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Treatment planning Flashcards

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1
Q

What are the 5 categories in the multidisciplinary tx plan?

A
  1. problem list by discapline
  2. tx objective and overview
  3. 6 phased tx plan & rationale
  4. prognosis
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2
Q

What are the problem list by discipline categories?

A

C MORE POOOPER

Chief Complaint
Medical/Systemic
Oral Path
Restorative
Endo

Perio
Oral surgery
Ortho
Occlusion
Prosth
Esthetics
Risk Factors

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3
Q

What should be discussed in the tx obje/overview?

A

statement of desired goals of tx- taking into account findings, pts situations and resources of the practitioner. — where you are headed with the case

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4
Q

What are the 6 tx plan phases?

A
  1. systemic phase
  2. emergency phase
  3. preparatory
  4. re-evaluation
  5. corrective restorative
  6. maintenance
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5
Q

What would you discuss during the prognosis?

A

a short and long term prediction based on an educated calculation ofthe response of heard and soft tissues planned treatment. Will take into account existing dental dn perio support, vulnerability to disease host resistance, pt adaptibility,

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6
Q

For the systemic/medical section? what might you be looking for?

A

med hx, ROS (how it might effect tx), Meds, Allergies, socail habits, labs, asa,
bleeding disorder
cardiac
repiratory
muscoloskeletal
GI, skin, endocrine
neurologic and genitourinary

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7
Q

What to look for during Oral Path?

A

review radiographs: note pneumitized sinus, RL/RO lesions,
Intra/extra oral photo review- lesions in the mouth, moles
Endo PARL
diffdx for everything!

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8
Q

What to look for during Restorative?

A

CD-PUNQ-C
Carious and fx teeth
Defective/unesthetic restorations

Prior endo (no cuspal coverage, GP exposure)
Underminded tooth structure or overhangs- like BW invasions,
Non- carious lesions (abfraction, attrition, erosion etc)
Questionable restorability- available restorative space, or perio considerations

Caries risk assessment– ICDAS, CAMBRA, low/med/high

Consider also: bac counts, OH status, Fl intake/exposure, salivary function, and dietary habits

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9
Q

What about Endodontics?

A

SP5 UP
Symptomatic teeth
PARL
Potential endo
Prior endo (comment on taper, density, length of obturation)
Parulis
Pre-Prosth endo

Unusual canal morphology (calcific metamorphosis, receded pulp_
*Pulpal and periapical dx!

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10
Q

Perio?

A

PBR2-MFO2-GSDP

Probing depths (>4mm, 5-6, >7mm, and CAL
BOP (and suppuration)
Recession (Cairo: RT 1-3)
Root Proximity

Mobility (miller 1-3)
Furcation (glickman grade 1-4)
O’Leary Plaque index (modified = 85% or higher is goal)
Open contacts (food impactions)

Gingival excess/discrepancy (5 reasons ***)
Systemic factors (smoking, DM, cardiac)
Diagnosis (Stage 1-IV, Grade A-C, localized, generalized or molar/incisor
Prognosis (Kwok-FQUH)

Other: cervical enamel projection and pearls
bifurcation ridges
palato-radicular grooves
marginak ridge discrepancy, 3rd molar angulation

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11
Q

Ortho?

A

R O3 M3AC

Rotated/crowding

Open contact
Over bite
Overjet

Missing teeth
Midline discrepancy
Mesially tilted molar/malpositioned teeth
Angle’s classification (Class I, II, Div 1, 2, 3) canine class
Crossbite

Skeletal profile?

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12
Q

Occlusion TMD

A

OW- CROP-IT

Occlusal scheme (mutually protected, group function, canine/ant guidance
Wear facets (attrition, erosion, abfraction)

Co/MI discrepancy
Rotated
Occlusal plane discrepancy (super-eruption, steep curve of spee/wilson
Parafunctional habits (nails, bruxism, chewing on non-food)

Interferences (excursive)
TMJ Status

Also: Vertical Dimension (Of occlusion, VDO- and Rest VDR)
Restorative space- tissue to bone/opposing,
for implants0 crown heigh space (misch)
Classification of oral facial pain

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13
Q

Prosth?

A

ABUM3 PRICE2 T3

Abutment status/length of edentulous span
Biologic width invasions (exisitng and new)
Undercuts (RPD)
Margins of crowns
Marginal ridge discepancies
Missing Teeth

P&C (existing, or needed)
Ridge (seibert 1-3) reiterate here to justify restoring with Implants, RPD, FDP
Inter arch and overall space considerations
Crown:Root (1:1 min, 2:3 ideal)
Estahtics
Endo without cuspal coverage

TMJ
Tori (if RPD)
Tuberosity (if RPD)

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14
Q

Esthetics

A

G2 TC SE
Gingival architecture (marins and papilla heights equal?)
Gingival display (is it excessive)

Tooth qualities: form, dicoloration, length, rotation
Crown qualities: margins, fx porcelain, stains

Smile disharmony
Expectations (via CC)

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15
Q

Risk Factors

A

CPC
Caries
Perio
Cancer

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16
Q

Treatment planning Phases

A

Emergent
Systemic
Preparatory Phase
Re-eval
Corrective Restorative
Maintenance

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17
Q

Emergent/Urgent Phase

A

CC- if it includes pain
Swelling
Oral path- if concerning
emergent esthetic concerns
systemic issues, if needed

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18
Q

Systemic Phase

A

DISCUSS TX MODS OR PRECAUTIONS
med consults as needed
Med list
Labs
Allergies
ASA

PMhx, ROS, meds, allergies, vitals, labs, asa, consultations

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19
Q

PREPARATORY PHASE

A

no crowns, preps, ortho
dx: work up (casts, O analysis, wax up, radiographs, photos)- rational for articuator selection, information obtained in anh of the above. why certian xrays, photos
Caries risk and charting- rationale for assessment and how it effects tx plan

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20
Q

What kind of articulator will be used? What is its class and why?

A

Whipmix- Celenza Class 3B, semi adjustable
Will accept an arbitrary facebow, and most lateral records (condylar/bennett angle)

helps reproduce simulated mand movement and resembles the anatomic structure of the pt.

can complete a custom incisal guide table to record ant guidance for prosthetic fabrication

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21
Q

When making an RPD- what do you need to do to the casts?

A

Make lab form
Tripod
Red: tooth modifications
Blue: Acrylic outlines
Brown: Metal outlines

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22
Q

For an RPD, what metal will I use and why?

A

Vitallium: alloy of 60% cobalt, 20% chromium, 5% molybdenum
Why: high MOE, high strength, relatively low cost

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23
Q

For an RPD- what teeth would i choose and why?

Study These Flashcards
A

20 degree Portrait IPN
WHY: strong resin resists abrasion, balance of esthetics and function/chewing effeciency/cusp height, easy to adjust

24
Q

When deliverying an RPD or CD, what do i do during the try in phase?

Study These Flashcards
A

Verify occlusion and adjust as needed
Check and verify esthetics with the patient- natural light/light they are in most often

Phonetics-
P,B,M: Bilabial- lip support, A-P position, flange thickness VDO/lip closure
F V: labial dental- incisors in the post 1/3 of lip, too short max V=F, long max F=v
Th: 3mm tongue tip visible(unless class II div I) if not visible, teeth too forward
T,D: T=D if max too L, D=T is max too facial.
S (silibants): opening too small or post arch too narrow=whistle, Opening too big, lisp
OR: is S on mand–> whistle = mand too L, Faulty S, L flange too thick.
SCZ: too gret a VDO= teeth come together.

25
occlusal scheme: Why would I choose a mutually protected occlusion-
ideal ant teeth protected during MIP Post teeth protected during excursive THUS: protecting my restore and improving overall prognosis of all definitive tx
26
occlusal scheme: Why would i choose group function?
if unable to have Mutually protected due to loss of cainine done to distribute forces to as many teeth as possible
27
Why would i restore the pt in CO?
restoring multiple post teeth bilaterally on both arches preparing teeth that act as 1st content CO is most repeatable which helps the lab too
28
Why would I restore someone in MI
pt has stable occlusion in the post (instability = hypermobility, excessive wear, migration of teeth, TMJ pain)
29
Diagnositic: What articulator do i use? and why?
Whip Mix Class IIIb- Arcon, smi adjustable, accepts arbitray facebow and lateral records, and I guide table fabrication
30
What facebow do i use and why?
arbitrary- Nasion for whipmix is external related max cast to condylar hinge axis
31
What amalgam do i use and why?
Contour- admix- 30%lathe, 70 spherical Contour: high copper (28%)- no gamma 2 (tin-mercury) 533mPa @24 hrs compressive good condensability, ease to develop interprox contacts, good compressive strength, long hx of success. or Spherical- Tytin occlusal best, fast setting time, 608mPa @ 24 hr compressive
32
What composite do i use and why?
*Nanocomposite- Filtek supreme -nanoclusters (zirconia/silica or silica nanomer sized particles) clusters are silate treated and crosslink to resins, broad filler distribution. -Higher filler loading, increased strength, nanomer filler particles allow increased polish retention Microfill-Venus Esthetic, good polishability, lower MOE, flexes with the tooth Wears well. Use in class 3 or 5 only
33
What bond do i use? Do i etch and with what? HOW do i use the bond?
Optibond FL- 4th gen 3 step (E, P, Adhesive)- highest strength 37% phosphoric acid- 15 secs Prime: 15 secs, rub in. Gently air dry for approximately 5 seconds. Bond: adhesive 15 secs, airthin 3s, light cure for 20
34
What is the primer in Optibond FL and what are common primers?
Primer in optibond: IDK Common: HMEA, Polyalkenoic acid, aceton, ethanol, PENTA, water
35
What are common adhesives in bond?
Bis-GMA, HEMA/UDMA
36
Why might you use a 6th gen, and what is it and give an exampl
Because there is not etch, can use for deeper restorations to decrease sensitivity. no post conditioning rinse 6th gen: P and cond then adhesive, 2 step (no etch, or selective etch) moderately high bond strengths. Clearfil SE, Optibond XTR
37
What is glass ionomer, which one do i use and why? How does GI bon?
Fuji II LC: dual cure, excellent retention to dentin (similar strength and CTE as dentin), moderate esthetics, fl release and recharge. Use on Class 5 lesions in high caries risk pt. Bond: A/B rxn polyacrylic acid is the conditioner, 20 secs, remove smear EQUIA Forte HT - hybrid filler is more susceptible to moisture and temperature cycling. Fuji II LC exhibits a smoother surface with reduced cracks, voids, and clumps compared to EQUIA Forte with and without a resin coating.
38
What is my endo procedure
Crown down, Protaper Gold- variable taper Sx, S1, S2 (Y, P, W)- orifice shapers F1-5 (Y, R, B)= finishing files. Irrigate with NaOCL 8%, and 17% EDTA Endo activator use in canal Continous wave- set plugger to 5-7mm from apex. Back fill and plug. Permaflow purple over orifice. Use MTA for perfs or other probelms. Close access- depends on plan with tooth.
39
What do i use for ridge preservation after ext?
70% FDBA/30%DFDBA (allograft): Why: osteoinductive and conductive Biomend (Bovine collagen)- resorable, prevents ET/CT down growth. Suture with PTFE (non-resorbable) ABX 7-10 days tryt o get 1 closure
40
For crowns, why would I use gold? What is the prep? What kind of gold?
durable, kind ot opposing, burnishable, minmal reduction. Prep design: 1mm axial with chamfer or shoulder, 1.5mm for stamp, 1mm sheer High noble metal (Type III, IV) such as Jelenko 7 or Firmilay
41
For crowns, why would I use MCR? What is the prep?
tooth color, more durable than ACR 10-20* taper, 1.5mm axial, 2mm O, shoulder margin 0.3mm metal, 0.2mm opaque, 1mm porcelian
42
For crowns, why would I use empress? What is the prep? What is empress? What is the strength?
Leucite filler particles- empress 80-160mPa veneers butt joint, 1mm at margin, 1.5 at incisa
43
For crowns, using emax? What is the prep? What is emax? What is the strength?
lithium disilicate 500MPa 1mm reduction if bonded treated with 5% acid etch for 20 second and a silane primer esthetic and strong- single unit crowns
44
For crowns, why would I use zirconia? What is the prep? What are the types of zirconia What is the strength?
3Y: 1000mPa, Lacal, emax zircad LT, bruxzir 4Y: 750MPa: Zircad MT, Katana ST/STML 5Y: 500MPa( lava ethetic, Katana UT.UTML) strength, posible can be bonded, longer span bridges, can make more esthetic with less wear on enamel than emax when polished Treated with Tribochemical silicates or 50um aluminum oxide and MDP
45
For an FDP, what are the connect sizes for LiDi and Zirconia
LiDi: 16mm^2 Zirconinia: 7mm^2 (ant) 9mm (post) 12mm(2pontics)
46
Which cements do i use and why?
No bonding- Fuji Cem- RMGI. chemical adhesion, F release, low leakage, high compressive strength Resin bondng: least soluble, highest strengths, no need for retnetion, need bonding agents, deceases leakage. Veneers: Variolink LC, Variolink DC= dual cure Self Adhesive Relyx unicem- use with pre-fab prosts.
47
What kind of temporary materials do I use for C&B?
Jet (PMMA)- long span FDP *indirect* Low cost, strong enough, good color stability - high polymerization shrinkage, high heat, Bisacryl (integrity) - single unit chemically polymerized resin, good color stability, good strength, easy to report, low shrinkage, Tempbond NE: zinc oxide, good retention, does not interfere with bond.
48
What kind of post do i use?
Prefab, parallel 0 WHY: dislodgement will leave salvagable tooth resin cement to retain- self adhesive Custom: one piece, increased resistence and retention, minimal loss of tooth structure, include core
49
For an RPD- what are the major connectors?
Max: A-P strap, Mand: L bar/plate
50
For an RPD what are the minor connectors?
guide plate, denture base connectors
51
For an RPD what do direct retainers must have?
R2,EPS2 Reciprocation Retention Encirclement Passivity Support stability
52
What different types of Direct retainers?
Suprbuldge Intrabuldge Combo
53
What are the suprabulge retainers?
Circumfrential clasp (good for class 3, or mod spaces) Ring- embrasure RPA: when I bar cant be used, Class I or II
54
What are the infabulge retainers?
I bar- T, Y RPI: clas I or II- has a mesial rest
55
IWhat kindo f unercut do you need for a combo clasp?
WW in 0.02" undercut
56
What is the material do I use for RPD framework?
Wironium- cobalt-chromium, or type IV gold acrylic teeth
57
What kind of implants do i use? Describe them
3i Certain, osseotite parallel or tapered Ossteotite: acid etched surface, increases clot/implant attachement, increases PLT activation an d RBC agglomeration to allow for increased rate and extent of bone healing Internal connection Tapered sizes: Length: 8.5, 10, 11.5, 13, 15 Width: 3.25, 4, 5, 6mm Width at apex: 1.9, 2.4, 3.1, 4.1 Parallel Length: 8.5, 10, 11.5, 13, 15, 18, 20 Width: 3.25, 4, 5, 6mm Width at apex: 2.4, 2.6, 3.1, 4.1 screw retained, UCLA abutment waxed to full contour, and custom cast abutments TiBase screw retained: cad/cam milled to full contour.

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