Restoring LARGE restorations Flashcards by Annabella Moody

An extremely sensitive part of the tooth where enamel & dentin meet:

DEJ

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Dentinal tubules are filled with _____ and are wrapped in ______

odontoblastic processes; afferent nerves and dentinal fluid

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When enamel or cementum is removed during cavity preparation, the _____ of dentin is lost which allows small fluid movements in the tubules, causing distortion s in the afferent nerve endings, hence pain

external seal

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refer to a situation when one tooth, or multiple tee4th at the same appointment are treated quickly by:

removing the infected dentin
medicating the pulp, if necessary
restoring the defects with a temporary material

Caries control restorations

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T/F: according to caries control restorations undermined enamel can be left to better retain the temporary material

true

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What are the steps to caries control restorations?

removing the infected dentin
medicating the pulp (if necessary)
restoring the defects with a temporary material

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Used when a deep carious lesion occurs and there is NO CLINICAL OR RADIOGRAPHIC EVIDENCE OF IRREVERSIBLE PULP DAMAGE (such as history of spontaneous pain, heat sensitivity relieved by cold, or a P.A. lesion)

Indirect pulp cap

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In order to perform an indirect pulp cap, the tooth should be ____ or at most have symptoms consistent with ____ such as moderate cold sensitivity with pain subsiding within about 15 seconds

asymptomatic; reversible pulpits

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T/F: caries are typically less extensive than the radiograph shows

False- usually deeper than appears on radiograph

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The objective of an indirect pulp cap is to:

AVOID A PULP EXPOSURE

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A liner may be added to the:

deepest parts of a prep, closest to the pulp

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When using a liner , the liner material should be kept away from:

the margin

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Liner materials include:

calcium hydroxide
resin modified glass ionomer

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Brand names for calcium hydroxide liners:

Life, Dycal

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Indications for calcium hydroxide liners (Life & Dycal):

Used on deepest prepes- pulp capping material

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Brand name for resin modified glass ionomer:

Vitrebond

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Vitrebond must be _____ and releases ________ over time

light cured; fluoride

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The “two appointment approach” of indirect pulp capping is done when the removal of all the infection (soft, leathery) dentin is most likely going to result in:

a pulp exposure

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The “two appointment approach” of indirect pulp capping is done when the removal of all the infection (soft, leathery) dentin is most likely going to result in a pulp exposure:

remove-
leave-

remove all caries both affected and infected dentin, from all areas except the deepest, closest to the pulp
the last little bit of infected dentin, cover it with calcium hydroxide (dycal or life) and glass ionomer (vitrebond)

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T/F: with the two appointment approach for indirect pulp capping some infected dentin (closest to pulp) can be left

True

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T/F: with the appointment approach for indirect pulp capping affected dentin is left while infected dentin is removed

false- both are removed except for the last little bit of infected dentin closest to pulp

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T/F: with the two appointment approach for indirect pulp capping, either dycal/life or vitrebond is used:

false- both are used (liner AND RMGI)

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After placing liner and RMGI with the two appointment approach to indirect pulp capping, place:

a temporary restoration, such as IRM or Ketac silver

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According to the two appointment approach to indirect pulp capping it is okay to:

leave some undermined enamel TEMPORARILY to help hold in the temporary restoration

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How long should you wait between the first and second appointment with the two appointment approach to indirect pulp capping?

Several weeks- perhaps 12

With the two appointment approach to indirect pulp capping why should you wait several weeks between the first and second appointment?

to allow the body to form reparative dentin in the site of near exposure- if we get the desired result, a dentin bridge will have formed

What is the desired result for waiting the several weeks between appointments with the two appointment approach to indirect pulp capping?

dentin bridge formation

With the two appointment approach to indirect pulp capping, at the end of the 12 weeks confirms that the patient is _____ and do a _____ before anesthetizing

asymptomatic; vitality test

With the two appointment approach to indirect pulp capping, the traditional approach following the 12 weeks and confirming patient is still asymptomatic is:

1. remove the temp restoration, glass ionomer & CaOH 2. carefully remove the remaining infected dentin 3. leave affected dentin 4. place new liner of dycal & if desired place vitrebond 5. remove all undermined enamel & modify prep 6. restore with permanent material

soft, leathery caries= dry, powdery caries=

infected dentin; affected dentin

Is affected dentin invaded by microorganisms?

What is the more common approach for indirect pulp capping?

single appointment approach

Used when a small pulpal exposure occurs during cavity preparation:

direct pulp cap

For a direct pulp cap- a thin layer of ____ is floated over the exposed pulp. A layer of _____ is placed over that.

Calcium hydroxide; glass ionomer

For a direct pulp cap- a thin layer of CaOH is floated over the exposed pulp. A layer of RMGI is placed over that. This may help stimulate the pulp to form ______, which can produce a ____ across the exposure site.

secondary odontoblasts; dentin bridge

With a direct pulp cap, it is most successful when the exposure is ____ rather than ____

mechanical; carious

Direct pulp caps work better at the _____ than they do on an exposure on the ____

tips of pulp horns; side of a pulp chamber

If the tooth will require a crown to adequately restore it, DO NOT RELY ON:

Direct pulp cap

Whether you are doing an indirect or direct pulp cap, temporary or "permanent" restoration:

SEAL THE CAVITY

When is a smear layer created?

whenever the dentin has been cut

The smear layer is a few micrometers thick and is composed of:

denatured collagen. hydroxyapatite & other cutting debris

The smear layer acts like a natural bandage over the cut surface since it occludes many dentin tubules with debris called:

smear plugs

When using "total etch" systems we do not want to:

bond to the smear layer

Acid conditioners=

35% phosphoric acid pH=0

Most dentin bonding systems have _____ that remove the smear layer and partially demineralize the intertubular dentin

acid conditioners

Dentin without a smear provides a good area for:

micromechanical retention

What is the pH of acid primers? Give an example of one:

pH=2.5 HEMA

Acid primers do not remove the:

smear layer

What removes the smear layer- acid primers or acid conditioners?

Acid conditioners

Resin bonding to _____ can last for many years, however the strength of resin bonding to ____ has a limited lifespan

enamel; dentin

Why does resin bonding to dentin have a limited lifespan?

due to deterioration of the hybrid layer

Often the bond of restorations that rely exclusively on resin bonding to dentin will be severely weakened after about:

4 years

Regardless of if etching to dentin or not, the enamel:

must be etched with 35% phosphoric acid, with total-etch or self-etch

Adesive bond strengths to _____ dentin are greater than those for ____ dentin

superficial; deep

Dentin with more tubules:

deep dentin

dentin larger diameter of tubules:

Deep dentin

Deep dentin has a ____ amount of interlobular dentin in deep areas

reduced

_____ dentin is more permeable than ____ dentin

deep; superficial

The defensive function of the pulp is related to:

its response to irritation by mechanical, thermal, chemical or bacterial stimuli

Why might the inflammation of pulp become irreversible leading to death?

Because the confined, rigid structure of the dentin limits the inflammatory response

The size of the pulp cavity ____ with age

decreases

What are more reparative? -younger or older pulps

younger

A primary objective during operative procedures must be the _________. All __________, except im the event of an indirect pulp cap.

preservation of the health of the pulp; caries must be removed

Usually manifests as cold sensitivity, and sometimes spontaneous pain, in the maxillary posterior teeth. Often hard to isolate to a single tooth:

maxillary sinusitis

Usually manifests as cold sensitivity, or sudden, usually unreproducible pain- when chewing. Can be evaluated with a tooth slooth or fiber optic light. These teeth require crowning:

cracked tooth

Usually manifests as cold sensitivity, or pain in chewing. Slight tooth movements when the teeth are clenched and then moved from side to side may be seen, nut not always. This is called fremitis. Pain can often be relieved by occlusal adjustments:

Occlusal trauma

Slight tooth movements when the teeth are clenched and then moved from side to side may be seen, nut not always (seen with occlusal trauma):

Fremitis

Cementum is slightly softer than dentin and consists of about ____ to ____ % of inorganic material by weight

45-50%

Has the highest fluoride content of all the mineralized tissues:

cementum

In about 10% of teeth enamel and cementum do not meet and this can result in :

a sensitive area

Regarding tooth contours: _____ is the WORST. It results in flabby, red-colored, chronically inflamed gingiva and increased plaque retention ____ results in trauma to the gingival tissues

overcontouring undercontouring

Where are the proximal contacts located in maxillary and mandibular central incisors?

Incisal third

Where are the proximal contacts in teeth posteriorly to the central incisors?

junction of occlusal and middle 1/3 (creates larger occlusal embrasure)

Marginal ridges should be the same height to prevent:

food impaction

Proximal contacts are sightly _____ to the center of the proximal surface FL

Facial

Regarding periodontal concerns what is extremely important to preserve in the restorative process?

attached keratinized tissue

T/F: if recurrent caries extends gingivally in the box area, it is acceptable and preferable to have a "box within a box" rather than deepening the entire box gingivally unless caries require it

true

Liners should be added to the:

deepest parts of the preparation close to the pulp

Keep liners away from:

margins of the restoration

Liner materials are ________ Brand names:

calcium hydroxide- (Dycal, Life) Resin modified glass ionomer (vitrebond)

What type of line is used on the deepest preps and is a pulp capping material:

CaOH (life or dycal)

What type of liner is light cured?

RMGI (vitrebond)

What type of liner releases fluoride over time?

RMGI (vitrebond)

Restorations should be supported by at least:

a tripod of natural structure

DO NOT have the entire floor of the restoration covered by _____. Why?

Calcium hydroxide- CaOH is too soft to support the restoration

Restoring LARGE restorations Flashcards

(86 cards)