Clinical Flashcards
What are the 4 types of non-carious tooth substance loss?
Attrition - tooth to tooth
Abrasion - foreign object
Erosion - chemical
Abfraction - function
When should we restore a cavity?
Alleviare pain Remove disease Restore tooth integrity, function and aesthetics Aid plaque control High caries risk
When should we avoid restoring a cavity
Patient can access the cavitated lesion with cleaning aids
Prior to cavitation
Small, cleanable cavities with no active caries
Can it be remineralised
Describe a Black’s CI cavity?
Occlusal surface of molars and premolars, buccal pits of molars and palatal pits of anterior teeth
Describe a Black’s CII cavity?
Interproximal surfaces of molars and premolars
Describe a Black’s CIII cavity?
Interproximal surfaces of incisors and canines
Describe a Black’s CIV cavity?
Incisal edges of incisors and canines
Describe a Black’s CV cavity?
Cervical margins
Describe a Black’s CVI cavity?
Cusp tips of molars, premolars and cuspids
What are the 4 anatomical sites of a carious lesion?
Pit or fissure
Smooth surface
Enamel
Root
What are the 3 classifications of caries?
Primary
Secondary
Residual
What are the 3 types of activity of caries?
Active
Rampant
Arrested
Indications for a CI cavity?
Fissure sealant
PRR
Conventional therapy
Indications for a CII cavity?
If confined to enamel - encourage lesion to arrest via Fl
If dentine visible - amalgam or composite possible
Indications for a CIII cavity?
Restore with composite
Indications for a CIV cavity
Composite
Indications for a CV cavity?
Composite
How to prepare a CII cavity?
Caries accessed through MR, due to loss of contact area, with a matrix band
Avoid damage to adjacent tooth
If using amalgam create undercuts
If using composite rubber dam is essential
How to prepare a CIII cavity?
Access caries palatally
How to prepare shallow and deep root caries?
Shallow: - recontoured and Fl applied, if they’re cleansable then restoration may not be necessary
Deep:
- remove caries and restore with GIC or composite
How to prepare a patient for a rubber dam?
General outline to patient
Teeth cleaned and contacts checked with floss
Rough contacts smoothed
If occlusal restoration work planed, occlusion should be marked prior
Lips lubricated
LA given for clamp
How many holes to punch for an anterior tooth?
First premolar to first premolar
How many holes to punch for a posterior tooth?
Tooth needed for restoration as well as one further distal tooth
How to apply the rubber dam clamp?
Clamp bow towards distal aspect
Apply from lingual to buccal
Ensure 4 point contact
How to prepare the enamel of a cavity?
Gain visual access of the carious lesion
Remove demineralised, weakened carious enamel
Create a peripheral enamel margin to be able to form a seal
High speed
How to correct enamel margins?
Unsupported enamel is weak and prone to fracture
Thin section of material is weak and prone to fracture
Bevel to increase surface area for bonding (not amalgam)
How to correctly remove dentine from a cavity?
Lateral extent from the EDJ periphery to the caries overlying the pulp
Slow speed
Circular brush-strokes
What is the definition of a line angle?
Where 2 surfaces meet
What is the definition of the cavosurface angle?
Where the cavity wall meets tooth surface (between 90-110)
What is the cavo-surface angle for amalgam and composite?
Amalgam:
- 90
Composite:
- >90, with bevel
What is the definition of a point angle?
Where 3 or more surfaces meet
What is the purpose of rounded angles?
Reduces stress in restored unit
Reduces loss of tooth tissue
What occlusal anatomy should you try and preserve?
Oblique ridge in max molars
Marginal ridge in anterior/premolar teeth
Explain the clinical protocol for a fissure sealant?
Isolate - rubber dam Clean tooth Etch for 20-30s Wash for 10-20s and then dry for same amount of time Apply FS Apply light for 20-30s Check sealant for seal and retention
Explain the clinical protocol for a PRR?
Etched for 20s Washed for 10s Primer for 10s Gently air dry to leave fine layer Apply 2-3 coats of adhesive Gently air dry and light cure for 10s Apply composite to cavity incrementally as required. Shape with burnisher or flat plastic between increments 20-30s light application Apply fissure sealant
How to recreate a proximal wall for a CII restoration?
Proximal box:
- buccolingual extension of 0.2-0.3mm clearance from the adjacent tooth buccally and lingually
- gingivally there should be a 0.5 mm from adjacent tooth
- axial wall should follow the external tooth contour
What is the size of the proximal box?
1.5mm
What is the depth of the proximal box?
1.5-2mm
Explain the clinical protocol for a CV cavity?
Rubber dam helps to retract gingiva and gives isolation
Remove caries
Etch, prime and bond
Restore with GIC or composite
Explain the cavity needs for an amalgam restoration?
Depth occlusally at least 2mm Cavity floor flat Walls should be parallel with slight convergence No unsupported enamel margins No sharp angles Undercuts
Explain the condensation rules of amalgam?
Condenser tooth must fit Place amalgam in small increments Condensing for up to 4 mins Overfilled with amalgam Condense with heavy pressure - hear a squeak - promoting adaptation to cavity walls and eliminates voids
Explain the carving rules of amalgam?
Remove gross excess
Use probe to relive a ring around the matrix band and contour the marginal ridge after carving
CArver should rest on enamel/cusps adjacent and be parallel to the margin of the prep
Do not let tip of carver leave the middle of resto
Centre should be smoothed with a burnisher
Follow the cusps with tool
What to include when reporting on a radiograph?
Date taken Type of radiograph Grade Teeth present Caries Restorations Plaque retentive factors Bone level Other
BPE Code 0?
Pocket <3.5mm
No plaque or calculus/overhangs, no BoP (black band entirely visible)
BPE Code 1?
Pocket <3.5mm
No plaque or calculus/overhangs
BoP
(black band entirely visible)
BPE Code 2?
Pocket <3.5mm
Supra or subgingival plaque/calculus/overhangs
(black band entirely visible)
BPE Code 3?
Probing depth between 3.5-5.5mm
Black band partially visible, indicating a pocket 4-5mm
BPE Code 4?
Probing depth >5.5mm
Black band disappear, indicating a pocket of 6mm or more
BPE Code *
Furcation involvement
Treatment for BPE Code 0?
None
Treatment for BPE Code 1?
OHI
Treatment for BPE Code 2?
OHI
Removal of plaque retentive factors, including all supra and subgingival calculus
Treatment for BPE Code 3?
OHI
Removal of plaque retentive factors, including all supra and subgingival calculus
6 point pocket chart recording pockets over 4mm (in that sextant)
Possible root surface debridement
Treatment for BPE Code 4?
OHI
RSD
6 point pocket chart in all sextants
Assess for more complex treatment (UNC15)
What to include for a periodontal assessment?
Type Distribution Stage Grade Status Risk factors
