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Operative techniques Flashcards

1
Q

Hand piece safety

A

Check back cap
Check bur
Check coupling (ie attachment to machine)
Check resistance/ grainy
Check lateral movements of bur
Check for weird sound and water

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2
Q

Principles of cavity design and preparation

A
  1. Identify and remove carious enamel
  2. Identify maximal extent of lesion at the ADJ, smooth enamel margins
  3. Remove peripheral caries in dentine, circumferential deeper to avoid exposing pulp
  4. Outline form modification (ie shape)
  5. Internal design modification (smooth and rounded)
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3
Q

Line angle

A

Line angle = two linear surfaces meet

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4
Q

Point angle

A

Point angle = three linear surfaces meet

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5
Q

what angles can act as stress concentration points

A

sharp angles

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6
Q

what happens if we leave stress concentration points

A

stress and fracture or microleakage

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7
Q

when to restore a tooth

A
  • lesion is cavitated
  • patient can’t access lesion for prevention
  • lesion into the dentine radiographically
  • Lesion causing pulpitis or pain
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8
Q

whats LA and PA

A

LA = labial approach
PA = proximal approach

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9
Q

WHEN TO Pulp exposure

A

If necrotic material in pulp

Irreversible pulpitis

RCT

Sensitivity tests required

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10
Q

why keep Configuration factor low

A

reduce polymerisation contraction stress, ie less bonded surfaces, restoration involves minimal tooth structure

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11
Q

Configuration factor

A

ratio of bonded to unbounded surfaces, especially important for composite restoration

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12
Q

Polymerisation contraction stress

A

Polymerisation contraction shrinkage -> plastic deformation; composite pulls away from the bonded surface towards the direction of curing light

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13
Q

plastic deformation

A

Plasticity = non reversible change of shape in response to an applied force
Deformation = change in shape due to an applied force

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14
Q

Differential etch

A

Differential etch = 10 sec on enamel before moving the etch to dentine for another 10 seconds (total 20sec on enamel)

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15
Q

Injuries of pulp

A
  • Caries
  • Cavity prep
  • Trauma
  • Heat, vibrations, sharpness, strong force from high speed
  • Chemicals from materials eg. Etch
  • Tooth wear
  • Periodontal health
  • Ortho
  • Dehydration of dentine
  • Cutting odontoblastic processes, essentially damaging pulp
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16
Q

what risky substances can permeate into the pulp

A
  • Bacteria
  • Immune complexes
  • Antibodies
  • Microorganisms that cause pulpal disease
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17
Q

which fibres respond to an EPT

A

A fibres

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18
Q

what pain does C fibres detet

A

C fibres unmyelinated for dull pain, increased pulpal blood flow -> pressure -> pain

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19
Q

when looking at pulpal health what are the two broad categories of diagnosis

A

pulpal diagnosis and periapical diag

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20
Q

Reversible pulpitis vs Irreversible pulpitis

A

Can reverse to health
pain to cold
no change to pulpal blood flow
A fibres

vs

Still vital but inflammation cannot be healed
negative pain to cold
C fibres due to increase in pulpal blood flow

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21
Q

how to treat Reversible pulpitis and Irreversible pulpitis

A

o Vital pulp therapy
vs

o Pulpotomy -> vital pulp therapy
o Pulpectomy -> RCT

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22
Q

what is a necrotic pulp

A

o Non vital
o Can be partial or total necrosis

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23
Q

where do you find open apices?

A

 Immature teeth

24
Q

difference in treatment of open and closed apices

A

Closed apices
 RCT or extraction

Open apices
 Pulpotomy -> vital therapy
 Pulpectomy -> RCT
 Extraction
 Open apices immature teeth have more recovery potential since more blood supply

25
dangers of rct on open apices
, rct can be dangerous because the materials used can be shoved through the open apex
26
c fibres stimulated is reversible or irreversible pulpitis
irreversible
27
5 types of periapical diagnosis
healthy periapical periodontitis acute apical abscess chronic apical abscess condensing osteitis
28
4 types of pulpal diagnosis
healthy reversible pulpitis irreversible pulpitis necrotic pulp
29
how to diagnose healthy periapical
o Not sensitive to tapping or palpation lamina dura intact PDL space uniform
30
Periapical periodontitis
 Pain when biting or palpation  Inflammation
31
wha is Acute apical abscess
o Inflammatory rxn to infection
32
symptoms of acute apical abscess
o Rapid onset o Spontaneous pain o Extreme tenderness o Pus o Swelling o Fever or malaise o Lymphadenopathy
33
difference between acute and Chronic apical abscess
both are Inflammatory rxn to infection acute is rapid while chronic is Gradual onset acute is very pain while chronic has little to no pain
34
another name for Chronic apical abscess
sinus
35
what is a gp cone used for
o Can use GP cone to tell you which tooth pulp is the source of infection
36
Condensing osteitis
Represents localised bony reaction to inflammation usually found at apex No treatment usually because RCT doesn’t clear up this bone condition
37
How to tell if a tooth is vital or not?
- Discoloration - Sinus - Gross caries - Large restoration - PA Radiolucency - Sensibility tests
38
RMB THAT SENSIBILITY TESTS DOES NOT MEAN THE SAME AS VITALITY TEST
39
Electric pulp tester which fibres stimulated
A delta fibres stimulated - If current is high and patient still doesn’t feel anything prob necrotic - EPT doesn’t tell you the condition of pulp
40
why EPT on young pulps and recently traumatised pulps are unreliable
the nerves may not be fully developed the pulp may not have recovered from the trauma
41
Cold -> outward or inward flow of dentinal fluid?
Cold -> outward flow, nerves stretched, cold more sensitive than hot
42
Thermal tests work on the basis of?
Thermal tests work on the basis on dentinal fluid movement
43
what is used in hot test and what fibre does it stimuate
Hot test - Hot gutta percha - A and c fibres - Too much heat can cause irreversible pulpitis be careful
44
what happens to pulp as we age
o less regenerative potential o pulp becomes smaller, less blood vessels and nerves o more fibrous content o Less resistant to inflammation
45
what does insult to the pulp do to it
o Dentinal tubules occlude, tertiary dentine forms, pulp becomes smaller
46
reparative vs reactionary dentine
Reactionary is mild stimulus Reparative is intense stimulus
47
treatment for an unexposed pulp
indirect pulp cap stepwise excavation seal caries in
48
stepwise excavation
- remove caries but leave someone over the pulpal floor if too close to the pulp - temporary restoration - Wait for tertiary dentine to form over the pulp - Remove remaining caries and fully restore
49
seal caries in
- Leave caries there over the pulpal floor - Seal well so that you cut off the sugar supply of bacteria - Caries doesn’t progress
50
exposed pulp treatment options
direct pulp cap partial pulpotomy + vital pulp therapy complete pulpotomy pulpectomy RCT
51
pulpotomy vs pulpectomy
Partial pulpotomy – remove necrotic parts only Complete pulpotomy – remove all but the root pulp Pulpectomy – remove all and RCT
52
materilas used for vital pulp therapy
o Calcium hydroxide o RMGIC o Bioceramics ->Mineral trioxide aggregate MTA or Biodentine
53
what happens to dentine permeability as we get closer to the pulp?
it increases
54
how does CaOH work
kills bacteria-high pH irritates pulp and stimulates tertiary dentine as a protective layer stimulates recalcification of demineralized dentine neutralizes pH from acidic restorative materials
55
how does MTA work
high pH to kills bacteria bacteria tight seal hard enough to act as a base biocompatible
56
how does biodentine work
same as MTA but no discoloration
57
whats a complete pulpotomy
remove entire pulp from pulp chamber but leave the pulp in root canals

BDS2 CDS (15 decks)

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