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BDS2 CLINICAL Operative Dentistry > Prep of a cavity > Flashcards

Prep of a cavity Flashcards

1
Q

What determines the design of a cavity?

A

structure and properties of the dental tissues
the diseases
properties of restorative materials

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2
Q

what was stereotypic thinking

A

caries was classified in classes and the class determined the shape of the cavity

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3
Q

why do we no longer use stereotypic thinking

A

as it resulted in the removal of healthy tooth tissues

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4
Q

why do we have to sometimes take out healthy tooth tissues if we are using amalgam

A

amalgam does not stick to the tooth therefore the bottom of the cavity has to be wider to lock it in

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5
Q

what must be continually reviewed and reassessed when preparing a tooth for restoration

A

position of the caries
extent of the caries
shape of the prepared cavity
final restorative material

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6
Q

what are the different classifications on the position of the caries

A

pit & fissure
approximal
smooth surface
root

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7
Q

why are pits and fissures prone to caries

A

the depths of these can cause susceptibility to caries as patients struggle to clean these areas resulting in accumulated plaque

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8
Q

what are the different types of approximal caries

A

posterior

anterior

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9
Q

what are the different types of smooth surface caries

A

can be caries or erosion/abrasion/abfraction/hypoplasia

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10
Q

what is approximal caries due to

A

the surface of particularly crowded teeth can be more susceptible due to the lack of access for oral hygiene aids

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11
Q

what is root caries

A

root caries is caries on an exposed root which often penetrated more easily into the exposed dentine

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12
Q

what are the different stages of caries

A

it has an initiation and development
carious lesion forms as a direct consequence of the metabolic activity in the biofilm, if factors tip the de/remineralization balance towards demineralization, the stages of progressive lesion formation leading to cavitation can be clinically detected

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13
Q

what should operative treatment be done with the context of

A

prevention

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14
Q

when should operative intervention be done

A

o When the lesion is cavitated

o When the patient can’t access the lesion for prevention

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15
Q

when should a restoration be considered

A

o The lesion is into dentine radiographically
o The lesion is causing a pulpitis
o The lesion is unaesthetic

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16
Q

why is a restoration not a positive thing

A

placing a restoration puts the patient into the restorative cycle

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17
Q

what is the restorative cycle

A

describes the unintended consequence for all operative procedure’s which is to place the patients tooth into the restorative cycle which will continue throughout the life of the patient

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18
Q

describe briefly the structure of enamel

A

prismatic structure

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19
Q

what are the different cut of prisms when cutting enamel

A

side cut prisms or end cut prisms

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20
Q

why does resin composite adhere to enamel

A

it is a dry tissue - the ultrastructure of enamel permits the adhesion successfully

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21
Q

what should be removed before a restoration is placed

A

any unsupported enamel and/or under occlusal load

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22
Q

what is important to consider in terms of the dentinal-pulp complex

A

Operative procedures involving dentine affect the pulp

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23
Q

describe briefly the structure of dentine

A

dentine is porous
more elastic
wet tissue

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24
Q

why is dentine more difficult to adhere to

A

Because dentine is innately wet and so this becomes a problem that must be overcome during operation as the composite is hydrophobic

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25
Q

what is the difference between primary dentine and tertiary dentine

A

tertiary dentine occurs in chemical and biological trauma while primary dentine has big open tubules and it is not as mineralized

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26
Q

what should be assessed before bonding dentine

A

quality of the proposed dentine

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27
Q

what are you looking for when assessing dentine

A 
dead tracts
secondary dentine 
tertiary dentine
sclerosis 
calcification
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28
Q

what are the different types of dentine

A

intra, inter and peritubular dentine

29
Q

how can dentine vary

A

Tubules can have different diameters
There are different densities of dentine
Different levels of mineralization with the dentine

30
Q

what is intratubular dentine

A

dentine within the tubules

31
Q

what is intertubular dentine

A

dentine between the tubules

32
Q

what is peritubular dentine

A

dentine that makes up the walls of the tubules

33
Q

when can you remove healthy tooth tissue

A

o The material used for the restoration requires it
o The margins of the cavity are in contact with another tooth surface
o The margins of the cavity cross an occlusal contact

34
Q

what are the steps to cavity preparation

A
  1. identify and remove carious enamel
  2. remove enamel to identify the extent of the lesion at the ADJ and smooth the enamel margins
  3. progressively remove peripheral caries in dentine
  4. only then remove deep caries over the pulp
  5. outline form modification (enamel finishing, occlusion, requirement of restorative material)
  6. internal design modifications (internal line and point angles, requirements of the restorative materials)
35
Q

what is a wall

A

any surface of the tooth preparation is referred to as a wall

36
Q

what is the cavosurface angle

A

formed by the junction of a prepared tooth surface wall and external surface of a tooth

37
Q

what is a line angle

A

a junction of two surfaces of different orientations along the line and its name is derived from the involved surfaces

38
Q

what is a point angle

A

junction of 3 plane surfaces or three line angles of different orientation and its name is derived from its involved surfaces or line angles

39
Q

what do stress concentrators do

A

allow a crack to spread

40
Q

what can a sharp line angle lead to

A

a potential crack

41
Q

what are the final steps in the final cavity design

A

ensure no traces of restorative material remain
smooth external enamel sharp line or point angles
create appropriate cavo surface margin angles
check for stress concentrators

42
Q

what is the first principle

A

access caries

43
Q

what are the steps to accessing caries

A

apply a dental dam
remove overlying enamel
follow caries at the ADJ
do not extend to non carious areas

44
Q

if you find discolored dentine that is hard what do you do

A

do NOT remove it

45
Q

how do we access inter proximal caries

A

via healthy enamel through palatal side and move forwards to labial and gingival side

46
Q

what is the second principal

A

extent

47
Q

what determines the outline form

A

how the caries has spread at the ADJ

48
Q

what are the steps of these second principle

A 
clear all caries at ADJ
check staining at ADJ
smooth enamel cavo-surface margins
examine adjacent contact for caries
avoid trauma to adjacent tooth
49
Q

when do you remove dentine

A

if dentine sticks to probe

50
Q

how do you remove restorations

A

high speed bur - start at centre and cut towards the edge

cut restoration into pieces

51
Q

what is the 3rd principle

A

removing dentinal caries

52
Q

what is dentinal caries detected as

A

brown stain or soften tissues when using a SHARP probe

any sticking of the probe indicates residual carious dentine which should be removed

53
Q

what caries should be removed first and which last

A

residual carious dentine must first be removed from the ADJ and last from the plural floor

54
Q

what instruments should be used when removing caries from the ADJ

A

hand held excavator

round bur

55
Q

what instruments should be used when removing caries on the pulpal floor

A

large round bur

large hand held excavator

56
Q

why should we use large instruments when working on the pulpal floor

A

small burs and excavators will cut more deeply more quickly which gives a risk of pulp exposure

57
Q

what is the fourth principle

A

modification

58
Q

what happens in the fourth principle

A

Once caries removal or removal of an existing restoration is complete then the material to be used can be decided and the cavity should be prepared appropriately

59
Q

what are the advantages of composite

A 
o Aesthetics 
o Conservation of tooth tissue
o Support for remaining tooth tissue
o Adhesion/bonding
o Command cure
o Low thermal conductivity
o Elimination of galvanism
o Amalgam alternative
60
Q

what are the disadvantages of composite

A

operator sensitive

61
Q

what are the disadvantages of amalgam

A

o Does not bond to enamel or dentine
o Does not support the tooth
o Held into the cavity by retention and resistance form
o Cut dentine may require sealed resin layer
o Amalgam is prevented from fracturing by adequate bulk, needs to be at least 2mm deep

62
Q

what are the advantages of amalgam

A

o It is strong under occlusal load
o Not tooth coloured
o Less moisture and technique sensitive

63
Q

what is retention

A

Features of the cavity which prevent the restoration being dislodged in any occlusal direction

64
Q

what is the cavosurface angle for amalgam

A

90 degrees and 120 degrees

65
Q

what is the configuration factor

A

number of bonded surfaces to the number of unbonded surfaces in a dental restoration

66
Q

what does a high configuration factor mean

A

leads to increased polymerization contraction stress

67
Q

what does a low configuration factor mean

A

reduced polymerization contraction stress

68
Q

what should be done after preparing the cavity

A

Wash the cavity with a mixture of air and water to remove the loose debris, rinse with chlorhexidine and remove
Rinse with water and leave surface moist

BDS2 CLINICAL Operative Dentistry (12 decks)

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