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1 - BDS4 finals - big topics > Restorative > Flashcards

Restorative Flashcards

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1
Q

Reasons for treating tooth loss

A
  • aesthetics
  • function
  • speech
  • maintenance of dental health
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2
Q

advantages of resin bonded bridges

A

minimal or no preparation
no la needed
less costly
less surgery time
can be used as a provisional restoration
if fails - usually less destructive than alternatives

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3
Q

indications for resin bonded bridge

A

young teeth
- less destructive
good enamel quality
large surface area of abutment tooth
minimal occlusal load
good for single tooth replacement
simplify partial denture design

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4
Q

resin bonded bridge disadvantages

A

rigorous clinical technique
metal shine-through
chipping porcelain
can debond
- high chance of debonding again
- occlusal interference
no trial period possible

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5
Q

resin bonded bridge contraindications

A

insufficient or poor quality enamel
long spans
excess soft or hard tissue loss
heavy occlusal force e.g. bruxism
poorly aligned, tilted or spaced teeth
contact sports?

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6
Q

bridges - treatment planning

A

history
establish habits e.g. bruxism

examination
clinical
- Perio status
- radiographs
- dynamic occlusal relationships

study models
- mounted on semi-adjustable articulator
- consider diagnostic wax ups

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7
Q

adhesive bridge - prep (if required)

A

rest seats
- posterior teeth
cingulum rests
- anterior teeth
supra gingival chamfer finish line -0.5mm
prep should ideally remain in enamel

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8
Q

how to fit an adhesive bridge

A

try in retainer
- check fit and aesthetics
(retainer should have already been sandblasted by lab)
add silane coupling agent to retainer

isolate tooth and etch
wash and dry
add primer for 30 seconds then air dry
apply composite luting cement to retainer
fit retainer and remove excess cement
apply oxygen inhibitor (oxyguard II) around margins for 3 minutes and wash off OR light cure for 20 seconds

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9
Q

what luting cement is used for an adhesive bridge?

A

Panavia 21 EX (anaerobic cure composite luting cement)

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10
Q

RBB 5 year survival

A

80%

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11
Q

disadvantages of conventional fixed-fixed bridge

A

preparation difficult
- parallel tooth preparations needed
common path of insertion for abutments
removal of tooth tissue
- danger to pulp

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12
Q

conventional cantilever bridge - advantages

A

conservative design
- compared to fixed-fixed conventional
- lab construction straightforward
- no need to ensure multiple tooth preparations are parallel

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13
Q

causes of tooth wear

A

attrition
abrasion
erosion
abfraction

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14
Q

features of attrition

A
  • attritive lesions found in occlusal and incisal contacting surfaces
  • early appearance is polished facet on cusp or slight flattening of an incisal edge
  • progression leads to reduction in cusp height and flattening of occlusal planes
  • can be a shortening of the clinical crown of the incisor and canine teeth
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15
Q

abrasion - common clinical features and signs

A

site and pattern of tooth loss related to abrasive element
most common is labial/buccal, cervical on canine and premolar teeth
v shaped or rounded lesions
Sharp margin at enamel edge where dentine is worn away preferential

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16
Q

erosion - define

A

loss of tooth surface by chemical process that does not involve bacterial action
- most common cause of pathological tooth wear

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17
Q

what are the intial/early signs of tooth erosion?

A

enamel surface affected
- loss of surface detail
- surfaces becomes flat and smooth
- typically bilateral, concave lesions without chalky appearance of bacterial acid decalcification

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18
Q

tooth erosion - later stages signs

A

late stages
- dentine becomes exposed
- wear of dentine leads to ‘cupping’ of incisal edges of anteriors and occlusal surfaces of molars

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19
Q

abfraction - define

A

loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum of the tooth

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20
Q

tooth wear - special tests

A

sensibility testing
radiographs
articulated study models
intra oral photographs
salivary analysis
diagnostic wax up
dietary analysis

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21
Q

tooth wear - immediate treatment options if patient presents with symptoms

A

deal with pain/sensitivity
- desensitising agent
- fluorides
- bonding agents
- GIC coverage of exposed dentine
pulp extirpation
- if wear has compromised pulpal health
smooth sharp edges
- prevents trauma to cheeks and tongue
extraction
- pain from unrestorable/non-functional tooth
TMJ pain
- important in attrition - acute symptoms need to be controlled

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22
Q

tooth wear - initial phase treatment options

A

stabilise existing dentition
treat caries
treat perio condition
oro-mucosal

once you have a diagnosis and identified primary cause:
- establish preventative regime
treatment without prevention will fail

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23
Q

tooth wear prevention: abrasion

A

remove foreign object or substance involved
change toothpaste
alter brushing habits
change habits
- nail biting
- wire stripping
- piercing biting
- pen chewing

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24
Q

How to create space to treat maxillary anterior tooth wear

A

increase OVD
- multiple posterior extra coronal restorations
- downsides - complex, destructive and expensive
occlusal reorganisation from ICP to RCP
- complicated, can be destructive, specialist treatment
surgical crown lengthening
- doesn’t really create more space
elective RCT and post crowns
- very destructive
conventional orthodontics
- lengthy treatment

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25
what is the Dahl technique?
method of gaining space in cases of localised tooth wear originally a removable CoCr anterior bite plane - now carried out in composite (better aesthetics, better compliance, easier to adjust) covering palatal survives and allowing occlusion on raised cingulum results in posterior dislcusion and increase in OVD of 2-3 mm occlusal contacts only on incisor/canine teeth
26
Dahl technique How is spaced gained?
over a period of 3-6 months space gained between incisors anteriors intrude posteriors erupt results in space between upper and lower anteriors allowing restoration without need for occlusal reduction
27
Dahl technique - effectiveness
variable rate of affect - faster in younger patients if no movement in 6 months = won't work >90% success rate occlusion initially disorganised but reestablishes with time
28
Dahl technique - contraindications
active periodontal disease TMJ problems post orthodontics bisphosphonates dental implants existing conventional bridges
29
Dahl technique is the treatment of choice to treat...
localised anterior tooth wear
30
contraindications for buildups for anterior wear
short roots reduced periodontal support due to periodontal disease
31
why is lower anterior tooth wear more difficult to treat than upper anterior tooth wear?
less enamel smaller bonding area
32
how is a clear vacuum form matrix used in composite build ups?
alginate impression taken diagnostic wax up impression of this poured in stone - vacuum formed clear plastic matrix formed on this cut to size and used as mould for build-up
33
Give examples of Veneer use cases
aesthetic improvement change tooth shape/colour correct peg laterals space and diastema closure align labial surfaces of teeth
34
basic principles of veneers
caries removal keep as much sound tooth tissue as possible maintain pulpal and periodontal health restore form and function longevity aesthetics occlusal stability must be cleanable
35
types of veneers, and options for materials
palatal - porcelain - lithium disilicate - composite - zirconia - gold - nickel-chromium buccal - porcelain - lithium distillate - composite - zirconia
36
palatal veneers - uses
tooth wear - erosion increasing OVD Dahl approach
37
buccal/labial veneer contraindications
uncontrolled caries and periodontal disease poor oral hygiene excessive spacing severe malocclusions - malpositioned teeth bruxism insufficient enamel severe discolouration
38
downsides of buccal/labial veneers
higher failure rate if involves dentine or other restorations lute and leakage cyclical replacement technique sensitive
39
labial/buccal veneers - cases to take additional care with
lower incisors gingival recession root exposure high smile lines heavy occlusal contacts previous failed veneers
40
indications for external bleaching
age related darkening/discolouration mild fluorosis post smoking cessation tetracycline staining
41
bleaching - warnings for patient
sensitivity relapse and retreatment restoration colour allergy might not work or only work partially compliance with regime
42
internal non-vital bleaching indications
non vital tooth adequate RCT no apical pathology
43
internal bleaching contraindications
heavily restored tooth better with crown or veneer staining due to amalgam
44
internal non vital bleaching potential complications
external cervical resorption
45
combination bleaching for non vital teeth (inside out bleaching) - outline steps
make bleaching tray with a palatal reservoir bleach placed in access cavity and in tray replaced frequently over about a week
46
What are the advantages of using an inlay over a direct restoration?
- superior materials and margins - won't deteriorate over time
47
Extrinsic causes of tooth discolouration
- smoking - tannins e.g. tea, coffee - chromogenic bacteria - chlorohexidine - iron supplements
48
intrinsic causes of tooth discolouration
- fluorosis - tetracycline - non-vitality - amalgam - cystic fibrosis - grey teeth - sickle cell anaemia
49
factors affecting external tooth bleaching
- time - cleanliness of tooth surface - concentration of solution - temperature
50
external vital bleaching - warnings to patients
- sensitivity - relapse - won't bleach restorations - allergy - might not work - compliance with regime
51
in office external bleaching technique
- thorough clean of teeth - rubber dam or at least gingival mask - apply bleaching gel to tooth - apply heat and light - wash, dry and repeat - takes 30 mins to an hour
52
internal non-vital bleaching Indications
- non-vital tooth - adequate RCT - no apical pathology
53
what are the minimum requirements for a legal prescription?
prescriber must write clearly in black pen each individual letter must be visible must contain the following details: - name and address of patient - name of drug - form of drug e.g. SR tablet - strength - dose the patient is supposed to take, and frequency - total quantity of the preparation - prescribers signature, registration number and contact details - date
54
how long is a standard NHS prescription valid for?
6 months
55
how long is an NHS prescription for a controlled drug valid for?
28 days
56
What is the ideal operator seating position? give the features of this position
balanced position - approx 90 degree angle at the hip and knee - thighs roughly parallel to floor - feet on floor, back and neck upright - shoulders relax - move with back, do not bend, twist or stoop
57
How is direct aspiration done?
aspirator placed adjacent to tooth being treated best place slightly distal to tooth bevel adjacent to tooth remove any excess fluid or debris at back of patients mouth
58
when is indirect aspiration necessary?
if the aspirator obscures view of the operator - upper anterior region
59
What can be used for soft tissue retraction?
aspirator dental mirror cheek retractor 3 in 1 syringe tongue depressor
60
Name and describe
Protrusion condyle moves forwards and downwards on articular eminence only incisors +/- canines touch no posterior tooth contacts
61
name and describe
Intercuspal position (ICP) tooth position regardless of condylar position the comfortable bite maximum interdigitation of teeth
62
intercuspal position is also known as...
centric occlusion
63
name and describe
Edge to edge teeth slide forward from ICP guiding on palatal surfaces of anterior teeth incisal edges of upper and lower incisors touch
64
Name and describe
Maximum opening (T) no tooth contacts mouth wide open full translation of condyle over articular eminence
65
Name and describe
retruded axis position no tooth contacts most superior anterior position of condylar head in fossa terminal hinge axis
66
Name and describe
Retruded contact position first tooth contact when mandible is in retruded axis position ICP is approx 1mm anterior to RCP in 90% of population most reproducible position
67
what are functional cusps?
cusps that occlude with the opposing teeth in ICP - lingual cusps of upper posterior teeth and buccal cusps of lower posterior teeth
68
What are non-functional cusps?
cusp that do not occlude with the opposing teeth in the intercuspal position - buccal cusps of upper posterior teeth - lingual cusps of lower posterior teeth
69
What is canine guidance?
when mandible moves to working side; - only canines contact - no posterior teeth contact
70
What is group function?
when the mandible moves to the working side; - multiple teeth contact
71
Types of occlusal interference
working side non-working side protrusive
72
types of articulator
simple hinge average value semi-adjustable fully adjustable
73
temporisation options for a resin bonded bridge
consider RPD if prep into dentine and tooth becomes sensitive: - cover with layer of dentine bonding agent - or high fluoride toothpaste
74
What is a fixed-moveable bridge?
a bridge that has a rigid connector at the distal end of the Pontic and a moveable connector mesially - allows some vertical movement at the mesial abutment tooth
75
advantages of a fixed-movable bridge
preparation don't require common path of insertion more conservative of tooth tissue allows minor tooth movement may be cemented in 2 parts
76
disadvantages of a fixed-movable bridge
length of span limited laboratory construction more complicated possible difficulty in cleaning beneath moveable joint can't contract provisional bridge
77
what is a hybrid bridge?
one retainer = conventional preparation other retainer = minimal preparation - adhesive/resin retained
78
what is a spring cantilever bridge?
one Pontic attached to end of a metal arm that runs across palate to a ridgid connector on the palatal side of a retainer
79
spring cantilever - cases where this may be necessary
spacing present between upper incisors adjacent teeth unrestored posterior tooth would provide suitable abutment - large crown/restoration
80
disadvantages of spring cantilever
can only be used to replace upper incisors difficult to clean beneath palatal connector may irritate palatal mucosa difficult to control movement of Pontic
81
general contraindications for bridgework
uncooperative patient medical history poor oral hygiene high caries rate periodontal disease large pulps (conventional)
82
local contraindications for bridgework
high possibility of further tooth loss within arch prognosis of abutment poor length of span toot great ridge form and tissue loss tilting and rotation of teeth degree of restoration periapical status periodontal status/bone loss
83
What is a wash-through Pontic and when would it be appropriate?
a Pontic that makes no contact with soft tissue - functional rather than for appearance - consider in lower molar area
84
What ridge surface designs are available for bridge pontics?
wash-through dome shaped - useful in lower incisor, premolar or upper molar area modified ridge lap - buccal surface looks like tooth - lingual surface cut away - problems with food packing on lingual surface ridge lap/saddle - greatest contact with soft tissue - take care not to cause blanching or displace soft tissue ovate - excellent aestehtics - more difficult to clean
85
why do preparations for a fixed-fixed conventional bridge need to be parallel?
provides a common path of insertion increased retention
86
why are distal cantilevers less desirable?
occlusal forces on Pontic may produce leverage forces on abutment tooth causing it to tilt
87
basic principles of onlays and posterior crowns
caries removal keep as much sound tooth tissue as possible maintain pulp and periodontal heath restore form and function longevity aesthetics occlusal stability cleanable thorough case assessment
88
advantages of a posterior crown over an onlay
retention and resistance often better easier technically covers all cusps aesthetically sound
89
disadvantages of posterior crowns
more destructive than onlay often sub gingival margins cannot access for sensibility testing need a sound crown core
90
metal ceramic crown prep dimensions
1.5mm occlusal reduction 1.3mm buccal shoulder margin - 0.5mm above gingival margin 0.5mm lingual chamfer margin 0.5mm functional cusp bevel
91
Give 4 uses for a face bow
mounting the upper cast transferring the relationship between the maxillary teeth and axis of rotation from the patient to the articulator positions the upper cast vertically transfers the angulation of maxillary occlusal plane in relation to a horizontal reference plane
92

1 - BDS4 finals - big topics (17 decks)

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