Final Revision Flashcards
(120 cards)
SOS
What types of splits do you know? (+explain)
1.soft splints (Made of silicone – Ideally not to be used in severe bruxists as they may wear through it)
2.hard splints: for reversible treatment (Made of acrylic - Ideal option in severe bruxists bruxists bruxists)
-full coverage: design of choice
ex: michigan (upper jaw) /tanner (lower jaw)
-anterior repositioning splint
or
-partial coverage: allow overeruption of non-covered teeth (Should be avoided as teeth may move and overerupt if worn long)
ex: anterior or posterior
they are avoided
ADV Vs DISADV of Soft splints:
ADV:
- for emergencies such as restriction of mouth opening and taking recording compromised so there’s pain
- cheap
- little equipment needed to get it done
- made from a single alginate impression and its resultant cast with no occlusal record
- protective device
DISADV:
- soft is easily chewable so not good at all for bruxists (can make it worse) and increased pain of masticatory muscles due to working harder - (Made of silicone – Ideally not to be used in severe bruxists as they may wear through it)
- can wear down quicker and may need replacement
SOS
What is the role of splints?
- check patient if in RCP
- test if increase in OVD
- treat TMD patients where the pain is of muscle origin
- prevent toothwear before and after restorative care
- check if pts can wear partial dentures, overdentures or onlay dentures
- pt achieves mutually protected occlusion: ICP=RCP
- protect the teeth or prostheses its covering
How long are the splints worn?
- usually at night time but also can be worn all the time
- worn until the pain is relieved, until the tooth wear is addressed by restorative dentistry or until the pt is in an RCP
- can reduce the time they wear it once stress is reduced
Fabrication technique:
- take alginate impressions and mount in RCP on a semi adjustable articulator maybe using Lucia jig. then open the incisal pin on the articulator to allow 2-3 mm clearance on the posterior teeth
- mark the outline of the splint on the cast so that the buccal covers incisal edges and cusp tips of posterior by 2 mm, where as palatal doesn’t cover the whole palate (1 mm)
- wax up the splint to give max even occlusion in ICP
- add canine ramps to give disclusion of all other teeth in lateral movement (posterior not in occlusion in this movement)
- posterior disclusion in protrusion with as many anterior teeth in occlusion as possible
- waxed cast is flasked, packed
- is needed add denture anterior teeth if absent
- a heat cure clear acrylic splint is made
How to check if patient wears the splint?
- lightly blast the occluding surface with 25micron Al2O3 to allow easy marking when checking occlusion in mouth
- leave lightly blasted when pt is dismissed to check working and non-working side interferences in function
- if these areas show as polished when they return: they have worn it, if not then they haven’t had it in
TMJ =
articulation b/w condyle of mandible and squamous portion of temporal bone
SOS
which muscles are involved in the elevation of the mandible?
Medial Pterygoid
Masseter (most powerful)
Temporalis
SOS
which muscles are involved in the depression of the mandible?
Lateral pterygoid (inferior head)
Syprahyoids – digastric, geniohyoid, mylohyoid, stylohyoid
Infrahyoids – sternothyroid, sternohyoid, omohyoid & thyrohyoid
SOS
which muscles are involved in the protrussion of the mandible?
Inferior head of lateral pterygoid
Superficial layer of masseter
Medial pterygoid
SOS
which muscles are involved in the retrusion of the mandible?
Superior head of lateral pterygoid
Deep layer of masseter
Posterior portion of temporalis
SOS
TMJ Dysfunction/Myofascial pain:
Joint associated Problems Vs Muscular Problems:
Joint associated Problems:
- Pain localized to joint (easy to detect)
- Joint noises
- Abnormal/limitation of movement due to internal derangements
Muscular Problems:
- Poorly localized/diffuse pain (not easy to detect))
- No joint noises
- Abnormal/limitation of movement due to muscles
SOS
Aetiology of TMD/ Myofascial pain:
Joint overloading Malocclusion / alteration of occlusion Arthritis Psychological factors Multifactorial Trauma Parafunctional habits
Extend and severity of symptoms UNRELATED to aetiology
SOS
What would be the ideal treatment for a TMD patient?
- Reassurance and Explanation - Counselling alone reduces symptoms
- Conservative management (soft diet, jaw rest, cut food into smaller size)
- Physical therapy (exercises, head, acupuncture, OCCLUSAL THERAPY)
- Cognitive Behavioral Therapy (can help you manage your problems by changing the way you think and behave)
- Medications (NSAIDs, Anti-depressants, Botox) -ibuprofen
- Surgical management
SOS
Enamel fracture:
=
Clinical Finding:
Treatment:
= uncomplicated crown fracture
-Clinical Finding:
loss of enamel with loss of tooth structure, dentin not exposed, no tenderness, no vitality lost
-no sensitivity
-Treatment:
if visible fragment then bond to tooth or contouring of restoration with composite resin depending on the extent and location of fracture
SOS
Enamel – dentin fracture:
Clinical Finding:
Treatment:
-Clinical Finding:
A fracture confined to enamel and dentin with loss of tooth structure, but not exposing the pulp, positive sensibility test
-Treatment:
if visible fragment then bond to tooth or contouring of restoration with composite resin
=> if exposed dentin is w/in 0.5 mm of the pulp, place CAOH base as a liner (on top of the pulp)
-test if there is any pulp involvement; there might be irritation
SOS
Enamel - dentine - pulp fracture:
Clinical Finding:
Treatment:
-Clinical Finding:
A fracture involving enamel and dentin with loss of tooth structure and exposure of the pulp sensitive to stimuli
-Treatment:
CaOH placed on pulp, RCT/pulp capping/pulptomy
=>if visible tooth fragment bond it to the tooth
=>future treatment: crown
SOS
Concussion:
=
Treatment:
=An injury to the tooth - supporting structures without abnormal loosening or displacement of the tooth, but with marked pain to percussion
-tender to touch or tapping
-Treatment: NO
monitor pulpal condition for at least one year
SOS
Subluxation (loosening):
=
Clinical Finding:
Treatment:
= An injury to the tooth - supporting structures resulting in increased mobility, but w/o displacement of the tooth
-Clinical Finding:
tender to touch or tapping
bleeding
-Treatment: NO
flexible splint to stabilize the tooth for patient comfort for 2w
SOS
Extrusion:
=
Clinical Finding:
Treatment:
= Partial displacement of the tooth out of its socket
-Clinical Finding:
elongated, excessive mobile, negative sensibility tests
-Treatment:
reposition tooth by gently reinserting it into socket, stabilize it for 2w, RCT
SOS
Lateral luxation:
=
Clinical Finding:
Treatment:
= Displacement of the tooth in a direction other than axially. Displacement is accompanied by comminution or fracture of either the labial or the palatal/lingual alveolar bone
-Clinical Finding:
displaced in P/L direction, immobile, high metallic (ankylotic) sound on percussion, fracture of alveolar process and loss of vitality
-Treatment:
reposition it with fingers or forceps in original position, stabilize it for 4w using flexible splint, monitor pulpal condition, RCT
SOS
Intrusion (central dislocation):
=
Clinical Finding:
Treatment:
=Axial displacement of the tooth into the alveolar bone. This injury is accompanied by comminution or fracture of the alveolar socket
-Clinical Finding:
immobile, high metallic (ankylotic) sound on percussion, negative sensibility test
Treatment:
allow eruption w/o intervention if it is intruded less than 3 mm, if no movement after 2-4w reposition surgically or orthodontically before ankylosis develops
=>if tooth intruded 3-7 mm reposition surgically or orthodontically
=>if tooth intruded beyond 7 mm reposition surgically
=>pulp will become necrotic in teeth with complete root formation, RCT using temporary filling with CaOH 2-3w after repositioning
=>once intruded tooth has been repositioned surgically/orthodontically, stabilize with a flexible splint for 4w
SOS
Avulsion (exarticulation) and its treatment:
=The tooth is completely displaced out of its socket
-pick it, lick it, stick it (NOT with primary teeth b/c it will lead to ankylosis which will cause problem with permanent teeth later on)
SOS
What are the problems with dentine pins?
- cause stress in the dentine leading to micro cracks (weaken the tooth further), which in turn cause microleakage, then caries. this causes failure of restoration
- do not bond with amalgam alloys or composite
- don’t fill the whole prep depth so a space will be left and bacteria can accumulate