CLINICAL SYNOPSES Flashcards
When doing your intra-oral exam, what do you need to be able to note in relation to occlusion?
- Angles classification & incisal classification
- History of orthodontic therapy or occlusal disorder
- Presence, location of crowding and malocclusion
- Loss of posterior occlusal contacts
- Signs of toothwear
- Occlusal guidance
- Presence of fremitus
- OVD/RVD
When charting what is the order you follow?
- Teeth present/absent
- Restorations = type, location, integrity, nature, material
- Caries = primary or secondary, active or arrested
- Endodontics = need radiograph
- Aesthetics = toothwear, crown/veneer margins, gingival health & contour, exposed root surfaces, lip line, smile width
Give any further investigations that may be carried about after your initial exam & chart?
- Biopsy
- Diet analysis
- Photography
- Radiographs
- Strategic probing
- Sensitivity tests
- Occlusal examination
- Study casts
What is level 1 of a treatment plan?
Immediate
- relief of pain/symptoms
- address patients presenting problems
What is level 2 of a treatment plan?
Stabilisation
- Home care management = OHI, diet advice etc
- Periodontal/gingival management = PMPR, removal of overhangs/poor restorations, relief/treatment of periodontal/gingival problems associated with removable or fixed prosthesis
- Caries management
- Endo management
- Prosthetic/restorative management
What are visual signs of occlusal caries?
- opacity after drying the tooth for 5 seconds
- opacity without air drying
- opacity +/- localised surface breakdown
- grey/brown appearance underlying
- cavitation
What radiograph is preferred for detection of occlusal and interproximal caries?
Bitewings
What are the procedural steps of placement of an indirect pulp cap:
- caries removed carefully in a progressive manner
- cavity cleaned with 0.2% chlorhexidine
- stained (not soft) dentine over the pulp should be left in situ
- cover with a setting calcium hydroxide cement lining (Dycal or Life)
- stronger lining material over this eg RMGIC Vitrebond
- provisional restoration placement
What is the most appropriate method of isolation when doing a direct pulp cap?
Dental dam
Why is RMGIC Vitrebond the preferred lining material?
- Bactericidal
- Adheres to dentine
- Very low solubility
- Radiopaque
- Good compressive strength
What can be used to record dynamic occlusion?
Miller forceps and thin articulating paper
In order to mount study casts on a semi-adjustable articulator, what two records are required?
- facebow transfer
- interocclusal record
What can cause problems/inaccuracy when recording interocclusal records?
- free end saddles
- multiple bounded saddles
- heels of the casts have not been trimmer properly
When is the conformative occlusal restorative approach not advisable?
- when it is not possiblen
- when an increase in OVD is indicated
- when teeth are significantly malposed
- the patient requires a significant change in appearance
- history of persistant fracture of restorations
When should shade selection for an aesthetic direct/indirect restoration be undertaken?
Prior to tooth preparation
- tooth changes colour as they lose moisture
What are the clinical steps of caries removal?
- remove superficial carious enamel & restorative material to the depth of the amelodentinal junction
- extend the superficial preparation to identify the spread of the lesion at the amelo-dentinal junction
- remove dentinal caries peripherally first, then extending deeper by progressive circumferential removal
- reassess the cavity and check proximity to pulp
What should be used to etch teeth?
37% phosphoric acid
What is composite best placed with?
Zirconium Nitride-coated materials
What may suggest that there is interstitial enamel fracture due to polymerisation contraction stresses?
White opaque lines at the cavosurface margins
What is used for ‘fine’ finishing of composite restorations?
Reducing grit size fine abrasive disks (Sof-Lex 3M)
What clamps are used for molars?
A or AW
What clamp is used for incisors, canines and premolars?
E or EW
What can be used to achieve a better seal with dental dam?
Or a seal or OpalDam
What instrument is used to irrigate during endodontic treatment?
Luer lock syringe with gauge 27 endo needle attached to 3mL syringe
What instrument is used to identify root canal orifices during endodontic treatment?
DG16 endodontic probe
What endodontic file should be used for raduographic working length determination?
size 15 K-file
How is a coronal flare created in the Modified Balanced Force Technique?
Using Gates Glidden burs
What is an example of a non-setting calcium hydroxide?
Ultracal
What is an example of a setting calcium hydroxide?
Dycal
What are the advantages of presence of a labial flange on an immediate denture?
- greater stability and increased retention forces
- improved strength of denture
- tooth arrangement can be altered
- improved appearance with labial flange if space allows a flange
- procedure to reline is easier
What are the functions of a provisional restoration?
- protection of vital and freshly prepared dentine
- prevention of sensitivity
- maintenance of occlusal contacts (prevention of over-eruption)
- maintenance of proximal contacts (prevention of drift/tilting)
- restoration of function and aesthetics
- promotion and maintenance of gingival health
When is a fibre post the preferred option of post?
When a sufficient ferrule is present (1-2mm of remaining sound dentine)
What post should be used when no ferrule can be achieved?
A cast/prefabricated metal post and core should be used
What are the typical lab instructions for production of lower special trays for complete dentures?
Please pour up primary impression in 50:50 plaster:stone and construct a close fitting (1mm spaced), non-perforated light-cured acrylic resin tray with extra-oral handles.
What are the lab instructions for production of lower special trays when bony undercuts are present for production of complete dentures?
Please pour up primary impression in 50:50 stone:plaster and construct a 2mm spaced, non-perforated light-cured acrylic resin tray
What are the typical lab HANDLE instructions for production of lower special trays where there is a very atrophic ridge?
Stub handles in the incisal and premolar regions
What are the typical lab instructions for production of upper special trays for complete dentures?
Please pour up the primary impression in 50:50 plaster:stone and construct a light-cured acrylic resin spaced tray (2mm spaced). Stub handle in midline region.
You have just completed master impressions, what are the next instructions you send to the lab in the fabrication of complete dentures?
Please pour up secondary impressions in 100% stone and construct upper and lower wax occlusal rims on light cured bases
Why are light-cured acrylic bases preferred when requesting wax occlusal rims?
- optimum retention and stability (valuable when little ridge remains)
What instruments can be used to assess the resting vertical dimension?
- Willis gauge
- Callipers technique
Where should the incisal edge typically lie in relation to the incisive papilla?
7-10mm anterior to the posterior portion of incisive papilla
Where should the incisal line lie on a record block?
Approximately 0-2mm below the relaxed upper lip
What should the incisal plane be parallel to?
Interpupillary line
How are the posterior occlusal planes on a wax occlusal rim corrected to the correct orientation?
Using a Fox’s occlusal plane guide & should be parallel to the ala-tragus line
You have just done a jaw registration, what are the instructions you give to the lab technician?
Please mount casts on an average value articulator and set up the upper teeth to the wax rim. Please set lower teeth to uppers. Include special features eg diastema or imbrications. Give tooth shade and mould.
What should be checked when doing a try-in of complete dentures?
- stability and retention
- border extension and shape of polished surfaces
- positioning of teeth in relation to the potential space between lips, cheeks and tongue
- appearance
- freeway space
- occlusion
- speech
You have just completed a try-in of complete dentures and are happy, what instructions do you provide to the technician?
Please wax up for finish and process in heat cured acrylic resin
Why should hot water not be used with denture cleaning chemicals?
It can discolour the acrylic resin
What are the different stages of treatment planning?
- Immediate
- Initial (disease control)
- Re-evaluation
- Reconstructive
- Maintenance
What is involved in the immediate stage of treatment planning?
- relief of acute symptoms
- consider endodontics and extractions
- consider immediate denture/bridge
What is involved in the initial (disease control) phase of treatment planning?
- extraction of hopeless teeth
- OHI and dietary advice
- HPT/PMPR
- management of carious lesions and defective restorations with direct restorations or provisionals
- endodontics
- denture design, wax-up for fixed pros
What is involved in the re-evaluation stage of treatment planning?
Re-assessment of periodontal status, confirm denture/bridge design
What is involved in the reconstructive stage of treatment planning?
- perio surgery
- fixed and removable prosthodontics
What is involved in the maintenance stage of treatment planning?
Supportive periodontal care and review of restorations
Why might you choose to restore a tooth with a crown?
- to protect weakened tooth structure
- to improve or restore aesthetics
- for use as a retainer for fixed bridgework
- when indicated by the design of a RPD
- to restore tooth function
Why might you choose NOT to restore a tooth with a crown?
- active caries and periodontal disease
- more conservative options available
- lack of tooth tissue for preparation
- unable to provide post & core
- unfavourable occlusion
What different finish line configurations exist prior to crown placement?
- knife edge
- bevel
- chamfer
- shoulder
- bevelled shoulder
What are the tooth preparation requirements for a porcelain onlay?
- Non-working cusp = 1.5mm reduction
- Working cusp = 2mm reduction
- Margins = 1mm shoulder or chamfer
What are the tooth preparation requirements for a gold onlay?
Non-working cusp = 0.5mm reduction
Working cusp = 1mm reduction
Margins = 0.5mm chamfer
What are the tooth preparation requirements for a veneer?
Cervical third = 0.3mm labial reduction slight chamfer margin
Mid third = 0.5mm labial reduction
Incisal reduction = 1-1.5mm
