17. Restorative Dentistry

Question 1

Repairing/replacing teeth

1. 5 indications
2. 5 contraindications
3. Principles of cavity prep
4. Define 3 types of caries (D1, D2, D3)
5. Define caries/cavities according to Black’s classification
6. Difference between affected and infected dentine
7. Describe 2 methods of caries removal
8. Name 3 other types of caries removal

Answer 1

1. Pain, sensitivity, poor aesthetics, fracture, functional problems (mastication, speech), structure problems, occlusal instability, perio splinting, restoring OVD
2. Damage to tooth and pulp, secondary caries, effect on periodontium, cost, failure
3. Access - identify and remove carious enamel. Remove enamel to identify maximal extent of lesion at ADJ and smooth enamel margins. Ensure ADJ margins are caries-free
   Caries management - progressively remove peripheral dentinal caries. Remove deep caries over pulp.
   Cavity modification - outline form modification and internal design modification (for chosen material)
4. D1 - clinically detectable enamel lesions with intact surfaces
   D2 - clinical detectable cavities limited to enamel
   D3 - clinically detectable lesions into dentine
5. I - pit and fissures, II - posterior proximal, III - anterior proximal , IV - anterior incisal edge, V - cervical third of buccal/lingual surfaces of any tooth
6. Affected - softened demineralised dentine that has not been invaded/contaminated by bacteria
   Infected - - softened demineralised dentine that has been invaded/contaminated by bacteria
7. Partial caries removal - access, caries removal, removal of infected dentine where possible, definitive restoration
   Stepwise caries removal - access, caries removal, leave caries over pulp, temporary restoration, allow tertiary dentine formation, remove temporary restoration, remove remaining soft dentine, definitive restoration
8. Self-cleansing, direct pulp cap, pulpotomy

Question 2

Occlusion definitions

Define

1. Ideal occlusion
2. Functional/stable occlusion
3. Mutually protected occlusion
4. Supporting and non-supporting cusps
5. Centric stops
6. Occlusal interference
7. Bennet angle
8. Sagittal condylar guidance angle
9. Rest position
10. FWS

Answer 2

1. Anatomically perfect
2. Free of interferences to smooth gliding movements of the mandible, with the absence of pathology
3. Gold standard. Canine guidance, posterior disclusion in lateral excursions, no protrusive interference, no non-working/working side contacts
4. Supporting - cusps that occlude with opposing centric stops (usually upper palatal and lower buccal)
   Non-supporting - cusps that don’t occlude with opposing centric stops (usually upper buccal and lower lingual)
5. Points on the occlusal surfaces which meet with the opposing teeth
6. Undesirable tooth contacts that may produce mandibular deviation during closure to ICP or may hinder smooth passage to and from ICP. Contacts that hinder smooth excursive movements of the mandible.
   Lateral obtrusive - undesirable working side contact
   Protrusive - posterior contact during protrusion
7. Angle described by the orbiting condyle during lateral protrusive movements. Average is 10-15d
8. Angle at which the condyle descends down the glenoid fossa of the TMJ in the sagittal plane
9. Normal position when not eating/talking. Teeth slightly apart (interocclusal clearance), TMJs in fossa. Neutral, relaxed position
10. Difference between rest position and ICP/difference between OVD and RVD. Average is 2-4mm

Question 3

Occlusion

1. Name and define 2 types of approaches to occlusion
2. Define guidance and describe 3 types of guidance
3. Describe 3 features of ideal occlusal contacts
4. Describe 2 features of unfavourable occlusal contacts
5. Give 4 features of normal occlusal forces
6. Give 4 features of abnormal occlusal forces and when might they occur

Answer 3

1. Conformist - maintain existing/original occlusion
   Reorganised - altering existing/original occlusion (new occlusal scheme, patient in RCP)
2. Factors which control protrusive and excursive movements of the mandible/ Anterior - anterior teeth contact (incisors/canines) on working side during excursive movements
   Group function - multiple posterior tooth contacts on working side during excursive movements
   Canine - disclusion of teeth on working side, except canines, and absence of non-working side contacts during excursive movements. reproducible and protects posterior teeth, so is preferred
3. Lower incisal edges and canine tips occlude against opposing upper cingulum (BSI class I), lower buccal cusps and upper palatal cusps occlude against fossa and marginal ridges of opposing teeth, tripid/cusp tip to base of fossa contacts, forces directed down long axis of tooth
4. On cuspal inclines, not at all
5. Contact only during ICP, short duration, light forces compared to maximum biting forces, forces directed down long axis of tooth, protective neuromuscular reflexes prevent injury
6. Greater forces exerted, longer duration, contacts in many mandibular positions, horizontally directed, protective neuromuscular reflexes do not operate, may cause damage to teeth, periodontium, muscles and joints

Question 4

Posselt’s envelope of motion

1. Define
2. Name and describe 5 tooth positions
3. Name and describe 4 jaw positions

Answer 4

1. 3D concept of mandible movements - a combination of border movements in all 3 planes (sagittal, transverse, frontal)
2. ICP - position of maximum interdigitation/intercuspation. Position of best fit between maxillary and mandibular teeth.
   RCP - Guided tooth position in which condyle in most anterior superior position within condylar fossa.
   Edge-to-edge - incisal edge to incisal edge. Upper and lower incisors at same coronal/frontal level
   Protrusive contact - occlusion when mandible maximally protruded (class III)
   Centric occlusion - RCP
3. Retruded axis position - position adopted by condyle during terminal hinge movement opening and closing (condyles in most anterior superior position - rotation not translation)
   Maximum opening - when mandible maximally depressed
   Centric relation - mandible position when condyles are in most anterior superior position in their fossa, resting against the posterior slopes of the articular eminences with articular discs interposed. Repeatable, reproducible position that can occur anywhere between retruded axis position and RCP
   Protrusion - jaw position when mandible maximally protruded

Question 5

SDA

1. Define
2. 4 indications
3. 4 contraindications
4. Define occlusal stability
5. 5 features which can determine occlusal stability
6. 5 requirements of occlusal stability
7. 3 options for extending SDA

Answer 5

1. Dentition where most posterior teeth are missing, but satisfactory function without RPD. LT occlusal stability, 3-5OU left. Usually 5-5 upper and lower
2. Missing posterior teeth with 3-5OU remaining, sufficient occlusal contacts to provide large enough occlusal table, favourable prognosis for remaining teeth, patient not motivated to pursue complex treatment plan, limited finances
3. Poor prognosis of remaining dentition, untreated/advanced perio disease, pre-existing TMD, signs of pathological wear, significant malocclusion (class II, class III)
4. Stability of tooth positioning relative to its spacial relationship in occluding dental arches. Absence of tendency for tooth migration, other than normal physiologic compensatory movements over time
5. Absence of pathology (wear, perio disease), perio support, number of teeth in each arch, interdental spacing, occlusal contacts, mandibular stability
6. Stable contacts on all teeth of equal intensity in CR (balanced occlusion), anterior guidance in harmony with Posselt’s envelope of motion, disclusion of all posterior teeth during mandibular protrusive movement, disclusion of all posterior teeth on non-working side due to mandibular lateral movement, disclusion of all posterior teeth on working side during mandibular lateral movement
7. Bridge, implants, RPD

Question 6

Facebow and Articulator

1. Define face bow
2. Purpose of face bow
3. Define articulator
4. 2 functions of articulators
5. 3 types of articulators

Answer 6

1. Horizontal record of the hinge axis of the mandible
2. Used to orient maxillary cast in same relationship on articulator as maxilla is related to condyles
3. Mechanical devices the represent TMJ and jaw members to which casts can be attached to simulate jaw movements
4. Observe occlusal relations, provide diagnostic wax-ups
5. Non-adjustable (hinge, average value), semi-adjustable (arcon/non-arcon), fully adjustable

Question 7

Indirect Restorations

1. Name 6 types of indirect restorations
2. Give 5 advantages of indirect gold restorations
3. Give 4 disadvantages of indirect gold restorations
4. Give 4 indications of indirect gold restorations
5. Give 2 advantages of indirect composite vs direct composite
6. Give 3 advantages of ceramic
7. Give 2 advantages of CAD-CAM (milled - Cerec) indirect restorations

Answer 7

1. Veneers, inlays, inlays, overlays, crowns, bridges
2. Excellent strength, good support, good cuspal protection, durable, corrosion resistant, wear resistant
3. Expensive, poor aesthetics, difficult to make, demanding and non-conservative prep
4. Small lesions leading to complete coronal breakdown, cuspal coverage for molar, coronal protection, ideal occlusal production, prevent galvanism
5. No PCS, no cuspal flexure
6. Best aesthetics, good wear resistance, good retention
7. Excellent marginal fit, single visit

Question 8

Veneers

1. 5 advantages
2. 3 disadvantages
3. 5 indications
4. 5 contraindications
5. 2 types and 2 advantages of each
6. Describe standard tooth prep for veneers

Answer 8

1. Improve aesthetics, change tooth shape/colour, correct peg-shaped lateral incisors, reduce/close spaces, align labial surfaces of in-standing teeth
2. Destructive tooth prep, often fail and require replacement with crown, irreversible, expensive
3. Sound tooth, mild discolouration, hypoplasia, fractured tooth, wear, space closure, shape modification
4. Heavily restored tooth, poor OH, high caries rate, interproximal caries/restorations, gingival recession, root exposure, heavy occlusal contacts, severe discolouration, extensive tooth loss (insufficient bonding areas)
5. Composite - less destructive, direct or indirect
   Porcelain - better aesthetics, stronger
6. 0.5mm incisal depth cuts, labial reduction, finish line (chamfer) extending to gingival margin and into embrasures (short of contact point), incisal edge reduction

Question 9

Crowns

1. 5 indications
2. 5 contraindications
3. 5 advantages
4. 5 disadvantages
5. Principles of crown prep
6. 4 types of crowns
7. Typical crown margins for metal crowns, PJC, MCC, all ceramic (alumina/zirconia)

Answer 9

1. REET, protect weakened tooth structure, fixed bridge retainer, restore function, after veneer failure
2. Active caries, perio disease, lack of tooth tissue available, unfavourable occlusion, healthy tooth
3. Strong, good aesthetics, restore tooth shape, restore tooth function, relatively straightforward prep
4. Destructive prep, irreversible, likely to fail and require post core, expensive, tooth sensitivity/pulp exposure
5. Preserve tooth structure, retention and resistance forms, structural durability, marginal integrity, preserve periodontium, aesthetic considerations
6. Metal (GCS), PJC, MCC, all ceramic (alumina, zirconia)
7. Metal - 0.5mm axial, non-functional cusp; 1.5mm functional cusp; 0.5mm chamfer
   PJC - 1.0mm axial, non-functional cusp; 1.5mm functional cusp; 1.0mm shoulder
   MCC - 1.3mm axial, non-functional cusp; 1.8mm functional cusp; 0.5mm lingual chamfer, 1.3mm buccal shoulder (0.4mm metal and 0.9mm porcelain)
   All ceramic - 1.5mm axial, non-functional cusp; 2.0mm functional cusp; 1.0-1.5mm chamfer

Question 10

Provisional indirect restorations

1. 4 functions
2. 4 ideal properties
3. 4 stages in extra-coronal restoration
4. 3 types of preformed provisionals - 1 advantage and 1 disadvantage
5. Stages in custom-made provisionals

Answer 10

1. Restore function, restore aesthetics, restore occlusion, prevent sensitivity, prevent microleakage, prevent bacterial ingress
2. Non-irritant, good aesthetics, good strength, good wear resistance, dimensionally stable, able to be removed
3. Prep, temp, impression, reg and cement
4. Metal, plastic, polycarbonate. Easier to use, unlikely to fit accurately (large bank required)
5. Pre-prep impression, prep, fill impression with temp cement, re-seat impression, cure, remove impression, trim temp, check occlusion

Question 11

Restoration of RCT Teeth

1. 3 options for anterior tooth with intact marginal ridges ± discoloured crown
2. 2 options for anterior tooth with destroyed marginal ridges
3. 3 options for posterior teeth
4. What should be avoided in posterior teeth
5. Define core
6. 3 types of materials for cores and when to use
7. Define ferrule
8. Define post
9. 4 considerations of post placement
10. 3 ideal features of posts
11. 3 types of posts and 3 features of each
12. 3 problems with posts and cores

Answer 11

1. Composite ± bleaching, veneer ± bleaching, crown ± bleaching
2. Core + crown, post-core crown
3. Crown, onlay, core build up + crown
4. Post
5. Provides retention for crown in a tooth with insufficient tissue remaining
6. Composite - good aesthetics, strength, bond. Technique sensitive
   Amalgam - strong, not retentive, poor aesthetics
   GIC - temp only
7. Collar of dentine that should surround a tooth prepared for post-crown. Min 1.5mm height above crown margin around tooth
8. Provides retention for core in teeth with insufficient tissue remaining
9. Placed in canal (leave 4-5mm apical GP), at least 50% of length into root, ideally 1:1 post:crown length ratio, aim for longest, straightest canal, =1/3 root width
10. Parallel sided, non-threaded (passive), cement-retained
11. Cast metal/SS - poor aesthetics, radiopaque, root # common, corrosion. Most common
    Ceramics - high flex strength and # toughness, good aesthetics, difficult retrievability, root # common
    Fibre - flexible, good aesthetics, retrievable, bonds to dentine (DBA), radiolucent, similar properties to dentine. Requires 2mm ferrule
12. Core/post #, root #/crack, perforation

Question 12

Bridges 1

1. Define bridge
2. 5 indications
3. 5 contraindications
4. 5 advantages
5. 5 disadvantages
6. 3 types
7. 4 key considerations of Pontic design
8. 5 types of pontics
9. 3 reasons for failure
10. 5 and 10yr success rates for different types

Answer 12

1. Prosthesis used to replace missing teeth and attached to one/more natural teeth
2. Restore function, prevent unwanted tooth movements (stability), restore aesthetics, space maintenance, cooperative patient, systemic disease (implants contraindicated), improve distribution of occlusal load, heavily restored dentition
3. Poor cooperation, poor OH, high caries rate, perio disease, further tooth loss within arch likely, poor abutment prognosis, span length too great, bone loss (mobility), tilted/rotated teeth
4. Restore function, restore stability, restore aesthetics, fill gaps, improve distribution of occlusal load
5. Destructive prep, generally expensive, risk of debond (caries, etc.), if teeth not stable, may rotate, metal shine through
6. Adhesive/cantilever, conventional, fixed-moveable,
7. Cleansability, appearance, strength, surfaces
8. Wash-through (hygienic/sanitary) - no contact, not aesthetic
   Dome-shaped - point contact with tip of ridge
   Ridge lap/saddle - difficult to clean
   Ovate - greatest mucosal coverage, difficult to clean
   Modified ridge lap - minimal buccal ridge contact, lingual cut away. Good aesthetics, most popular, risk of food packing
9. Loss of retention, mechanical failure (fracture of casting), abutment teeth problems (secondary caries, loss of vitality, perio disease)
10. Adhesive - 80% 5/10yrs
    Conventional - 93%, 89%
    Cantilever - 91%, 80%
    Implant-retained - 95%, 87%

Question 13

Bridges 2

Define

1. Abutment
2. Pontic
3. Retainer
4. Connector
5. Edentulous span
6. Saddle
7. Pier
8. Unit
9. Support
10. Resistance
11. Retention

Answer 13

1. Tooth used as a bridge attachment
2. Artificial tooth suspended from abutment tooth/teeth, replaces missing tooth
3. Extra-coronal restorations connected to Pontic and cemented to abutment teeth
4. Connect Pontic to retainer
5. Space between natural teeth to be filled
6. Area of edentulous span over which Pontic will lie
7. Abutment tooth which stands between and supports 2 pontics (each Pontic attached to a further abutment tooth)
8. Retainer or pontic
9. Resistance to occlusal load/occlusally-directed displacement
10. Prevents dislodgement of restoration by forces directed in apical/oblique direction and prevents movement under occlusal forces
11. Prevents removal of restoration along PoI or long axis of abutment

Question 14

Bridges 3

1. Fixed-fixed - describe, 2 advantages, 2 disadvantages
2. Fixed-moveable - describe, 2 advantages, 2 disadvantages
3. Cantilever/adhesive - describe, 5 advantages, 5 disadvantages, 5 indications, 5 contraindications

Answer 14

1. Rigid connector at either end of edentulous span. Robust, good retention, good strength, difficult prep, destructive prep
2. Pontic anchored rigidly to major retainer at one end and via moveable joint to minor connector at other end. No PoI required, conservative prep, allows for minor tooth movement, complicated lab construction, limited by span length
3. Resin retained by (usually) metal (NiCr) wing.
   Advantages - minimal/no prep required, no LA, cheaper, quicker, long-lasting, can be rebonded
   Disadvantages - metal shine through, can debond, caries under debonded wing, occlusal interferences, dentine exposure during prep
   Indications - young teeth, good quality enamel, large abutment tooth surface, minimal occlusal load, single tooth abutment, short span
   Contraindications - long span, heavy occlusal forces, tilted/spaced/poorly aligned teeth, excess abutment tooth tissue loss, poor quality/insufficient enamel, poor prognosis of abutment tooth

Question 15

Wear 1

1. Define tooth wear
2. Name and describe 4 types
3. 2 clinical features of 2 types, 4 of one
4. 3 classification indices
5. Describe one answer to 4
6. Aetiology of erosion
7. 4 consequences/features of (untreated) erosion
8. 4 types of intrinsic and 4 types of extrinsic acids

Answer 15

1. Irreversible loss of tooth substance by factors other than caries or trauma
2. Attrition - physiological wear caused by tooth-tooth contact
   Abrasion - physiological wear caused by abnormal mechanical processes independent of occlusion. Toothbrushing, wire stripping, pipe smoking, etc.
   Erosion - pathological loss of tooth substance by chemical process not involving bacteria
   Abfraction - controversial. Pathological loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum of the tooth
3. Attrition - polished wear facets, reduced crown height, matching wear facets on opposing teeth
   Abrasion - V-shaped/rounded lesions (usually cervical), sharp enamel margin
   Erosion - occlusal cupping, exposed dentine, smooth surface, loss of surface detail, no chalky appearance, restorations stand proud, no staining, labial/buccal if extrinsic acid, palatal/lingual if intrinsic, irregular occlusal plane, non-uniform loss, reduced crown height
   Abfraction -
4. BeWe, Smith and Knight, Eccles and Jenkins
5. BeWe
   0 – no surface loss
   1 – initial loss of surface texture
   2* – distinct defect, hard tissue loss <50% of surface area
   3* – distinct defect, hard tissue loss >50% of surface area
6. Chronic exposure of dental hard tissues to acidic substances
7. Pain, sensitivity, loss of OVD, poor aesthetics, loss of vitality
8. Extrinsic - fruit juice, iron, vitamin C, fruits, carbonated drinks
   Intrinsic - GORD, vomiting, eating disorders, pregnancy, stress, rumination

Question 16

Wear 2

1. 5 management options for erosion
2. 5 management options for attrition
3. 5 management options for abrasion
4. 2 types of desensitising agents and methods of action
5. 2 techniques of composite build-ups
6. 5 advantages
7. 4 disadvantages
8. How to treat localised anterior tooth wear
9. How to treat localised posterior tooth wear
10. How to treat generalised tooth wear (excessive) with loss of OVD
11. How to treat generalised tooth wear (excessive) without loss of OVD but with space e available
12. How to treat generalised tooth wear (excessive) without loss of OVD and no space available

Answer 16

1. Identify and remove cause, prevention (OHI, FV), diet advice, desensitising agents, composite build-ups, indirect restorations, crown lengthening
2. Identify and remove cause, behaviour management, hard/soft splint, composite build-ups, indirect restorations, crown lengthening
3. Identify and treat cause, behaviour Mx, OHI, lifestyle/habit change, composite build-ups, indirect restorations, crown lengthening
4. Strontium chloride/NaF/stannous fluoride - occludes dentinal tubules, narrowing opening, less affected by air and hydrodynamic theory
   Potassium nitrate - interacts with AP propagation, preventing APs firing as efficiently, reducing sensitivity
5. Putty matrix, vacuum-formed stent
6. Good patient satisfaction, seldom TMJ problems, no detrimental effect on pulp, no perio disease worsening, easy to repair, no LA, no drilling
7. Short/medium-term solution, requires repair and maintenance, good aesthetics but not excellent, unrealistic patient expectations
8. Composite build-ups, lowers before uppers
9. Asymptomatic - prevention, monitoring
   Occlusal wear - fill in defects with composite (ensure canine guidance)
10. Dentures, composite build-ups
11. Reorganised occlusion, splint
12. Increase OVD using splints ± dentures (specialist

Question 17

Dahl Technique

1. Define
2. Describe technique
3. 2 (ideal) indications
4. 5 contraindications
5. 2 advantages
6. 2 disadvantages

Answer 17

1. Method of creating interocclusal space where no existing space for restoration placement in cases of localised wear
2. Composite build-ups to anteriors (incisor and canine contacts only), posterior disclusion, 2-3mm OVD increase, 3-6mths to create inter-incisal space - anteriors intrude and posteriors erupt causing posterior occlusion and inter-incisal space when composite removed
3. Younger patient, localised wear with loss of OVD
4. Bisphosphonates use, active perio disease, TMJ problems, immediate post-ortho, implants, existing conventional bridges, ankylosed teeth
5. No prep/LA, relatively simple and atraumatic
6. Long treatment course, likely to require to be replaced over time

Question 18

Tooth Whitening 1

1. 4 extrinsic and 4 intrinsic causes of discolouration
2. 4 treatment options for discoloured teeth only
3. 4 constituents of bleaching gel
4. Name and describe how active ingredient works
5. Max concentration of active ingredient
6. 8 risks of whitening
7. 4 predictors of sensitivity

Answer 18

1. Extrinsic - smoking, tannins, chromogenic bacteria, CHX, iron supplements
   Intrinsic - fluorosis, amalgam, tetracycline, ageing, porphyria, cystic fibrosis
2. HPT, micro-abrasion, external vital bleaching, internal non-vital bleaching
3. Carbamine peroxide, carbapol, urea, surfactant, potassium nitrate, fluoride, pigment dispersers, preservatives, flavourings
4. Carbamine peroxide - breaks down to form hydrogen peroxide and urea. Hydrogen peroxide pbreaks down to form water and oxygen and forms free radical per hydroxyl
5. 16.7% (6% H2O2)
6. Sensitivity, wears off/relapse, allergy, does not affect restoration colour, gingival irritation, cytotoxicity/mutagenicity, tooth damage, damage to restorations, problems with bonding to tooth, might not work, reduced compliance leads to a reduced effect
7. Pre-exisiting sensitivity, high concentration of bleaching agent, frequency of technique change, bleaching method, gingival recession

Question 19

External vital bleaching

1. Describe how discolouration occurs and how external vital bleaching works
2. 4 indications
3. 2 types and describe procedures
4. 3 advantages of both types

Answer 19

1. Discolouration occurs due to the formation of chemically stable, chromogenic products within the tooth substance. Whitening causes oxidation through H2O2. Oxudation leads to the formation of smaller molecules which are often not pigmented and can cause ionic exchange in metallic molecules, leading to a lighter colour
2. Age-related darkening, mild fluorosis, post-smoking cessation, tetracycline staining
3. Chairside - HPT, dam, bleaching gel applied, heat/light applied, tooth washed, dried, repeated
   Home - dentist for HPT, impressions, tray fitting. Trays have 1mm buccal spacer. Patient brushes teeth, loads spacer with bleaching gel, seats tray for 2hrs (usually overnight). Trays should stop 1mm short of gingival margin
4. Chairside - controlled by dentist, quick results for patients, can use heat/light
   Home - easy and quick to do, good results, relatively cheap

Question 20

Internal non-vital bleaching

1. 2 indications for internal bleaching
2. 2 contraindications
3. 3 advantages
4. 2 disadvantages
5. Describe procedure
6. Describe external cervical resorption

Answer 20

1. Non-vital tooth, adequate RCT, no PAP
2. Heavily restored teeth, amalgam staining
3. Easy, conservative, good patient satisfaction
4. Doesn’t always work, external cervical resorption
5. HPT, dam, remove filling, remove GP to 2mm below ACJ, RMGIC over GP to seal canal, dark dentine removed, etch internal surface, place gel, cotton wool roll, GIC temp. Repeat weekly for 3-4 weeks then place white GP in pulp chamber and lighter composite shade
6. Occurs due to diffusion of H2O2 through dentine into perio tissues. More likely if higher concentration and heat. Prevent by placing RMGIC over GP to seal canal

Question 21

Tooth Whitening 2

1. Describe combination bleaching
2. Define micro-abrasion
3. 4 indications for micro-abrasion
4. 3 contraindications
5. 3 advantages
6. 3 disadvantages
7. Describe technique of micro-abrasion

Answer 21

1. Internal bleaching as normal but no temp restoration. Bleaching tray with palatal reservoir. Gel in cavity and tray and replaced regularly
2. Removal of discolouration limited to outer layer(s) of enamel. Controlled acid erosion and pumice abrasion
3. Mild fluorosis, post-ortho demin, demin with staining, before veneering if dark staining present
4. Eroded teeth, tetracycline/amalgam staining, primary teeth
5. Quick, easy, no LT problems
6. Sensitivity, yellowing dentine shine through, can only have one course, only works for superficial staining
7. HPT, dam, sealant. 18% HCl mixed with pumice, applied to teeth. For 5s x10 or 10s x5. Teeth rinsed/washed, dam removed, fluoride prophy polish, FV. Avoid coloured foods for 7 days post-Rx

Question 22

Implants

1. 5 factors to consider before placement
2. Bone dimensions required
3. Best way to measure bone dimensions
4. 3 alternative options
5. 2 risk factors
6. 3 contraindications
7. Name 4 types of grafts that can be used for bone augmentation
8. Describe average integration time for implants

Answer 22

1. Smoking status, bone quality, bone quantity, OH, patient motivation, occlusion, aesthetics
2. 1.5mm horizontal bone around impact, 3mm between implants, >5mm space for papilla between bone crest and contact point, 7mm height of bone, at least 2mm from important structures (IAN, sinus, etc.)
3. CBCT
4. Do nothing and accept, RPD, bridge
5. Smoking, untreated perio
6. Immunosuppression, poorly controlled diabetes, bisphosphonate use. scleroderma
7. Autograft, allograft, xenograft, also-last
8. Mandible - 3mths
   Maxilla - 4-6mths