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Prostho 3 > 8. Endodontically treated teeth > Flashcards

8. Endodontically treated teeth Flashcards

1
Q

FPD options for endodontically treated teeth?

A
  • large restoration with prefabricated post

- cast post and core

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2
Q

RPD options for endodontically treated teeth?

A
  • over denture

- RPD

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3
Q

Characteristics of ETT? (3)

A
  1. Dentin modification
  2. reduction of structural integrity
  3. reduction of sensitivity
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4
Q

Properties of dentin?

A
  • Help inhibit crack progression

- Fracture toughening mechanisms

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5
Q

Properties of dentin in ETT? (4)

A

Increased fragility:

  • Dehydration
  • collagen fibers reduction and degeneration

Less fatigue resistant

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6
Q

Clinical situations when a tooth has degradation of collagen fibers? (3)

A
  • more minerals
  • higher brittleness
  • higher fracture risk
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7
Q

When do collagen fibers in a tooth degrade? (2)

A
  • endodontically treated teeth

- older teeth

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8
Q

Why is there a reduction of structural integrity in ETT? (2)

A
  • due to the irrgants over the dentin (NaOCL, EDTA, Ca(OH)2)

- less original structure

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9
Q

What happens to lower molars and upper premolars with MOD restorations and endodontic therapy?

A

Vertical fracture in 50% of the cases

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10
Q

Reduction of sensitivity in ETT? (5)

A

• Reduced proprioception.
• Higher pain threshold.
• Lowered capability of recording stimuli.
• Less control of the applied forces over it. Needs twice the forces
to react.
• It leads to inadequate behavior under high occlusal loads.

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11
Q

Assessment of the ETT: When is a tooth considered healthy clinically? (3)

A
  • No fractures that extend beyond the boundaries of the
    restoration.
  • Periodontal health.
  • No infection (no fistulas, no oozing, etc).
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12
Q

Assessment of the ETT: When is a tooth considered healthy radiographically? (4)

A
  • no root fractures
  • no internal/external resorption
  • good apical seal
  • no radiolucent periapical areas (at least 6 months after endo treatment)
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13
Q

When do we use a cast post and core?

A

Great destructions

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14
Q

When do we use a prefabricated post?

A

Smaller and medium destructions

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15
Q

If the pulp canal is cylindrical what do you place inside?

A

Cast post and core OR prefabricated post

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16
Q

If the pulp canal is oval what do you place inside?

A

Cast post and core

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17
Q

Where do you place the post in an upper molar?

A

Palatal canal

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18
Q

Where do you place the post in multicanal teeth?

A

Largest, straightest canal

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19
Q

Where do you place the post in a lower molar?

A

Distal canal

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20
Q

Where do you place the post in a premolar with two canals?

A

palatal canal

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21
Q

What do you place in the canal if the canal is very inclined relative to the occlusal plane?

A

prefabricated post

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22
Q

Every posterior ETT will need…

A

A restoration that covers the cusps : onlay or crown

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23
Q

What is the ferrule effect?

A
  • Crown has to have atleast 1.5-2mm of healthy cervical dentin all around the contour of the tooth (on top and all sides)
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24
Q

Why is the ferrule effect important for teeth? (6)

A
  • to optimize the biomechanical properties
  • elevates resistance of the crown
  • reduces and transmits stress
  • dissipates forces concentrated at tooth circumference
  • stabilizes restored tooth
  • optimizes the resistance form
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25
Q

The more ferrule height, the …

A

better the prognosis

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26
Q

The more uniform the ferrule in the whole circumference, the…

A

better and less risk of fracture

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27
Q

A non-uniform ferrule is…

A

better than none. More important on the palatal and buccal surface

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28
Q

Incase of no ferrule..

A
  • today many prefer the prefabricated post

- if not viable, extract and restore with implant or bridge

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29
Q

What is the minimally acceptable crown to root ratio? why?

A
  • 1:1

- to resist lateral forces

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30
Q

What crown to root ratio will have a better prognosis?

A

1:2

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31
Q

What are the solutions for a tooth with subgingival destruction? (3)

A
  • crown lengthening
  • orthodontic extrusion
  • tooth extraction
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32
Q

What do we need for a ETT tooth?

A
  • 1.5-2mm ferule effect
  • respect 3mm biological width
  • min 4.5mm of supraalveolar tooth structure
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33
Q

What does surgical crown lengthening do? (4)

A
  • increases crown:root ratio
  • reduces volume of root dentine
  • good option for molars
  • delays treatment 3-6 months
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34
Q

What occurs when orthodontic extrusion occurs?

A

reduction of bone support

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35
Q

Why should orthodontic extrusion be considered before surgical option? (2)

A
  • more favorable mechanical behavior

- preferable for pm and incisors

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36
Q

ETT patients with excessive occlusal wear or parafunction have a higher risk of…(3)

A
  • fracture
  • debonding
  • fracture of the composite core
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37
Q

If a ETT tooth has a limited prognosis and has to act as an abutment, we should…

A

evaluate the higher risk of fracture

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38
Q

If a ETT tooth has a limited prognosis and is in a strategic position in a wider restoration plan, we should…

A

consider extraction

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39
Q

If a ETT tooth has a limited prognosis and is between two implants, we should…

A

consider extraction and restore with an implant

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40
Q

What determines a successful clinical outcome of the ETT?

A
  • adequate root canal treatment

- adequate restorative treatment

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41
Q

What characteristics does an adequate restorative treatment have? (3)

A
  • good post and core system
  • luting agent and techniques
  • restoration type, full or partial coverage crown
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42
Q

Why are posts used?

A
  • The retention of the core
  • Optimization of the resistance
  • Transfer and dispersion of the loads into the root

*strengthens tooth and restoration overall

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43
Q

Indications for placing a post (4)

A
  • Large defects requiring crowning
  • Large defects requiring partial coverage
  • Narrow abutment diameter
  • Immature root with a large root canal
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44
Q

Which materials do not have a reinforcing effect over the tooth or restoration? (3)

A
  • gutta percha
  • MTA
  • composite
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45
Q

Posts and upper central incisors?

A

Three times tougher if it doesnt have a cast post and core

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46
Q

Why is a post sometimes beneficial in anterior teeth? (2)

A
  • anterior teeth suffer more from flexural stress

- helps increasing the rigidity and biomechanical properties

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47
Q

What must you always take into consideration with anterior tooth with loss of tooth structure?

A

the translucency of the final restoration to choose the restorative material

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48
Q

Recommended treatment plan for anterior tooth with loss of tooth structure?

A
  • endo
  • prefabricated post and composite resin restoration
  • CP&C
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49
Q

Recommended treatment plan for posterior teeth with minor tooth structure loss? (3)

A
  • crown
  • onlay
  • endocrown
50
Q

Recommended treatment plan for posterior teeth with moderate (<50%) tooth structure loss? (2)

A
  • increased seveirty if there are also cervical lesions

- prefabricated post and composite resin restoration and crown/onlay

51
Q

Recommended treatment plan for posterior teeth with severe (>50%) tooth structure loss? (3)

A
  • Post is recommended
  • CP&C and crown
  • prefabricated post and crown
52
Q

What is considered moderate (<50%) tooth structure loss? (2)

A

big occlusal or proximal caries

53
Q

What is considered severe (>50%) tooth structure loss? (3)

A
  • two or less walls left
  • MOD caries
  • Cusp loss
54
Q

If there is no ferrule effect in the posterior ETT, the treatment plan is…

A
  • crown lengthening + CP&C + crown

- CP&C with additional post

55
Q

ETT premolars? (4)

A

• Smaller teeth means less structure.
• Smaller pulp chamber to use to increase retention and
adhesion
• Subject to lateral forces during mastication
• The post is usually indicated

56
Q

ETT when is a post is more indicated in molars? (4)

A
  • coronal structure is totally missing

- small pulp chamber that will not allow us to gain retention and adhesion

57
Q

Why can an ETT not be the abutment of a free ended RPD?

A

Four times more risk of fracture

58
Q

Why cant an ETT be used in a cantilever bridge?

A

High risk of fracture or failure

59
Q

In which situations can a ETT NOT be used? (2)

A
  • free ended RPD

- cantilever bridge

60
Q

What happens to ETT used as abutments of bridges?

A

Suffer fractures twice as often as teeth without endodontic treatment or single tooth FPDs even with furrule efect

61
Q

The use of ETT as abutments for bridges with more than one pontic is…

A

questionable

62
Q

The clinical preformance of the restored ETT will depend on… (5)

A
  • The post and core material
  • The luting agent and technique
  • The overlying crown
  • The ferrule effect
  • The functional occlusal loads
63
Q

What are posts classified by? (3)

A
  • material
  • shape
  • surfae
64
Q

What are the different post materials? (2)

A
  • metal

- esthetic

65
Q

What are the different post shapes? (2)

A
  • cylindrical

- tapered

66
Q

What are the different post surfaces? (2)

A

threaded

unthreaded

67
Q

What are the different metal posts? (3)

A
  • stainless steel
  • Ni-Cr alloy
  • Titanium alloy
68
Q

What are the different esthetic posts? (4)

A
  • carbon fiber
  • glass fiber
  • quartz fiber
  • zirconia
69
Q

Metal post rigidity?

A

Very rigid

70
Q

Metal post indications?

A

indicated more for posterior teeth and / or crowns

71
Q

Titanium post characteristics? (3)

A
  • Appeared to avoid corrosion.
  • Low radioopacity.
  • Low toughness when small diameter.
72
Q

Stainless steel post characteristics?

A

Still used successfully

73
Q

Carbon fiber post characterisitcs? (5)

A

◦ 8 µm fibers parallel to the axis of the post.
◦ Epoxy resin matrix.
◦ Radiolucent.
◦ Biocompatible

74
Q

Carbon fiber post elasticity?

A

◦ Elasticity 21 GPa (dentin 18 GPa)

75
Q

Carbon fiber post disadvantage?

A

Dark color

76
Q

Glass fiber post characteristics? (4)

A

◦ Translucent.
◦ Favorable color.
◦ Transmit light (cements).
◦ Similar elasticity to the dentin.

77
Q

Fiber post characteristics?

A

Flexibility can lead to microleakage and fracture is there isnt adequate ferrule effect

78
Q

Zirconia post characteristics? (3)

A

◦ Prefabricated or custom-fitted.
◦ High compression strength.
◦ Very rigid.

79
Q

Cons of zirconia posts? (4)

A

◦ Almost impossible to remove.
◦ Require more pulp canal preparation.
◦ Cannot be etched.
◦ Better not to be used.

80
Q

Cylindrical post characteristics? (2)

A
  • greater retention (more friction)

- create a weaker area of the root at the tip of the post

81
Q

Tapered post characteristics? (3)

A

◦ Fit better the pulp canal.
◦ Lower retention.
◦ “Wedge effect” if not deep
enough.

82
Q

Threaded post characteristics? (3)

A

◦ Risk of fracture.
◦ Creates high tension
over the residual walls
◦ Don’t use.

83
Q

Unthreaded post characterisitcs?

A

Lower risk of fracture of the

root

84
Q

Prefabricated post purpose?

A
  • intraradicular retention
  • doesnt reinforce tooth perse
  • helps reinforcement of the tooth (new literature)

*crown really reinforces the tooth

85
Q

The post’s design will depend on (4)

A

◦ Length.
◦ Shape.
◦ Surface.
◦ Diameter.

86
Q

The posts retention depends on… (2)

A
  • design of post

- cement

87
Q

Characteristics of the post’s length for retention? (4)

A
  • Minimum: crown height.
  • Minimum: +/- 8 mm.
  • 2/3 of the length of the tooth.
  • Leave at least 4-5 mm of apical seal.
88
Q

Best shape for a post?

A

cylinder/tapered.

89
Q

Most retentive surface for a post?

A

Threaded but high risk

90
Q

Prefabricated posts are usually…

A

FLUTED

91
Q

Characteristics of the diameter of the post?

A
  • The greater the diameter, the greater the retention.
  • Not greater than 1/3 of the diameter of the root.
  • At least 1 mm of root wall thickness.
  • Always try not to weaken the tooth.
92
Q

Prefabricated post procedure? (12)

A
  • radiograph
  • Confirm apical seal and performance of the endodontic treatment
  • Calculate working length (4-5 mm of apical seal)
  • Remove gutta-percha with GatesGlidden drills.
  • Shape canal
  • Put post into canal and take xray
  • Cement post
  • Build up core
  • Crown prep
  • impression
  • provisional restoration
  • cementation of crown
93
Q

How do we shape the pulp canal with drills? (3)

A
  • Increasing diameter.
  • Contra-angle hand piece.
  • Up to the desired width.
94
Q

Why do we take an xray of the post in the canal? (2)

A
  • check the fit

- Confirm all gutta percha has been removed

95
Q

How do you cement fiber posts? (3)

A
  • composite resins
  • translucent post: dual-cure
  • opaque post: self cure
96
Q

How do you cement metal posts? (2)

A
  • zinc phosphate cements

- glass ionomer cements

97
Q

What is a CP&C

A

Cast posts and cores

Cast in one piece (core and post joined)

98
Q

CP&C requires a ___ afterwards

A

Crown placement

99
Q

CP&Cs are independent from… (2)

A
  • the final restoration

- the fit of the restoration

100
Q

CP&Cs must be made of… (2)

A
  • a noble alloy

- the same alloy as the final restoration

101
Q

How long should the post of CP&Cs be?

A

Into the root below bone level to prevent fractures

102
Q

What is the minimum diameter for a CP&C?

A

1mm

103
Q

What type of surface is needed for a CP&C?

A

Flat supporting surface

104
Q

Margin of CP&C restoration must …

A

end over healthy dentin

105
Q

Crown of CP&C must..

A

surround the CP&C completely to double its strength

106
Q

How do you prepare the pulp canal for CP&C? (3)

A
  • Same as for prefabricated posts.
  • Conical drills should be used after GatesGlidden drills.
  • Width of no more than 1/3 of the diameter of the root.
107
Q

How do you prepare do the coronal prep for CP&C? (3)

A
  • A small slot must be made to prevent rotation.
  • Surface must be flat to provide support.
  • Remove any undercuts in the coronal area (check direction of the pulp canal)
108
Q

Indirect procedure for CP&C? (5)

A
  • manufacturing at lab
  • LBS poured in pulp canal
  • bolt placed right after
  • rest of impression taken
  • wax pattern made over cast with shape of final abutment
109
Q

What characteristic is needed for the bolt in the direct impression pattern?

A

Must have a retentive end

110
Q

Direct pattern clinical procedure? (9)

A
  • Pattern of the CP&C is made in the patient mouth.
  • Made of acrylic resin.
  • Sent to the lab for casting.
  • canal lubricated with petroleum jelly
  • plastic bolt used as support for resin
  • resin prepared and pushed into canal
  • acrylic core built
  • when set, prepared for crown
  • dental tech casts the CP&C
111
Q

how is the acrylic resin prepared and pushed into the canal in the direct pattern?

A

With lentulo and bolt

112
Q

How is the acrylic resin core built in the direct pattern ?

A

With a brush and plastic instrument

113
Q

What is the overstable post procedure for CP&C?

A
  • A noble alloy prefabricated post is put into the canal.
  • The rest of the core is built with acrylic resin.
  • The dental technician overcasts the CP&C.
114
Q

What is the multiple canal post procedure for CP&C? (3)

A
  • A second canal is used to increase retention.
  • The widest pulp canal is prepared in the usual way.
  • The preparation of the second canal is shallower
115
Q

What is the multiple canal post procedure for telescopic CP&C? (4)

A
  • Overcastable post in the main canal.
  • Prefabricated post in the secondary canal.
  • Core build with acrylic resin.
  • The abutment preparation can also be designed at the
    laboratory
116
Q

When do we have no post and composite core building?

A
  • Molars and small destructions. -

It is enough taking advantage of the anatomy of the pulp chamber

117
Q

When do we use a fiber post? (5)

A
  • When at least 50% of the structure is lost
  • Two surfaces or less are present.
  • Incisors and premolars.
  • Studies on pm demonstrated less fractures when
    posts are placed
  • Molars, if crown structure is missing and insufficient
    pulp chamber
118
Q

When are the pre-restorative treatments for ETT?

A
  • crown lengthening

- ortho extrusion

119
Q

When do we need a cast post and core? (4)

A
  • Big destruction
  • No ferrule
  • Patients insisting on trying to save the tooth
  • Acceptable results
120
Q

When do we do an extraction? (2)

A
  • When the tooth has no viability
  • Because of the planification the extraction makes more
    sense

Prostho 3 (11 decks)

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