BDS3 treatment planning

Question 1

what are diff types of special investigation?

Answer 1

• sensibility testing
• radiographs
• study models
• facebow
• diagnostic wax-up

Question 2

what is purpose of a facebow?

Answer 2

to find relationship between maxilla and angles of the mandibular condyles

Question 3

what are stages of treatment planning?

Answer 3

• immediate
• initial
• re-evaluation
• reconstructive
• maintenance

Question 4

what do you do during immediate stage for treatment?

Answer 4

• relief of acute symptoms
• consider endo and extractions
• consider immediate denture/bridge

Question 5

what do you do during initial stage of treatment?

Answer 5

disease control
- extraction of hopeless teeth
- OHI and diet advice
- HPT
- Management of carious lesions and defective restorations with direct or provisional restorations
- endo
- denture design, wax up for fixed prosthodontics

Question 6

what do you do during re-evaluation part of treatment?

Answer 6

• re-assessment of perio status, confirm denture/bridge design

Question 7

what do you do during reconstructive part of treatment?

Answer 7

• perio surgery
• fixed and removable prosthodontics

Question 8

why place veneers?

Answer 8

 Improve aesthetics
 Change teeth shape and/or contour
 Correct peg-shaped laterals
 Reduce or close proximal spaces and diastemas
 Align labial surfaces of instanding teeth

Question 9

what do you do during maintenance part of treatment?

Answer 9

• supportive perio care and review of restorations

Question 10

what is gurel minimal prep technique?

Answer 10

Veneers
 Wax up
 Stent
 Intra-oral mock up
 Preparation into mock up (can use depth cut burs

Question 11

when not to use veneers?

Answer 11

 Poor OH
 High caries rate
 Interproximal caries and/or unsound restorations
 Gingival recession
 Root exposure
 High lip lines
 If extensive prep needed (>50% of surface area no longer in enamel)
* Consider alternatives – PJC, DBCs MCCs
 Labially positioned, severely rotated and overlapping teeth
 Extensive TSL/insufficient bonding area
 Heavy occlusal contacts
 Severe discolouration

Question 12

when is extensive prep needed so veneers can’t be used?

Answer 12

> 50% of surface area no longer in enamel

Question 13

why restore teeth with inlays/onlays?

Answer 13

 Tooth wear cases
* Increase OVD
 Fractured cusps
 Restoration of root treated teeth
 Onlays provide cuspal coverage
 Replace failed direct restorations

Question 14

why not use inlays/onlays?

Answer 14

 Active caries and periodontal diseases
 Time
* Tooth preparation and laboratory fabrication required
 Cost

Question 15

Why restore teeth with crown?

Answer 15

 To protect weakened tooth structure
 To improve or restore aesthetics
 For use as a retainer for fixed bridgework
 When indicated by the design of a RPD
* Rest seats
* Clasps
* Guide planes
 To restore tooth function
* e.g. restore in OVD

Question 16

Why not restore with crowns?

Answer 16

 Active caries and periodontal disease
 More conservation options available
 Lack of tooth tissue for preparation
 Unable to provide post and core
 Unfavourable occlusion

Question 17

what are the principles of crown prep?

Answer 17

o 1) Preservation of tooth structure
o 2) Retention and resistance
o 3) Structural durability
o 4) Marginal integrity
o 5) Preservation of the periodontium
o 6) Aesthetic considerations

Question 18

what does under preparation of crown prep result in?

Answer 18

• Poor aesthetics
• Over built crown with periodontal and occlusal consequences
• Restorations with insufficient thickness

Question 19

in terms of principle of crown prep what is meant by retention?

Answer 19

Prevents removal of the restoration along the path of insertion or the long axis of the tooth preparation

Question 20

in terms of principle of crown prep what is meant by resistance?

Answer 20

Prevents dislodgement of the restoration by forces directed in an apical or oblique direction and prevents any movement of the restoration under occlusal forces

Question 21

what is the ideal inclination of opposing walls with taper?

Answer 21

6-10 degrees

Question 22

what do longer walls of a crown prep interfere with?

Answer 22

tipping displacement

Question 23

in terms of principle of crown prep what is meant by path of insertion?

Answer 23

• Imaginary line along which the restoration will be place onto or removed from the preparation.
• Is set before the preparation is begun and all the features of the preparation must coincide with that line

Question 24

what are extra means of retention for crown preps?

Answer 24

• Grooves
• Slots

Question 25

how is retention in crown preps improved?

Answer 25

limiting the number of paths of insertion.

Question 26

what is structural durability of crown prep?

Answer 26

 Restoration must contain a bulk of material that is adequate to withstand the forces of occlusion.

Question 27

how is structural durability of crown prep achieved?

Answer 27

• Occlusal reduction
• Functional cusp bevel
• Axial reduction

Question 28

what are finish line configurations for marginal integrity of crown preps?

Answer 28

• (a) Knife edge
• (b) Bevel
• (c) Chamfer
• (d) Shoulder
• (e) Bevelled shoulder

Question 29

how should the margins of the restoration be when preserving the periodontium during crown preps?

Answer 29

• 1) Smooth and fully exposed to a cleansing action.
• 2) Placed where the dentist can finish them and the patient can clean them.
• 3) Placed supra-gingival or at gingival margin whenever possible.
  o Placement of the margins subgingival may be required

Question 30

what is considered when deciding aesthetic considerations of crown preps?

Answer 30

• Smile lines
• provides best aethetics so will the restoration(s) be visible?
• Has the least destructive preparation?
• Is least destructive to opposing teeth?
• Is best suited to bruxists?

Question 31

when planning bridgework what is occlusal stability?

Answer 31

Prevent tilting and overeruption of adjacent and opposing teeth

Question 32

what not replace teeth for bridgework?

Answer 32

 Damage to tooth and pulp
 Secondary caries
 Effect on the periodontium
 Cost
 Failures

Question 33

what needs to be discussed for informed consent?

Answer 33

o What treatment is to be performed
o Why it is necessary
o Consequences of not having treatment
o What risks may be involved (material risks)
o What alternatives are there (and their risks)
o Relative costs