Flashcards in Operative II Deck (113):
After caries risk, describe the 3 Phases of Treatment Prioritization:
Phase I: Emergency infection, pt discomfort, prevention, gingival health, and sealants
Phase II: Simple restorations
Phase III: Complex restorations
What are the 7 Orderly Steps to the approach to restoring Individual Teeth?
Removal of remaining carious dentin
Finish enamel walls/cavosurfaces
Opposing teeth often hit a _______, an area with a lot of function.
(any ridge, really)
What is the junction between an unprepared tooth (normal tooth) and prepped tooth?
A line angle is between 2 walls/floors and a Point Angle is between any 3 walls/floor.
Pits and fissures of occlusal surfaces on Posterior Teeth are ______ cavity preparations.
What class are pits in the occlusal 2/3 of facial and lingual surfaces of molars?
The lingual pits of maxillary incisors in the top 2/3 of the tooth are considered what class?
The proximal surfaces of posterior teeth (premolars and molars) are what class of prep?
The proximal surfaces of anterior teeth not involving the icisal edge are what class of prep?
The proximal surfaces of anterior teeth involving the incisal edge is what class of prep?
The surfaces of all teeth in the gingival 1/3 of facial and lingual surfaces are what class of prep?
The incisal edge of anterior teeth and occlusal cusp tips of posterior teeth are what class of prep?
What is the diameter of an explorer?
1mm in 0.5 mm wide
Round bur #'s:
Inverted cone #:
Round: 1/4, 1/2
Inverted Cone: 33
Straight bur #'s:
End cutting #:
330, 244, 245
Enamel is ___% inorganic, 3% water, and ___% organic
Dentin is ____% inorganic, 20% water, and ___% organic.
Dentin is ___ times softer than Enamel
In the pain response, neuropeptides are released and vasodilation occurs, following by Odontoblastic swelling and closing of the Dentinal Tubule. From here, minor fluid changes distend odontoblasts and create pain.
Pulp is made up of mostly pain fibers
Name 4 causes of Pulpal Inflammation.
Heat (bur friction)
Osmotic changes (sweets)
Bacterial (endotoxin, invasion, etc)
Drilling depths closer than ___ mm affect the pulp more severely.
Where are dentinal tubules smallest?
Coolants are mandatory for Diamond Burs
*abrade, cause subsurface cracks
25-35% of D1 students aren't unsurable
Leaning forward causes 40% increase in pressure on spine
Your neck should be limited to a flexion of ___ degrees.
One reason to use a rubber dam is to reduce humidity when bonding restorations
Endodontic procedures may or may not use a rubber dam
Most dentists dam to the ipsilateral cuspid, but he contralateral cuspid is ideal (and what is used in skoo)
#'s for rubber dam clamps on Molars
Molar: 14, W8
Premolar: 2A, W2
Anterior: 212, 9
You could use a symmetrical clamp for a maxillary molar, but never use ________ for a mandibular molar.
*Lower molars are symmetrical
**Upper molars are asymmetrical
# 2 hole in the punch table is used for ______
#1 hole is used for _____.
The Isolite system is an alternative to a Rubber Dam
Sealants can either be _____ or ______.
Unfilled Resin (Bis-GMA)
Filler in Resin (quartz/silica)
*filler usually less than 50%
Sealants 2 types of cure:
Chemical (auto polymerizing 2 components)
Light cured (20 seconds - held at least 1 mm from tooth)
What % of children 6-19 have dental caries in permanent teeth?
Of these, what's the high risk breakdown?
20% had 80% caries
Sealants are underused
The sealant prevalence on permanent teeth of children is about _____%
Sealants reduce caries 60-75% at 4 years
The detection of early lesions should be discovered via _____, not _____.
***however, no radiograph should be given solely to determine sealant placing. Caries Risk Assessment primary.
A sealant can be placed if the occlusal surface of a posterior tooth has a noncavitated carious lesion with a ____________.
White demineralization line
Name 6 risk factors used for sealant use criteria.
Current caries or hx
Certain people have the particular tooth morphology of Deep Pits/Fissures, putting them at high caries risk
Rank Caries Susceptibility by Tooth Type dependent on Pits/Fissures:
*memorize this question
1 - Lower Molars (50%)
2 - Upper Molars (35-40%)
3 - U/L 2nd Premolars
4 - Upper Laterals and 1st Premolars
5 - Upper Centrals and Lower 1st Premolars
What are 3 conditions not indicated for sealants?
Well coalesced pits/fissures
Caries free for years
Someone in Lowe Caries Risk has had _________, good oral hygiene/diet, regular dental visits, and adequate F exposure.
*Additionally coalesced/shallow pits/fissures
No caries in last year
To Apply Sealants:
1. Isolate with rubber dam
2. Cleanse pumice
3. Rinse and Dry (10 seconds)
4. Apply Acid for ____ seconds
5. Rinse and Dry (if contaminated, re-etch ____ seconds)
6. Apply sealant
7. Cure ____ seconds
87. Check retention, occlusion, and contacts
Apply Acid 20 seconds
Re-etch 15 seconds
Cure 20 seconds
**re-re etch 30 secs if needed
90% of sealants are NOT prepared with a mechanical bur (non-invasive)
Etched teeth have better...
Rinsing teeth (or swiping with gauze) immediately after a sealant is placed does what 3 things:
Removed oxygen inhibited layer in sealant
Removes bad taste
Limits BPA Xenoestrogen exposure
*2-5 times lower BPA exposure than daily food/environment
If there are contact marks on sealant, football diamond or #7404 bur can be used to adjust occlusion.
Last step or sealant placement is flossing (insures none has run over to proximal)
If sealants fail, all or part of sealant comes off within ___ months
However, the worst failure is the sealant that _____, and eventually there will be discoloration at the margins.
GIC, glass ionomer sealant, releases fluoride - what is its downside?
Not as retentive as resin
*only used as interim sealants
GC Fuji Triage is a new product that releases 6 times the F as GIC
Preventative Resin Restorations
Name 3 diagnostic tools that may determine whether a PRR is necessary.
There are no minimum depth or width requirements in a PRR
The 132F diamond and the 1/4 round burs can both be used in PRR
All stained dentin needs to be removed in a PRR
not if it is hard (just stained)
Undermined enamel is OK in PRR
After caries removal, the 1st step in a PRR is...
35% phosphoric acid etch for 10 seconds - to enamel
10 more seconds to dentin
*enamel therefore 20 seconds
After etching dentin in a PRR, it should be completely dried
*needs somewhat wet or collagen fibrils collapse (no more shag carpet to bond with)
What 2 types of bonding agent are used in PRR?
*How long are each cured?
Dentin/Enamel Bonding Agent (low viscosity resin)
Step 1 PRR, the low viscosity bonding agent is scrubbed for ____ seconds
Then, 20 seconds exposure to light to harden
Dry gently - removes solvents and water
Flowable composite is easier to get in tight areas, has high polymerization shrinkage, and _____ wear resistance.
Microhybrid (packable) is difficult to condense into tight areas, has lower polymerization shrinkage, and _____ wear resistance
The microhybrid composite (packable, Step 2 PRR), should be packed incrementally no more than __ mm thick
*each increment cured 20-40 seconds
If your grooves in a PRR are only in enamel and too small for packable composite, ______ can be used.
*layer and cure
If the preparation is large enough in a PRR, use only ______ composite.
Trimming excess PRR can be accomplished with _____ football diamond bur, and the normal anatomy can by re-established with a ______ bur
247 EF diamond
To polish the PRR, 1st use ____ color, then use _____ color
What is the unfilled resin used to reseal margins at the end of a PRR
Is this a substitute for polishing?
Do you have to re-etch?
What is the major disadvantage to sealants?
What is the avg lifespan of PRR composite?
Why isn't amalgam as technique sensitive as other options?
Corrosion self seals at borders
Why don't you want to cut into triangular/marginal ridges?
Structural integrity of tooth
When cutting outline, avoid making marginal ridge too thin and cutting into triangular ridges
Also, cavo surface shouldn't end at opposing contacts
Do not cut across the Transverse ridge of the _______
or the Oblique Ridge of the _______
Lower 1st Premolars
Upper permanent Molars
What is the minimum depth starting at the Central Groove for class I occlusal amalgam preparation?
How wide should an isthmus be in an amalgam prep?
Ideally, the isthmus should be ______ in the tooth.
Why should internal line angles be rounded?
Protects by reducing stress across the area
The smaller the isthmus, the ____ the convergence can be
In Mandibular molars, the center of an amalgam prep should be off-centered in which direction?
The Mandibular 2nd premolar position should be...
The 1st premolar...
Don't cut across Transverse Ridge
What are 5 Factors Determining outline form?
Conservation tooth structure
Extension for Restorability
What are 5 Modifying Factors of Outline Form?
Type of restorative matl used
What matl can have a curved angle of departure?
Why is a small amount of undermined enamel ok in composite?
Bonds to tooth
What are the design features that lock a restoration and prevent failure?
Amalgam bonding resin, slots, pins, are examples of...
Increasing retention form
How many mm's are required to retain a crown?
The 1.5 mm minimum required height at the central groove for an amalgam prep is how high at the walls (cavo-surface)?
Minimum Axial depth in a slot prep is ___ for bicuspids and ____ for molars.
The larger the isthmus the greater chance for cusp fracture
*but still needs 1mm min.
Amalgam creates a lot of internal strain via thermal expansion
What is the exception to floors being perpendicular to occlusal surfaces?
Lower 1st premolar
*pulp extends high
**If tooth was very lingually inclined, drill nearly horizontal
In what scenario would you make the bevel on the Axio-pulpal line angle larger (class II prep)?
Pulpal floor shallow and proximal very deep.
*otherwise can lead to fracture
The rationale for good separation in class 2 (0.5 mm) is convenience bases
(place band, avoid damage adjacent, access to carve amalgam)
Can we maintain contact on proximal extensions?
What is the rationale behind conservative slot preps and their designs?
Amalgam strength improvement
What is the Old amalgam with 388 compressive strength?
What is New amalgam with 545 compressive strength?
Retention grooves are added with a _____ bur in a slot prep.
Why are retention grooves not cut into the axial wall?
(cut into facial/lingual wall)
Axial extension of the slot prep is ___ mm premolars
___ mm molars
If amalgam exits the enamel at more than 90 degrees....
If amalgam exits the enamel at less than 90 degrees...
Amalgam too thin = fracture
Enamel undermined = fracture
Fully cleaning and disinfecting are key steps before placing amalgam
*Gluma scrubbed 30-60 secs
Before placing amalgam, dry tooth of excess moisture, but don't over-dry dentin (can reduce bonding)
Pt head should be above belly button to mid thorax