pair

166
Q

advantages of hand cutting instruments

A

self-limited in cutting enamel; will not cut sound enamel, but will cut only enamel undermined by loss of dentin; they can remove large pieces of undermined enamel quickly, thus saving time and effort; no vibration or heat accompanies the cutting, making it painless and with no adverse effects on the tooth tissues; they are the mot efficient means for precise cutting, especialyl when cutting is needed adjacent to important anatomy; they can create the smoothest surface of all cutting instruments; they have the longest life span

167
Q

contra-angle handpiece

A

air turbine / electric high speed

168
Q

low speed

A

preferred for removal of caries + dentin tissue

169
Q

high speed

A

preferred for cutting enamel and dentin

170
Q

high speed sped range

A

from 400,000 rpm

171
Q

low-speed hand piece speed

A

10,000 to 30,000

*4,000 to 10,000

172
Q

bur-locking types

A

latch-type

friction-grip-type

173
Q

head of bur

A

portion that cuts; diamonds or blades

174
Q

neck of the bur

A

connection; can be extended to promote better access

175
Q

shank of the bur

A

latch or friction type; short, standard or long shank; need to be totally inserted in head of handpiece

176
Q

ISO size

A

diameter of head (mm)

177
Q

inverted cone

A

to create angulation and retention forms (undercuts) in the wall of the prep; to flatten the pulpal floor; #33 1/2, 34-19

178
Q

plan fissure straight

A

has a parallel side head; to prepare proximal box; promote cavity extension, forms the cavity wall of the preparation; elongated cylinder; #556

179
Q

tapered fissure

A

has a long parallel side head; slight divergent; promote cavity extension; similar to straight fissure; most used to create expulsive preps.; i.e. inlay preps #669

180
Q

pear shaped

A

has a long parallel side head; slight convergent; round angles, open and extend the prep; similar to straight fissure; most used to create retentive preps i.e. amalgam preps; #330 and #245

181
Q

caries removal

A

low speed handpiece with the largest round bur that will fit in the carious lesion used with light force and a wiping motion; removed first peripherally by excavating peripheral 1 to 1.5 mm tooth structure to “sound” dentin including a visually stain-free DEJ; histological “sound” dentin will have similar hardness and texture to sound unaffected dentin when applying a spoon excavator or slowly rotating round bur; generally operate at 5,000 RPM

182
Q

bur head shapes for finishing

A

used to make very smooth cuts in preparations; adjust occlusal contacts; contour and finish restorations; differ by format of head and sizes; differ by number of blades - egg shape, bullet shape, needle shape, round shape

183
Q

aspects that influence longevitiy

A
  1. clinical related factors
  2. restorative material
  3. patient
  4. operator
184
Q

clinical related factors

A

position of the tooth in the mouth or the tooth type directly affects restoration longevity with restorations in premolars showing better performance than those in molars

cavity size, cavity type and the number of restored surfaces are related to the failure risk

multi-surface restorations, extensive cavities, and class II restorations are more likely to fail than single-surface and class 1 restorations

185
Q

restorative material

A

in a comparative amalgam-composite study after 5 years, no differences in performance were found; different composites show different performance

186
Q

patient

A

caries risk; habits (bruxism); social determinants

187
Q

operator

A

it is generally acknowledged that the operator is probably the most important factor in the longevity of a dental restoration

successful and efficient working dentists produce restorations with a higher survival rate than inefficient working providers

they work as accurately as possible, using knowledge and field isolation in their restorative procedures which result in fewer operator failures

188
Q

dental dam isolation

A

the dentist is better able to visualize the tooth or teeth; reduces microbial contamination: dentists/dental assistants are protected against infections which can be transmitted by the patient’s saliva

protects the patient: from sawllowing in debris associated with drilling teeth; from irritating chemicals used in dentistry such as those used to disinfect a root canal or the acids to etch teeth to prepare them to be filled with a composite resin filling; from injuring the tongue and cheek from the dental dril;

it helps isolate the tooth from the bacteria in the mouth; when resotring deep caries lesions that are close to the pulp; keep the pulp shielded from bacteria tht live in your motuh

increases operating speed and treatment quality; when using a rubber dam, there isn’t a tongue constantly in the way and it is easier for the dentist to drill with no other distractors in the mouth visible; bonding procedures require control of moisture to be able to perform a satisfactory adhesion to the tooth structure

control the moisture in the area

189
Q

disadvantages of a dental dam

A

require training by the dentists
difficult use for mouth breathers and gaggers
partially erupted teeth
subgingival caries lesions

190
Q

shiny side

A

facing tissues - slide over tissues without irritation

191
Q

dull side

A

facing the tooth - doesn’t reflect light

192
Q

thickness of dental dam

A

0.15-0.3

193
Q

latex dental dams

A

more comfortable / high tactile sensation / good for wearing for a long time

194
Q

winged clamp

A

offers additional retraction of the dam; allows attachment of the sheet to the retainer before placing the retainer to the tooth

195
Q

wingless clamp

A

less bulky and may be used easily in the posterior sectors in patients with particularly thick cheeks

196
Q

non-serrated clamp jaw

A

can be used in most clinical situation; can be used with porcelain crowns; have different angles of the jaw; the angle of the jaw is directed more gingivally for more anchorage; it is called gingivally approaching or deep reaching clamps

197
Q

serrated clamp jaw

A

used for badly decay teeth to gain more anchorage; but is contra-indicated with procelain crown

198
Q

W8A

A

molars: the size of the jaw is compatible with the diameter of a molar

199
Q

2

A

premolars; the size of the jaw is compatible ith the diameter of a premolar

200
Q

212

A

anterior/retractor/butterfly - retract gingival tissue

201
Q

restorative dental materials

A

metals, polymers/resin based, amalgam alloys, ceramics

202
Q

indirect restorative dental materials

A

requires the restoration to be fabricated outside of the mouth using the dental impressions of the prepared tooth

common indirect restorations include: bridges, crowns, veneers, inlays and onlyas

203
Q

direct restorative dental materials

A

the development of dental restorative materials, as well as the restorative techniques, made possible the reconstruction of teeth with small or moderate degrees of destruction directly by inserting dental material into the tooth cavity

common direct dental materials: amalgam, resin composite, glass ionomers, resin-modified glass ionomers (RMGI)

204
Q

non-adhering materials

A

requires mechanical retention

205
Q

adhering materials

A

resin composite, glass ionomers, resin-modified glass ionomers (RMGI) - does not require mechanical retention retention by adhesion

206
Q

glass ionomers

A

retention by chemical adhesion

207
Q

resin composite

A

retention by physicochemical adhesion

208
Q

resin-modified glass ionomers (RMGI)

A

retention by physico and chemical adhesion

209
Q

alloy

A

dental amalgam - mixture of silver, tin, zinc, copper and mercury; mercury is nearly 50% of the mixture

210
Q

amalgam high compressive strength

A

they can withstand the forces of chewing

211
Q

negative of appearance of amalgam

A

can corrode or tarnish over time; this can cause discoloration where the filling meets the tooth

212
Q

glass ionomer cement (GIC)

A

water-based, self-adhesive restorative materials in whcih the filler is a reactive glass called fluoroaluminosilicate glass and the matrix is polymer or copolymer of carboxylic acids

fluoroaluminosilicate glass; polymer or copolymer of carboxylic acids; self cured

213
Q

setting reaction of glass ionomer cement

A

the setting reaction involves an acid-base ionic reaction that takes 24 hours - retention by chemical adhesion

214
Q

when is glass ionomer cement (GIC) used

A

they are used as filling materials in clinical situations when isolation is a problem and fluoride release is desirable for the patient

215
Q

two types of main types of glass ionomers

A

conventional glass ionomer

resin-modified glass ionomer

216
Q

resin-modified glass ionomers (RMGI)

A

created to increase the working time and have a qick setting time so that immediate finishing can take place; essential components are similar to those in conventional; methacrylate (resin component) added; the resin-modified glass ionomers contain some methacrylate components common in resin composites; the physical and mechanical properties of GIs are lower than that of composite resins and hence these materials are indicated for conservative restoration

217
Q

resin composite

A
  1. organic polymer matrix (several monomers)
  2. inorganic filter particles consisting of particulates such as glass, quartz, and/or fused silica
  3. initiator-accelerator system for free radical polymerization
  4. coupling agent usually an organo-silane, that chemically bonds the reinforcing filler to the resin matrix
  5. stabilizers for maximizing the storage stability of the uncured resin composite and the chemical stability of the cured resin composite
218
Q

resin composite components

A
  1. organic polymer matrix
  2. inorganic filler particles
  3. initiator-accelerator system
  4. coupling agent

the organic polymer matrix in most commercial composites today is a cross-linked matrix of dimethacrylate monomers

219
Q

BisGMA

A

dental monomer - bisphenol A -glycidyl methacrylate 1956 by Dr. Bowen; bulky, difunctional monomer has a large molecular size and chemical structure, providing lower lower volatility, lower polymerization shrinkage, more rapid hardening, and production of stronger and stiffer resins

220
Q

main dental monomers

A

TEGDMA, UDMA

double bonds at each end of these molecules undergo addition polymerization by free-radical initiation; this results in a greater molecular weight and increased strength and rigidity

221
Q

dimethacrylate-based resin applications

A

used as adhesives, pit-and-fissure sealants and can be combined with silane-coated glass fillers to render the most widely used esthetic direct restorative material, composites, as well as cementation agents and veneering materials

222
Q

resin component of a cured dental resin composite

A

polymetric matrix

223
Q

filler component of a cured dental resin composite

A

a set of inorganic fillers

224
Q

polymers

A

large molecule built up by repetitive bonding together of many smaller units called monomers

225
Q

polymerization

A

the process by which monomers are joined together and coverted into polymers

occurs through the carbon-carbon double bonds of the two methacrylate groups

226
Q

cross-linked

A

improves strenght

227
Q

monomers used in dentistry

A

are generally liquids and during the process of polymerization they become converted to solid; the extent to which monomer is changed into polymer is termed the degree of conversion

228
Q

degree of conversion

A

The DC (%) was calculated from the ratio between C=C bond obtained from the cured and uncured specimens

The DC of conventional dnetal composites lies in the range of 50 and 60% and depends on several factors, such as the organic and inorganic components, specimen geometry, amount and type of photoinitiator, and light energy delivered for conversion

increasing degree of polymerization correlates with higher mechanical strength

229
Q

what makes the polymerization start?

A

initiator-accelerator system

230
Q

photo initiator-accelerator system

A

introduction of UV lightcuring resulting in command-setting resins; with the UV system, fractured anterior teeth could be rebuilt quite esthetically and conveniently, unlike with the previous chemically-setting resins; these UV resins remained popular for a number of years, until the introduction of visible light-curing composite resins in about 1978; the visible lightcuring resins offered the advantages of no UV hazards, faster setting times and better color stability

one part contains an organic amine accelerator and the other part contains a peroxide initiator

231
Q

components responsible for initiator, propagation of polymerization

A

photosensitizier camphorquinone (CQ)

initiator-amine dimethylaminoethylmet ihacrylate (4E)

232
Q

fillers

A

make up a major portion by volume or weight of the composite; the function of the filler is to reinforce the resin matrix, provide the appropriate degree of translucency, and control the volume shrinkage of the composite during polymerization

233
Q

filler types

A

glass, quartz, barium silicate, colloidal silica, zirconium silicate

234
Q

filler function

A

to reinforce matrix, provide translucency, control volumetric shrinkage

235
Q

macrofill composites

A

75-80% filler by weight; relatively large sized particles (20-30 microns), rough surface that wears quickly, opaque; not much application today

236
Q

microfill composites

A

colloidal silica particles of very small size; not as heavily filled (35-60% wt) but highly polishable; very wear resistant but relatively poor wear in functional areas

237
Q

hybrid composites

A

high filler load (77-84% by wt.); a mixture of small (2-4 microns) and very small (5-15%, 0.04-0.2 microns) particles; good handling, relatively smooth surface but become rough with time, good wear resistance and mechanical properties, suitable for stress-bearing applications

238
Q

flowable composites

A

lower filler content (42-53% by volume), lower strenght and wear resistance, high polymerization shrinkage, low MOE, easy to use, favorable wettability

239
Q

dental etching agents

A

acidic solutions/gels to prepare the dental surface for adhesion

240
Q

dental primers

A

are composed of a low viscosity resin and they are applied to obtain wetting of the surface prior adhesive application

241
Q

dental adhesives

A

presents unfilled light-polymerisable resin of similar composition as the resin matrix of the resin composite material

242
Q

adhesion

A

the joining together of two independent surfaces for which contact is maintained without the aid of external forces; result from the formation of primary chemical bonds

243
Q

physical adherence

A

mechanical interlocking between adhesive and the material surface roughness (mechanical adhesions)

244
Q

chemical adherence

A

chemical interaction between the adhesive and the material

245
Q

interfacial molecular contact

A

a necessary first step in the formation of strong and stable adhesive joints

246
Q

“wetting out”

A

for optimum adhesion, an adhesive must thouroughly “wet out” the surface to be bonded

wet out means the adhesive flows and covers a surface to maximize the contact area and the attractive forces between the adhesive and bonding surface

247
Q

the more surface wets/spreads out

A

the smaller the contact angle

248
Q

why do surfaces have high energy

A

because molecules present at the surface have unsatisfied bonds

249
Q

what do contaminants/oxgen/ water do to energy at surface

A

decrease their energy

250
Q

approaches to raise the energy of a substrate surface and enhance adhesion

A

surface treatments have been used to raise the substrate surface energy; etching with mild or strong acids; cleaning by pumice or prophylactic pastes to remove the contaminants

251
Q

what does etching do to the surface energy

A

double the orginal surface energy; enlarge the surface area available for bonding

35-37.5% phosphoric acid per 15 s.

252
Q

good conditions for bonding

A

clean substrate
high surface energy
low contact angle
high wettability

253
Q

poor conditions for bonding

A

contaminated substrate
low surface energy
high contact angle
low wettability

254
Q

what else does etching with 35-37.5% phosphoric acid do

A

removes mineral

creates enamel microporosites

255
Q

mechanisms of mechanical interlocking

A

mechanical interlocking occurs when adhesive flows into microporous at enamel surface or around projections on the surface

256
Q

mechanisms of chemical interaction

A

adhesive molecules absorb onto a solid surface and bonds to it

257
Q

are adhesives hydrophobic or hydrophilic

A

hydrophobic

water hating/resin loving

258
Q

dental primers

A

agents for perparing the dental surface with enhanced hydrophilicity

259
Q

smear layer

A

when enamel or dentin is cut, the surface becomes covered by an adherent layer of cutting debris called the smear layer; smear layers are created on hard tissues whenever they are cut with hand or rotary instruments; its composition presumably reflects the composition of the underlying dentin

it interferes with attempts to bond dental material directly to dentin

if it is removed, the dentin becomes much more permeable and fluid shifts across the open tubules

260
Q

role of water in mechanical interlocking

A

maintains the collagen in a soft state; mash of collagen fibrils remains in its anatomical position

if the dentin is excessively dried after rinsing the etching agent, the water content will be evaporated and collagen fibrils will collapse, closing the interfibrillar spaces where the adhesive should occupy

if the dentin is excessively wet after rinse the etching agent, the water content will interfere with a hydrophobic adhesives, leading to poor bonding

261
Q

how to achieve durable bonds between tooth dental hard tissues and directly applied resin composites

A

a separate polymerization of the adhesive is routinely performed

regarding the duration of the separate light-curing step, manufacturers normally recommend a 10-second period

262
Q

hybrid layer formation or hybridization

A

zone where the adhesive micromechanically interlocks with the intertubular dentin and collagen fibrils

263
Q

dentin bond strength is proportional to____

A

the interlocking between adhesive and collagen as well as to the quality of the hybrid layer

264
Q

a restorative material properly joined to the tooth substrate is able to

A

provide an improved marginal seal while reducing marginal contraction gaps reducing marginal staining, reducing caries, improving restoration retention from a durable interfacial adhesion between tooth and biomaterial

265
Q

a suitable dental adhesion or binding, biomechanically,

A

reinforces tooth structure, and biologically, it preserves tissues, seals dentin tubules and provides long-term functional success

266
Q

operator

A

more important than all

267
Q

bonding

A

more important than the restorative materials

268
Q

what is the photo activation effect based on

A

interaction of photoinitatior, light, monomers

operative (2 decks)

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