Restorative dentistry

Question 1

What is the sequence of treatment?

Answer 1

Relief of pain
control of active disease and achievement of stability
reassessment of success of initial treatment
definitive treatment
monitoring

Question 2

What are symptoms, signs and treatment options of reversible pulpitis?

Answer 2

fleeting sensitivity to hot/cold/sweet - immediate onset. sharp pain, difficult to locate. quickly subsides.

Exaggerated response to pulp testing. not TTP

remove any caries present and restore. place a sedative dressing

Question 3

What are symptoms, signs and treatment options of irreversible pulpitis?

Answer 3

spontaneous, dull throbbing. lasts for several minutes or longer. worse at night, can be pulsatile. Sensitivity to hot/cold. pain continues after removal of stimulus.
tooth is sensitive to pressure

exaggerated or reduced/no response to EPT

treatment is extirpation of pulp and RCT. place intercanal medicament

Question 4

How do you distinguish between dentine hypersensitivity and cracked tooth syndrome?

Answer 4

DH = response to thermal, tactile or osmotic stimuli

CTS = pain on release of biting. can be visualised with a torch

Question 5

What are the possible occlusion restoration techniques?

Answer 5

Conformative approach - maintaining the patients current occlusal position

reorganised approach - establishing a new occlusion

Question 6

what are the benefits of using a rubber dam?

Answer 6

airway protection, field isolation, improved moisture control, reduced contamination risk, patient cant talk

Question 7

What are the principles of cavity preparation?

Answer 7

gain access, remove carious tissue from the outside in, remove unsupported enamel, modify cavity based on restoration materials used.

Question 8

What are the preparation techniques for an inlay?

Answer 8

take impression of tooth before preparation with silicone
Preparation has slightly divergent walls, rounded line angles, slight bevel to enamel margins which arent occlusal.
block out undercuts with RMGI
take impression of occluding arch
choose shade
make temp with the silicone impression

Question 9

what are causes of restoration failure?

Answer 9

poor occlusion, incorrect preparation (caries left, incorrect margin), incorrect choice of restorative material, incorrect management of material (poor moisture control)

can be failed margins, bulk fracture or failed aesthetics. Failed margins allows secondary caries

Question 10

What is non carious tooth surface loss?

Answer 10

NCTSL is loss of dental tissue for reasons other than bacterial.
attrition - tooth on tooth contact
abrasion - tooth on non - tooth surface
erosion - intrinsic and extrinsic
abfraction - abnormal cyclical loading on the tooth causes fracture at the cervical margin

Question 11

how do you treat NCTSL?

Answer 11

identify aetiological factor and treat that - might be refer to GP, soft splint, diet advice, refer to psychiatrist

monitor by taking study models and photographs

restore if required - comp or GI can be useful

Question 12

What are vital bleaching techniques?

Answer 12

Home bleaching - 10-15% carbamide peroxide in splint
worn up to 8 hours per day for 2 weeks
give patient advice and instructions - small drop of gel into the tray. review weekly

“in office” bleaching - higher concentration of bleach or light activated.
need orobase to protect gingiva before dam. use dam - must be sealed. polish teeth with pumice, apply bleach, wash teeth, remove dam and polish.
pt needs to avoid dietary stains

Question 13

What is a non-vital bleaching technique?

Answer 13

inside/outside bleaching
construct a bleaching tray. open access cavity, remove root filling to 2mm below gingival margin and seal with GI.
remove stained dentine in the cavity, wash with etchant and then alcohol. dry. place pledget with carbamine peroxide (10%) and get the patient to replace this every regularly (active for 2 hours) and also place bleaching material in the tray

Question 14

What are the indications for veneers?

Answer 14

teeth are sound but discoloured
fractured teeth
hypoplasia
toothwear
closing space/modifying shape

Question 15

What are the contraindications for veneers?

Answer 15

large restorations, severe discolouration, insufficient surface for bonding, parafunctions

Question 16

what are types of veneers?

Answer 16

resin composite and porcelain

Question 17

what are options for crowns?

Answer 17

Metal ceramic, porcelain jacket, dentine bonded, all ceramic

Question 18

What is the preparation for a crown?

Answer 18

interproximally - walls should have 5 degrees taper
labial
lingual
occlusal - 0.5mm reduction for gold up to 1.5mm reduction for all ceramic (zirconia) crown.

chamfer for metal, shoulder for porcelain

Question 19

What are the different types of post and core system

Answer 19

prefabricated or custom made
parallel sided or tapered
threaded, smooth or serrated

metal - StSt or Ti
non metal - carbon fibre, glass fibre

Question 20

how do you remove an old post/core/crown?

Answer 20

remove the crown with a tornado bur, protecting the patients air way. use ultrasonic scaler to remove left over cement.
use Spence - Wells forcepts and twist

can use eggler post remover or masseran

Question 21

What are some concerns patients may have about amalgam?

Answer 21

environmental impact
toxicity
aesthetics
cancer
tooth wear

Question 22

What reassurance would you give someone about mercury toxicity?

Answer 22

small amount, well controlled
doesnt leak out 
compressing it into the cavity pushes mercury to the top - then removed
good logenvity
no link to cancer
metal scavengers and recycling

Question 23

what are the principles of cavity design?

Answer 23

access the cavity to the ACJ - extend to the edge of caries
remove affected enamel and dentine from outside in, cleaning ACJ
leave no unsupported enamel
clear the contact areas
dont finish restoration on contact area
cavo surface margin angles/internal line angles/undercuts for the restorative material to be used

Question 24

how is resin composite bonded to dentine?

Answer 24

remove smear layer and etch with phosphoric acid (37%) to demineralise and open tubules to expose collagen

prime - primer monomer which is bifunctional molecule - hydrophobic and hydrophillic and allows bonding

bond - unfilled resin monomer - creates hybrid layer with resin tag for micromechanical retention

Question 25

How can you check if a resin bonded bridge has debonded?

Answer 25

is there any flex over the tooth? can you see bubbles in saliva? can you get probe underneath? can you get floss through it?

Question 26

if a patient comes in with #MOD od 36 which broke 6 months ago, how would you proceed?

Answer 26

Hx, exam, Rx, investigations, sensibility testing, check for caries,

Question 27

when would you re-root treat a tooth where the GP has been exposed?

Answer 27

<6 months

Question 28

20yr old male attends with increasing discolouration of 21 over 2 years. good PDH

Answer 28

could be intrinsic colour change - pulp obliteration, root resorption (int+ext), caries, plaque/calculus extrinsic: diet, bacteria, smoking, tanins, CHX check trauma history, diet, SH

Question 29

what are the differences between reversible and irreversible pulpitis?

Answer 29

reversible: sharp, shooting pain to stimulus but stops when stimulus removed. +ve EPT and EtCl. poorly localised. Tx - restoration, indirect pulp cap Irreversible: spontaneous, dull ache, persists after removal of stimulus, keeps pt awake, worse when lying down. ++ or -ve response to EPT and EtCl. Tx - XLA or RCT

Question 30

What is dentine hypersensitivity?

Answer 30

osmotic theory movement of dentinal fluids within the dentine tubules pulls on nerve fibres and elicts a painful response thermal, osmotic or tactile response Dx by elimination

Question 31

What are the benefits of provisionalising a tooth during restorative work?

Answer 31

``` protects tooth vitality maintains occlusion and positional stability patient gets used to it aesthetics diagnosis function ```

Question 32

How do you improve the function and longevity of a posterior composite restoration?

Answer 32

``` linings good setting technique - in steps occlusal condsideration dry field correct composite - macrofilled ```

Question 33

What are different reastons for post failure?

Answer 33

``` perforation bacteria introduced in post prep accessory canals not cleaned poor post design or placement occlusion not taking into account not cemented properly ```

Question 34

What are treatment options for dentine hypersensitivity?

Answer 34

``` toothpastes with desensitising agents (strontium Chloride) duraphat varnish GI dentine bonding agents RCT if severe ```

Question 35

What is ludwigs angina?

Answer 35

potentially life threatening cellulitis involving the sub mental, sun lingual and sub mandibular spaces usually caused by periapical abscess of mandibular molars urgent referral to hospital, need IV ABs

Question 36

Who is susceptible to osteomyelitis?

Answer 36

alcoholics drug users diabetic patients immuno suppressed

Question 37

How do you treat osteomyelitis?

Answer 37

remove sequestra and necrotic bone | treat with amox 500mg TID plus flucloxacillin 250mg QID