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Moursi > 9 - Restorative Dentistry > Flashcards

9 - Restorative Dentistry Flashcards

1
Q

What are the complications in asthma and obese pts?

A

Asthmatic pts:

  1. Pts tend to be mouth breathers.
  2. Reduction in salivary flow and dry mouth may increase caries risk.
  3. Throat irritation
  4. Dryness of mouth
  5. Candidiasis
  6. Gingivitis

Overweight pts:

  1. Hypertension
  2. Diabetes mellitus
  3. Increased caries rate
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2
Q

What is the AAPD recommendation for a radiographic exam of a new pt with a transitional dentition?

A

Posterior bitewings and a PAN or selective periapical radiographs.

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3
Q

What is different in the EAPD recommendation compared to the AAPD recommendation?

A

The European Academy of Pediatric Dentistry (EAPD) states that:

  1. Baseline radiographs should start at the age of 5 or based on individual risk assessment.
  2. A PAN is not required on healthy, asymptomatic children.
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4
Q

What was a defective property in early resin-based composites that led to breakdown of the resin-based composite when placed in areas where significant wear occurred?

A

The early resin-based composites had large silica particles as fillers and they were not silinated to bond to the resin within the restorative material.
–These properties led to breakdown of the resin-based composite when placed in areas where significant wear occurred.

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5
Q

Describe the minimally invasive resin restoration procedure?

A
  1. Only carious tooth structure is removed with bonded resin-based composite replacing tooth structure that was removed due to decay.
  2. A sealant is placed over the entire occlusal surface, filling in any surface imperfections in the filled resin-based composite restoration that may have been created during finishing and covering all caries-susceptible pit and fissures on the occlusal surface that were not included in the tooth preparation.
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6
Q

What are the advantages of minimally invasive resin restorations?

A
  1. Conservative preparation design
  2. Ability to isolate tooth
  3. Sealant for prevention
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7
Q

What will be helpful to identify overweight and/or obesity in children older than two years of age?

A

Body mass index (BMI) calculation

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8
Q

What is the purpose of the sealant placement in a preventive resin restoration (PRR)?

A

Eliminate the need to extend the preparation to prevent future decay and to fill any voids in the surface of the hybrid resin-based composite during finishing.

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9
Q

What is a contraindication to placing a resin restoration?

A

Inability to isolate the tooth; known allergy to resin-based composite material.

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10
Q

Is the wear of resin-based composite a significant concern when placing a resin restoration?

A

No. Current materials have biochemical properties that can reduce the risk of excessive wear.

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11
Q

When should a glass ionomer cement restoration be placed?

A

Difficulty in isolating the tooth and the caries risk status of the pt.

Saliva contamination:

  • Composite - saliva contamination causes the tooth/resin interface bond to be compromised, with subsequent restoration failure.
  • Glass ionomer - can still chemically cure in the presence of minimal contamination. The fluoride release can aid in inhibiting tooth demineralization at restoration margins.
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12
Q

A resin-modified restoration would not be appropriate for?

A

A high-caries risk child.

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13
Q

A glass ionomer cement setting reaction occurs over?

A

24 hours.

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14
Q

Placing a sealant over a composite restoration can have what benefits?

A
  1. Reduce occlusal wear
  2. Seal the restoration
  3. The additional light curing will also help to obtain maximum polymerization of the resin restoration
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15
Q

For a class II composite restoration, describe the preparation for a proximal box?

A
  1. Prepare the proximal box by moving the 330 bur in a pendulum motion from buccal to lingual.
  2. Break gingival contact and check to see that the gingival margin is wider than the occlusal margin.
  3. The axial pulpal line angle is slightly rounded, and a dovetail extension is made on the occlusal surface with the cavosurface margins beveled.
  4. The proximal box should not extend past the line angles; if so, then a SSC is indicated.
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16
Q

If the pt has poor behavior, what material should be used to restore the tooth?

A

If the behavior of the pt is poor, making it difficult to isolate the tooth for a class II resin restoration, the alternative treatment would be a stainless steel crown.

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17
Q

According to the AAPD, what are the indications for a composite restoration?

A
  1. Small pit and fissure caries in which conservative preventive resin restorations are indicated in both primary and permanent dentition.
  2. Occlusal surface caries extending into dentin.
  3. Class II restorations in primary teeth that do not extend beyond the proximal line angles.
  4. Class II restorations in permanent teeth that extend approximately one-third to one-half the buccolingual width of the tooth.
  5. Class III, IV, V restorations in primary and permanent teeth.
  6. Strip crowns in primary and permanent dentition.
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18
Q

According to the AAPD, what are the contraindications for a composite restoration?

A
  1. In cases in which a tooth cannot be isolated to obtain moisture control.
  2. In individuals who need large multiple surface restorations in the posterior primary dentition.
  3. In high-risk pts with multiple caries and/or tooth demineralization and who exhibit poor oral hygiene, and when maintenance is considered unlikely.
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19
Q

In the cavity preparation for primary teeth is the cavosurface margin beveled?

A

Yes.

20
Q

Are retention grooves placed in a class II preparation for primary teeth?

A

No.

21
Q

How long should you place the etch on the tooth for a composite restoration?

A

15-20 seconds.

22
Q

How long should you rinse the etch off for a composite restoration?

A

Rinse thoroughly for 20 seconds.

23
Q

Should the class II resin restoration receive additional light curing after polishing?

A

Yes.

24
Q

Describe the outline of a class V RMGI preparation?

A

1, The cavity outline is kidney shaped and follows the extent of the lesion to provide retention.
2. The cavosurface margins of the cavity preparation must be 90 degrees (butt joint).

25
Q

How do you prevent the RMGI from sticking to the hand instrument during placement?

A

The instrument may be dabbed in a bonding agent to prevent the RMGI from sticking to it and pulling the restoration out of the cavity preparation. It also reduces the surface roughness of the restoration.

26
Q

Describe the finishing of the RMGI restoration?

A
  1. Finishing with a rotary instrument may not be necessary if the steps were done properly.
  2. Use of a finishing bur at very low speed to reduce roughness is appropriate.
  3. The RMGI should have an unfilled resin adhesive placed over the final restoration surface.
27
Q

What are the properties of RMGI?

A
  1. Chemically bonds to enamel and dentin
  2. Releases fluoride
  3. Provides acceptable esthetics
  4. Less moisture sensitivity than resin-based composite
28
Q

What are the indications for Class V glass ionomer cement restoration?

A
  1. Difficulty isolating the tooth (less moisture sensitive than resin-based composite).
  2. Poor pt behavior (easy and fast).
  3. Moderate caries risk (fluoride release).
29
Q

What are the indications for ITR?

A
  1. Uncooperative pts who will be managed non-pharmacologically.
  2. Pts with special needs.
  3. Interim restoration for caries control.
  4. When other restorative materials cannot be used.
30
Q

How do you manage a pt that becomes hypoglycemic while in your care?

A
  1. If conscious, they can receive oral carbohydrates in the form of cake frosting.
    - -If oral carbohydrates are ineffective, medical assistance should be called to the scene.
  2. If unconscious, 50% dextrose can be administered by an IV catheter. If IV access is unavailable, glucagon can be administered intramuscularly.
31
Q

Describe the outline of a class V composite preparation?

A
  1. The pulpal walls should be convex, following the shape of the outer enamel surface.
  2. The lateral walls should be slightly flared near the proximal surfaces to prevent undermining of the enamel.
  3. A short bevel is placed around the entire cavosurface margin. It is important to place a beveled enamel margin and a butt cementum/dentin margin to enhance restoration of the resin.
32
Q

What is the concentration of fluoride ion in 5% sodium fluoride varnish?

A

2.26% fluoride ion

33
Q

If a pt has a heart murmur, what questions do you ask about the medical history?

A
  1. Documentation of heart murmur status
  2. Follow-up evaluation of heart murmur
  3. Any consults to a pediatric cardiologist
  4. Any need for echocardiograms or chest films
  5. Any symptoms experienced by the pt
  6. Any medications that pt takes for this condition
  7. Any need for antibiotic prophylaxis for subacute bacterial endocarditis
  8. Any limitations or restrictions on any activities
34
Q

What percent of infants have heart murmurs?

A

Almost 90% of infants have a detectable heart murmur, particularly if they are febrile or dehydrated.

35
Q

What is the cause of most heart murmurs?

A

Most heart murmurs are clinically insignificant and are referred to as being “innocent.” They are caused by increased flow or turbulence across anatomically normal valves.

36
Q

Why are heart murmurs a concern?

A
  1. Certain dental procedures occasionally induce severe cardiovascular complications.
  2. Murmurs may indicate existing heart disease that is a risk factor for infective endocarditis following a dental procedure.
37
Q

How are heart murmurs diagnosed?

A

EKG is the primary means of evaluating heart murmurs.

38
Q

What additional things are evaluated in the post-trauma assessment?

A
  1. Rule out additional, undiagnosed intra-oral or extra-oral trauma.
  2. Rule out any possibility of child abuse
    - -Story is consistent and fits the clinical picture
    - -No additional trauma noted
    - -No other suspicious trauma locations
39
Q

What type of radiographs are indicated for pt with a traumatized permanent incisor?

A

Diagnostic errors are reduced when practitioners take two or more periapical radiographs following a traumatic injury. Each image should have a slightly altered beam direction.

40
Q

Following an uncomplicated crown fracture, when is final restoration recommended?

A

Final restoration is recommended in 6 to 8 weeks.

41
Q

If there is a root fracture in the middle third of the root, what treatment would be indicated?

A

Stabilization with a splint for 6-8 weeks or until mobility is reduced.

42
Q

How do you avoid the potential of air voids to be created during placement of a strip crown?

A

Place a small hole in the incisal edge of the strip crown so that composite can extrude when the crown is pushed into place over the prepared tooth. This relieves the potential for air voids to be created.

43
Q

How do you remove the excess resin at the gingival margin after placement of the strip crown?

A

Excess at the gingival margin can be removed with the tip of an explorer prior to photo-polymerization of the resin.

44
Q

What indicates the use of crowns rather than placing composites on anterior teeth in children?

A
  1. Severity of the caries, extension, caries risk assessment of the pt (pts with high caries susceptibility).
  2. Restoration of carious primary molars where more than two surfaces are affected following pulpotomy or pulpectomy procedure.
  3. Restoration and protection of teeth with extensive surface loss (attrition, erosion, abrasion).
  4. Teeth anomalies, developmental defects, discoloration, pt’s bite.
  5. Appropriate cleaning and frequency of brushing, pt compliance.
  6. Use as abutments for certain appliances (space maintainers).
  7. Children who have extensive caries and must be treated under general anesthesia.
45
Q

What are the indications for SSC?

A
  1. Extensive decay, large lesions, or multiple surface lesions in primary molars.
  2. High-risk children exhibiting anterior tooth caries and/or primary molar caries.
  3. Children who require general anesthesia.

Moursi (9 decks)

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