Question 92 Flashcards
(8 cards)
what is amelogensisis imperfecta types, probelms and tx
o Hereditary
o 4 types:
Hypoplastic – reduce bulk or thickness of enamel
Hypomineralised – disturbance of enamel formation resulting in a reduced mineral content
Hypomaturational
Mixed with taurodontism
o Problems – sensitivity, caries susceptible, poor aesthetics, poor OH
o Treatment – prevention, composite veneers, FS, onlays, SSCs, ortho
what is fluorisis and tx
o White or brown spots on teeth caused by overexposure/ingestion to fluoride during developmental years
o Microabrasion, veneers or vital bleaching
what is MIH and tx
o Hypomineralisation of systemic origin of one to four permanent first molars, frequently associated with affected incisors
o Loss of tooth substance – beakdown of enamel, tooth wear, secondary caries
o Sensitivity
o Appearance
o Treatment of affected molars – composite/GIC restorations, SSCs, XLA
o Treatment of affected incisors – microabrasion, external bleaching, composite restorations, composite or porcelain veneers
what is dentinogeneiss imperfecta and tx
o Rare genetic condition leading to translucent, grey-blue weak teeth
o Poor aesthetics, caries susceptible, spontaneous abscess
o Treatment – prevention, composite veneers, overdentures, dentures, SSCs
what is tx of discolouration
o Prior to treatment – record a baseline shade, clinical photos
o Microabrasion
External vital bleaching
Non-vital (dead tooth) internal bleaching
o Resin infiltration (ICON) – infiltration of enamel lesions with low-viscosity light curing resins
o Localised composite restoration
o Veneers – composite or porcelain
o Do nothing
explain external vital bleaching
o Prior to treatment – record a baseline shade, clinical photos
o Bleaching
GDC – products containing or releasing between 0.1% and 6% hydrogen peroxide cannot be used on any person <18 except where such is intended for the purpose of treating or preventing disease
External vital bleaching
* Chairside bleaching
o Uses unstable rapidly reacting hydrogen peroxide 15-38% - more dangerous, sensitivity, expensive
* Night guard vital bleaching (at home)
o 10% carbamide peroxide gel
o Tray only covers teeth to be bleached
o Brush teeth, apply a little gel to tray (half grain of rice), set over teeth and press down, remove excess, rinse gently and do not swallow, wear overnight, remove tray in morning, brush with TP, rinse with cold water
o Takes 3-6 weeks, or until colour acceptable
o Important to have this done before placement of composites or restorative work – allow 2 weeks for colour to settle
* Side effects – sensitivity, gingival irritation
explain non vital internal bleaching
GDC – products containing or releasing between 0.1% and 6% hydrogen peroxide cannot be used on any person <18 except where such is intended for the purpose of treating or preventing disease
Non-vital (dead tooth) internal bleaching
* Inside outside technique
o 10% carbamide peroxide
o Access cavity open, custom made mouthguard, patient applied bleaching agent to back of tooth and tray, patient keeps access cavity clean and replaces gel every 2 hours or so except during night, tray worn all the time except eating/cleaning
* Walking bleach technique
o Oxidising process allowed to proceed gradually over days
o Access tooth coronally and ensure GP removed to CEJ, place cement over GP to prevent ECR, clean tooth with ultrasonic, insert bleaching agent on CW pellet, cover with dry CW pledget and seal with GIC
o Renew bleach no more than 2 weeks between appts
o If no changes after 3-4 visits stop, 6-10 visits total
* After treatment – pulp chamber is restored with ns-CaOH paste for 2 weeks and sealed in with GIC. Then either white GP and composite resin or incrementally cured composite (can’t rebleach but stronger)
* Veneer or crown prep if regression
* Case selection – assess root filling/disease with PA
* Advantages – simple, tooth conserving, no gingival irritation
* Disadvantages – ECR, failure to bleach, over bleach, brittle crown
Effects of bleaching are not premanent
explain microabrasion
Removal of surface layer of stained opaque enamel
Technique
* PPE, pumice and water, petroleum jelly, dam
* Sodium bicarbonate guard, HCI pumice slurry in rubber cup (10x5s applications per tooth)
* White fluoride varnish (Profluoride) – remineralisation and desensitivity
* Finish with finest soflex disc and polish with TP
* Warn patient – avoid highly coloured food and drink for at least 24 hours, if possible a week
* Review in 4-6 weeks – compare photos. Can offer second cycle only if improvement seen
Indications – Fluorosis, decalcification, traumatic discolouration
Advantages – easy, cheap, conservative, permanent
Disadvantages – removes enamel, sensitivity, acid
