CONS questions + answers

Question 1

Describe steps to manage proximal caries in an upper incisor tooth with direct composite resin:

Answer 1

1. Gain access
   -for aesthetic purposes, gain access through the palatal side.
   -Use rubber dam
   -Use high speed diamond bur

2.Removal of soft caries
-Use excavator
-Slow speed rosehead bur

3.Place clear plastic tape inter proximally
-Ensures bonding material doesn’t seep into adjacent teeth

4.Etch
-Using phosphoric acid (37%) for 20 seconds.

5.Prime and Bond
-Scotch-bond combines etch+prime+bond (all-in-one adhesive)
-Cure

6.Select colour for resin
-Apply incrementally and light cure
-Check occlusion and polish

Question 2

Describe the sand which technique using GIC + Composite to manage proximal dentinal caries:

Answer 2

1.Gain access
-Access caries using high speed micro motor + diamond bur

2.Remove dentinal caries
-Remove dentinal caries at periphery + EDJ using slow speed micro motor + stainless steel rose head bur

3.Remove soft caries
-Remove soft caries from floor of the tooth

4.Wash and dry tooth
-Preparation

5.Apply GIC
-No curing required, just let it set.
-Apply in increments
-GIC releases fluoride, helps with enamel remineralisation

6.Apply direct resin composite
-Etch,prime,bond,cure again to enhance bond strength

Question 3

How does Fuji IX set?

Answer 3

-Self setting (like GIC)

-Tooth is prepped by accessing cavity and applying dentine conditioner (poly acrylic acid for 20 seconds)

-Fuji capsule mixed in machine

-Injected into the cavity using a capsule gun

Question 4

How would you operatively manage occlusal caries?

Answer 4

1. Explain to the patient what the problem is and gain informed consent
2. Check pulp vitality by using the electro pulp test (healthy tooth will feel electric current)

3.Local anaesthetic + rubber dam

4.Gain access via high speed diamond bur

5.Remove peripheral caries via excavator

6.Remove soft infected dentinal caries, leave affected dentine in tact.

7.Etch using phosphoric acid (37% for 20 seconds)

8.Adhesion of restorative material

Question 5

What is caries-infected dentine?

Answer 5

-Outermost layer of dentine

-Little mineral present, collagen is irreversibly denatured.

-Dentine cannot be self-repaired and cannot be remineralised.

-Removal is essential for sound restorations.

-Soft and mushy as the collagen network has denatured.

Question 6

What is caries affected dentine?

Answer 6

-Collagen cross linking remains

-Softer than normal dentine but still rough and hard.

-Sticky and makes a scratchy sound

-Collagen damaged but to a lesser extent permitting dentine repair.