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ACS Flashcards

1
Q

What are the different occlusal schemes (4)

A

Ideal occlusion - three contacts between mandible and maxilla when you move out of ICP

Group function

Gnathological occlusion - restoration made so each cusp tip intercuspates with its opposing fossa

Balanced occlusion

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2
Q

What is ideal occlusion (3)

A

Load distributed in most favourable way

Workable and replicable occlusion scheme

Simple to apply principles (RCP=ICP, forces distributed through long axis of teeth, posterior disclusion in eccentric position, mutual protection)

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3
Q

What teeth contact when RCP = ICP

A

Posterior teeth contact, anterior teeth have very light contacts

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4
Q

When RCP = ICP explain load and condyle position

A

Occlusal load must be directed through long axis of the tooth

Condyles are positioned to distribute load into the bone with minimal muscular involvement

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5
Q

If RCP doesn’t = ICP

A

Functioning in ICP requires muscular activity to position the condyle and intra articular disc

Can cause bruxism - function on the RCP contacts causing damage to vulnerable restorations and wear facets on sound teeth

Can also grind in/from ICP - will cause wear on anterior teeth then premolars due to increased muscular activity

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6
Q

How to minimise large loads by RCP contacts (4)

A

Know if and where the RCP contacts are

Tough restorations

Provide multiple contacts in RCP to spread out the load

Minimise difference between RCP and ICP

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7
Q

How to distribute forces in ideal occlusion and why

A

Distributes occlusal loads favourably

Contacts on inclines result in horizontal forces, which leads to wear, tooth movement, bone loss, fracture of restorations

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8
Q

When would you want posterior discclusion

A

Lateral and protrusive excursion (eccentric positions) In this case, the anterior teeth discclude the posterior teeth

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9
Q

Benefit of posterior discclusion

A

Avoids lateral forces on posterior teeth Simple to engineer - often just one tooth contact in eccentric positions

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10
Q

What occurs if posterior contacts do occur

A

Working side - group function

Non working side - NWS interference (undesirable)

Protrusion - protrusive interference (undesirable)

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11
Q

Anterior guidance (2)

A

Palatal surfaces of upper anterior teeth dictate the movement Interference would occur on mesial of lower and distal of upper teeth

Mutual protection occurs - in ICP posterior protect the anterior from large forces, in excursions the anterior protect posterior

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12
Q

Canine guidance (3)

A

Canine morphology makes it an ideal tooth - Root of canine is longer than crown making it stronger

Distant from hinge and muscle

Highly innervated

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13
Q

Group function

A

Multiple contacts on working side

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14
Q

Class 1 incisor relationship

A

Lower incisors occludes behind the upper incisors cingulum plateau

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15
Q

Class 2 incisor relationship

A

Div 1 - Lower incisor occludes behind the upper incisor cingulum plateau (may or may not be proclined)

Div 2 - Lower incisor occludes behind the upper incisor cingulum plateau, upper central incisors are retroclined

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16
Q

Class 3 incisor relationship

A

Lower incisors occludes in front of the upper incisor cingulum plateau

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17
Q

Anterior open bite

A

No contact on anterior teeth

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18
Q

Occlusion in practice (3)

A

Know where tooth contacts are pre and post operatively

If conforming, don’t introduce unfavourable contacts

If reorganising, work to ideal occlusion

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19
Q

If the tooth has to be restored in all situations…

A

No ICP contacts - consider whether the tooth would be better with an ICP contact or not

Contact on the incline of a cusp - reintroduce the contact or recreate ideal occlusion

A non working side interference - consider whether reintroducing contact once restored would be ideal?

An RCP contact

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20
Q

What is the movement of the mandible dictated by (3) What can the movement be traced by

A

Position of the condyle in the fossa

Condylar pathway along the articular eminence

Teeth interfere with this border movement

Traced by Gothic arch Tracing

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21
Q

Centric relation

A

Relation of the mandible to the maxilla when the condyles are seated in the uppermost, anterior most position in the glenoid fossa

Only position the mandible can rotate about a hinge without using lateral pterygoid muscles

Neuromuscular system can function optimally

Repeatable

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22
Q

Why study occlusion (9)

A

Failure of routine restoration

Fractured teeth and restorations

Overeruptions

Fractured crowns

Worn teeth

Complex restorative tx

Localised periodontitis effects

Loss of tooth vitality

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23
Q

ICP

A

Intercuspal position - position of mandible when there is maximum intercuspation of the teeth

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24
Q

RCP

A

Retruded contact position - first contact when the condyles are fully seated in the glenoid fossa

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25
Q

RCP vs ICP

A

They do not usually coincide - close to RCP and slide to ICP

High cusps = vertical slide

Shallow cusps = horizontal slide

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26
Q

Terminal hinge axis

A

Condyles hinge about a horizontal axis when it is in CR

Lateral pterygoids can relax, NOT required to brace against closing muscles

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27
Q

How to find CR

A

Denture patients - ask to put tongue to back of the mouth and close slowly

Crowns/Bridgework - Dawson technique - easily learned, consistently repeatable, allows verification of position (firmly stabilise the head, position fingers on the lower border of mandible, thumbs of the symphysis, no pressure at this stage, next with a gentle touch manipulate so that jaw hinges slowly open and close freely, then gently but firmly guide condyles upward with little fingers, apply gentle posterior pressure with thumbs)

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28
Q

Recording CR

A

Used for patients difficult to manipulate

Anterior jig is a flat anterior stop which separates posterior teeth, allowing elevator muscles to seat condyles

Because teeth are separated for a while, patient falls into neuromuscular dissociation

Record using wax or silicone

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29
Q

When is CR useful in restorative dentistry (5)

A

Routine restorations

Occlusal reorganisation

Diagnosis of TMJ dysfunction

Occlusal analysis and equilibrium

Complete denture construction

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30
Q

Functions of articulators (4)

A

Hold models in ICP - limited, do not mimic opening/lateral movements of the jaw

Anatomical articulator - hinge in the same place as condyle, replicates jaw movements

Mounting models in CR

Correct relationship between teeth and condyle - position models by Bonwill triangle (average relationship OR record relationship with face bow)

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31
Q

Average value anatomical articulator (3)

A

30 degrees condylar angle

Straight condylar pathway

Doesn’t replicate the exact movement of the condyle

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32
Q

Semi adjustable anatomical articulator (3)

A

Condylar path can be adjusted between 0 - 60 degrees

Condylar path is flat

Intercondylar width and Bennett movement may also be adjusted on some models to get a better replication of the patient

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33
Q

Fully adjustable (3)

A

Custom made condylar pathways

Mechanically replicate the movements of the condyles

Use a pantograph or stereograph to record the condylar movement

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34
Q

What three things to consider when selecting equipment

A

Occlusal schemes

Objectives of the treatment

Clinicians skills

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35
Q

Signs/symptoms showing loss of occlusal harmony (10)

A

Mandibular dysfunction

Mobility of teeth

Drifting of teeth

Fracture of restorations, cusps, teeth

Facetting of teeth

Fremitus

Parafunction

Loss of tooth vitality

Localised periodontitis

Facial pain

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36
Q

Concussion (4)

A

Injury to supporting tissues

No loosening or displacement or mobility

Tender to pressure

May be bleeding at gingival margin

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37
Q

Subluxation (4)

A

Injury to tooth supporting tissues with abnormal loosening

Slight mobility

Bleeding around gingivae

No displacement

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38
Q

Lateral luxation (4)

A

Bodily movement of the tooth within the socket

Root moves buccally and becomes wedged by bone - so not mobile

Rupture of neuromuscular bundle

Tearing and crushing of PDL cells in the palatal cervical region - tearing is repairable but not crushing

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39
Q

Extrusion (4)

A

Axial displacement partially out of the socket

Very mobile

Appears elongated

DONT USE HIGH SPEED SUCTION NEAR THESE TEETH

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40
Q

Intrusion (4)

A

Tooth forced upwards into the socket - difficult to tell in developing dentition as the teeth may be PE

Complex and severe injury

Crushing of PDL cells and neuromuscular bundles (non reversible)

If apices are closed, the tooth will not survive

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41
Q

Avulsion (3)

A

Tooth completely lost in the socket

Ischaemic injury to the pulp

PDL cell death

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42
Q

Prognosis of pulp depends on (3)

A

Type of injury - more serious = less likely to recover

Age of the patient and the stage of the apical development - open apex = room for blood supply to redevelop

Concomitant injury - fracture of the crown (another injury = another bacteria pathway)

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43
Q

Three ways of pulpal healing

A

Complete healing

Pulp canal obliteration

Pulp necrosis

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44
Q

What is complete healing in terms of pulpal healing

A

If the tooth is immature, complete healing means that the tooth will be able to develop normally

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45
Q

What is pulp canal obliteration in terms of pulpal healing

A

Pulp lays down secondary dentine leading to pulp canal obliteration

This is a sign of healing so does not need RCT

As time passes, root canal becomes thinner

Very few teeth become non vital after this stage

Tooth becomes yellower thus may need bleaching

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46
Q

What is pulp necrosis in terms of plural healing

A

Inflammatory response

Pulp is dead, bacteria thus leads into the PA space

This initiates an immune response - the cells also begin to destroy the tooth as well

Only way to stop this destruction is by removing the pulp and applying calcium hydroxide - this will allow PDL cells to heal

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47
Q

Types of resorption (3)

A

Inflammatory

Replacement

Internal

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48
Q

External inflammatory resorption

A

Continuation of surface resorption due to toxins from the necrotic pulp

It is progressive until the bacteria is removed (pulp extirpation)

It will be filled in with cementum or bone upon healing

Moth eaten appearance

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49
Q

Internal inflammatory resorption

A

Infrequent complication, necrotic pulp, ballooning/widening of canal, rapid progression, requires immediate extirpation and calcium hydroxide dressing, filled with thermoplastic GP

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50
Q

Replacement resorption

A

When root is replaced by bone

Usually from intrusion/extrusion

Extensive PDL damage - so cells can’t close the gap fast enough

Osteoclasts are in direct contact with the dentine, so the osteoclasts treat the dentine as bone and break it down

Not much can be done to stop this

Normal bone turnover process leads to progressive replacement resorption

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51
Q

General advice/management after trauma (5)

A

Soft diet for 7 days - help PDL heal

Analgesics as necessary - paracetamol, ibuprofen

Good oral hygiene - inflamed gingivae slow down healing

Chlorhexidine mouthwash or gel - rub onto affected area

Review splint at 48hrs

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52
Q

Treatment for concussion

A

No treatment required

Monitor at 4 weeks, 6-8 weeks and 1 year

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53
Q

Treatment for subluxation

A

Flexible splint placed for up to 2 weeks

Monitor at 4 weeks, 6-8 weeks and 1 year

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54
Q

Treatment for extrusion

A

Reposition by gently repositioning - LA may be needed

Avoid high speed suction

Flexible splint for 2 weeks

Monitor at 2 weeks, 4 weeks, 6-8 weeks, 6 months, 1 year and yearly for 5 years

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55
Q

Treatment for lateral luxation

A

Reposition, disengaging tooth from any bony lock - with LA

Flexible splint for 4 weeks

Monitor at 2 weeks, 4 weeks, 6-8 weeks, 6 months, 1 year and yearly for 5 years

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56
Q

Treatment for intrusion

A

Leave - allow spontaneous eruption

Orthodontically extrude

Surgically extrude

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57
Q

Treatment for avulsion

A

Telephone advice - find tooth, hold tooth by crown, if dirty rinse with cold water for 10 seconds, put it in cold not flavoured milk or patients saliva

Replace tooth - place tooth in socket, get child to bite on rolled up tissue to hold in place

Unfavourable healing - occurs if tooth is out of mouth but in milk for over 90 mins, occurs after 30 mins if tooth not in fluid, 90% chance of ankylosis if replanted after this time

Replacement resorption - this occurs when PDL cells die, tooth becomes in contact with bone, causing ankylosis

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58
Q

Replant or not?

A

Consider prognosis, medical status, behavioural aspects, burden of care, child/parent wishes, advantages and disadvantages

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59
Q

Advantages of replanting (6)

A

Aesthetics

Space maintenance

Maintain options

Function

Prevent restorative treatment

Psychological benefit

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60
Q

Disadvantages of replanting (4)

A

Infraocclusion

Loss of gingival contour and bone

Multiple visits

Tooth will be lost eventually

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61
Q

Contraindications of replanting (5)

A

Immunosupression

Caries/periodontal disease

Severe cardiac disease

Children with severe learning difficulties - they might not be able to manage further treatment

Severe incisor crowding, supplement incisor

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62
Q

Management of avulsion

A

REPLANT AS SOON AS POSSIBLE

Store the tooth in saline or milk

Hold tooth at crown not root LA if required

Gently irrigate the socket with saline to remove the clot

If tooth contaminated, clean with debris If stubborn debris, dab with saline soaked gauze (May want to measure the root of the tooth before replanting for RCT WL)

Gently replant, if it doesn’t plant, STOP!

Reposition any bony fracture with blunt instruments

Flexible splint for 7 - 14 days

Systemic antibiotics

Etirpate in mature tooth between 0-10days

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63
Q

Systemic antibiotic indication for trauma (3)

A

Contamination

Multiple injured teeth

Medical conditions rendering child susceptible to infection

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64
Q

What antibiotics to give with paediatric trauma

A

Over 12 year olds - doxycycline 200mg twice daily for 1st day, then 100mg twice daily for 10 days

Under 12 year olds - amoxicillin 250mg 3 times a day for 5-7 days

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65
Q

RCT on paediatric trauma teeth is….

A

Mandatory for teeth with mature apex

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66
Q

What is the ideal time for RCT of paediatric trauma teeth

A

0-10 days - before splint is removed so tooth is stable during treatment

If extirpation occurs prior to 7 days, odontopaste should be used instead of calcium hydroxide

Dress with non setting calcium hydroxide for 1 month and definitive obturation at this point

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67
Q

Extra oral endodontics

A

Usually in older patients where growth complete and excessive, there is extra oral dry time, so ankylosis is expected, replant tooth and flexible splint for 7-10 days

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68
Q

Types of splints (2)

A

Direct - aim for physiological splint to encourage healing and reduce risk of ankylosis

Indirect - Essix type retainer

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69
Q

How to splint

A

Reposition the tooth with or without LA

Control bleeding Bend wire into passive arch, extend to one stable tooth either side of mobile teeth and cut to size

Spot etch teeth mid crown and apply composite using dark shade

Place arch wire on uncurled composite, light cure

Place second composite layer over the arch white and light cure

Check no rough pieces of composite and no sharp edges of wire poking out

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70
Q

What are enamel infractions

A

Disruption of the enamel prisms, extends from surface to ADJ, usually seen when light is parallel to long axis of tooth

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71
Q

What are enamel fractures

A

Loss of enamel only, generally requires only smoothing

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72
Q

Treatment options for crown-root fracture

A

Fragment removal and restore tooth - can be difficult if the fragment extends subgingivally

Fragment removal and orthodontic extrusion - when fragment tooth subgingivally

Fragment removal and root burial and supply of removable denture

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73
Q

Root fracture healing is dependent on (3)

A

Approximation of two fragments at the time of injury

Stabilisation

Absence of infection

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74
Q

Root fracture healing process

A

Hard tissue healing/union Interposition of connective tissue

Interposition of bone and connective tissue

Granulation tissue

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75
Q

What may occur following root fracture healing (3)

A

Coronal pulp necrosis

Coronal segment pulp extirpation

Healing

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76
Q

Prognosis of root fractured tooth depends on (4)

A

Concomitant crown fracture

Maturity of tooth

Location of fracture

Degree of displacement

77
Q

What happens in Alveolar fracture and the treatment for it

A

Fracture of segment, several teeth move as one block, gingival lacerations

Reposition, can be difficult due to bony lock, splint for 4 weeks

78
Q

Uncomplicated enamel dentine fracture

A

Doesn’t involve the pulp

Most common injury

Prognosis almost 100% maintain vitality

79
Q

Emergency treatment for uncomplicated enamel dentine fracture

A

Ideally composite - flowable is easy and quick If excessive bleeding - RMGIC but not preferred due to leakage (weaker bond)

80
Q

Definitive restorations for uncomplicated enamel dentine fracture

A

Long bevel before direct resin restoration

Fragment replacement - stick fragment back on

Complete coverage composite build up

81
Q

Complicated enamel dentine fracture

A

Fracture that involves the pulp

Treatment options depending on extent, time of exposure, developmental stage

82
Q

Treatment options for complicated enamel dentine fracture (3)

A

Pulp cap

Pulpotomy

Pulpectomy

83
Q

Pulp cap

A

Pin point exposure, minimal exposure time (less than 24hrs)

84
Q

Pulpotomy

A

Partial removal of the coronal pulp where there is an incomplete apex

Exposure bigger than pin point

85
Q

How to do a pulpotomy

A

Amputate pulp to gingival level

Arrest haemorrhage with saline soaked pledget - if not achieved in few minutes, remove more pulp tissue

Place calcium hydroxide onto pulp to stimulate calcium hydroxide

Place setting calcium hydroxide and then restore composite

86
Q

Pulpectomy

A

Complete removal of coronal and radicular pulp

Carried out on non vital teeth

87
Q

Apexification

A

Chemically induced hard tissue barrier formation created by the placement of non setting calcium hydroxide dressing to apex

Dressing replaced at 3 month intervals, can take 12 - 18 months

88
Q

Apexification process

A

Extirpation of pulp - with or without LA

Rubber dam

No mechanical prep required due to wide canal Irrigate with sodium hypochlorite or chlorhexidine

Non setting calcium hydroxide placed with syringe

Small file (25) placed to WL to ensure no air bubbles

Cotton wool placed in access cavity and CaOH compressed to be in contact with apical tissues

Dressed with IRM Replace every 3 months test for barrier with paper points

89
Q

Problems with root fillings (3)

A

Too short

Deficiencies

Bubbles

90
Q

Disadvantages of calcium hydroxide

A

Multiple visits

Dehydration of dentine

Cervical root fractures

91
Q

Types of splints (5)

A

Occlusal splint

Mitchigan splint (upper)

Tanner appliance (lower)

Stabilisation splint

Interocclusal appliance

92
Q

What is an occlusal splint

A

Removable device made of acrylic resin, which fits between the mandibular and maxillary teeth

93
Q

Indications for splint therapy (5)

A

TMJ dysfunction and pain

Diagnosis of occlusal disharmony

To establish CR prior to extensive rehabilitation

Severe bruxism

Protection of extensive dental work

94
Q

Goals of the splint therapy (4)

A

Isolate the contact relations of teeth from masticatory system - keeps teeth apart

Allow condyles to seat in optimal position - stabilise and improve TMJ function

Allow optimum function of neuromuscular system

Protect teeth from attrition and adverse loading

95
Q

Features of occlusal splints (5)

A

Uniform contact in centric relation

Canine guidance - separate posterior teeth in eccentric excursions

Anterior guidance - separate posterior teeth in protrusion

Full coverage

Create artificial ideal occlusion

96
Q

Clinical stages of splint construction

A

Visit 1 - Upper and lower alginate imps, jaw reg in CR, facebow

Visit 2 - Fit splint Subsequent visits - review and adjust

97
Q

Soft splints advantages (4)

A

Sometimes tolerated better by patients

Easily constructed

Cheap

Useful for protection from trauma

98
Q

Soft splints disadvantages (3)

A

Difficult to adjust

Can encourage bruxism

Research shows muscle pain either did not change or increased

99
Q

What is occlusal adjustment

A

Occlusion adjusted to remove unwanted/interfering contacts, especially prior to restorative treatment

100
Q

What is occlusal equilibrium

A

Reorganising the occlusion to give an ideal occlusion by selectively adjusting tooth tissue

101
Q

What is the Dahl concept

A

Restorations placed in supra occlusion with the intention for the dentition to adapt to the altered occlusal scheme, in order to achieve even occlusal contact in ICP through over eruption/intrusion

102
Q

Indications of Dahl concept (3)

A

Anterior teeth wear cases - due to loss of vertical tooth height

Teeth to be restored to normal contour by increasing the vertical dimension of selected teeth without necessarily requiring restoration of all teeth

However not an excuse to cement any restoration high where it is not previously planned

103
Q

What do you need when planning a case using Dahl concept (6)

A

Impressions

Face bow

Occlusal records

Diagnostic wax up

Patient information and consent

Use hard splint to increase vertical dimension and check patient tolerance

104
Q

Practical aspects of Dahl concept

A

Warn patient regarding functional problems for a number of weeks

Movement often occurs quickly with occlusal contact being achieved in 6-8 weeks - it can take months depending on amount of VD increase

Keep record of occlusal changes and review the patient regularly

Very large increases in VD can usually be tolerated

105
Q

Why we need to restore root filled teeth (3)

A

Avoid bacterial leakage

Restore coronal structure

Restore aesthetics

106
Q

Why does coronal leakage occur (2)

A

GP - dentine interface is weak link (GP is thermoplastic causing it to shrink on cooling creating a gap between itself and dentine - this is why a sealer is used)

Sealer gives limited protection

107
Q

Challenges to root filler teeth (7)

A

Extensive coronal damage

Compromised mechanical integrity of remaining tooth

Reduced capability for stress distribution

Greater potential of bacterial leakage

Damage to periodontal structures

Changes to dentine physical properties

Loss of proprioception from the pulp

108
Q

What materials can be used as intracoronal restorations

A

Amalgam - requires cusps coverage, not conservative, unaesthetic

Composite - adhesive, unpredictable bond strength to dentine, chemical degradation, adequate for small access cavities

109
Q

Interradicular post considerations (4)

A

Parallel or tapered

Surface configuration

Active or passive

Design - length, width, ratio, depth, diameter

110
Q

What are the different post systems

A

Parapost

Composipost

Cosmopost

Radix anker

Kurer

111
Q

How to address failure of root filled teeth (4)

A

Analysis of cause

Elimination of cause

Prevention of recurrence

Restoration of function and aesthetics

112
Q

How to increase the success of post crowns (5)

A

Keep to reliable methods

Lateral/vertical condensation with gutta percha and bland root sealer

Leave 3-5mm GP at apical root terminus

Use passive adhesively retained custom post

Use of ferrule

113
Q

What is root surface debridement

A

Removal of deposits and a thin layer of cementum bound endotoxin from the root surface

114
Q

Limitations of RSD (4)

A

May not stop progression completely

Deep complex bone defects make it difficult

Severe hyperplasia or tissue defamation

Pathology

115
Q

Aims of periodontal surgery (7)

A

Gain access to root surface for debridement

Visualisation of bone defects

Improvement in tissue contour

Reduction in pocketing

Encourage regeneration of lost periodontal support

Removal of hyper plastic gingival tissue

Crown lengthening

116
Q

Indications for periodontal surgery (3) and what type of surgery

A

Hyperplasia, pseudo pocketing = gingivectomy

Deep persistent bleeding pockets = reduced flap

Unsuccessful multiple RSD = apically repositioned flap

117
Q

Considerations before periodontal surgery (6)

A

Has non surgical therapy tried and reviewed adequately

Is patient suitable - no anticoagulants

Consented by patient

Is it warranted based on pathology

OH compliance

Has restorative strategy been considered

118
Q

How to carry out gingivectomy

A

LA

PD markings

Incisions with external bevels

Removal of excised tissue to base of the pocket depth

Scaling

Haemostasis

Periodontal dressing

119
Q

Types of sutures (5)

A

Interrupted

Vertical mattress

Horizontal mattress - long wounds

Sling - when one side needs to be raised higher

Continuous - if multiple teeth have been under surgery

120
Q

Post op care for periodontal surgery (6)

A

Analgesia

Suture removal at 7-10days

CHX MW 2 x day 2-3 weeks

No mechanical cleaning

Soft toothbrush after 3 weeks

Fortnightly dental visits

121
Q

Signs of periodontal surgery success (8)

A

Decrease in inflammation

Less bleeding on probing

Decrease in pocket depth

Increase in attachment

Eliminate pus

No increase in mobility

Improvement in tissue contour

Stabilisation of bone levels

122
Q

Options for missing teeth (4)

A

Do nothing

RPD

Bridges

Implants

123
Q

Design criteria for bridgework (5)

A

Periodontal support

Occlusal loading

Conservation of tooth tissue

Cleansability

Appearance

124
Q

Retention for bridges (2)

A

Full coverage crowns

Adhesive retainers

125
Q

Types of abutments for bridges (2)

A

Fixed fixed - two abutments

Cantilevered - one abutment only

126
Q

Factors to consider about abutments for bridges (4)

A

Tooth position

Crown shape

Restorative status

Endodontic status

127
Q

What are typically poor abutments for bridges (3)

A

Maxillary lateral incisors

Tilted incisors

Root filled

128
Q

Factors to consider with complete dentures (4)

A

Denture security (retention and stability)

Adhesives

Neutral zone

Pre contact check record

129
Q

What is denture security

A

A fuunction of stability and retention

Patients main concern

Considers the three surfaces (polished, occlusal, fitting)

130
Q

What is denture retention

A

Retention is the resistance of displacement in an axial direction

131
Q

How is complete denture retention improved (2)

A

Cohesion between denture and oral mucsosa

Peripheral seal

132
Q

How is RPD retention improved (2)

A

Cohesion between denture and oral mucosa

Tooth undercut

133
Q

Why can RPDs not rely on peripheral seal for retention

A

Seal broken by the remaining teeth

134
Q

How is complete denture retention compromised (3)

A

Poor denture adaptation

Unfavourable supporting anatomy

Dry mouth

135
Q

What is denture stability

A

The ability to resist forces attempting to displace denture in directions other than at right andgles to the supporting tissue

136
Q

What is denture stability dependent on

A

Size and shape of ridge - atrophic? torus palatinus bulbous ridge?

137
Q

To increase denture stability, what do you need to take in to account

A

Periphery - muscle insertions (border moulding)

Occlusal surface - balanced occlusion and articulation

Polished surface - concave surfaces to allow muscles to stabilise denture, removal of undercut on lingual

138
Q

Denture stability is compromised by

A

Uneven or unfavourable occlusal contacts

Lever arm forces that cause tipping effect

139
Q

Lack of denture stability is caused by

A

Poor design of occlusal patterns

Retained teeth causing no peripheral seal

140
Q

What are the aims of denture adhesives (4)

A

Help retain denture

Enable effective function

Avoid social embarrassment

Achieved with minimal inconvenience

141
Q

What makes a denture adhesive a facilitator (5)

A

Clear need - pt driven

Largely effective

Temporary use = lack of adaptation

Permanent use = poor supporting tissues

Product/delivery/application is good

142
Q

What makes a denture adhesive a barrier (6)

A

Need is often associated with failure

Customer confusion

Effectiveness is patient driven and variable

Problems of - perception, alteated taste/sensation

Does not focus on user

Poor instructions

143
Q

Indications for thin film denture adhesives (3)

A

Dentures well adapted

Denture bearing anatomy is unfavourable for effective retention

There is a need to enhance salivary cohesion

144
Q

Indications for volume filler denture adhesive (3)

A

Dentures are ill fitting

Poor adaptation between denture and mucosa

There is a need to fill the gap

145
Q

What is neutral zone

A

Site where opposing forces exerted by the lips, cheeks and tongue are in balance

146
Q

How to ensure the denture sits in the neutral zone (7)

A

Request heat cured base for registration rims after definitive impressions

Set registration rims in even contact

Remove most of the wax from the anterior region

Apply adhesive to the cut surface and repplace the missing wax with a small amount of stiff alginate or heavy bodied silicone

Place in mouth

Patient to touch palatal surface of upper anterior rim with tip of tongue, occlude, smile and relax

147
Q

Why is pre contact check record carried out (5)

A

Ensure occlusal balance

Remove discrepancies due to errors when recording jaw relationship and processing of denture

Method of registering coincidence of RCP and ICP

Avoid contact between occlusal surfaces

Ensure balanced articulation

148
Q

How to do the pre contact check record

A

Use articulating paper to find contacts

Deppend fossae using bur

Repeat until contact includes first molars at least

149
Q

Problems when a complete denture opposes natural teeth (2)

A

Uneven occlusal plane due to overeruption/tipping

Stable/rigid natural dentition against mobile denture

150
Q

What are the ideal properties of cement for fixed prostheses (11)

A

Low viscosity and film thickness

Long working time with rapid set

Low solubility

High compressive and tensile strengths

High proportional limit

Retrievability

Adhesion to tooth structure and restorative materials

Cariostatic

Biocompatibility

Translucency or opacity when required

Radiopacity

151
Q

Properties of zinc phosphate cement (5)

A

Low film thickness

Non adhesive and low tensile strength

Poor acid resistance

Easy to dismantle

Largely superseded by modern materials

152
Q

Properties of zinc polycarboxylate (2)

A

Similar to zinc phosphate but more soluble

Some adhesion, but less than GIC or resins

153
Q

Properties of glass ionomer cements (4)

A

Releases fluoride

Acid soluble

Similar adhesion to zinc polycarboxylate

Superseded by resin modified GIC

154
Q

Properties of RMGIC cement (3)

A

Higher tensile and bond strength than GIC

Low film thickness

Good acid resistance

155
Q

Properties of resin cements (4)

A

Strong

Adhesive

Technique sensitive

Available as chemical, dual, light cured

156
Q

Properties of hydrophobic resin cements (3)

A

Require bonding agents

Supplied as visible light cure and dual cure

Wide range of shades and opacities

157
Q

Properties of hydrophilic resin cements (4)

A

High affinity to non precious metals

High cost

Chemical or dual cure

Highly oxygen inhibited

158
Q

Properties of self etch resin cements (3)

A

Easy to use and clean up

Strongly self adhesive to dentine

Dual cure

159
Q

What is primary occlusal trauma

A

Injury to a periodontium of normal bone height as a result of excessive occlusal forces

160
Q

What is secondary occlusal trauma

A

Injury to a periodontium of reduced bone height as a result of excessive occlusal force

161
Q

Aetiology of occlusal trauma (5)

A

Premature contacts

Parafunctional habits

Tooth drifting following tooth loss of periodontal disease

Loss of posterior teeth

Occlusal discrepancy

162
Q

Clinical findings of occlusal trauma (6)

A

Increased mobility

Fremitus

Tooth migration

Pain and tenderness

Tooth surface loss

Temporomandibular signs

163
Q

Radiographic findings (2)

A

PDL widening - primary occlusal trauma

Bone loss and PDL widening - secondary occlusal trauma

164
Q

What can go wrong in tooth development (4)

A

Number

Shape/form

Size

Structure

165
Q

Aetiology of dental anomalies (2)

A

Genetic - chromosomal, single gene syndromes, single gene localised effect

Environment - rubella, thalidomide, irradation

166
Q

What is hypodontia

A

Developmental absence of one or more teeth excluding third molars

167
Q

Aetiology of hypodontia (5)

A

Obscure

Polygenic plus intrauterine systemic factors

Increased frequency - low birth weight, multiple births, increased maternal age

Single gene mainly for upper 2s

PAX9, MSX1

168
Q

What medical conditions is hypodontia linked to

A

Downs syndrome, rubella, thalidomide embryopathy

X linked hypohidrotic ectodermal dysplasia, AR chondroectodermal dysplasia, Ellis van Creveld syndrome

Cleft lip/palate

169
Q

What is hyperdontia

A

Condition where there are suppernumerary teeth present

170
Q

Types of supernumeray teeth (3)

A

Supplemental - normal size and form

Accessory - atypical form

Mesiodens - adjacent to midline suture

171
Q

What are supernumerary teeth associated with (3)

A

Invaginated teeth

Palatal cleft

Syndromes - cleidocranial dysplasia, oral facial digital syndrome, Gardner syndrome

172
Q

What is anodontia

A

Genetic disorder characterised by the absence of all teeth

173
Q

What is microdontia

A

Atypically small teeth

174
Q

Macrodontia

A

Atypically large teeth

175
Q

Aetiology of atypically sized teeth

A

Multifactorial - polygenic and environment

Microdontia - single gene inheritence, associated with Dons syndrome and ectodermal dysplasia

176
Q

What are double teeth

A

Fusion of two tooth germs or gemination of one tooth germ splitting into two

177
Q

Aetiology of Double teeth

A

Unknown, genetic?

178
Q

What does double teeth look like

A

Minor notch to almost separate crowns

+/- common pulp space, root canal

Do not confuse with concrescences in which two teeth become united after forming by excess cementum

179
Q

What is an invaginated tooth

A

Where dentine is mssing and enamel may be incomplete, therefore the pulp is directly exposed when tooth erupts

180
Q

Aetiology of abnormal root size (2)

A

Irradation

Racial variation

181
Q

What is taurodontism

A

The crown of the tooth is elongated and the roots are short

182
Q
A
183
Q

What is the aim of obturation

A

Establishment of a fluid tight barrier with the aim of protecting the periradicular tissues from microorganisms which reside in the oral cavity

184
Q

Well obturated system would serve three main functions

A

Prevent coronal leakage of microorganisms or potential nutrients to support their growth into the dead space of root canal system

Prevent periapical or periodontal fluids percolating into the root canals and feeding microorganisms

Entomb any residual microorganisms that have survived the debridement and disinfection stages of treatment in order to prevent their proliferation and pathogenicity

185
Q

Ideal properties of root filling material (10)

A

Easy handling and ample working time

Seal canal laterally and apically conforming to complex internal anatomy

Dimensionally stable

Non irritant

Does not stain tooth structure

Antimicrobial

Impervious and non porous

Unaffected by tissue fluid

Radiopaque

Easily removed

186
Q

What is the role of an endodontic sealer (4)

A

Seal the space between the obturating core material and the internal root surface

Fill the space between core and accessory filling materials

Seal irregularities of complex canal anatomy

Lubricate and facilitate seating of core and accessory filling material

187
Q

Indications for RCT (7)

A

Irreversible pulpitis

Periapical pathology

Post retained restoration

Overdenture

Teeth with doubtful pulps

Periodontal disease

Pulp sclerosis following trauma

188
Q

Contraindications for RCT (9)

A

Inadequate access

Poor OH/attitude

Medical conditions - vertigo, arthritis

Tooth unrestorable

Insufficient periodontal support

Non strategic tooth

Root fractures

Root resorption

Bizarre anatomy

ICP (5 decks)

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