Restorative Flashcards
What iatrogenic faults from an RCT may be found on an OPT?
Fractured file
Perforated file
Lodging
GP overfill/underfill
Extruded sealer
Missed canal
What iatrogenic faults may be found on restorations on an OPT?
Overhangs
Fractured restorations
Poor margins
Post without RCT
Perforated post
What developmental findings may be found on an OPT?
Cysts - dentigerous, radicular etc
Unerupted, ectopic, impacted teeth
Dentinogenesis imperfecta - bulbous crowns, abscess, pulpal obliteration
TMD
Give instructions on taking a facebow registration
Reference point frankfurt plane - EAM and 43mm from incisal edge of lateral incisor
Attach transfer jig to bow ensuring numbers facing operator
Apply bite reg onto bite fork and register maxilla bite
Position bow earbuds into EAM - pull upwards and make sure bow is centred and tighten screw
Slide bow and jig up and down to align with reference point of the infra-orbital foramen then tighten screw 1 then 2
Unscrew transfer jig from bow and then unscrew bows centre wheel and remove from pts ears
Remove from pts mouth, disinfect for sending to lab
How should you discuss with a pt that their tooth cannot be extracted today due to their warfarin?
Introduce self and year
Ask about INR - when was last done and what value was
Ask to see INR book
Explain tooth cannot be extracted today due to high risk of bleeding as result of the warfarin
Refer to SDCEP - INR ideally within 24 hours, 72 hours if stable (<4 for last 3 months), can proceed without interrupting meds if <4
Convince pt not to proceed
Deal with pain - acknowledge this and discuss options - analgesia +/- pulp extirpation and sedative dressing
Ask if pt understands and if they have any questions
How is veneer prep carried out?
Remember PPE and seating position
2x putty index - 1 for provisional, 1 for reduction determination (section along long axis)
Use chamfer bur:
- create 3 notches on buccal surfaces just below 0.5mm
- ensure tooth cut in two planes as for crown prep
- connect notches with chamfer bur
Reduce incisal edge 1mm
Bevel incisal edge
Use rugby ball bur (yellow) to finish
How is cavity prep 14MO carried out?
Remove artificial caries with high speed and slow speed burs
Avoid damage to adjacent teeth
CSMAs
No sharp line angles
No excessive prep
Make sure cavity margins not at contact point/clear contact
How is rubber dam placed for 35MOD?
Select correct clam
Can use nurse for assistance
Place dam over 36-34 due to contacts
Use widget and floss ligature
Give instructions for filling a DO cavity with amalgam
Avoid damage to adjacent teeth
Make sure cavity margins not at contact point/clear contact
Remember to Vitrebond cavity floor
Dam normally would be placed
Remember to check occlusion and for overhangs
What details should be written for a bridge prescription for conventional cantilever?
Pt detail sticker on all 3 sheets
Practitioner details
Date and time of recording imp
Date and time of completed required lab work
Plan - stage of tx (prep or fit), other lab work
What instructions should be given for a bridge prescription for conventional cantilever?
Please pour up imps with 100% improved stone, mount on semi-adjustable articulator using wax bite provided
Construct a metal ceramic (NiCr) conventional mesial cantilever bridge to replace tooth XX
Use XX as abutment and XX as a pontic
Shade XX
Staining and special effects
Surface features and finish
Ridge lap if posteriors
Modified ridge lap if upper anteriors
Dome shape if posteriors or lower anteriors
Please construct in canine guidance and ensure pontic is free of excursive movements
Please return the bridge with cast
When should each cement be used?
Aquacem (GIC) - Metal post, MCC, Gold or zirconia restorations
Panavia (anaerobic dual cure composite) - adhesive bridge (RBB)
Nexus NX3 (dual cure composite) - fibre post, composite/porcelain restorations, veneers
What precementation checks should be carried out?
Check on cast:
- is restoration as asked for
- rocking, contact points, marginal integrity, aesthetics
- occlusal interferences on excursions
- natural teeth contacting (articulating paper)
Remove from cast:
- check if occlusion correct and still the same
- check crown thickness with calipers
Crown placed with airway protection:
- recheck all above
- pt happy with aesthetics
What post cementation crown checks should be carried out?
Excess cement removed
No space around margins
Interproximal contact points exist and are clear
Occlusion checked with articulating paper (and excursions)
Restoration cleansible
Confirm pt happy with aesthetics and feel
Give instructions for applying dental dam to a 16 for RCT
Sit down
Correct clamp
Floss for airway protection
Single hole punch
Dam completely below clam
Frame above dam
Frame secure
Opal dam applied around clamp
Test leakage with CHX around clamp
What are the stages of tx planning?
Immediate
Initial
Re-evaluation
Re-constructive
Maintenance
What is involved in immediate tx planning?
Pain - Pericoronitis, toothache, perio abscess,
What is involved in the initial stage of tx planning?
HPT - diet advice, medical referrals, smoking cessation, alcohol advice, scaling
Removal of non-symptomatic teeth of poor prognosis - inform of risks
NCTSL management - find cause, fluoride, dirty advice, desensitising agents
Caries management
Endo treatment and temp restorations
What is involved in the re-evaluation stage of tx planning?
Perio review 6-8 weeks post completion
NCTSL pics and casts
What is involved in the re-constructive phase of tx planning?
Filling spaced
Dentures, bridges, implants
Indirect restorations
What is involved in the maintenance phase of tx planning?
Perio maintenance
NCTSL review
How can you avoid the fault of a crown not fitting properly?
Measure the temp crown thickness before cementing
Use a sectioned putty index when prepping
Give instructions on placing an MOD amalgam
Avoid damage to adjacent teeth
Make sure contacts clear
Vitrebond on cavity flood
Dam or CWR for moisture control
Place matrix and wooden wedge
Placement of AM from carrier into cavity then compact down with amalgam plugger
Hold down amalgam then wiggle off matrix band
Use Wards carver to carve and remove overhangs
Check occlusion with articulating paper
