Advanced restorative dentistry

Question 1

What are the aims of advanced restorative dentistry?

Answer 1

Achieving predictable restorations, attention to detail, correct use of materials, protocol, mantenance
Maintaining pulp vitality
Technology of the dental surgery; handpieces, burs (high speed limited torque, low sped more control, finishing instruments, curing lights, CAD-CAM

Question 2

What is restorative dentistry?

Answer 2

Eliminating disease and restoring function and aesthetics using the most appropriate materials and techniques

Question 3

Why is replacing a restoration such an issue?

Answer 3

Structural degradation - when restoration is placed
increased stress fields due to: Fatigue effects, Change in physical properties and other destructive lesions, Placement of adjacent restorations
Pulp receding leaving sclerotic dentine - unorganised, missing collagen more brittle and high mineral content

Question 4

Where does the restored tooth get its stress from?

Answer 4

Occlusal loading
Reduced occlusal support
Stress induced para-function

Question 5

How do you achieve a predictable result/

Answer 5

Choice of materials

Choice of clinical technique

Question 6

What influences choice of material?

Answer 6

LAb and clinical trials

Question 7

What is important in clinical technique?

Answer 7

Attention to detail
Care at every stage 
Correct use of materials
Correct use of technologies 
Maintenance of pulp vitality 
Use of protocols 
Maintenance (professional and patient)

Question 8

What are randomised clinical trials?

Answer 8

Final step of the research ladder
Is the best evidence on the true performance of a medical device, technology or technique
They inform our evidence based practice

Question 9

What is the Hierarchy of evidence?

Answer 9

1. Systematic reviews and meta-analysis of RCTs
2. RCT’s
3. Cohort studies
4. Case-controlled studies
5. Cross-sectional surveys
6. Case reports
7. Expert opinion

Question 10

What does evidence-based practice give us?

Answer 10

evidence we need to assess how predictable our result is

The integration of the best research evidence with clinical expertise and patient wishes

Question 11

What is the rationale for evidence?

Answer 11

Support clinical decision making
Inform patient choice
Inform planning and commissioning of dental services
Support the development of dentistry

Question 12

What is the process of concept to reality?

Answer 12

1. concept
2. Development
3. Lab testing: physical properties, citotoxicity and mutagenicity, cell studies
4. animal studies
5. clinical trials
6. Randomised trials
7. Meta-analtsis of RCT’s

Question 13

Flowable composites - when are they required?

Answer 13

In miniscule volume to round off sharp internal irregular cavity floor
To avoid air entrapment

Question 14

Advanced restorative dentistry is….

Answer 14

doing everything really well so have a predictable outcome and following protocols and guidelines