BDS4 Flashcards
what is BSI definition of class 2 div 1
lower edges lie posterior to cingulum plateau of upper incisors
increased overjet
upper centrals proclined or of average inclination
why do you treat class 2 div 1
aesthetics and trauma
what is the skeletal pattern for class 2 div 1
class 2
what are the soft tissues like in class 2 div 1
incompetent lips
lower lip trap
mandible postured to allow lips to meet
tongue between incisors
what are the dental factors of class 2 div 1
increased overjet
variable overbite
variable alignment
dry gingiva
what is the aetiology of class 2 div 1
sucking habits
skeletal growth
what are the consequences of sucking habits
procline upper anteriors
retrocline lower anteriors
AOB
incomplete overbite
narrow upper arch
how do you stop a sucking habit
positive reinforcement
nail polish
glove
habit breaker
what are the treatment options for class 2 div 1
accept
growth modification
URA only
camouflage
orthognathic surgery
why would you accept class 2 div 1
mild increased OJ
patient happy
what is used for growth modification for class 2 div 1 and what does it do
twin block
distalise uppers
mesialise lowers
retrocline uppers
procline lowers
when would you use a URA only for class 2 div 1
very mild malocclusion
proclined overjet and spaced incisors
what is the BSI definition of class 2 div 2
lower incisors occlude posterior to the cingulum plateau of the upper incisor
upper incisors are retroclined
overjet reduced
what is the skeletal pattern with class 2 div 2
mild/moderate class 2
reduced FMPA
prominent chin
what are soft tissues like with class 2 div 2
high resting lower lip line
marked labio-mental fold
upper 2s trap lower lip
what are the dental features of class 2 div 2
retroclined upper centrals
upper 2s crowded
reduced arch length
poor cingulum on upper laterals
deep overbite
why do you treat class 2 div 2
aesthetics and traumatic overbite
what are the treatment options for class 2 div 2
accept
growth modification
camouflage
orthognathic surgery
why would you accept class 2 div 2
good aesthetics
patient happy
overbite not an issue
what is used for growth modification for class 2 div 2
modified twin block
procline upper incisors
how do you camouflage class 2 div 2
reduce overbite
correct inter-incisal angle
torqueing upper incisors
proclining lower incisors
what features of class 2 div 2 have high relapse rate
deep overbite
rotated laterals
what is the BSI definition of class 3
lower incisor edge occludes anterior to the cingulum plateau of the upper central incisor
overjet reduced or reversed
what is the skeletal features of class 3
AP class 3
bilateral crossbites
retrusive maxilla and wide mandible
what are the dental features of class 3
class 3 incisors and molars
reverse overjet
reduced overbite
AOB
crossbites
crowded maxilla and spaced mandible
dentoalveolar compensation
displacement on closing
How do the soft tissues influence dental features of class 3
tongue proclines uppers
lip retroclines lowers
why do you treat class 3 malocclusions
aesthetics
attrition
recession
displacement
speech
mastication
what factors of class 3 can make it harder to treat
facial growth
crossbite
AOB
what are the treatment options for class 3
accept
growth modification
camouflage
orthognathic surgery
what interceptive treatment for class 3 would a patient receive
URA to procline incisors over the bite
what is growth modification used for in class 3
reduce mandibular growth and encourage maxillary growth
what appliance is used for growth modification in class 3
reverse twin block
protraction headgear with rapid maxillary expansion
when would you camouflage a class 3
when growth stopped
ANB > 0
average or increased overbite
edge-edge
minimal dentoalveolar compensation
how do you camouflage a class 3
extract upper 5s and lower 4s
retrocline lowers
procline uppers
correct overjet
how do you check for the presence of a canine
palpate buccally and palatally
mobility of c’s
angulation of laterals
mobility of lateral
colour of c and lateral
radiography
what is the aetiology of unerupted canines
long path of eruption
genetics
class 2 div 2
crowding
ectopic position of tooth germ
what are the treatment options for unerupted canine
accept
extract c
expose
surgically remove
autotransplantation
when would you accept position of unerupted canine
if canine has not migrated mesially further than midline axis of lateral
what could accepting the position of an unerupted canine cause
root resorption
ankylosis of canine
cyst formation
problems for restorative
when would you surgically remove an unerupted canine
if good eruption path not possible
if damage to lateral incisor
if good occlusion
what is the aetiology of unerupted maxillary incisors
trauma to primaries = dilaceration
tuberculate supernumerary
retained primary
early loss of primary
crowding
ectopic position of tooth germ
what are the treatment options for unerupted maxillary incisors
accept
bring into arch
what can accepting the position of an unerupted maxillary incisor cause
ankylosis
root resorption
drift of lateral
cyst formation
what are the causes of hypodontia
non-syndromic - genetic
syndromic - CLP/ectodermal dysplasia
environmental - trauma/cancer therapy
what is the presentation of hypodontia
delayed/asymmetric eruption
retained deciduous/absent deciduous
tooth form
what are the associated issues with hypodontia
microdontia
spacing/drifting
over-eruption
aesthetics and function
what are the options for missing upper 2s
accept
restorative
orthodontics
combined
what are the restorative options for missing upper 2s
retract 3 and create space for RBB for 2
pressure retainer with 2 as pontic
implant
shape canine to be lateral
partial denture
what classification is used for cleft lip and palate
LAHSAL
what are the dental implications of cleft lip and palate
missing teeth
impacted teeth
crowding
growth
caries
what are the functions of fixed appliances
camouflage
alignment
rotations
centreline
overbite and overjet
spaces
vertical movements
what are the advantages of NiTI archwire
flexible
light continuous force
shape memory
higher friction than SS
name 4 generators of force in orthodontics
elastic power chain
NiTi coils
elastics
active ligature
what features have a high chance of relapse
diastema
rotations
palatal ectopic canines
proclined lower incisors
AOB
instanding upper 2s
what are the dental health benefits of orthodontics
impaction by missing teeth
trauma risk by overjet
perio support and wear caused by crossbites
caries/perio caused by contact issues
gingival stripping by overbites
what are the main risks of orthodontic treatment
decalcification
root resorption
relapse
soft tissue trauma
how do you prevent decalcification in orthodontics
case selection
oral hygiene
diet
fluoride
what are the risk factors for root resorption
tooth movement - prolonged/intrusion/torque
root form - blunt/pipette
previous trauma
nail biting
what are the issues with adult orthodontics
lack of growth
periodontal disease
missing/restored teeth
physiological factors
adult motivation
what is the goal of orthodontic treatment aiming to achieve
Andrew’s six keys
what are Andrew’s six keys
tight contacts with no rotations
class 1 incisors
class 1 molars
flat occlusal plane
slight mesial inclination
canines - molars lingually inclined
what are the complications of cannulation
venospasm
extravascular injection
intraarterial injection
haematoma
fainting
how do you treat venospasm
take time dilating
efficient technique
gloves to keep warm before
how do you treat extravascular injection
remove cannula, apply pressure, reassure
how do you treat intra-arterial injection
monitor for loss of pulse
leave cannula in for 5 mins post drug then remove if no problems
symptomatic = hospital referral
how do you treat haematoma from sedation
time
rest
reassurance
ice pack
what are the complications of drug administration in sedation
hyperresponders
hyporesponders
paradoxical reactions
oversedation
allergy
how do you manage oversedation
stop
try to rouse
ABC
reverse with flumazenil 200mcg then 100mcg each minute
watch for 1-4hrs
how do you manage respiratory depression
check oximeter
stimulate patient
head tilt, chin lift, jaw thrust
supplemental oxygen - nasal cannula 2l/min, hudson mask 5l/min, ambu bag
flumazenil
what are the signs and symptoms of N2O2 overdose
patient discomfort
lack of co-operation
mouthbreathing
giggling
nausea
vomiting
LoC
what is the treatment of nitrous oxide overdose
decrease concentration by 5-10%
reassure
dont remove nosepiece
what does choice of sedation technique depend on
patient co-operation
anxiety and previous experience
dentistry needed
facilities and team skills
what are the advantages of IHS
anxiety relief, rapid recovery, flexible duration
what are the disadvantages of IHS
nasal hood needs kept in place
less muscle relaxation
need good breathing coordination
what are the advantages of IV sedation
good sedation and muscle relaxation with little co-operation
what are the disadvantages of IV sedation
baseline readings needed
cannulation
continuously reassess sedation level
what is the distribution and elimination half lives of midazolam
distribution = 4-18mins
elimination = 1.5-2hrs
what are the causes of dental anxiety
trauma
transference
fear of criticism
fear of dress
lack of communication
helplessness
surgery appearance
staff continuity issues
what are the contraindications to sedation in general
severe/uncontrolled systemic disease
severe psychiatric problems
narcolepsy
hypothyroidism
what are the contraindications to IV sedation
COPD
hepatic insufficiency
pregnancy
what are the contraindications to IHS
blocked nasal airway
COPD
pregnancy
what ASA classifications can we treat in primary care and what in secondary care
1 and 2 primary
3 in secondary
why do oxygen saturations start to rapidly decrease once they go past 90%
as the affinity of haemoglobin to O2 is decreasing
what vital signs are assessed at sedation assessment
heart rate
BP
oxygen sats
BMI
what are the effects of benzodiazepines as sedative agents
enhance GABA effects
respiratory depression - CNS and depression and muscle relaxation
decreased cerebral response to increased CO2
decreased BP
increased heart rate
what is the concentration of midazolam used
1mg/ml
where is midazolam metabolised
liver
where can the cannula be put for sedation
dorsum of hand
antecubital fossa
what structures do we need to be careful of if using the antecubital fossa for cannulation
brachial artery and median nerve
when do you stop administering midazolam
slurred and slow speech
relaxed
willingness to accept treatment
verrils sign
eves sign
what are verrills and eves sign in sedation
eyes drooping
finger to nose
what is the concentration of flumazenil
500mcg/5ml
what are the anxiety assessments that are used
mcdas
mcdasf
what is the 5 factor model of CBT
situation
thoughts
moods/emotion
behaviour
body reaction
what are the key factors of sedation
remains conscious
retains protective reflexes
understands and responds to verbal commands
what are the indications for IHS
anxiety
needle phobia
gagging
traumatic procedures
what are the contraindications for IHS
medical issues, cold, large tonsils, COPD, pregnancy, claustrophobia
name some safety features of IHS
reservoir bag
colour coding
scavenging system
oxygen flush button
pressure reducing valves
what are the signs and symptoms of adequate sedation via IHS
relaxed
slower blinks
reduced gag
awake
still verbal
lethargic
dreaming
what are the signs of oversedation via IHS
mouth closing/breathing
vomiting
decreased cooperation
uncontrollable laughter
LoC
incoherent speech
what are the pre-op instructions given before a sedation appointment
light meal first
accompanied by adult
sensible clothes
plan to remain in clinic up to 30mins after
what is the procedure of IHS
100% O2 5-6l/min for 1 min
reduce O2 by 10%, wait 1 min and repeat
after O2 reaches 80% reduce by 5% per minute
stop titrating when ready
constantly reassure during treatment
gradually increase O2 by 10-20% per minute or turn straight up
100% O2 for 2-3mins
what is attrition caused by
tooth to tooth contact
parafunctional habit
what are the signs of attrition
facets on occlusal surfaces
reduction in cusp height
what is abrasion caused by
wear through abnormal mechanical process independent of occlusion (foreign object)
toothbrushing
what are the signs of abrasion on the tooth
labial, cervical v-shape lesions on canines and premolars
what is the cause of erosion
chemical process but no bacteria
what are the signs of erosion
flat and smooth surfaces
bilateral concave lesions
dark incisal edges
high restorations
what is abfraction
biomechanical loading forces resulting in flexure and failure of enamel and dentine at location away from loading which disrupts enamel and dentine by cyclic fatigue
what does an abfraction lesion look like
v-shaped
how do you start preventing/reducing tooth weae
recognise problem
grade severity
diagnose likely cause
monitor progression
what medical history issues can cause erosion
GORD
medications
alcoholism
ED
pregnancy
reumination
what social history causes can cause tooth wear
lifestyle stresses
habits
diet
sports
what extraoral signs would be indicative of wear
restriction of TMJ movement
hypertrophy
restricted mouth opening and deviation
what wear indices are there
smith and knight
bewe
apart from wear indices what other special tests are included in tooth wear cases
sensibility tests
radiographs
articulated study models
photos
wax up
diet analysis
what are the patterns of wear
localised or generalised
what are the 3 types of generalised wear
with OVD loss
without OVD loss but limited space
without OVD loss but no space
what is prevention for abrasion
RMGIC in cavities so patient wears this away instead
what is prevention for attrition
CBT, hypnosis
splints - soft/hard/michigan
what is a michigan splint
splint with canine rise for disclusion and stops which put you in centric occlusion
how do you prevent erosion
fluoride
desensitising agents
habit changes
medical - GMP
how do you monitor wear
indices
photos
study models
remove cause
what factors influence what the treatment of maxillary anterior wear is
pattern
inter-occlusal space
space needed for planned restorations
quality and quantity of tooth left
aesthetic demands
why would there be no space left if someone has wear with no loss of OVD
the alveolar bone grows to compensate and maintain mastication
what are the methods of creating interocclusal space
increase OVD
reorganise from ICP to RCP
surgical crown lengthening
RCT and post crowns
conventional ortho
what is the Dahl technique
composite on anteriors to open bite
posterior disclusion occurs and OVD increase of 2-3mm
occlusion only on canines/incisors
anteriors intrude and posteriors erupt
what is the Dahl technique used to treat
localised wear
when is the Dahl technique not suitable
active perio
TMJ
after ortho
bisphosphonates
implants
existing conventional bridge
what is the first line treatment for anterior wear
composite build ups
what is the treatment for localised posterior wear
composite to palatal of upper canines for posterior disclusion to aim for canine guidance
what are the methods of composite build ups in wear
alginate, wax, putty matrix
lab made vacuum formed matrix
what is the patient information for composite build ups for wear
front teeth have tooth coloured fillings
no/minimal drilling
bite feels strange for a week
back teeth take 3-6 months to touch
lisp for few days
likely need to replace crowns/bridges at back of mouth
will require maintenance
what is the treatment for excessive loss of OVD in wear
splint to assess tolerance to face height
increase height with comps
dentures to provide posterior support
what is the treatment for wear without OVD loss and limited space still available
re-organisation
splint considered for height
restore to new height
what is the treatment for wear without OVD loss but no space
specialist opinion
splints/dentures/crown lengthening/overdentures
what is the SDA
sufficient adaptive capacity when 3-5 units left which occlude
what does loss of molars mean for SDA
TMJ issues
less occlusal stability
mandibular displacement
reduced masticatory efficiency
what are the main conclusions about the SDA
sufficient oral function and comfort
sufficient mandibular stability
sufficient occlusal stability
occlusal attrition not significantly different
alveolar bone decreases at same rate
what are the indications for SDA
missing posteriors with 3-5 occluding units
sufficient contacts large enough to get occlusal table
favourable prognosis for remaining teeth
patient not motivated to pursue complex plan
limited money for dental care
what are the contraindications for SDA
poor prognosis for remaining dentition
periodontal disease
TMJD
pathological wear
severe class 2 or 3
what factors of the patients dentition would make you opt to replace teeth rather than give SDA
problems chewing
appearance concerns
occlusal instability
what happens in the SDA if the PDL is not healthy
drifting, loss of alveolar bone
distal tooth migration - increasing anterior load, occlusal contacts and interdental spacing
what are the 5 requirements of occlusal stability
stable contacts on all teeth of equal intensity
anterior guidance in harmony with envelope of function
disclusion of posterior teeth during protrusion
disclusion of posteriors on non-working side in lateral movement
disclusion of posteriors on working side in lateral movement
what is occlusal stability determined by
absence of pathology
perio support
number of teeth in arches
interdental spacing
occlusal contacts
mandibular stability
how can you extend the SDA
RBB
conventional bridge
implants
RPD
what are the local indications for bridgework
big teeth
heavily restored
favourable occlusion
favourable abutment angulations
what are the contraindications to bridgework
uncooperative
poor OH
high caries
perio disease
large pulps
high chance of further tooth loss
prognosis of abutment poor
length of span too great
tilted teeth
periapical status
bone loss
what are the advantages of RRB
minimal prep
quicker
cheaper
used as temporary
what are the disadvantages of RRB
metals shine through
porcelain can chip
can debond
has occlusal interference
what are the indications for a RRB
young teeth
good enamel
large surface bonding area
minimal occlusal load
single tooth replacement
simplify denture design
what is a direct RBB
uses own tooth/acrylic tooth as pontic in emergency situations like trauma or after extraction
what is the prep for a RBB
minimal
180 degree wrap around
rest seats
proximal grooves
prep in enamel only
what is used to cement RBB
dual cure composite luting cement - panavia
what is a fixed-fixed bridge and what are the advantages
retainer at each end
robust, max strength and retention, long spans
what are the disadvantages of fixed-fixed bridge
difficult prep
path of insertion
minimal taper
what is a cantilever bridge and what is the advantage
pontic support at one end only
conservative design
what are the disadvantages of cantilever bridges
short span only
rigid
what is a fixed-moveable bridge and what are the advantages
rigid connector distally and moveable connector mesially
no common path of insertion, conserve tooth tissue, allows minor tooth movement
what are the disadvantages of fixed-moveable bridges
span limited, complicated, clean beneath moveable joint
what is hybrid bidge
one retainer is conventionally prepped and the other is resin-bonded
what is a spring cantilever bridge
metal arm from pontic to abutment (usually posterior abutment)
what are the requirements of abutments for bridges
withstand forces
free of inflammation
crown to root length needs to be 2:3 or minimum 1:1
what is evaluated for abutments for bridges
roots
angulation
perio
bonding surface area
risk of pulp damage
endodontic quality
tooth structure remaining
what are the different types of pontics used for bridges
wash through
dome shaped
modified ridge lap
ridge lap
what materials are used for bridges
all metal - gold
metal ceramic
zirconia
what do you cement conventional bridges with
all metal = aquacem/relyx
metal ceramic = aquacem/relyx
zirconia = nexus
what do you cement adhesive bridges with
panavia
why should distal cantilevers be avoided on bridges
occlusal forces on the pontic produce leverage forces on abutment meaning it will lift
what are the signs of bruxism
significant wear
repeated restoration failure
root fracture
progressive
lack of posterior support
why might someone be without posterior support
denture intolerance
denture refusal
supervised neglect
what does lack of posterior support mean for the remaining dentition
increased severity of wear
increased rate of wear
occlusal collapse
functional and aesthetic problems
what are the advantages of overdentures
correct occlusion and aesthetics
support
tooth wear management
preserve ridge form
proprioception
denture retention
MRONJ
what are the disadvantages of overdentures
need good oral health
increased caries and perio
discomfort and infection
what is the purpose of transitional dentures
increase OVD and get patient used to this
what do you need when you are planning to rehabilitate wear
impressions and facebow
mounted casts
high quality interocclusal record
wax ups
stents
temporary transitional dentures
photos
what can you do to increase retention and resistance for wear patients
grooves
inlays
ferrule
crown lengthening
parallel prep
margins and occluding surface
what is a failing dentition
deteriorating teeth, restorations or oral health means loss of inadequate basic oral functions such as mastication
what model is used to break bad news
SPIKES
name the steps of the SPIKES model
set up interview
assess what patient knows
invite them to new information
give medical facts
respond to emotions
negotiate follow up steps with a summary
what is osseointegration
direct functional and structural connection between load bearing implant and bone
what is primary osseointegration
implant anchored due to frictional forces provided between osteotomy and implant
what is secondary osseointegration
living bone grows onto surface of implant
what are the supra and sub crestal tissues like with implants compared to tooth
supra - more collagen, less fibroblasts, parallel collagen fibres
sub - rigid connection
what are the types of implant
bone level
tissue level
tapered
parallel
what factors are important when deciding risk for implants
medical
smoker
aesthetic demand
lip line
biotype
shape of crown
bone level to contact point
local infection
neighbouring restorations
width of space
soft tissues
bone defect
what are the bone distance requirements for implant
1.5mm mesial-distal
1mm bone labially
2mm from apical part of implant to gingival margin
what are the planning aids for implants
study models
wax up
surgical template
clinical photos
CBCT
surgical guide
what are the 2 impression techniques for implants
open tray
closed tray
what are the common causes of compromised tissue sites
post XLA defects
trauma
hypodontia
perio
thin biotype
what are the determinants of aesthetic outcome for implants
bone volume
space dimensions
3D implant position
biotype
operator skill and experience
what is the disinfection temperature, hold time and contact rate of the WD
90-95 degrees
1 min hold
12 secs contact rate
what does the SHTMs give you
guidance on design, installation, operation of technology
decon stages and description of each
requirements of machine operation and tests needed
what is SHTM 01-01
decontamination of medical devices in a CDU
what part of the SHTM01-01 refers to steam sterilisation
C
what part of the SHTM01-01 refers to automated cleaning and disinfection
D
what part of the SHTM01-01 refers to test equipment and methods
B
what part of the SHTM01-01 refers to management
A
when would you reference the SHPN
when designing a facility and installing equipment
what is the NP143
national procurement
contract for decontamination equipment used in LDUs
what document do you look at when procuring decontamination equipment
medical device regulations
what should the instruments be marked with when you are procuring them and what does this mean
CE
materials used to make this are of the required grade/standard
what does the Labour Standards Assurance System do
ensure that equipment is made in an ethical way
what is included in the ACT for the WD
date, operator, cycle start time
cycle number, duration, wash temperature, disinfection temperature, hold time, was detergent added, was cycle complete
what is a parametric release
release of a batch of sterilised items based on data from the sterilisation process but all parameters within the process have to be met before the batch can be released for use
who ensures that validation of tests are complete in the LDU
CP(D)
what daily steriliser information should you take down
date, time, operator
cycle number, sterilisation temperature
daily tests performed, bowie dick, sterilisation machine complete
what should be included in the ACT for the steriliser
temp and pressure of each stage
during sterilisation stage record temperature each minute
steam penetration, air leakage, ADFT
what are the daily/weekly checks for the WD
spray arms rotate and jets not blocked
door seal for damage or contamination
load carrier condition
no instruments from previous load
strainer/filter clear
sufficient amount of chemical
protein detection test and soil test
disinfection temperature and times
full ACT
what are the daily/weekly steriliser checks
door seal for damage
condition of load carrier and chamber
fill and drain feed and used water reservoirs
air leakage
bowie dick
air detector function test
daily sterilisation temperature, pressure and time
full cycle ACT
what are the quarterly checks for the steriliser
weekly safety checks
calibration of test instruments
air leakage
ACT and verification of calibration
small load thermometric test
calibration checks
ADFT
bowie dick test
what are the top 5 causes of handpiece faults
incorrect compressor settings
damaged or oversized bur fitted
incorrect instrument usage
poor cleaning
incorrect lubrication
when is the handpiece lubricated in the decon cycle
after wash but before sterilisation
why do we need compressors
incorrect air pressure causes faulty operation
what are the treatment options for intrinsic discolouration in permanent anteriors
microabrasion
bleaching
resin infiltration
composite restoration
composite veneers
what records are needed before treating discoloured teeth
photos
shade
sensibility testing
diagram of defect
radiographs
what are the safety features of microabrasion
PPE
patient bib and gloves
dental dam
sodium bicarbonate guard
what is the process of HCl and pumice microabrasion
dental dam and guard
HCl pumice and rotating rubber cup for 5 seconds (x10)
wash after each 5 seconds
fluoride varnish
polish with lightest blue sandpaper disc
final polish with toothpaste
why are sandpaper discs used in microabrasion
they change the optical properties of enamel so areas of intrinsic discolouration become less perceptible
how much enamel is lost as a result of HCL pumice microabrasion
100microns
what are the advantages of microabrasion
easy
conservative
minimal maintenance
effective
permanent results
what are the disadvantages of microabrasion
removes enamel
requires protective apparatus
what is the patient warning after microbabrasion
avoid highly coloured food and drink due to the fact that teeth are dehydrated
what is the home vital bleaching via nightguard technique and what percentage carbamide peroxide is used
10%
brush teeth
gel to tray
set over teeth and press down
remove excess
wear overnight for 3-6 weeks
what does 10% carbamide peroxide equate to
3% H2O2 and 7% urea
what is the walking bleach non-vital bleaching process
remove GP to below gingival margin
bleaching agent on cotton wool
cover with dry cotton wool
seal with GIC
renew bleach no more than 2 weeks apart
what is the inside-out non-vital bleaching process
access cavity open
mouthguard and bleach applied
worn all the time
gel changed every 2 hours
restore with CaOH and GIC then either white GP and resin or cured composite
what are the complications of non-vital bleaching
external cervical resorption
spillage of bleaching agents
failure to bleach
brittleness of crown
how do you prevent ECR with bleaching
layering cement over GP or non-setting CaOH for 2 weeks before definitive
what are the short term soft tissue effects of bleaching
ulceration/irritation
plaque reduction
aids wound healing
what are the long term soft tissue effects of bleaching
delayed wound healing
periodontal harm
mutagenic potential
how would tooth mousse be used to supplement bleaching and microabrasion
bleaching = 2wks at home application
microabrasion = 4 wks at home application
what is resin infiltration
erosion of the surface layer, desiccating the lesion and applying resin infiltrant