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class IV restoration Flashcards

1
Q

what is a class IV lesion?
- what can they be casued by

A

a proximal lesion of anterior teeth that involves one or more incisal angles

  • trauma, carries, occlusal interferences and grinding
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2
Q

what MUST you do before starting the restoration

A

Evaluate occlusion

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3
Q

what shade of composite do you use?
- when should you choose the shade?

A
  • Multiple shades and opacities may be required to properly restore
    and match existing tooth structure (gingival vs. incisal shading)
    \
  • prior to beginning in proper light
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4
Q

Classification of fractures:

Historically done according to the _______ __ ____ _______?

A

extent of the fracture ( Ellis classifications)

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5
Q

Class I
- what tooth material is affected
- how is pulp affected
- why may the retention for the restoration be challenging?

A
  • Class I : in enamel only
  • Best pulpal prognosis
  • due to occlusion, etc
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6
Q

Class II
- what tooth material is affected
- how is pulp affected
- how can be restored

A
  • extends through enamel and dentin
  • Risk of pulpal
    involvement long term
    increases (due to
    original trauma)
  • Can be restored with
    direct composite,
    veneers or crowns
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7
Q

Class III
- what tooth material is affected
- how is pulp affected
- how is it restored

A
  • extends through enamel
    and dentin and exposes pulpal
    tissue clinically
  • Minimally requires pulpal protection prior to restoration
  • Need for root canal therapy
    dramatically increases
  • Restoration may be with direct
    composite, but long term may
    require a crown (especially if root
    canal therapy is indicate
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8
Q

What are other non class IV lesions

A

A. Non vital tooth without loss of
tooth structure

b. Total tooth loss (Avulsion)

c. Displacement of tooth without
fracture of crown or root

d. Fracture of entire crown

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9
Q

what should you consider prior to treatment with TRAUMA?

A
  • Must evaluate for other injuries if tooth fracture is due
    to trauma (lacerations, head injury, jaw fractures, etc)
  • Must evaluate tooth for vitality and if vital, must
    periodically re-test vitality as tooth can become nonvital in the future.
  • Radiographic exam a must! Evaluate for widened
    PDL, caries, root fractures
  • Discuss treatment options with patient (include risks
    and benefits, longevity, esthetics, finances, need for
    future root canal therapy)
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10
Q

what do you need to consider prior to the treatment ( pt2)(5)

A
  • Must consider nature of injury (caries, trauma,
    grinding)
  • Consider need for root canal therapy now or in the
    future
  • Must consider preparation design (need for retention,
    pulpal protection, esthetic design-bevel)
  • Consider best restorative material (direct composite,
    veneer, crown)
  • Must evaluate patient occlusion
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11
Q

what complications should you consider

A
  • Retention when too much of
    clinical crown is missing
  • fracture
    is not large enough

-if occlusal
interferences complicate

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12
Q

what are some bite complications you should consider

A
  • Class I, II, III or open bite
  • Lateral or protrusive
    interferences
  • Severely worn dentition
    (Bruxism)
  • Collapsed bite
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13
Q

what is bruxism

A

severely worn dentition

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14
Q

what are some considerations for young pts
- what may you consider

A
  • “Young” tooth will
    have a large pulp
    chamber and high pulp horns
  • The tooth’s apex may not be closed and will require treatment prior
    to root canal therapy
  • Might consider pulpal
    protection even in a
    moderate fracture
    (Calcium Hydroxide asa liner; Glass Ionomer
    as a base)
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15
Q

what are some considerations regarding the pulp?
- what can you see in a radiograph
- what may pulp trauma require

A

Recognize signs of
pulpal injury from
trauma
1. Receded pulp
2. Widened
PDL/Periapical
Periodontitis
May require root canal therapy. Tooth may clinically present with a
darkened color

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16
Q

According to what is the preparation shaped

A
  • shaped according to the extent of the fracture in a natural tooth
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17
Q

where is the retention placed?
- where do you bevel?

A
  • Note that retention is placed
    internally in the dentin area,
    and the entire external cavosurface margin has a
    continuous bevel (facial, lingual, incisal and margins).
    NOT GINGIVAL:
18
Q

with what bur should you remove the dentin and at what length

A
  • 35 carbide bur
  • 1mm
19
Q

what are the steps for a class IV prep

A

1) Follows outline form of the
fracture
2) ½ mm into dentin (35 carbide bur)
3) Smooth internal surfaces (hatchet and hoe)
4) Retention at the axio-gingival
line angle and at the axioincisal point angle (1/2 roundbur)
5) 1 mm bevel around the facial,
lingual and incisal margins (tapered diamond bur)
(NOT GINGIVAL

20
Q

what should you do before bonding? what are the steps

A
  • etch
  • acid etch the enamel for 30 seconds
  • wash the preparation with water for 30 seconds
  • dry the enamel of the preparation with air (do not desiccate
    the dentin)
21
Q

what are the steps for applying the bonding agent

A
  • Pop the bonding agent and
    pick up a small amount of the
    bonding agent with the end of
    the applicator
  • Apply the bonding agent to
    the tooth by “rubbing” the
    applicator onto tooth surface
    for 20 seconds
  • Air thin any excess bonding
    agent with the air syringe
  • Cure the bonding agent for 20
    seconds
22
Q

where should you place a mylar strip and wedge

A
  • Place a Mylar® strip interproximally,
    and place a wedge tightly from the
    lingual embrasure to hold the strip
    against the tooth
  • make sure the wedge is in tight enough so that the strip cant move
23
Q

how do you choose a wedge size and what is the goal of placing a wedge

A

Wedge sizes vary (must chose
according to size of embrasure with
the goal to seal the gingival margin
and prevent an overhang of
composite)

24
Q

what is the matrix material

A

A polyvinyl siloxane putty material is used to produce the lingual
matrix

25
Q

what should the lingual matrix be constructed from

A

 A waxed-up model of the desired final contour of the restoration
 A properly contoured existing restoration that needs to be replaced

26
Q

which surfaces of the teeth should the matrix cover

A
  • The polyvinyl siloxane putty material should cover the lingual surface
    of the tooth to be restored and preferably at least one teeth on each
    adjacent side
  • The lingual matrix should extend to the gingival portion of the tooth
    to be restored and cover the incisal edge, ending just at the facioincisal line angle. Excess should be trimmed with a sharp scalpel
    blade
27
Q

what should the lingual matrix preproduce?
- what does it NOT provide
- what doesnt it seal?

A
  • The lingual matrix should reproduce the correct contour of the lingual
    surface, embrasures, and marginal ridges and helps to confine the
    material to the restored area; it does not provide proximal contact or
    proximal contour. It also does not seal the gingival margin
28
Q

how do you match a composite shade to ivorine teeth

A

its impossible

29
Q

how should you place the composite into a restoration
- what should you hold against the tooth while doing this

A
  • Place a small amount of material
    into the preparation, and
    condense it into the retentive
    areas of the preparation using a
    composite placement
    instrument. All the time you
    should be holding the matrix
    against the facial surface of the
    tooth
  • light cure for 20 seconds
30
Q

after the first layer of composite how do you continue to fill the restoration

A
  • add material in layers no grater than 2 mm thick
  • fold matrix over the facial and lingual surfaces to produce proppper contour / prevent concavity
  • light cure through matrix from facial and lingual
  • light cure each layer for 20s
  • continue to build proper contours
  • slightly overbuild to allow for removal during finishing and polishing
31
Q

what will overbuilding then removing during finishing and polishing eliminate?

A

the oxygen inhibition layer

32
Q

what is the oxygen inhibition layer

A
  • When composite is light
    cured, oxygen in the air causes an
    interference in the polymerization
    resulting in the formation of
    an oxygen inhibition layer on the
    surface of the composite.
    The oxygen-inhibited layer is the
    sticky, resin-rich layer that is left on
    the surface
  • Oxygen Inhibition Layer is removed
    during finishing and polishing (a
    reason for slightly overbuilding)
33
Q

how should you hold the matrix ( mylar strip) against the tooth during the final addition of composite
- what does this do

A
  • Hold the matrix strip against both the facial and lingual
    surfaces while curing the final addition of composite
  • restore original 3-D interproximal
    anatomy and prevent excess composite from lodging
    inter-proximally. (This excess is difficult to remove)
34
Q

what are the steps after building up and curing the composite

A
  • remove mylar strip, leave wedge in place
  • add anatomical contours to the tooth to create a mirror image with the contralateral tooth
  • use tapered diamond bur for contouring facial and lingual surfaces
  • use football shaped diamond bur for contouring the lingual concavity
35
Q

what should you check after the final restoration

A

Final restoration must
be checked for
interferences in
maximum
intercuspation,
protrusive and lateral
excursions

36
Q

what are the steps for finishing the restoration ( facial and lingual)

A
  • Starting with the dark blue» medium blue» light blue
    (coarse) Soflex® disc, finish
    the facial surface and incisal
    edge
  • wipe restoration with a 2x2 gauze between disc changes to remove debri and coarser abrasive
  • Use the flame shape/point rubber abrasive
    (bullet shaped) to finish the lingual concavity
  • Enhance® bur* (not the white stone) on a slowspeed hand-piece to pre-polish the lingual fossa
    and marginal ridge area.
37
Q

what are the steps for finishing the inter proximal surface

A
  • Use the abrasive strip to finish
    the interproximal surface using
    the coarse side first, followed by
    the fine abrasive side.
  • Be careful to use non-abrasive
    section of strip when inserting
    so as to not destroy your
    existing contact
  • Avoid using the abrasive strip in
    the contact area, as you may
    weaken the interproximal contact
38
Q

what is the protocol for polishing the restoration

A
  • Polish the restoration
    using Luminescence®
    polishing paste
  • Assemble the felt
    polishing tip onto the
    screw-end mandrel as
    shown
  • Place a generous
    amount of polishing
    paste on the felt tip and
    polish the entire
    restoration for one to
    two minutes
  • Wipe the polishing paste
    off the restoration
39
Q

what is the criteria for the finished restoration

A

1) Surface is smooth and shiny (check with
explorer)
2) No pits or scratches in the surface
3) Natural anatomic contours which are a
mirror image of the contralateral tooth
(other central incisor) Check contour of
marginal ridge and lingual fossa
4) No excess composite (flash) at margins
5) Natural shape of INCISAL EMBRASURES
and GINGIVAL EMBRASURES are
reproduced
6) No ditching at the margins
7) Strong interproximal contact present
(confirm with floss)

40
Q
A

operative (2 decks)

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