Flashcards in Operative II E3 Deck (115):
3 general types of materials for Inlays/Onlays:
Advantages to Direct Composites:
Less cost/time, simple technique, repairable
Tech. sensitive, isolation, matls not fully set
Advantages to Indirect Composites:
Control contours, Better Wear resist, repairable, flexible
Advantages to Indirect Ceramics:
Control contours, Best wear resist, better bond to enamel
Most cost/time, brittle, isolation, NOT repairable
Indirect Composite Advantages are ______ physical/chemical properties
______ polymerization shrinkage
Predictably better ______
*also great esthetics and matl advancements
Indirect Composites are _______, improving pretty much all properties over Direct Composites
A big advantage to Indirect Composites is that they are compatible with what?
*Ceramics can be abrasive
What has better plaque resistance, composite or ceramics?
Describe Steps to make Indirect Composite - chairside:
Silicone die (Mach III)
*make composite on silicone die
4 Steps Lab takes to make Indirect Composite:
When building up an Indirect Composite, mark borders of die red and add what?
Color, Dentin shades in layers, then Enamel shades
Trim an Indirect Composite build up (on die) with what?
Then is the final ______ cycle
Final polymerization of Indirect Composites is done under what?
Increases hardness and polishability
Describe Mechanical Retention method for Delivering Indirect Composites?
Roughen internal surface
Describe Mechanical/Chemical retention method for Delivering Indirect Composites?
The fastest growing segment of the dental Tx market is All ceramic restorations - annual growth of 20%
All Ceramic CAD crowns have similar success rate to what?
List 4 all ceramic matls of increasing strength
Silica CAD blocks
Ceramics are durable but ________
Ceramics are more costly than gold
Ceramics have low _______ strength
3 General Ceramic choices:
(w/ 3 specific products)
High glass (silica - highly esthetic)
Low Glass (LiDisilicate - Emax)
No glass (Zirconium)
MCC's (PFMs) are weak when...
What is the main advantage of a Monolithic Restoration matl vs. a Layered?
Chipping can occur along layer lines.
*milled ceramic blocks are monolithic
Emax (LiDisilicate) has what intrinsic property allowing for increased flexural strength?
LiDisilicate wears similarly to what?
What product is milled in a softer Blue State?
After milling, what is done?
IPS Emax CAD
Sintered, glazed, recrystallized into stronger structure
What all ceramic product is pressed into a Lost Wax Casting?
IPS Emax Press
Zirconia is very opaque, durable, can be made thinner,, wears _____ heavily, and is not ______, therefore there is little _______
What is the advantage to bonding an all ceramic restoration?
Chemical bonding via Silane coupler
Would you use Bond or Cement for all ceramics?
Should Posts be bonded or cemented?
Bonded - reduces fracture
Bonded ceramics allow us to be more_______ b/c of micromechanical bonding and Chemical bonding via silane coupler
Conservative w/ preps
All ceramic preps are similar to what 2 preps?
Zirconia can be bonded
List 3 prep designs for All Ceramics in increasing strength:
Full Wall defect (one wall)
Full Onlay (MOD and both L and F cusps reduced)
Where are the margins (in the Hood region) in All Ceramic Inlay/Onlay preps?
The Box margins are what?
All axial _____
All other walls ______
Facial and lingual walls diverge ____ degrees per side
Butt Joint Margins
Onlay prep - Functional cusp reduction:
Non-functional cusp reduction:
1.5 - 2.0 mm
Onlay Isthmus width minimum:
The milling software will ______ the inside of a crown prep if there are sharp angles, etc
*so it will seat
The milling software will _____ the marging
*so will not seat
Best to have a roller coaster effect on Onlay preps
There is no retention/resistance form in on Onlay prep
*modern bonding allows for this
The butt joint in bonding an Onlay should be ____ degrees
Why is a 2nd plane of reduction important to in a Ceramic Onlay prep?
maintains thickness of restoration - avoids fracture
ACC prep design (Crown!) Anterior incisal:
What shouldn't you use on Provisionals for All ceramic Onlays?
CAD CAM takes the place of what 3 traditional lab steps?
Models, dies, wax ups
Before Isolate/Bond an Onlay:
HF acid only works on _______
So, wouldn't work on what?
3 Bonding materials, starting with the best one:
Total Etch bonding resins
Self Etch bonding resins
What bonding system allows for the most conservative, highly tapered prep?
1 Brand name?
What would you use Glass-Ionomer bonding system with?
After try-in, what has the Ceramic Onlay been contaminated with?
salivary phospholipid biofilm
Zirconia has a strong affinity to bind with what?
To clean after Try In, use ultrasound for ___ minutes and Ivoclean for ___ seconds
Ivoclean creates a larger surface by adding small metal oxide particles and has a high affinity for proteins
Pre-bonding, what not to use with Silica based ceramics?
Only use sandblasters with what?
Do not clean the inside of a ceramic with _____ to remove biofilm
Use _____ to before applying Silane agent
What product has added dopants to Zirconia for better translucency?
How long should Silane be applied?
Keep excess within the ____ of the crown
In a Selective Etch Technique, etch enamel margins only _____ secs
Lastly apply 1 layer of ______
Tack cure CAD restoration for how long?
Then remove doughy flash with what?
Final cure how long?
What is recommended post cementation?
*find IP resin flash
Total etch systems are what generations?
Self etch systems are what generations?
4th Gen has how many steps?
3 - Etch, primer, bond
2 - Etch, primer/bond
What is the 4th Gen system we used?
All in One Self Etch systems (6th gen), what can be lowered enough to etch undercut enamel?
What is retained?
What might be entrapped into the hybrid layer?
Smear layer - this is a con
6th gen systems are Prompt L-Pop, One-Up Bond F
The single component system (7th gen) is convenient and less technique sensitive but has what disadvantages?
Smear layer retained
Water absorbed into resin
There is no pH incompatibility with resin cements
Bonding Adhesive systems remove the smear layer with what?
pre conditioning gel
Everything we restore eventually fails due to what?
Dentin Bonding Primers denature what?
Resins have what relationship with water?
Because Intertubular dentin is the majority of Dentin Bonding, seal with what to avoid water/hydrostatic pressure?
*peritubular dentin more mineralized
What is in the smear layer?
Can you rinse it away?
What removes the smear layer?
What bonding system does not?
Etch and rinse steps
What binds the restorative matl to normal dentin?
Over time water trees develop
What activity increases hydrolysis of Collagen, causes Gap Separation?
What can you decrease MMP wit to increase bonding longevity?
Polymerization shrinkage can lead to restoration failure
Bonded resin surface / un-bonded resin surface
What does a high C factor mean?
Composite curing pulls away from the tooth
The filler in Optibond solo plus makes it milky and does what?
Why don't you wet your instrument with a bonding agent during placement?
Resins contain HEMA - will discolor composite
For deep restorations, what 4 steps?
Gluma - 20 secs
Optibond solo plus - 15 secs
Gluma is a ________ made specifically for ______
Gluma is made from glutaraldehyde
Research reveals the 2 most important things to do when curing are:
Correct light placement
4 curing light systems by cure time (start with fastest)
Xenon Plasma Arc
3 ways to reduce internal stresses:
Stres breaking liner
A modified flowable composite that can fill the entire gingival and pulpal floor before being cured:
*up to 4 mm
Bulk Fill Composites
If Bulk Fill is the new paradigm, why are we still doing layered technique?
Wear resistance is poor
Shrinkage greater than conventional composites (increases C factor)
What is the main advantage to Bulk Fill (up to 4mm) technique?
Best marginal adaption
Best technique is still to use Flowable 1st, then add layers - will get best marginal adaption
What are the BioActive restoratives?
Giomers have a surface property that does what?
*neutralizes acids, etc
The future may be Giomers with Surface Sealers with nano-fillers
Each tooth should appear ____ times narrower than its mesial neighbor from the frontal view
_____ in California
The top of the smile line:
Face height is the Rule of...
Lower Face height is the rule of ...
*upper lip 1/3, lower lip to chin 2/3
Youthful teeth have Prikymata and Mamelons
A rounded face will have wider teeth proportionally and a longer face will have narrower teeth proportionally
Esthetic inclinations: CI's
Primary planes align with the long axis of the tooth and have a slight mesial prominence
With a normal smile, pts maxillary incisal edge should just lightly touch or miss lower lip
The Zenith of each tooth should be slightly distal to the center
Tx sequence basics Perio Health:
The Smear Layer may reduce dentin permeability be as much as ___%