Restoration of Extensively Damaged Vital Teeth

Question 1

According to central core guidelines the pulp and ___mm thick of surrounding ____ should be preserved

Answer 1

1mm; dentin

Question 2

According to central core guidelines, retentive features should not be cut deeper than:

Answer 2

1.5 mm at cervical line or central fossa (2mm)

Question 3

According to central core guidelines, the auxillary retentive features should ideally be kept in:

Answer 3

“safe zone”

Question 4

According to central core guidelines, for caries removal, deeper areas should be:

Answer 4

filled with base

Question 5

Avoid excessive tooth removal in the name of:

Answer 5

retention

Question 6

Describe what happens to the pulp chamber as we age?

Answer 6

shrinks

Question 7

List the five categories to consider in decision making:

Answer 7

1. Type of restoration
2. Using defects as retentive features
3. Pin placement & retention
4. Bases & cores
5. Tooth preparation procedures

Question 8

What questions should you ask yourself to determine the type of restorations to use when LARGE DECAY has destroyed tooth structure? (5)

Answer 8

1. WHERE is the decay?
2. How much tooth structure is remaining?
3. WHERE is the remaining tooth structure?
4. Can I restore this?
5. Should I restore this?

Question 9

Extensive peripheral damage =

Answer 9

full crown

Question 10

What restoration would you choose based on the following image?

Answer 10

full crown (extensive peripheral damage)

Question 11

Isthmus destruction greater than 1/2 intercuspal width=

Answer 11

Inlay or onlay

Question 12

More than 50% of tooth structure is gone an floss of cusps support=

Answer 12

crown (likely a core build up too)

Question 13

Less destructive central lesion =

Answer 13

inlay or onlay

Question 14

Large central lesion =

Answer 14

build up & crown

Question 15

Combined central and peripheral destruction =

Answer 15

core build up and crown (possible RCT/post)

Question 16

When would you decide you needed root canal treatment with combined central and peripheral destruction?

Answer 16

1. if pulp is exposed
2. if post is needed for retention of build up

Question 17

Often, a tooth preparation will need to be modified by adding retentive features to:

Answer 17

increase retention and improve resistance form

Question 18

List some examples of retentive features used to modify a prep:

Answer 18

1. re-orinetation of sloping surface
2. adding grooves
3. adding box forms
4. adding pins with a build up

Question 19

T/F: There are times when leaving a crown prep without a build up can help with retention too. Sometimes, you need to leave it ugly

Answer 19

True

Question 20

What can we do to increase resistance form with “less-than-ideal” tooth structure remaining?

Answer 20

1. reduce TOC of axial walls
2. add grooves
3. add box forms
4. increase wall height

Question 21

What are ways to increase wall height of a prep, in order to increase resistance form with less-than-ideal tooth structure remaining?

Answer 21

1. place finish line more apical
2. pin retained core
3. crown-lengthening
4. orthodontic extrusion

Question 22

Increased axial reduction in the cervical 1/2 of the preparation wall will:

Answer 22

reduce taper and create more retention and greater resistance form

Question 23

Grooves should be placed ____ when trying to increase retention & resistance

Answer 23

parallel to the long axis of the tooth

Question 24

Grooves should be placed parallel to the long axis of the tooth with the following requirements: (3)

Answer 24

1) atleast 1mm wide and deep
2) 0.5 to 1.0mm away from the finish line
3) spaced around the tooth

Question 25

Proximal grooves ____ the radius of the arc of rotation

Answer 25

shorten

Question 26

Walls of a groove or a box are best placed ___ when in a short prep with minimal occlusal clearance.

Answer 26

perpendicular to the displacing forces

Question 27

- remove caries - convert caries removal into a box form by squaring walls - not needed on intact walls - box should be well into dentin (deep enough) to resist displacing forces What is being described? What is this used for?

Answer 27

Box form- used for retentionW

Question 28

Why should the box form be placed well into the dentin?

Answer 28

to resist displacing forces

Question 29

Box forms can aid in:

Answer 29

retention & resistance

Question 30

When two boxes are needed, less than 180 degrees of tooth circumference remains. Why is this significant and what should you do in this situation?

Answer 30

Great risk for cuspal fracture; use a build up and full crown to protect against fracture

Question 31

The following aid in ____. - sloping walls - box form - grooves

Answer 31

retention

Question 32

When increasing the wall height by placing the margin more apically often this is below the gingiva, however, we must:

Answer 32

avoid invading the biological width

Question 33

When adding materials to "build up" the tooth, this can give more wall. Remember, the ___ needs to be on tooth structure and you still need a minimum of _____ of ferrule

Answer 33

finish line; 2-3mm

Question 34

How might you remove the biological width restriction?

Answer 34

crown lengthening

Question 35

extruding the tooth out of the bone to gain height:

Answer 35

orthodontic extrusion

Question 36

What procedure had this effect?

Answer 36

crown lengthening

Question 37

Where can the margin be placed if you are trying to increase wall height?

Answer 37

more apically and below gingival line

Question 38

Also called a foundation restoration:

Answer 38

core build up

Question 39

Replaces lost tooth structure to improve retention of a crown:

Answer 39

core build up

Question 40

a ___ must be anchored firmly to the tooth and not just be placed to fill the void:

Answer 40

core build up

Question 41

Retention for a core is often with the use of:

Answer 41

pins

Question 42

A build up is needed when ___ of the tooth structure is lost

Answer 42

more than 50%

Question 43

What would be needed in the following image?

Answer 43

core build up

Question 44

Describe what is occurring in the following images:

Answer 44

1. not enough tooth structure for crown retention 2. build up added after crown lengthening 3. success

Question 45

What happens to a crown when a prep has short axially walls?

Answer 45

repeated de-cementation

Question 46

When there is excessive interocclusal distance (tall crown height), this needs:

Answer 46

pin-retained core

Question 47

Crown margin (finish line) needs to be on ____ or prognosis of restoration will be compromised

Answer 47

sound tooth structure

Question 48

What is the difference between amalgam core build ups and composite core buildups?

Answer 48

amalgam core build ups = STRONG (but not retentive) composite core bud ups = RETENTIVE (not as strong)

Question 49

Use of pins is recommended when:

Answer 49

1/2 or more of the clinical crown has been destroyed

Question 50

Cusps thinner than 1/2 their height are considered weak and should either be:

Answer 50

shortened or removed

Question 51

For amalgam core, the cavity floors and walls should be:

Answer 51

flattenedC

Question 52

Crown margins should be at a minimum ____ to build up material margin

Answer 52

1mm apical

Question 53

What are the mechanical properties of an amalgam core build up?

Answer 53

1. compressive strength 2. dimensional stability 3. corrosion- sealing

Question 54

What are the limitations to an amalgam core build up?

Answer 54

1. matrix placement can be difficult 2. slow setting material 3. no bonding or natural 4. requires atleast 2 mm thickness 5. color shows through some ceramic crowns 6. final crown prep occurs another day

Question 55

List the mechanical properties of a composite core build up:

Answer 55

1. bonds to tooth structure 2. still needs help with pins

Question 56

Three advantages to a composite core build up (compared to an amalgam core build up include):

Answer 56

1. quick setting 2. can be thinner than 2 mm 3. color in material aids in crown matching

Question 57

Your patient needs a core build up and crown in the same day. What material will you use?

Answer 57

composite (amalgam takes more than 1 visit)

Question 58

The limitations to composite core build ups include: (3)

Answer 58

1. technique sensitive 2. isolation can be challenging 3. micro leakage possible as material shrinks when cured

Question 59

____ are helpful to support the build up material when residual tooth structure does not provide adequate retention itself.

Answer 59

Pins

Question 60

Pins increase ___ for build up support

Answer 60

resistance

Question 61

Where do pins increase the resistance of the core build up?

Answer 61

both internally and apically

Question 62

T/F: Pins should be placed parallel

Answer 62

False- They should be placed non-parallel

Question 63

What are the guidelines for pin placement?

Answer 63

1. Place in sound, healthy dentin 2. Do not damage or undermine nearby enamel 3. Avoid perforations of pin into pulp 4. Best used in line angles of posterior teeth 5. 1 pin per missing cusp, line angle, or axial wall 6. atleast 5mm of space between pins 7. max of 4 pins per tooth

Question 64

It is important to not damage or undermine nearby enamel when placing a pin. How can this be accomplished?

Answer 64

1) flat area of placement 2) 0.5-1.0 mm from DEJ or axial wall 3) atleast 0.5 mm of dentin should surround the pin

Question 65

Pin placement procedure: 1. Use ___ to make ____. 2. Used with ____ hand piece 3. Watch ____ & ____

Answer 65

1. pilot drill; pilot hole 2. slow speed 3. angulation and position

Question 66

- cutting tip and helical flutes - 2mm deep (threaded pins) - one motion without stopping - too much wobble or imperfect handpiece technique creates a pilot hole that is too wide These steps describe:

Answer 66

Self- limiting twist drill (for pin placement)

Question 67

T/F: Pins often need to be bent to help create non-parallelism and to create even more retention

Answer 67

true

Question 68

Pins placed into dentin should be: 1) _____ deep into the dentin 2) _____ coronal into buildup 3) minimum ___ radius of build up still around pin after prep is done

Answer 68

1) 2mm 2) 2mm 3) 1 mm

Question 69

What pin complication is seen in the following image?

Answer 69

fluted root shape

Question 70

What pin complication is seen in the following image?

Answer 70

furcation

Question 71

What pin complication is seen in the following image?

Answer 71

Pulp penetration (RCT needed)

Question 72

How would you resolve the following pin complication? - Pin into pulp

Answer 72

RCT needed

Question 73

How would you resolve the following pin complication? - Pin exits tooth surface above bone

Answer 73

flap and smooth to tooth contour

Question 74

How would you resolve the following pin complication? - Fractured pin

Answer 74

Move to another location 1.5mm away

Question 75

How would you resolve the following pin complication? - Stripped pin (loose pin)

Answer 75

Use a larger size of pin

Question 76

_____ are used only to protect pulp in teeth that have excavations that are deep and near the pulp

Answer 76

bases

Question 77

When are bases used?

Answer 77

only to protect pulp in teeth that have have deep excavations near pulp

Question 78

Bases can be used to fill in ____ when an entire build up is NOT needed

Answer 78

undercuts

Question 79

Bases are ____ materials that do NOT provide ____ like a build up

Answer 79

weaker; strength

Question 80

Bases are NOT strong enough to:

Answer 80

support grooves, boxes, or other retentive features

Question 81

_____ material protects the pulp and provides smooth, flat pulpal floor

Answer 81

base

Question 82

What materials are used as bases? (4)

Answer 82

1. Polycarboxylate cement 2. Glass ionomer cement 3. Resin-modified glass ionomer cement (RMGI) 4. Silver-reinforced glass ionomer cement (Ketac-silver)

Question 83

CaOH (Dycal) is an example of a:

Answer 83

liner

Question 84

If used, a liner is placed:

Answer 84

under base

Question 85

Give an example of the common protocol used with bases:

Answer 85

1. gluma (gluteraldehyde) 2x60 seconds 2. Dycal (calcium hydroxide) 3. Vitrebond 4. Glass Ionomer 5. Routine restoration steps

Question 86

What can be seen in the following images? What does this aid in?

Answer 86

Orthodontic extrusion- increase in wall height for retention

Question 87

In the process of restoring extensively damaged vital teeth, prior to prep:

Answer 87

evaluate periodontal and endodontic health

Question 88

In the process of restoring extensively damaged vital teeth, if periodontal & endodontic health is non-vital, what should be done?

Answer 88

RCT

Question 89

In the process of restoring extensively damaged vital teeth, after evaluating periodontal and endodontics health:

Answer 89

remove all caries