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key Rx things to learn Flashcards

1
Q

determinants of cavity design

A

structure and properties of dental tissues
diseases
properties of Rx materials

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2
Q

principles of cavity design

A

1 - identify and remove carious E
2 - remove E to identify max extent of lesion at ADJ and smooth E margins
3 - progressively remove peripheral caries in D - from ADJ first and then circumferentially deeper
4 - only then remove caries over pulp
5 - outline form mod: E finishing, occlusion, requirements of Rx material
6 - internal design mod: internal line and point angles, requirements of Rx material

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3
Q

in what instances can you leave a small amount of carious D overlying the pulp?

A

risk of pulpal exposure high
good Rx seal can be achieved
pulp asymptomatic

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4
Q

affected D

A

softened
various levels of demineralised D that is not yet invaded by bacteria
inner carious D (does not require removal)
has sensitivity more pulpally
does not stain acid red with propylene glycol
should be left to remineralise

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5
Q

infected D

A 
outer carious D, bacterial plaque
softened and contaminated with bacteria
highly demineralised, lacks sensation
stains acid red colour with propylene glycol
should be excavated
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6
Q

when to intervene in a lesion

A 
if cavitated
pt can't access it for prevention
aesthetics
causing pulpitis
into D on xray
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7
Q

aims of cutting through E to gain access to carious D

A

1 - gain visual access to carious D requiring removal
2 - remove demineralised and often unsightly carious E
3 - create a sound peripheral E margin to which adhesive Rx can form seal

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8
Q

composite cavity design

A

no US E
no sharp internal LAs
bevel CSMA to increase area for bonding - composites adhere and support E
- so a light bevel increases SA for bonding and removes any US E at cavity edge

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9
Q

2 types of extent of D caries

A

anatomical extent of lesion - peripheral caries to caries overlying pulp at level of ADJ
histological depth of lesion - collagen and mineral content of carious D

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10
Q

peripheral caries and why should you never leave necrotic D at ADJ?

A

prevention of secondary caries entirely dependent on seal between Rx material and tooth at cavity periphery
should never leave necrotic D at ADJ - can’t be adhered to

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11
Q

configuration factor

A

ratio of bonded to unbonded surfaces

high = increased polymerisation contraction stress

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12
Q

contraction stress consequences

A

poor E prep margin
composite dimensional change
etch bond stronger than interstitial E strength
composite will fracture with weak E and D attached

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13
Q

cavity toilet phenomenon

A

cavity will contain loose E and D chippings following prep
wash out mix air, water, CHX
rinse and leave moist

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14
Q

CSMA

A

angle of tooth structure formed by the jct of a prepared (cut) wall and the external surface of a tooth
- jct - CSM

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15
Q

line angle

A

jct of 2 surfaces

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16
Q

point angle

A

jct of 3 surfaces

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17
Q

hybrid layer

A

resin impregnated D layer

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18
Q

5 requirements of occ stability

A

1 - stable contacts on all teeth of equal intensity and centric relation
2 - anterior guidance in harmony with envelope of fct
3 - disclusion of all posterior teeth during mandibular protrusive movement
4 - disclusion of posterior teeth on NWS during mandibular lat movement
- disclusion of posterior teeth on WS during mandibular lat movement

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19
Q

subalveolar fracture makes tooth unrestorable

A

lack of coronal tissue to bond to/support/retain Rx
inability to achieve moisture control for Rx
inability to take imp for indirect Rx
hard to establish marginal integrity
difficulty cleaning

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20
Q

causes of secondary caries

A 
marginal failure of an existing Rx
poor adaptation of Rx material
fracture of US E leaving exposed area
amalgam ditching of margins
failure to remove all of initial lesion
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21
Q

reasons Rx fail

A

poor material selection
- e.g. amalgam and gold Rxs near each other can cause corrosion due to galvanic activity
incorrect cavity rep
material manipulation
oral env
- access, thermal changes, forces, microbes, aq

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22
Q

manifestations from a traumatic occlusion

A 
fracture of Rxs/teeth
mobility
odontogenic pain not from infection
TW
may be associated with TMD
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23
Q

Nayyar core

A

retention obtained from the UCs in the divergent canals and pulp chamber
2-4mm GP removed from canal and replaced with amalgam
immediate placement and coronal prep can be done at same appt

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24
Q

methods for fractured post removal

A 
US
masseran kit
cut out for fibre posts
stieglitz forceps
eggler post remover
sliding hammer
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25
3 types of contact
cusp tip to base of fossa tripod contacts - 3 points on the cusp engage 3 points around the fossa unfavourable contacts - on cuspal inclines (induces unfavourable lateral forces on teeth) - none at all
26
options for immediate anterior tooth replacement
adhesive cantilever with fractured tooth as pontic provisional overdenture provisional post-crown vacuum formed splint w tooth
27
what is cracked tooth syndrome
tooth cracked but nothing has broken off | technically a type of GS fracture
28
S+S of cracked tooth syndrome
``` sharp pain when biting rebound pain when pressure released pain when in occlusion and excursion pain to cold but not to heat eating/drinking sugary not always able to localise to one tooth ```
29
cracked tooth syndrome investigations
tooth sleuth gentian violet/methylene blue stain (2-5 days to work) transillumination radiographs - not v beneficial but good for pulpal and perio
30
cracked tooth syndrome tx
``` composite Rx/bond fixed ortho band round tooth core build up and crown RCT XLA ```
31
why obturate?
seal remaining bacteria provide apical and coronal seal prevent reinfection
32
primary D
laid down during development good for bonding open tubules
33
secondary D
laid down during fct | ok to bond to
34
tertiary D
reactionary due to mild stimuli and reparative due to intense stimuli poor for bonding due to poorly organised/sclerosed tubules
35
transient sensitivity to thermal stimuli and pain on biting after large composite Rx
``` polymerisation contraction stress soggy bottom insufficient coolant on prep uncured resins entering pulp and causing irritation high in occlusion no lining pulp exposure fluid from tubules occupying space under Rx ```
36
debonded post
``` post fracture core fracture root fracture at post level when not attributed to trauma (stress release) untreatable caries traumatic fracture inadequate moisture control furcation perforation (due to D pins) ```
37
fracture at jct of post and core
``` tooth structure loss age induced changes in D biocorrosion of metallic post-core Rxs and restorative procedures loss of free water from RC snd dentinal tubules effects of endo irrigants and medicaments on D bacterial interaction inadequate ferrule trauma - bruxist pt ```
38
criteria before obturating
asymptomatic canal must be able to be dried full biomechanical cleaning
39
composite techniques
flowable at base to reduce contraction stress incremental placement - low CF 2mm or less increments to avoid soggy bottom
40
amalgam cavity
``` UCs for retention other retentive features e.g. lock and key, grooves, dovetail, isthmus >2mm depth for sufficient strength flat occlusal floor CSMA 90 degrees no US enamel ```
41
causes of debonded post
incorrect cement contamination during cementation unfavourable occlusion inadequate or over-tapered post prep
42
detecting debonded bridge
check visually floss probe push on it and check for movement/bubbles may see secondary caries/demineralisation
43
core fractured from post
casting error inadequate ferrule trauma parafct
44
Hanau's quint
used for setting teeth
45
handpiece safety
check backcap secure tug tubing pull bur hard no lat movement/wobbliness of bur smooth and no friction run for 5s - sound
46
why not ledermix for direct pulp cap?
devitalising agent
47
consequences of high polymerisation contraction stress composite and how to avoid
shrinks etch bond is stronger than interstitial E strength - leads to E fracture and failure successive increments touching as few surfaces as possible - note final increments do not join E margins
48
CF
ratio of bonded to unbonded surfaces
49
stepwise
``` remove caries at periphery and ADJ remove infected D if you can give pulp time to repair and lay down D RMGI/GI over caries 6m later re-enter, remove hardened D (caries arrested as good seal), restore ```
50
why place flowable at base?
good adaptation and mediate contraction stresses
51
advantages of composite inlays/onlays
avoids open/poor contacts and poor proximal/occlusal morphology avoids polymerisation contraction and stresses avoids cuspal flexure
52
disadvantages of composite inlays/onlays
more destructive - UCs must be removed/blocked out
53
astringent
ferric sulphate
54
how to differentiate the 2 layers of dentine caries
solution of basic fuchsin
55
if pulp exposed?
caoh
56
if pulp not exposed?
RMGI
57
aims of caries removal
maintain pulp vitality eliminate D infections by removing, deactivating or sealing in bacteria conservation of intact tooth structure
58
should you bevel boxes for amalgam?
no
59
should you probe uncavitated carious E?
no
60
when can you leave a stain?
only if hard to probe - but must remove from ADJ
61
where is tubule density higher?
by pulp
62
composite where should you avoid CSMs?
in areas of occlusal contact
63
removing a Rx
never remove by cutting around the edges - excessively increase size of cavity start from centre of Rx and cut towards edge
64
never remove healthy tooth tissue unless:
material for Rx requires it margins of cavity in contact with another tooth surface margins of cavity cross an occlusal contact
65
which fibres are stimulated in reversible pulpitis?
A fibres
66
which fibres are stimulated in irreversible pulpitis?
C-fibres
67
how do D tubules change as they approach the pulp
they increase in number and diameter | so deeper cavity = increased D permeability

restorative (12 decks)

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