Advanced Restorative Dentistry

Question 1

What is restorative dentistry?

Answer 1

Eliminating disease and restoring function and aesthetic using most appropriate materials and techniques

Question 2

Reasons amalgam may need replacing?

Answer 2

Contour, ledges, carving, creep, corrosion

Question 3

What to consider when replacing restorations?

Answer 3

Management of disease rather than fix-it approach

Stabilisation and review of outcomes - important for management

Question 4

How to approach initial lesions?

Answer 4

Aim - eliminate disease (caries) w/ no further tx being necessary
Want - lesion arrest and total disease control achieved

Tx: OHI, caries management w/ restoration placement

Question 5

Challenges faces with restorations?

Answer 5

Restoration placed in compromised tooth structure
Degradation due to function inc. parafunction
Increased stress fields
Fatigue effect
Change physical properties - materials
Direct and indirect loading forces
Loading - often reduced occlusal support
Environmental damage

Question 6

What is environmental damage?

Answer 6

Mouth - wet/warm environment
Bacteria
Temperature changes - cyclic changes (expansion/contraction) - restoration and tooth have dissimilar rates (diff coefficient of thermal expansion)

Question 7

Why may cusp fractures occur?

Answer 7

Occlusal load
Stress
Different coefficient of thermal expansion
Remaining tooth structure not substantial
Thin brittle enamel left

Question 8

How to prevent cusp fracture when placing restorations?

Answer 8

Cavity design - no unsupported enamel

Material - predictable outcome

Question 9

Why may restorations change colour?

Answer 9

Hasn’t been polished - oxygen-inhibited later

Lack of polymerisation - unpolymerised monomer will absorb

Question 10

How to achieve predictable result with restorations?

Answer 10

1. Choice material: evidence, darker shades need longer curing, flowable don’t use more 2mm increment
2. Clinical technique

Question 11

What is hierarchy of evidence available?

Answer 11

1. Systematic review and meta-analysis of RCTs
2. RCTs
3. Cohort studies
4. Case-control studies
5. Cross-sectional surveys
6. Case report
7. Expert opinion

Question 12

Why use evidence?

Answer 12

Support clinical decision making
Inform pt choice
Inform planning
Support development of dentistry

Question 13

How are concepts made into reality?

Answer 13

1. Concept
2. Development
3. Lab testing: physical properties, cytotoxicity, mutagenicity, cell studies
4. Animal studies
5. Clinical trials
6. Randomised clinical trial
7. Meta-Analysis of RCTs.