class IV prep and restore

Question 1

class IV

Answer 1

1) all proximal and incisal edge on anterior teeth
2) 4 or more surfaces
3) can be extension of old class III
4) trauma

Question 2

prior to restoring this tooth

Answer 2

1) how much tooth is lost
2) pulp proximity, age?
3) vitality
- did they break any bones around it
4) fracture below or above gum
5) root fracture?
- radiograph
6) occlusion / incisal relationship
7) patient of record, pre-op record?

Question 3

palpate gently

Answer 3

1) is tooth or bone moving when you palpate?

Question 4

treatment options

Answer 4

1) reattachment
2) composite bonding
3) composite veneers
4) porcelain veneers
5) full coverage crown

Question 5

reattachment

Answer 5

1) reverify fit
2) bond into place with bonding agent
3) fracture line visible

Question 6

considerations for aesthetics

Answer 6

1) anatomy
2) shade/color
3) adhesive bonding
4) layering technique
5) finishing and polishing

Question 7

biomimetic dentistry

Answer 7

1) mimicking biochemical process with inspiration from nature
2) repairing teeth with restorations that imitate the living tissue
- less aggressive and restore function and biomechanics
- emphasis on prevention rather than reactive approach

Question 8

preparation goals

Answer 8

1) remove unsupported or vulnerable tooth
2) conservation of maximum tooth structure
3) bonding success-adhesive principles
4) no demarcation or lines

Question 9

prep design

Answer 9

1) no need for chamfers
2) create irregular scalloping
- staburst

Question 10

polychomatic teeth

Answer 10

1) multiple substrates
2) transparency and transopacity
3) shade selection is key
- BEFORE prep
- desiccation changes shade

Question 11

shade matchin

Answer 11

1) dentin shade
- from gingival third
2) enamel
- middle third
4) incisal
- translucencytra

Question 12

translucency

Answer 12

1) allows light to pass through
2) high translucency
- incisal edge

Question 13

opacity

Answer 13

1) blocks lightb

Question 14

benefits of incremental layering

Answer 14

1) shade and color
2) control volumetric shrinkage

Question 15

criteria

Answer 15

1) polish
2) reduce shrinkage
3) handlining
4) stain resistance
5) nano particles
6) resistance to wear
7) layering

Question 16

restoration technique

Answer 16

1) mylar
- good for small fractures
2) putty matrix
- better for bigger

Question 17

mylar

Answer 17

1) small fracture with minimal incisal edge
2) readily available
- no stone model required
3) flexibility leads to improper contour and contact establishment
- hard to obtain exact correct contour in palatal aspect

Question 18

putty

Answer 18

1) large fracture with incisal edge
2) exact palatal contour and from
- can restore multiple defects
3) mock build up of the defect has to be made
- second appointment
- UNLESS you have the stone model already

Question 19

putty steps

Answer 19

1) wax up on stone model
- or use composite to wax up
2) fabricate putty

Question 20

take putty matrix of typodont before prep

Answer 20

1) include the incisal area and extend onto the palate a little
2) must be cut right in the middle of the incisal area

Question 21

set up your patient fracture

Answer 21

1) large fracture
2) break the contact

Question 22

class IV prep steps

Answer 22

1) bevel the unsupported enamel 45 degrees on facial
- ONLY in enamel
3) lingual bevel in 45 degres
3) 2-4 starburst bevel
4) adapt teflon to adjacent teeth and palate
5) etch and bond
- dry and cure
6) apply a thin layer of wetting resin on putty to prevent sticking

Question 23

shade layering

Answer 23

1) lingual shell with enamel color
- may not adapt all the way to the incisal if there is incisal translucency
2) create dental lobes with dental shade
3) fill in between lobes with enamel color

Question 24

mylar steps

Answer 24

1) place a wedge
2) adapt mylar
- do not pull too hard
- hold at lingual very well with thumb
3) follow shade layering steps

Question 25

finish and polish

Answer 25

1) less is more
2) minimize overbulk when placing composite
3) use composite polishing burs and optidiscs
- following the coarse => very fine
- DO NOT CUT PEOPLES LIPS
4) 012 scalpel
- SO SCARY
- do not cut people or ditch cementum
- gentle scraping
5) follow the contour of the original tooth, shape those mamelons!

Question 26

what direction should the disc be moving

Answer 26

1) tooth => composite
- ditching
2) composite => tooth
- best!

Question 27

finishing strips

Answer 27

1) insert through bald spot
2) do not wipe out contact

Question 28

bristle brush

Answer 28

1) used at the end with the polishing paste

Question 29

composite repair

Answer 29

1) good isolation
- oxygen inhibited layer present
- just add composite and light cure
2) poor isolation
- roughen restoration and re-etch
- can use 1/4 bur for small pits

Question 30

white lines or halo

Answer 30

1) rotary instruments may make heat that cause enamel tags to tear
- as a result of tension of polymerization shrinkage
2) occurs when overaggressive use