capstone patient project Flashcards
anytime you tp a fixed unit
1) tp a buildup as well
today
1) create patient
- extract 7,13,14 fracture
2) add putty 7 concave, 13 convex
3) fracture #14
4) make upper and lower alginates, pour stone for diagnostic casts
5) after alginates, start 14 BU
Lab work
1) fabricate diagnostic casts and mount in MI
2) wax up 7, 13, 14
3) duplicate maxillary cast (soak cast for 5 mins)
4) fabricate putties for provisional bridge restorations
5) fabricate a maxillary custom tray or final impression 12-14
wax up 7 and 13
1) line angles ivory
2) fill gray
*use sticky wax at base of cast
provisional putties
1) make off of duplicate cast
Maxillary custom tray
1) make it from duplicate cast
should we always replace the amalgam?
1) durable
2) bacteriostatic
3) oxidation (corrosive) products between amalgam and tooth prevent leakage
4) class II composites bonding gingival margin is not reliable if margins are in dentin (root caries)
other considerations
1) drilling it out will cause temp spike in exposure
2) dental exposed to mercury vapor
3) it is not ethical to scare them
amalgam tattoos and staining
1) dentin under old amalgam may be stained due to seepage of corrosive products
2) stained areas may be removed or covered with opaque resin
- but will still be discolored
3) amalgam tattoos may be mistaken for melanoma
amalgam prep design
1) equally sized amalgam and composite preps are similar
2) rounded line angles
3) 90 degree angles of exit
4) 0.25 – 0.5 mm clearance
composite prep
1) rounded line angles
2) bevels
- occlusal if flat
- B, L, and gingival proximal (if there is enough)
3) no retention grooves necessary *unless it is a build up
4) occlusal prep can be minimally invasice
removing old amalgam
1) rubber dam
2) high speed
3) water spray
4) HVE
5) amalgam is easily removed
removing old composite
1) high speed handpiece
2) know diff from dentin
- dentin is smooth like wood
create a fracture
by removing DL cusp and extend to the gingival level
- do this outside mouth and just make pencil marks
remove amalgam from #14
1) use the transmetal bur
- 330 or 550
2) better to create chunks than paste
14 prep
1) you can put retentive features
- optional for buildups
- but recommended
2) examples
- truncated walls
- potholes or trough axial to DEJ (ONLY ON TYPODONT not on people)
review of buildup
1) before the tooth is prepped for a crown
2) lost tooth structure due to caries or fractured cusp
3) replace a large filling
4) for endodontically treated teeth
- if less than 50% coronal remaining, consider a post
5) INTERRIM ONLY!
-
margins and ferrule need to be on tooth structure
- check crown to root ratio as well
what if parts on margin is still in resin
1) drop the margin where there is JUST buildup
materials today
1) photocore
- translucent
2) anchor
photocore
1) for aesthetic areas
2) indicated for tooth margins about tissue level which can be easily seen
3)a light cure bonding system
- placed in increments for shrinkage
clearfil photo core
1) heavily filled micro hybrid particle size
2) cuts like dentin, radiopaque
3) allow tooth structure between photo core build up and your margin
- for ferrule
4) keep tooth out of occlusion or very light occlusion!!!
when do we consider subgingival
1) increase prep length for short clinical crowns
- better ferrule
2) caries or pre-existing restoration is subgingival
3) fracture is there
4) esthetic reasons for anterior teeth
5) allow lab to give more ideal contacts
things to consider with subgingival
1) biological width
2 )tissue management
3) be kind to soft tissue
4) verify clear margins, saliva and heme control, and tissue displacement
crown preps on NCCLs
1) if small and shallow, prep all the way to the base of it
2) what if its deeper and bigger?
- do not hit the pulp
- prep occlusal to the NCCL and restore with composite separately
- or place the resin and make it part of the axial wall (but make the margin on tooth)
