CON-B tutorial 8+ 9: management of deep caries using bio active provisional restorations

Question 1

What questions should you ask yourself before placing a definitive restoration such as direct composite resin?

Answer 1

1. How deep is the caries?
2. How am i going to maintain pulp vitality?
3. Is there a risk of pulpal exposure?
4. Is there a risk that the restoration could compromise pulp vitality.?
5. Would the patient’s tooth be better off if i place a “bioactive” provisional restoration such as glass ionomer cement or biodentine - a patented matieral.

Question 2

What should we never expose when managing a tooth?

Answer 2

The pulp, unless you are beginning endodontics.

Question 3

what is direct composite resin used for?

Answer 3

• Can be bonded very strongly to the tooth
• Seal any caries remaining
• Can be used to restore a lot of missing tooth structure.

Question 4

What other materials can be used, that may place less stress on a tooth?

Answer 4

Materials that remineralise dentine on the cavity floor that has been affected.

Question 5

If a patient who has caries is asymptomatic, what choices do you have when it comes to restorations?

Answer 5

1. Restore the tooth in one visit with a definitive restoration (long term).
2. Restore the tooth using a provisional restoration and then a definitive restoration later on.

Question 6

If you are limited for time, what restoration is recommended?

Answer 6

A provisional restoration (temporary, short term)

Question 7

If you are concerned for the health of the pulp, what type of restoration is recommended?

Answer 7

A provisional restoration ( temporary, short term)

Question 8

What is the difference between a provisional restoration and a definitive restoration?

Answer 8

Provisional : temporary restoration, provides protection until final restoration. Temporary materials include : acrylic or resin.

Definitive : Long-lasting, permanent restoration that replaces and repairs damaged/decayed tooth. Materials include: dental ceramics, composite resins, metal alloys.

Question 9

Where was the caries present in this tooth and what restoration was placed?

Answer 9

• Biodentine placed in mesial aspect of upper second molar

Glass ionomer cement has been placed in the distal aspect of the upper second premolar.

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Question 10

What can glass ionmer cement be used as?

Answer 10

Provisional material to manage caries or as a definitive restorative material in non-load bearing areas such as cervical cavities.

Cannot place it on the pulp as it is acidic.

Question 11

Describe the adhesion of glass ionomer cement :

Answer 11

1. Condition the dentine with poly acrylic acid (PAA)
   - Cleans pellicle from tooth
   -Pre wets tooth surface
   -removes smear layer
2. dynamic bonding with tooth
   - ionic exchange with tooth.

Question 12

Describe GIC maturation:

Answer 12

Using glass ionomer cement causes less stress which helps make sure the pulp does not become more inflamed.

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Question 13

What are the advantages of GIC?

Answer 13

-Very forgiving of moisture
-Transmits little stress to tooth when setting
-Seal well
-Wear resistance is improving.

Excellent for two-stage combination restorations.
- provisional restorations
-Cut back for e.g composite at a later visit (so GIC isn’t permanent !!!)

Question 14

What is biodentine powder mainly composed of?

Answer 14

Tricalcium silicate
Calcium Carbonate
Zirconium oxide

Question 15

What is the biodentine liquid composed of?

Answer 15

Water
Calcium chloride
Modified polycarboxylate

Question 16

What is biodentine?

Answer 16

-calcium silicate based material

-used for pulp capping, repairing perforations in teeth, and as a dentine replacement material

-Possesses properties that promote the formation of dentine and regenerates dental tissues.

-Has a liquid and powder component, which is mixed together to form a putty-like material and creates an alkaline environment

Question 17

What is the reparative effect of biodentine?

Answer 17

Induction of TGF-B1 causing laying down of the reparative dentine and bridging off the exposure site.

Question 18

What is the sand which technique?

Answer 18

nvolves layering different materials to achieve specific dental restorations.

E.g placing a bio active provisional material for a few weeks and when pulpitis is reversed, take away 1-1.5mm and place a layer of direct composite

image on doc

Question 19

Why do you think placing resin composite in thin increments is important?

Answer 19

• Reduced shrinkage : composite resin undergoes a degree of shrinkage during curing. Layering minimises the shrinkage.
• improved adaptation : thin layer helps achieve a more accurate and intimate fit, reducing gaps that might compromise the bond.
• optimal curing : Thinner layers = better light penetration during curing, ensuring each layer is fully cured.
• Enhanced aesthetics and contouring : thin layers = more precise shaping and contouring of the restoration

Question 20

What are the steps for bonding ‘direct’ composite resin to a prepared cavity?

Answer 20

1. Tooth prep :

-Decayed portions are removed via excavator.

-Diamond bur is used to prepare tooth for resin

-Clean + etch tooth, creating roughness for better adhesion

2. Application of bonding agent :

-bonding agent os applied.

-promotes adhesion between tooth and composite resin.

3. Layering and sculpting :

• resin is applied in thin, incremental layers.

-Each layer is cured

-Instruments used to shape and contour tooth to get wanted look.

4. Final finish + polishing:

• after all layers are applied, composite is shaped and polished.
• Done to try and replicate the natural appearance of the surrounding tooth