Case Pres Flashcards

Question

Answer 1

stop smoking loose weight avoid triggering activity drugs

Answer 2

○ Link to toothwear - erosion § More posteriorly § As acid from the stomach renters the mouth § Dentine hypersensitivity § Tooth discolouration ○ Dry mouth - side effect of meds, due to changes in saliva production due to acid exposure ○ Oral ulcers ○ Hallitosis ○ Perio Cancer risk

Answer 3

inhibits secretion of gastric acid from proton pumps in the parietal cell of the stomach lining

Answer 4

constipation diarrhoea abdominal pain nausea vit b12 deficiency overtime

Answer 5

15-30mg a day in the morning

Answer 6

dry mouth vit b12 deficiency increased risk of fractures dry throat

Answer 7

polypharmacy drugs GORD age related acinar tissue loss

Answer 8

lubricating digestion buffering antibac wound healing taste perception

Answer 9

where size and shape blister or ulcer how long for recurrent - same site painful

Answer 10

margins base surrounding systemic

Answer 11

6 low risk

Answer 12

score each sextant 1 - no erosive wear 2 - initial loss of surface texture 3 - distinct defect - hard tisse loss <50% 4 - >50% 0-2 no risk 3-8 low 9-13 med 14+ high

Answer 13

0 - no loss of surface enamel characteristics 1 - loss 2 - B L O loss, dentine exposure <1/3 3 - B L O >1/3 4 - complete enamel loss, pulp exposure

Answer 14

cause symptoms not improve fracture file

Answer 15

handfiles + solvent + reciproc refer to endo specialist - microsurgery / guided endo access

Answer 16

not to apex 16 - M root curved distally 47 - m root GP close to perforating

Answer 17

deposition of calcified tissue into the canals due to chronic irritation to the pulp or chronic pulpitis deposition of secondary dentine which becomes calcified dystrophic calcification - deposition of calcium salts in tissues undergoing necrosis / degeneration age related

Answer 18

so the half and half image is not diagnostically acceptable but together they are as i am able to place a crown on the tooth based off the information and it is not worth exposing pt to further radiation for this clinical question IRMER ALARP

Answer 19

fixodent diet advice - acids ETB 1450ppmf TP dry mouth denture hygiene wait 30min before brushing resize brushes

Answer 20

staff training on proper storage and handling of receptors quality assurance - checking receptors every 3m for image quality, uniformity and the receptor

Answer 21

been there a long time without symptoms preserve bone height max sinus

Answer 22

check if any debris comes out with it post op PA if radiolucency still present arrange further investigation or refer for secondary opinion

Answer 23

- Cuspal coverage for the RCT teeth - prevent catastrophic fracture, maintain coronal seal, prevent microbial ingress - Able to incorporate denture design for the uppers - Substantial tissue lost - Replace failing direct restoration 47,48 - Replace weakened tooth structure - Improve / restore aesthetics - Restore function - Lack of caries / periodontal disease - Good bone support Favourable occlusion

Answer 24

1.3mm NW / 1.8MM W 1.3mm shoulder buccal 0.5mm chamfer palatal

Answer 25

0.5mm NW, chamfer 1.5mm W

Answer 26

GI - aquacem resin based luting cement with metal bonding agent MDP - PANAVIA

Answer 27

moisture control as saliva pools in this area less preparation than all ceramic aesthetics better than metal

Answer 28

as placing rest seats in porcelain is more likely to cause shear fracture than in metal optimal junction w CoCr clasp least preparation not in aesthetic zone however can offer buccal porcelain strong less abrasive than porcelain

Answer 29

composite - best as bonds to tooth but requires moisture control amalgam - requires retention, poor aesthetics and core cannot be prepared same visit GI - expands with water

Answer 30

upper palatal lower distal

Answer 31

do nothing XLA - fucntional tooth, good perio condition, minimal caries, asymp his tooth is RCT so direct is not the best option as we want cuspal coverage to prevent fracture and maintain coronal seal direct - AMA, comp indirect - onlay, crown / metal, MCC, all ceramic due to hard moisture control for cementation, not being in a highly aesthetically demanding zone and having enough clearance for the preparation of an MCC we chose MCC reRCT or accept

Answer 32

become symptomatic

Answer 33

do nothing XLA direct - AMA, comp indirect - onlay, crown / metal, MCC, all ceramic direct is an option for this tooth as it is not RCT however the direct restoration was failing and there was substantial tissue loss rendering an indirect the best choice another option for this tooth was XLA as it is functionless however it is asymp, healthy, restorable, avoids XLA complication such as proximity to IAN/infection and is of psychological benefit due to hard moisture control for cementation, not being in a highly aesthetically demanding zone and having enough clearance for the preparation of an MCC we chose MCC

Answer 34

do nothing - asymp, no disease and functioning restoration XLA and complete denture replace with indirect and incorporate denture design as heavily restored and new denture required and also it is RCT so this gives cuspal coverage reRCT or accept

Answer 35

prevents fracture coronal seal to prevent microbial ingress

Answer 36

do nothing - asymp, no disease and functioning restoration XLA and complete denture replace with indirect and incorporate denture design as heavily restored

Answer 37

amount / quality of remaining tooth structure - ferrule, where would margins be placed dam bone levels

Answer 38

0.25mm buccal undercut suitable for CoCr clasp rest seat no palatal undercut to allow POI guide planes increase the SA in contact w denture saddle and increase retention must place rest seats into metal as placing in ceramic will lead to shear fractures

Answer 39

- Thinner so less bulky in mouth - Thermal conductivity - Stronger and she have opposing natural lower teeth which could cause flex in acrylic and risk breaking her denture and this pt has a history of breaking her upper denture in the past - Craddock 3 not 2 which acrylic would be meaning uses the teeth and ST for better retention and stability - Retention as can use CoCr clasps - Easier to keep clean as CoCr isn't porous like acrylic - Can still add to this should she lose her teeth as it extends onto the palatal of the molars - less periodontally destructive is heavier/expensive tho and acrylic would be the more conventional option

Answer 40

hypothyroidism is a natural cause of depression

Answer 41

biocompatible ductile corrosion resistance aesthetics

Answer 42

porcelain adhesion to metal by ceramic melting and wetting surface metal in a vaccum requires high melting metal with thermal properties matching porcelain

Answer 43

insufficient occlusal space high fucntional load aesthetics

Answer 44

sinus problem could present as an ill defined toothache in maxilla antihistamines have a synergistic effect with sedation antihistamines reduce salivary flow dry mouth due to nasal congestion causing mouth breathing allergy to dental products

Answer 45

surveyed study casts first and denture design crown preparation master imp of denture bearing area and crown prep at same time temp try in crown and denture temp only cement crown when denture ready to be fitted - must seat denture immediately after cementation

Answer 46

bounded saddle longer than 3 teeth free end saddle palate

Answer 47

resistance of a denture to lifting away from the tissues

Answer 48

resistance of a denture to occlusally directed load

Answer 49

loss of tooth structure by acids and not involving bacterial fermentation

Answer 50

wear of tooth against tooth

Answer 51

glassy appearance translucency dentine sensitivity unstained when active and stained unactive bilateral concave lesions without chalky appearance of bacterial and acid decalcification preferential wear of dentine leads to cupping restorations unaffected

Answer 52

chemical dissolution of tooth structure extrinsic - frequent consumption of acid instrinsic - regurgitation of gastric acid

Answer 53

shortened crown height flat incisal edge wear facets on teeth in guidance - canines and premolars limited to contacting surfaces of teeth restorations wear too

Answer 54

study casts to compare advice - don't swill drinks, straw to back of mouth, avoid acid last thing at night, dont brush immediately after acid instead rinse with water fluoride DBA Splint control gastric acid treat dry mouth

Answer 55

pt expectations rate of wear - will it compromise the longevity of the tooth sensitvity active treatment when wear leading to further complications, aesthetics beyond pt acceptability, leaving it might cause more complex treatments to be required

Answer 56

could have used a facebow or wax blocks however we were conforming to the occlusion lab were given study casts

Answer 57

I sensibility tested these teeth as this is my case presentation exam however upon reflection I might not have needed to do this due to there being no apical areas and her age as it likely would not have impacted my treatment plan

Answer 58

non smoker / drinker low caries rate no periodontal disease

Answer 59

thinner stronger better junction with CoCr claps

Answer 60

aesthetics flow and adaptability to cavity walls ensuring complete coverage and sealing of structure minimally invasive as doesn't require retentive preparation deep curing depth biocompatibility

Answer 61

pt doesn't want one copes fine wihtout lower dentures are less well tolerated adequate lower teeth left

Answer 62

to match the POI of anterior undercut

Answer 63

mill cuts out for a solid block of material based on specifications from a digital impression of prepared tooth scanned image of cast articulated select crown margin adjust crown margin select crown type and place on model adjust size and shape of crown save file send to milling machine and crown in 30-40mins

Answer 64

utilises canal orafices and pulp chamber to retain restoration

Answer 65

undermined by secondary caries cyclic loading - constant pressure from chewing overloading - bruxism inadequate condensation creep - gradual deformation under constant stress

Answer 66

local measures - frequent sips of water, suck on ice/sugar free pastilles, sugar free chewing gum topical fluroide artificial gel, spray or pastilles

Answer 67

the buffering and antibac role of saliva is lost therefore more prone to caries / periodontal disease the lubricating role of saliva is lost therefore denture retention would be reduced - which could help to explain her loose denture proteins and enzymes in saliva help with digestion also so that could be impaired reduced wound healing / taste

Answer 68

erosion is the chemical dissolution of tooth structure due to acid not involving bacteria whereas caries is when bacteria in dental plaque produce acids that lower the pH leading to demineralisation in localised areas

Answer 69

she had abutment teeth removed during covid, they were added back onto the denture by her GDP previously but she says it has been loose since the ridge will also have resorbed and changed

Answer 70

as worst BPE was 2 and she had <10% BOP

Answer 71

accumulation and mineralisation of plaque (due to minerals calcium and phosphate in saliva)