9/25: Restoration of Extensively Damaged Vital Tooth

Question 1

1. What are the central core guidelines?

Answer 1

a. Pulp and 1 mm dentin think surrounding layer should be preserved

Question 2

2. According to the central core guidelines, the retentive features should NOT be cut deeper than

Answer 2

a. 1.5 mm at cervical line or central fossa

Question 3

3. Deeper caries should be filled with

Answer 3

Base

Question 4

4. What happens or the Central core (Pulp chamber) as we age

Answer 4

a. Shrinks and recedes

Question 5

5. What are the 5 categories involved in decision making?

Answer 5

a. Deciding on type of restoration
b. Using defects as retentive features
c. Pin placement and retention
d. Base and cores
e. Tx plan procedure

Question 6

6. If you have extensive peripheral destruction, what restoration should you do?

Answer 6

a. Full crown

Question 7

7. Less destructive central lesion with isthmus destruction greater than 1⁄2 intercuspal width, you should do what restoration?

Answer 7

a. Inlay or onlay

Question 8

8. Large central lesion, with more than 50% of tooth structure gone and loss of cuspal support, what restoration should you do?

Answer 8

a. Full crown and possible build-up

Question 9

9. If you combined central and peripheral destruction, what should you do?

Answer 9

a. Build-up and crown
b. Possible RCT, build-up, crown
c. Maybe RCT, post, and crown

Question 10

10. When would you decide if a RCT is needed?

Answer 10

a. Pulp exposure
b. Post is needed for retention of build up

Question 11

11. Often a tooth preparation will need to be modified by adding retentive features to increase

Answer 11

a. Retention and resistance

Question 12

12. What kind of modifications can you make?

Answer 12

a. Re-orienting sloping
b. Grooves
c. Box forms
d. Adding pins with build-up

Question 13

13. Are there times where leaving a tooth without a build-up can help with retention?

Answer 13

a. Yes

Question 14

14. What can we do to increase resistance form with less than ideal tooth structure remaining?

Answer 14

a. Reduced TOC of axial walls
b. Grooves
c. Box form
d. Increase wall height

Question 15

15. How can you increase wall height?

Answer 15

a. Finish line more apical
b. Pin-retained core
c. Crown-lengthening
d. Orthodontic extrusion ← not intrusion

Question 16

16. How should you reshape axial walls for reduced TOC?

Answer 16

a. Reduce cervical 1⁄2 to make taper smaller

Question 17

17. Changing the slope wall after a cusp fracture or caries removal can improve

Answer 17

Retention

Question 18

18. How should you alter the sloped wall?

Answer 18

a. Break slope into vertical and horizontal components

Question 19

19. What happens if you convert a sloped wall into 1 single vertical compartment?

Answer 19

a. Weakens tooth and endangers vital core

Question 20

20. If you have >3mm vertical wall length apical to the fractured cusp,

Answer 20

a. Facial shoulder with axial wall reduction leaves adequate wall length for resistance form

Question 21

21. How should grooves be placed?

Answer 21

a. Parallel to the long axis

Question 22

22. What are the required dimensions for grooves?

Answer 22

a. 1mm wide and deep
b. 0.5-1 mm away from finish line
c. Spaced around the tooth

Question 23

23. In what kind of prep should grooves be placed?

Answer 23

a. Short wall prep

Question 24

24. What do the proximal grooves do to the arc of rotation?

Answer 24

a. Shorten radius

Question 25

25. Walls of a groove or a box are best placed how?

Answer 25

a. Perpendicular to displacing force

Question 26

26. When should a box form be used?

Answer 26

a. You remove caries and can convert space into a box

Question 27

27. How deep should a box form be placed?

Answer 27

a. Well within the dentin

Question 28

28. Should you do a box form on an intact wall where there was no caries removal?

Answer 28

No

Question 29

29. When 2 box forms are needed, less than 180 degrees of tooth circumference remain. What does this mean and what should you do?

Answer 29

a. Risk for cuspal fracture b. Do build-up and crown

Question 30

30. When placing the margin more apically, we must be careful of the

Answer 30

a. Biological width

Question 31

31. How can you remove biological width restriction?

Answer 31

a. Crown lengthening

Question 32

32. The retention for a core is often with the use of

Answer 32

Pins

Question 33

33. A build up is needed when how much tooth surface is lost?

Answer 33

50%

Question 34

34. If you have excessive interocclusal distance, what is indicated?

Answer 34

a. Tall crown

Question 35

35. Amalgam core build up is

Answer 35

a. Not retentive but strong

Question 36

36. Composite core build up is

Answer 36

a. Retentive but not strong

Question 37

37. When is the use of pins recommended?

Answer 37

a. 1⁄2 or more clinical crown destroyed

Question 38

38. Cusps thinner than 1⁄2 their height are

Answer 38

a. Weak and should be shortened or flattened

Question 39

39. When using an amalgam floor, the floor and walls should be

Answer 39

a. Flattened

Question 40

40. Crown margins should be at minimum _______ to build up material margin

Answer 40

a. 1 mm apically

Question 41

41. What are the mechanical properties of an amalgam core?

Answer 41

a. Compressive strength b. Dimensional strength c. Corrosion - sealing

Question 42

42. The amalgam core requires how much thickness?

Answer 42

a. Minimum of 2 mm

Question 43

43. The compost core requires how much thickness?

Answer 43

a. Can be thinner than 2 mm

Question 44

44. Pins should be placed

Answer 44

a. Non-parallel

Question 45

45. What are the guidelines for pins?

Answer 45

a. Solid dentin required b. Flat area c. 0.5-1 mm from axial wall or dentin d. 0.5mm of dentin should be surrounding e. Best used in line angles of posterior teeth f. 1 pin per missing cusp g. 5mm of space between pins h. Max of 4 pins per tooth

Question 46

46. What should you use to make a hole for the pins?

Answer 46

a. Pilot drill

Question 47

47. How do you create non-parallel pins?

Answer 47

a. After placing in dentin, you bend them i. Slight angulation

Question 48

48. Pins placed in dentin should be

Answer 48

a. 2mm deep into dentin b. 2mm coronal into build up c. Minimum 1mm radius of build-up around pin

Question 49

49. What are the types of pin complications?

Answer 49

a. Fluted root shape b. Furcation c. Pulp penetration

Question 50

50. What should you do if the pin gets into the pulp?

Answer 50

RCT

Question 51

51. What should you do if the pin exits the tooth surface above bone?

Answer 51

a. Flap and smooth to tooth contour

Question 52

52. What should you do if you have a fractured pin?

Answer 52

a. Move to another location 1.5mm away

Question 53

53. What should you do if you have a stripped pin (loose)?

Answer 53

a. Use a larger pin

Question 54

54. Bases are only used to protect

Answer 54

a. Pulp

Question 55

55. Bases can be used to fill what?

Answer 55

a. Undercuts when a entire build-up is unnecessary

Question 56

56. Are the bases and build-up the same?

Answer 56

a. No, bases are weaker

Question 57

57. Are bases strong enough to support grooves, boxes?

Answer 57

No

Question 58

58. What are the types of base material?

Answer 58

a. Polycarboxylate cement b. Glass ionomer c. Resin-modified glass ionomer cement d. Silver-reinforced glass ionomer cement

Question 59

59. What type of liner is there?

Answer 59

a. Dycal (CaOH)

Question 60

60. What is the common protocol for a base?

Answer 60

a. Gluma b. Dycal c. Vitrebond d. Glass ionomer e. Restoration

Question 61

61. What is the sequence of treatment?

Answer 61

a. Prior to prep: evaluate periodontal and endodontic health b. Remove all caries c. Evaluate prep d. Do restoration