Restorative Flashcards
(106 cards)
1
Q
what is the failure rate of composite over 8 years
A
13.7%
2
Q
what are advantages of composite
A
better aesthetics
bonds to tooth
minimal prep
on demand set
lower thermal conductivity
supports remaining tooth structure
3
Q
what are disadvantages of composite
A
underpolymerised base
polymerisation shrinkage
composite insufficiently cured
moisture sensitive (requires dental dam)
post op sensitivity
longer placement time
less wear resistant
shorter life span
4
Q
what is the composition of composite
A
glass filler particles - quartz and microfine silica
monomer BisGMA
photo initiator camphorquinone
silane coupling agent
5
Q
why should you place flowable composite at the base of a cavity to be filled with composite
A
reduces contraction stress and achieves optimal adaptation in non-load bearing area
6
Q
what is the benefit of warming composites
A
mediates contraction stresses
7
Q
how to avoid sensitivity following composite placement
A
place lining material
check occlusion after completing restoration with articulating paper
use fluoride varnish 22600 ppmF
use desensitising toothpaste
8
Q
what is the constituents of DBA
A
primer and adhesive
primer is bifunctional and bonds to dentine with hydrophilic ends and hydrophobic ends are exposed
9
Q
what is the purpose of etching enamel
A
increases surface energy
removes contaminants
increases surface area by allowing micromechanical interlocking
bond is 20MPA
10
Q
what are advantages of amalgam
A
durable
shorter placement time
radiopaque
colour contrast
self hardens at mouth temp
resistance to surface corrosion
good wear resistance
11
Q
what are disadvantages of amalgam
A
potential mercury toxicity
poor aesthetics
does not bond to tooth
requires removal of sound tooth tissue
lichenoid reactions
amalgam tattoo
tooth discolourations
12
Q
what is the failure rate of amalgam
A
can last up to 20 years, 5.8% failure rate at 8 years
13
Q
how would you describe process of RCT to patient
A
aim is to remove nerve of tooth, disinfect and shape the root canals using files and mild bleach
we fill the canals with rubber material to stop infection spread
14
Q
what is the comparison of RCT teeth longevity with crowns vs without crowns
A
94% success rate for crowned endo teeth
56% success rate for endo teeth not crowned
15
Q
name 6 risks of RCT
A
ledge creation
perforation
failure
pain
instrument separation
hypochlorite incident
16
Q
what are reasons for RCT failure
A
missed canals
under preparation
poor obturation density
extruded GP
perforation
not using dental dam
17
Q
what is the likelihood of RCT success on untreated tooth with no infection
A
70-80%
18
Q
for teeth with irreversible pulpilitis what is the success rate of RCT
A
90% over 10 years
19
Q
how often after RCT should you radiographically review tooth
A
1 year post op, continue to assess for up to 4 years
20
Q
what are 4 aspects of successful endo outcome
A
no pain or swelling symptoms
no sinus
no loss of function
normal PDL
21
Q
what are 4 signs of unsuccessful endo outcome
A
associated with signs and symptoms
lesion has appeared radiographically
pre-existing lesion has increased in size or remained the same
signs of continuing root resorption
22
Q
what are treatment options following failed RCT
A
leave and monitor - warn pt they may get infection
re-RCT - decreases success
- if post-core present removing may cause vertical root fracture
- refer if fractured instruments ect
peri-radicular surgery - remove infected root tip and seal canal externally
XLA
23
Q
what are symptoms of NaOCl extrusion
A
pain
swelling
haemorrhage
ecchymosis
airway obstruction
neurological issues
24
Q
how to manage hypochlorite extrusion
A
stop
inform patient and apologise
if pt in pain provide LA block
place steroid containing intracanal medicament (ledermix)
seal cavity
encourage analgesia
consider antibiotics
recommend hot and cold compresses
review in 24 hours
25
when would you refer hypochlorite extrusion to OMFS
if intraoral ulceration apparent
intraoral necrosis apparent
airway compromised
neurovascular deficit
26
what are risk factors for hypochlorite extrusion
excessive pressure
needle locking in canal
loss of working length control
higher sodium hypochlorite concentration
larger apical diameter
27
how would you manage explaining to a patient there is a broken file in their root canal
let patient know what happened and apologise
explain it happens in 0.5-5% of cases
explain that due to cyclic fatigue and torsional stress the instrument has separated
take PA of tooth
attempt removal if visible (tweezers/ forceps)
if you cannot remove dwp a referral to a specialist is required
28
what are the patient's options following a file separation
monitor
bypass - using small K files then using ultrasonics
remove file
obturate up to blockage
peri-radicular surgery
XLA
29
what steps would you take if you perforated a canal whilst prepping it for RCT
identify - blood haemorrhage, achieve haemostasis
apologise to pt - explain that during preparation the drilling has went outwith the canal which affects the long term prognosis
repair perforation if accessible - GIC, MTA or biodentine
MTA plug with microscope if close to apex
peri-radicular surgery as last resort
30
what is pulp necrosis and treatment options for this
death of pulp - does not respond to testing, pt experiences no symptoms
treatment - RCT or XLA
31
what are the functions of provisional restorations
maintain aesthetics
maintain function
prevent teeth drifting
maintain gingival margin contour
prevent sensitivity
confirm tooth prep
32
what are eugenol based temporary cements not used for
if definitive restoration to be cemented with composite cement
33
what are indications for onlay
sufficient occlusal tooth substance loss - buccal and or palatal cusps remaining
tooth fracture
remaining tooth structure weakened
MODs with wide isthmuses
replacing direct restoration that has failed
less destructive than crowns
34
how long do onlays typically last
10-15 years
35
what are 5 risks of placing crowns
20% risk of necrosis of pulp in 5 years
weakening of the tooth
cost
failure
recession
36
what are advantages and disadvantages of MCCs
advantages - cheaper, aesthetics acceptable, historic treatment, metal helps reinforce porcelain against fracture
disadvantages - may have metal shine through, fracture and chipping of porcelain, thicker which requires more tooth reduction
37
what are advantages and disadvantages of zirconia
advantages - thinner, lighter, better aesthetics, better if less space, no risk of allergy to metal, precise fit due to cadcam
disadvantages - no bonding, difficult to adjust, wear on opposing teeth, fracture, tooth sensitivity
38
what are the advantages and disadvantages of gold crowns
advantages - corrosion resistant, fracture and wear resistant, biocompatible, suitable for bruxists
disadvantages - expensive, poor aesthetics
39
what are the advantages and disadvantages of emax crowns
advantages - lighter, thinner so more conservative, better if less space, no risk of allergy, less prone to chipping than zirconia
disadvantages - prone to cracking, price
40
what is the reduction for all metal crowns
functional cusps - 1.5mm
non functional cusps - 0.5mm
finish line - 0.5mm chamfer
41
what is the reductions for metal ceramic crown
functional cusps - 1.8mm
non-functional cusps - 1.3mm
finish line - buccal shoulder 1.3mm and 0.5mm palatal chamfer
42
what are the reductions for all ceramic crown
functional cusp - 2mm
non-functional cusp 1.5mm
finish line 1-1.5mm chamfer
Note - zirconia only requires 0.9mm chamfer
43
when a crown is delivered from lab what is the first thing you should check
check correct patient/ prescription
check patient mouth
44
what aspects of a crown do you check on the cast before cementing
check on cast for: rocking, m and d contacts, margins, aesthetics, occlusion, occlusal interference on excursions, adequate reduction, breakages, check prep by measuring thickness with calipers
45
what should you check after taking a crown off the cast
check if teeth occlude on cast without vs with crown
check prep by measuring thickness with calipers
46
what are the three aspects to seating a crown
give LA if tooth vital
remove all temporary cement
fit passively - do not force it
47
name lab faults that may cause failure of crowns to seat
interproximal overextension - check with floss
marginal overextension (trim crown or remake)
blebs on fitting surface - mark high surfaces with fit checker and remove with yellow band bur
if broken - send back to lab
48
name clinical faults that may cause failure of crown to seat
incomplete temp removal
gingival tissue encroachment
impression issue - distortion/ handling
49
how do you check occlusal interference on a crown
articulating paper and miller's forceps
sandblast metal to show high spots
shimstock - should be held in evenly and firmly by index tooth and crown
50
what is the ideal prep properties of crown prep
6 degree taper
bevelled functional cusp
2 plane buccal reduction
smooth margins
retentive grooves and slots
51
what could be a consequence of a poor provisional crown
over-eruption of opposing teeth
52
how do you prevent a patient being unhappy with aesthetics of a crown
check with patient prior to bonding
53
what are the post cementation checks after cementing a crown
excess cement removed
margins - no space
interproximal contact points - clear
occlusion - checked with articulating paper (also in excursions)
cleansability
confirm pt happy with aesthetics and feel
54
what are indications vs contraindications for veneers
indications - improve aesthetics, mask enamel defects/ discolouration, close peg laterals, close interproximal spaces
contraindications - poor OH, high caries rate, gingival recession, high lip lines, heavy contacts
55
what are the veneer prep dimensions
0.3mm cervical reduction chamfer margin
0.5mm midfacial reduction
1-1.5mm on incisal edge with bevel
56
what are contraindications for bridgework in patients
insufficient area for bonding
high caries rate
poor patient motivation
long span bridges
significantly tipped or misaligned teeth
57
explain an adhesive bridge to a patient
the false tooth is retained by a metal wing or wings which are bonded onto minimally prepped tooth enamel of adjacent teeth
58
explain a conventional crown to a patient
false tooth is attached to a crown on a crown-prepped adjacent tooth
59
what is a sanitary/ wash through pontic
has no contact with soft tissue - considered for lower molars
60
what is a dome/ bullet pontic
useful in lower incisor, premolar or upper molar areas as you only see the upper 2/3rds of the tooth
61
what is a modified ridge lap pontic
lingual surface is cut away for better cleaning
62
what is a total ridge lap pontic
greatest contact with ridge, may be difficult to clean
63
what is an ovate pontic
gingivae moulded to shape, looks like tooth has erupted from gingivae
64
how is an anterior resin bonded bridge prepped
no prep if cingulum undercut and no heavy contact
minimal - cingulum undercut removal
heavy prep - incisal guidance finish line, cingulum rest
65
how is a posterior resin bonded bridge prepped
minimal - lingual surface 180 wraparound interproximally with guideplanes to limit path of insertion and displacement
heavy prep - lingual surface clearly defined margins and occlusal rest
66
what is the survival rate of resin bonded bridge at 5 years and 10 years
5 years - 80.8%
10 years - 80.4%
67
what is the survival rate of conventional bridge over 10 years
cantilever - 80%
fixed-fixed - 90%
68
what are the lab instructions for indirect restorations
please pour impressions and mount cast on semi-adjustable articulator to occlusal record provided
please fabricate (tooth, material, shade)
if a bridge - let lab know which teeth are retainers, what type of pontic, is there canine guidance or is it free from occlusion
69
what cement would you use for cementing MCC
aquacem or RMGIC
70
what cement would you use to cement a metal post
aquacem (GIC)
71
what cement should be used to cement a fibre post
dual cure composite and DBA (nexus)
or self adhesive composite (relyX unicem)
72
what should a veneer be cemented with
light cure composite and DBA with silane (nexus)
73
what should an adhesive bridge be cemented with
anaerobic cure composite (panavia)
74
what should a zirconia indirect restoration be cemented with
anything apart from light cure composite
GIC (aquacem) or dual cure preferred (nexus)
75
what should a lithium disilicate be cemented with
dual cure composite and DBA (nexus)
76
what should a composite onlay be cemented in with
dual cure composite (nexus) or
self adhesive composite (relyX unicem)
77
what should a porcelain onlay be cemented with
dual cure composite with silane (nexus)
78
what should a gold restoration be cemented with
GIC (aquacem) or RMGIC
79
what is ledermix or odontopaste and what is the use
corticosteroid and tetracycline used on vital pulp/ hot pulp
can aid in reduction of pulpal inflammation
80
what is kalzinol and its uses
a ZOE cement used for soothing temporary filling, temporary cement for crowns and inlays, indirect pulp capping
81
how do you explain to patient they need a pulp cap
the pulp was exposed and requires a pulp cap - vital to have treatment as there is a risk of pulpal death which would then require RCT
pulp exposure must be small and surrounding dentine relatively hard
82
what is the process of a direct pulp cap
LA and dam
haemorrhage control with copious irrigation with saline
cavity irrigated with chlorhex
blot dry with sterile cotton wool pellet
exposed pulp covered in setting calcium hydroxide
RMGI lining placed
restoration completed
continue vitality monitoring regularly
83
what is the procedure for a carious pulp exposure
LA and dam
extirpation
coronal pulp tissue removed with sterile spoon excavator
irrigated with saline and dried
explain to pt that RCT or XLA will be required
ledermix placed as palliative agent whilst waiting for commencement of RCT tx
cotton wool placed and GIC restoration then review in 2 weeks
84
what is the process of indirect pulp cap
cleanse cavity with 0.2% chlorhex
stained dentine that is firm left in situ and covered with setting calcium hydroxide
RMGIC liner placed and temp restoration placed
monitor for 3 months
if vital and asymptomatic - remove temp and restore
any pulpal symptoms - RCT
85
how would you describe a post to a patient
used for teeth with lack of tooth tissue remaining
posts retain a core which supports crown placed on top
they are preferred in RCT teeth as they prevent fracture and leakage
86
what are the requirements for a post
4-5mm root filling apically
1.5mm ferrule height
1:1 post to crown ratio
post to be no more than 1/3rd width of remaining tooth tissue at narrowest point
at least half of post's length should be in the root
87
what are ideal properties of a post
parallel sided- avoids wedging
non-threaded - less stress on remaining tooth
cement retained
88
where should posts be avoided
mandibular incisors
4s
curved canals
89
what are risks of post treatment
perforation
core fracture
post fracture
root fracture
endodontic failure
90
what is the parapost lab prescription
please construct cast post and core
para post colour used
please leave 2mm space in occlusion for crown using enclosed registration
shade
91
what treatment options would you offer a patient presenting with a post and no RCT but caries present in crown
leave and monitor - unable to tell when will flare up, risk of abscess, pain, fracture, tooth loss
remove crown and caries only
remove crown and post, RCT, replace - risks are tooth may become unrestorable during this and require XLA
92
how to explain IDB palsy to patient and management
reassure about what has happened
LA has been injected into parotid gland where facial nerve runs through
facial nerve controls muscles of facial expression - temporary paralysis
cover patient's eye with patch until blink reflex returns
review in few days
93
how do you confirm an IDB palsy
test branches of facial nerve, ask pt to:
- wrinkle forehead
- smile/ show teeth
- blow or puff out cheeks
- close eyes forcibly
94
if a patient has hyperthyroidism or phaeochromocytoma what should you avoid in LA
avoid adrenaline
95
what are the five phases of treatment planning
immediate - relief of acute symptoms/ pain
initial - OHI, caries management and restorations
re-evaluation - assess disease control has worked
reconstructive - crown, bridges, veneers, fixed and removable pros
maintenance - review restorations and OHI, monitor disease, review perio
96
what is attrition
physiological wear due to tooth-tooth contact
associated with parafunction
97
what is abrasion
physical wear of tooth substance due to abnormal mechanical process
overzealous brushing
98
what is erosion
loss of tooth substance as a result of chemical processes that does not involve bacteria
99
what is abfraction
loss of hard tissue from eccentric occlusal forces causing tensile stresses at the cervical fulcrum areas
100
what are some causes of tooth wear
medications - acidic or cause dry mouth
GORD
eating disorders
bruxism
pregnancy
alcoholism
poor diet
101
what is the BEWE examination
0 = no erosive wear
1 = initial loss of surface texture
2 = less than 50% of hard tissue loss but still distinct
3 = hard tissue loss is more than 50% of surface area
102
what are special tests for tooth wear
sensibility tests
radiographs
articulated study models
I/O photos
diagnostic wax up
dietary analysis
103
how can toothwear be treated
enhanced prevention
aid sensitivity - GIC, bonding agents, fluoride, desensitising toothpaste
diet modification
dahl technique
composite build ups
overdentures
104
what is the dhal technique
prop bite open with composite build ups/ bite plane causing posterior disclusion and allowing over eruption of posteriors - allowing more space anteriorly to restore toothwear
105
what are contraindications for Dahl technique
active periodontal disease
TMJ problems
previous orthodontics
bisphosphonates
presence of dental implants
106
what information should be given to a patient when placing composite build ups for wear
tooth restored with tooth coloured material which is worn instead of patients own tooth
no LA due to minimal/ no drilling
bite may feel strange for a few days
soft diet initially
may notice lisp
current crowns and bridges may need replaced
potential for debonding but can be replaced with no damage to natural teeth
maintenance will have a cost
