MA 1 Flashcards

(43 cards)

1
Q

1-Which of the following statements is true regarding the choice between doing a composite or amalgam restorations?

2-In comparison to amalgam restorations, composite restorations are:

3-Inter-rate reliability

4-research papers

5-performance of dental restorations

A

1-composite= more conservative

2-more technique sensitive but are more esthetically appealing

3-amt of agreement among raters, if high agreement= good

4-dont always describe calibration process

5-influenced by material used, level of experience, type of tooth, tooths position in arch, restorations design, restorations size, # of restored surfaces
—-#of surfaces restored & risk factor may influence the longevity of restoration

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2
Q

4-bleeding gums

5-sweet sensitivity

6-joint plain

7-slight dry mouth

A

4-gingivitis so restore gingival health

5-caries, so remove and restore

6-muscle sprain/TMD—relieve muscle discomfort

7-possible allergy induced—eval in the off allergy season & after use of biotene

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3
Q

1-bite block

2-night guard

3-constant contraindication of composite

4-restoration of appropriate proximal contact in all of the following but

A

1-child or regular adult—opening of mouth can be significant

2-bruxing appliance…splint—approx 2-3 mm in thickness

3-inability to isolate

4-inc retention form for restoration

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4
Q

1-Composite Indication

A

1- bonded composite= retained to tooth & strengthens unprepped tooth

  • shrinkage from poly = stress
  • incremental curing= max composite curing & min shrinkage
  • wedge for proximal
  • composite= bonded so prep= conservative, bulk isnt critical
  • prep=unique, so findings directed towards final prep
  • composite= insulative so doesnt need much protection w/ bases as other materials may
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5
Q

1-counterindications comp

2-indications comp

3-advantages

4-disadv

A

1-isolation= inadequare

  • restorations onto root (cementum binding is poor)
  • heavy occlusal stresses
  • denture clasps engage composite material

2-small, moderate restorations w/ enamel margin

  • esthetics considered for premolar/1st molar
  • w/o heavy occlusal contact
  • appropriate isolation
  • build ups prior to future crowns

3-esthetics, conservative remocal, less complex prep, benefits of bonding (dec microleakage, strengthen tooth)

4-wear/shrinkage, more time for placement, more technique sensitive than allow etching, bonding & curing, more expensive than allow restorations

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6
Q

1-automatrix band system

2-sectional matrix systems

3-conical light tips

4-max thickness of a composite incrememnt

A

1-circumferential system (tofflemire)

2-composi-tight—garrison

3-translumination tips—inesrted into composite while curing, push composite proximally to help create contact

4-1-2 mm

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7
Q

1-single tooth indirect restorations

2-crowns

3-restorative dentistry

4-indirect restorations via crown fabrications

A

1-artificial replacement that restores missing tooth structure by surrounding part or all of the remaining structure w/ a material such as cast metals, porcelain or a combo of materials

2-restorations that fully or partially cover the tooth. “caps”
-indirect restorations because they are fabricated outside of the oral cavity

3-art & science of proper tooth form, function & esthetics while maintaining the physiologic integrity of the teeth
—but the restorative needs cant always be met w/ the use of direct restorative materials/techniques which is why indirect is commonly used

4-allows us to fabricate a restoration that meets the functional/esthetic needs of the patient through a combination of the preparation design, restorative materials & improve the strength/esthetics of compromised teeth.

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8
Q

1- not crown treatment plans

2-your job

3-emptor decernit

4-medical history

A

1-only patient care treatment plans that may include crowns

2-Find out the chief complaint/what the patient wants before making a treatment plan

  • —your job is to correlate your finding w/ your patients chief complaint in order to determine the appropriate treatment plan
  • –don’t make treatment plan decisions based on clinical impressions w/o clarifications from your patient

3-customer is always right….we, as dentists, need to provide quality patient care while also satisfying our customers

4-the need to correlate the dental treatment plan w/ the overall health status of the patient

i. e.= cardiovascular disease, diabetes mellitus, oncologic disease, pulmonary disease, & surgical hx
- medication list, h/o allergies to medications, recreational drug use, tobacco product use
- –usually controlled medical conditions aren’t typically contradicted to restorative treatment

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9
Q

1-dental history

2-dental examination

3-range of mandibular motion-opening

4-range of mand. motion-protrusive

4-range of mand. motion- lateral

A

1-the need to correlate the dental treatment plan w/ overall dental health care history as expressed by the patient
—dental care, periodontal disease, pulpal disease, & of caries

2-the need to correlate the treatment plan w/ your examination findings—head & neck exam, oral & oropharyngeal exam, exam of dentition & supporting structures

3-opening

  • 15-20 mm of hinge opening
  • 25-40 mm if translational opening
  • 40-60 mm is normal maximal opening of an adult

4-protrusive
-8-11 mm

5–10-12 mm of max lateral translational movement in the frontal plane

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10
Q

1-lesion detection

2-restorative treatments indicated

3-material selection

4-composite

A

1-visual= cavitated & non cavitated
radiographic= E lesion, D1, & D2
transillumination- fiber optic (FOTI), operatory light

2-poor contour

  • caries under/around restorations
  • unaesthetic restorations

3-resin-esthetics—bonds to tooth structure, good wear resistance
RMGI-not as esthetic, bonds to tooth, lower wear resistance, Fl release

4-inorganic filler= quartz, silica, & glasses
coupling agent- silane
resin matrix- BIS GMA, UDMA
initiator= camphoroquinone (light activatior

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11
Q

1-inorganic filler

2-microfine fillers

3-radiopaque

4-not radiopaque

A

1-qurtz, lithium, aluminum, silicate, barium, strontium, zinc, ytterbium glasses = fine filler

2-colloidal silical particles

3-barium, strontium, zinc or yetterbium
—degree of radiopacity is proportional to the volume of the filler

4-quartz, lithium, and aluminum

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12
Q

1-macrofil

2-microfil

3-nanofil

4-hybrid

5-properties of composite

6-coefficient of thermal expansion

A

1-10-100 um

2-.01-.1 um

3-.005-.1 um

4- .4-1 um (small particle & microfill)
—nano hybrid= .005-.1 (tetric evo ceram)

5-poly shrinkage (caused by resin)
-gap formation in dentin margin—minimize by increment placement & curing in between
-wear resistance—infleunced by filler particle size/location/occlusion
-modulus of elasticity—stiffness, high module= stiff
microfill has lower module of elasticity than hybrid

6-dimensional change per unit change in temp
composite= 1-4 x’s coeff of thermal
Glass ionomer coefficient= same as tooth (better)

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13
Q

1-hybrid composite

2-microfil composite

3-microhybrid

4-nanofil

A

1-microfil + small particle

  • inorganic filler content= 75-90% weight 60-80% vol
  • surface = smooth patina surface texture
  • improved mechanical properties

2-smooth, lustrous surface

  • wear resistant/ less receptive to plaque
  • filler content= 35-70% weight 20-60% vol
  • mechanical= inferior, graeter poly shrinkage, more thermal expansion, low H20 sorption, low modulus of elasticity
  • cervical lesions, flexure nder occlusal forces
  • layered over hybrid

3-fine & microfine particles
85% by weight

4-80% by weight, high filler content
-highly polishable…& most popular compousre in use

***hybrid= good immediate & 12 mo color match
nano & microfilm= best surface appearance after 12 mo

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14
Q

1-classification of handling characteristics

2-flowable

3-packable

4-shade selection

5-lingual approach for prep

6-facial approach for prep

A

1-flowable & packable

2-low viscosity, .4-3 nanometers

  • 30-55% vol w/ low modulus of elasticity
  • high poly shrinkage
  • low wear resistance
  • cervical lesions & pediatric restorations
  • low stress bearing restorations & liners under hybrid

3-high viscosity, 50-70% by vol

  • low wear resistance (like enamel)
  • posterior & proximal restorations…like handling of amalgam but may be more difficult to adapt to margins

4-prior to rubber damn bc dehydration= lighter tooth color

  • composite changes color after polymerization
  • –natural light, upright, no distracting makeup

5-lingual= preferred, conserves facial enamel…some unssupported, not friable enamel can remain
-additional enamel for bonding & shade selection isnt critical

6-lesion is facial, teeth are irregularly aligned & if facial access conserves teeth

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15
Q

1-access to prep

2-pulpal protection

3-pulpal exposure

A

1-direct bur towards lesion, perp to enamel surface

  • entry angle puts bur as far into embrasure
  • outline form to include peripheral exten, some undermined enamel is okay
  • should not include prox contact area, or extend onto facial surface & sub gingival

2-small to moderate—no liner, bonding agent will seal dentin

3-direct cap, CAOH2, GI/RMGI linger bonding agent
composite
pink dentin= little RDT= indirect pulp cap, liner over pink area, DONT PUT LINER ON FACIAL SURFACE

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16
Q

1-bond enamel, not dentin

2-contraindications of bevel

3-large lesions

4-adjacent lesion prep

A

1-bc enamel has less h20 content & is highly mineralized

  • greater H20 content, more organic & differences w/in dentin
  • enamel & strength greater

2-dont remove prox contact

  • lingual bevel not placed in heavy occlusal area
  • margins apical to CEJ, w/ no enamel or little remaining enamel
  • facial approach= same as lingual

3-retention pt can be placed at axioincisal
retention groove= axiocervical line angles in dentin if needed

4-PREP large surfaces first & then small but
restore small surfaces first & then large

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17
Q

1-restoration

A

1-mylar matrix for anterior composite

  • confines restorative material, reduces excess material, assists w/ contours & protects adjacent tooth
  • interproximal wedge= provents overhang
  • etch—remove smear layer, open dentin tubulues, demineralizes dentin, leaving collagen
  • dentin= moist for bonding
  • bonding agent applied w/ agitation, light cured & hybrid layer formed
  • incremental placement of composite= 2.0 (complete curing= less poly shrinkage & less gap formation= less micro leakage)
  • gap formation & microleakage = greatest at margins w/ no enamel (cervical, apical to CEJ)
  • stress from poly shrinkage exceeds bond strenght= gap formation
  • immediate gap= white line margin
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18
Q

1-finishing & polishing

A

1-scalar for excess at gingival margin
30 fluted for gross reduction
points for concave areas
-interproximal strips can cause damage to tissue & gingival

  • polishing done w/ abrasive pt or disc rotation from composite to tooth
  • enhance pt
  • brasler (green white)
  • abrasive disc—-not usefule for concave, used to shape proximal line angle…but can damage tissue
  • final polishing= silicone carbide brush
19
Q

1-quality of image

2-radiographs your using

3-looking at radiographs

4-identifying radiographs

5-systematic process

A

1-contrast/density
region of interest
normal tissue that surrounds
geometric distortion

2-periapical, bitewing, occlusal, panoramic, CBCT

3-room should be dimly lit

  • bright view box
  • mask extra light
  • use magnifying glass

4-look at normal anatomy and see variations
pathology

5-anatomical landmarks
normal anatomy: bones, canals, foramina, cortices
-look at radiographs in order through quadrants (upper right to lower left)
-symmetry

20
Q

1-when looking at quadrants, checking for

2-checking height of interdental bone

3-checking teeth

A

1-normal

  • symmetry
  • sparse
  • dense
  • in direction of anatomical stress
  • altered

2–can use Bitewings (alveolar bone heights)
cortication, bone height and shape of alveolar crest

3-count, check enamel/dentin/pulp

  • count roots
  • compare anatomy
  • check existing restorations
21
Q

analyzing intraosseous lesions

1-localize abnormality

2-periphery

3-shape

4-size

A

1-look at anatomic position (epicenter)—
above mandibular canal= odontogenic
below mandibular canal= unlikely odontogenic
w/in mandibular canal= vascular or neural
epicenter of lesion= in sinus, not odontogenic in origin
-cartilaginous lesions are found nearer to condyle

-is it localized or generalized/ unilateral bilateral

2-well defined= punched out/corticated or sclerotic
ill defined= blended appearance & invasive

3-oval/circular
scalloped borders
multiocular

4-measure lesion in 2 dimensions= width & height
-surrounding structures to help estimate measurement

22
Q

1-analyze internal structures

2-analyze effect of lesions on structures

A

1-totally radiolucent
mixed lucen opaque
totally radiopaque

2-teeth, lamina dura, perio membrane space
iferior alveolar nerve canal/mental foramen
maxillary antrum
surrounding bone density & trabecular pattern
outer cortical bone & periosteal reactions
—displaced teeth, root resorption, expansion, perforation & destroy

23
Q

1-pediatric dentistry

2-individual levels

3-prevention

4-disease management

5-access to dental care services

6-systems of integration & coordination

A

1-age degined speciality that provides primary & comprehensive preventative & therapeutic oral health care for infants & children through adolescence, including those w/ special needs

2-observe, assess, detect, diagnose, educate, motivate, prevent, treat, manage/recall, re-assess, fine tune, learn from errors

3-fluoride, reduction of bacteria that cause toot decay, & education/anticipatroy guidance for parents & caregivers:
quality improvement markers for 0-6, 6-12, & 13-18 age groups

4-risk assessment for tooth decay & spectrum of dental treatment: acct for lag time b/w diagnosis to treatment

5-age 1 dental visit, dental home, & dental workforce/professional development
-age 1 & other dental marker visits

6-parternership w/ health & childcare providers
state & local dental public health programs
policy development
-w/ medical record

24
Q

1-considerations in pediatric dentistry

2-baby bottle

3-initial dental visit

4-early childhood caries

A

1-child isnt a small adult

  • modes of managing child patient are age related
  • consider fluorides, pulpal therapy, instrumentation, dental materials oral surgery, ortho, nutrition, growth/development, oral medicine & path

2-infants dont go to sleep w/ bottle & nocturnal breast feeding be restricted after eruption of 1st primary tooth

3-w/in 6 mo of age after eruption of 1st tooth but before 12 mo of age

40baby bottle tooth decay/nursing bottle caries

  • 1 decayed/filled tooth surface of primary tooth in kid under 6
  • severe ecc= cavitated or non cavitated smooth surface caries in kid under 13
  • b/w 3-5 severe ECC+ 1 or more cavitated missing or filled smooth surface in primary maxillary ant teeth or dmf greater than 4(age 3) 5(age 4) 6(age 5)
25
1-transmission of s mutans in kids 2-behavioral changes w/ kids 3-basics in managing child patients 4-critical moments in appt
1-vertical= mom---direct via saliva & kissing child -indirect via spoons/pacifiers -reduced w/ various techniques horizontal= nursery/preschool 2-emotionally compormised bc of home environment - shy ---cry to avoid - frightened---negative light - averse to authority 3-short appts...tell, show, do voice control praise/communication start w/ easy procedure 4-separation from parent getting into chair the injection
26
1-primary molars 2-mandibular primary molar root 3-mandibular primary first molar 4-mand primary 2nd molar 5-max prim 1st molar 6-max prim 2nd molar
1-smaller, narrow oclusal table greater buccal lingual width @ cervical -enamel + dentin thinner, w/ bigger pulp horns (long, thin horns...follow cuspal outline) -not as extensive preps 2-primary roots flare out mesial-distally= for bicuspid to erupt perm. molar roots= straight 3-mesial surface= straight, distal surface converges towards cervical line 4 cusps, 2 buccal (developmental depression) no dev. groove in between...mesial cusp= larger -prominent transverse ridge 4-resembles 1 perm molar 5-bucall convexity at cervical third 2 cusps, = perm max premolar 6-resemebles max 1st perm molar 4 cusps w/ buccal developmental groove, maybe carabelli lingual groove= present ML cusp is largest
27
1-material choices for pedo 2-goals of prep designs 3-burr selection
1-GI/compomer= for higher caries rate amalgam= difficult w/ isolate/cooperation composite stainless steel crowns= higher caries rate/durability RMGI= bonds to tooth, wears more, technique sensitive, releases fluoride not as long lasting 2-access to caries, smooth surface or pit/fissure -modify by anatomical differences resistance & retention---holds materials 3-smaller = better bc teeth/preps are smaller 1.5-1.8 long, .75 mm wide----330 rounded internal line angles & removes friable enamel rods
28
1-considerations w/ proximal box tooth diameter 2-occlusal key
1-buccal lingual walls of prox box are parallel to external tooth surfaces buccolingual diameter of occlusal surface is less than cervical diameter -proximal extensions are wider at gingival -converge at occlusal -establish box outline into cleansbale areas w/ rounded axial pulpal lines to reduce stress on dental material -internal line angles are rounded -reverse s not required bc contacts are mid proximally 2-small occulsal key into prep---mainly w/ amalgam mechanical lock, unlike regular rententive grooces -less chance of pulpal exposure -bur into enamel beyond axial wal to get dovetail facially & lingually, dept= 1.25-1.5 mm -bevel axiopulpal line angle
29
1-if gingival wall is over extended... 2-dilemma of large pulps in primary teeth
1-obtaining adequate axial wall depth w/o endangering pulp is difficult 2-extensive caries axially/gingivally compromises pulpal health wen preps are extended \*\*\*Dont give xylitol candy til anesthetic wears off
30
1-crowns 2-dental exam 3-crown preop 4-foundation failure
1-form, function, esthetics crowns= inc demand for tooth restoration 2-head & neck exam (symmetry) oral & oropharayngeal exam (symmetry) -path, pulpal disease, caries, perio, fractures -make cast put together= treatment plan 3-perio health, pulpal health, condition of tooth 4-common source of crown failure and tooth loss= our failure if not diagnosed initially. ANY COMPROMISED IN FOUNDATION OF TOOTH NEED TO BE ADDRESSED BEFORE CROWN FABRICATION.
31
1-perio considerations 2-crown fabrication goals 3-soft tissue
1-perio disease= cyclical inflamm host response to bacteria= tooth los - cant proceed w/ treatment w/ crown fabrication w/ tooth which has chronic perio disease - treat via oral home care, scaling/root planing, or extraction 2-good period health before crowning, make crown that maintains perio health & needs ---need patient compliance 3-affects crown design & where crown margins are put---margins put too deeply into sulcus = elicit adverse perio tissue response ...assess biolgical width (CT & junctional epithelium) healthy sulcus= 1-3 mm bio width= 2 mm if affect bio width= inflam, attachment loss, alveolar bone loss
32
1-gingival sulcus 2-managing sub gingival margins 3-crown lengthening 4-benefits for crown lengthing
1-avoid placing crown margins at base of gingival sulcus - supra gingival crown margins better than sub gingival, so place crown margin at or just below the crest of the gingival margin - --no more than 1/2 the depth of the base of the gingival sulcus...use probe to figure it out 2-extensive caries & fracture 3-surgical procedure repositions the attachment in a controlled manner to reestablish a biological width in harmony with our crowns. 4- - Expose more tooth for better crown prep - Permit crown margin placement - Margin placement without violating biological width - Improve crown esthetics
33
1-marginal gaps 2-marginal overhang 3-decrease adaptation discrepancies 4-pulpal considerations
1-space created vertically between the crown margin & the prepped tooth 2-amt the crown margin extends horizontally beyond the tooth 3-good tooth prep design good impression technique quality dental lab work acceptable gap discrepancy= 40-70 um 4-caries removal, conserve tooth structure, good temp control during prep - --incomplete caries removal= tooth damage & pulpal infection - --extensive caries= endo before crown - --restorative can proceed on presence of incomplete removal w/o endo, thin layer of denton overling pulp---pinpoint expousre of pulp and apply CaOH2 to affected area, isolating pulp from infection... - do pulp test before fabrication - if tooth non vital= endo therapy before crown fabrication - conserve as much tooth as possible, remove path - crown prep leads to damage of endoblasts= irreversibly damage to pulp - heat= damage to pulp if you cant treat pulp or periodontiumt he tooth may not be restorable
34
1-viral diseases 2-autoimmune
1-primary herpes recurrent herpes varicella herpes zoster hand-foot-and mouth disease herpangina measles 2-pemphigus vulgaris mucous membrane pemphigoid
35
Primary Herpes
- caused by HSV-1 - top half of body - seronergative host---direct contact w. HSV - 6 mo to 5 yr---not seen before 6 mo bc of moms immunity - 95% affected by 15 - chills, lymphadenopathy, fever, nausea, anorexia - enlarged red painful gingiva - pinhead vesicles, lesions enlarge & develop central ulceration - lip vermillion, satellite vesicles on skin, self-inoculation - treatment= 7-14 days, symptomatic treatment
36
1-Recurrent Herpes (secondary) 2-herpetic whitlow 3-herpes gladiatorum
- caused HSV-1 - 15-45% of US population has history - multiple trigger reactivation---stress, UV, illness (occurs at primary inocculation) - Pain, burning, itching, tingling, warmth, redness\> 6-24 hrs \> clusters of fluid filled vesicles \> 2 days \> rupture and crust \> 7-10 days \> healing - intraoral lesions= keratinized mucosa, less symptoms - tzanck cell ---multinucleated giant cell---floating epithelial cell - resolves 7-10 days - chronic herpetic infection in immunocompromised hosts - --topical, systemic or prophylaxis therapy: treatment in 48 hrs - no biopsy 2-due to self innoculation 3-scrumpox---wrestlers
37
1-Varicella 2- oral varicella
- varicella zoster virus HHV3 - via salivary droplets or direct contact - 5-9 yrs, 90% infected by age 15 - malaise pharyngitis rhinitis\>Pruritic exanthema, face, trunk, extremities\> vesicle\> pustule \>crust - Lesions in different stages often seen - Perioral lesions, intra-oral lesions - treatment= symptomatic...goes away in a couple of weeks: - Exposure\>heal\> virus goes into latency. When the virus reactivates develops zoster 2-white opaque vesicles which rupture and ulcerate
38
1-herpes zoster 2-hand food & mouth disease
1-reactivation of varicella zoster virus -virus latent in nerves where its protected from immune system -spinal cord segment or nerve hides in dermatome affected in outbreak -more prevalent in elderly -confined to an area, not usually spread, unilateral -face= trigem nerve treatment= antiviral 2-cocksackie A16 or enterovirus 71 -kids under 5 oral lesions precede skin changes -sometimes not all 3 areas are affected but clasically all 3 -oral lesions occur anywhere in mouth, number arises 1-30, vesicles that become ulcers -few to dozen skin lesions...palms & soles, vesicles that ulcerate -treatment---not needed, dont give aspirin to kids bc of reyes disease
39
1-herpangia 2-measles
1-coxsackie A1-6, A8, A10, B3 - similar to HFM but lesions at back of month - history & clinical diagnosis - no treatment since it is self limiting 2-measles virus---paramyxovirus -salivary droplests 9 days: Day 0 = 3 Cs: coryza, cough, conjunctivitis Day 3= fever Day 6-9= fever ends rash fades -kopliks spot= white macules over area of erythema -treatment= prevention, fluids & non sapirin antipyretics
40
1-pemphigus vulgaris 2-mucous membrane pemphigoid
1-little yellow circles: desmoglein 3 keeps cells together so Ab attacking wil end up having cells split - mediterranean & jewish origin - 1:1 gender ratio, adults over 50 - flacid vesicles & bulla which rupture quickly - all patients develop oral diseases - bulla rupture & have large red painful ulcer - nikolskis sign= induction of bulla upon pressure, normal skin & apply pressure that makes bulla, not 100% specific - intraepithelial split= NEED BIPOSY for diagnosis---proteins are gone so cells arent held together - treatment= systemic corticoid, mortality = 60-90% 2-BP180 & laminin 5= diff disease & diff protein attacked, between cells & CT - cicatrical pemphigoid= lots of scarring, not in pemphigoid - older adults: 2:1 women to men - vesicles---\>bullae---\>ulcers - desquamative gingivitis= diffuse gingival erythema - symblepharon= adhesion between bulbar & palpebral conjunctivae - subepithelial split= entire epithelia is detached - treatment= referally to ophthalmologist= topical/systemic corticoids
41
1-direct pulp cap 2-goals of pulp capping 3-indirect pulp cap 4-thermal protection 5-materials for pulp capping
1-vital pulp previously asymptomatic tooth w/ small exposure exposure occurd in a clean uncontaminated environment -hemorrhage is controlled -restoration is well sealed 2-maintain a healthy pulp stimulate dentin bridge formation 3-less than .5 mm remainign dentin thickness 4-under amalgam, reduce effects of thermoconductivity 5-MTA, CaOH, Calcium Silicate, GI/RMGI
42
1-CaOH
1-gold standard, both direct/indirect capping - stimulates dentin formation - antimicrobial - alkaline - poor physical properties---soluble in H20, poor compressive strength, limit placememnt to smallest area as possible, away from margins - powder in solven= thin film of CaOH---Dycal - paste system--base= Ca tunstate and catalyst= CaOH - --mix equal parts of both: 2 min 20 s working time, 2.5-2.5 min setting time - placed on exposure or pink dentin, only on axial or pulpal floor - soluble, must not extend onto margins---wash out of material = open margins, low compressive strength
43
GI/RMGI
1-linear not a pulp -not be used directly over pulp or if RDT is \<.5 -over pulp capping materials...sandwich technique -fluoride release -can be used under amalgan as line for thermal protection closed samich= restorative material at all cavosurface margins open samic= GI/RMGI exposed at cervical margins ---samich used for composite