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Fixed Prosthodontics > Cores for Teeth with Vital Pulps > Flashcards

Cores for Teeth with Vital Pulps Flashcards

1
Q

What are the indications to make cores for teeth with vital pulps

A
  • Teeth that are vital and have lost a lot of tooth tissue and where RCT is unnecessary and need for it in the near future is unlikely
  • Periodontal condition and hard tissues are stable
  • You can never place an indirect restoration (crown) without a core being constructed first
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2
Q

What materials can benefit the most from additional retention methods when making a core

A
  • Amalgam

- Composite

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3
Q

What additional retention features can be added to a prep

A
  • Slots
  • Grooves
  • Amalgapins
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4
Q

What problems can occur with the pulp after a crown has been prepared and fitted

A
  • Teeth can become non-vital
  • ## Stressed pulp syndrome can lead to pulp death and necrosis
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5
Q

How close can you go to the pulp when you start to cause irreversible symptoms

A

If you go nearer than 1mm its likely to cause irreversible symptoms

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6
Q

How far from the pulp can you be until changes start to occur in the pulp

A

2mm.

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7
Q

Name some materials that can be used to protect a thin wall of dentine

A
  • Setting calcium hydroxide cement
  • Dentine bonding agents
  • Glass ionomer
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8
Q

What advantages of using setting calcium hydroxide cement to protect a thin wall of dentine are there

A
  • High pH stimulates tertiary dentine and walls of the pulp chamber to protect the nerve
  • Toxic to carious bacteria
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9
Q

What disadvantages of using setting calcium hydroxide cement to protect a thin wall of dentine are there

A
  • V brittle so should only be applied thinly and only in discrete areas of thin dentine
  • V voluble and micro leakage can cause it to be leached away
  • Doesnt bond to tooth structure
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10
Q

What is the aim of dentine bonding agents when trying to protect a thin wall of dentin

A
  • Aim is to seal the cut dentine tubules after removal of the smear layer
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11
Q

What is a disadvantage of using dentine bonding agents to protect a thin wall of dentine

A
  • They are readily hydrolysed
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12
Q

Why is using Glass ionomers to protect a thin wall of dentine not suitable

A
  • Low bond strength of 3-5MPa compared to 20MPa with resins
  • Its brittle
  • Easily leaches away
  • Etch and bond to composite is not comprehensive
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13
Q

What are the advantages of using Amalgam as a core (this is usually the first choice)

A
  • Strong af
  • Easy to mix
  • Relatively cheap
  • Good longevity
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14
Q

What are the disadvantages of using Amalgam as a core (this is usually the first choice)

A
  • Colour
  • Not chemically adhesive
  • Environmental issues
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15
Q

What are the disadvantages of using composite resin cores

A
  • Composite is improving but still has a problem of water inclusion over time (expansion of 8%)
  • Initial polymerisation shrinkage
  • Bonds to tooth but how long for, saline is the weakest link
  • If trying to remove it can be hard to distinguish between tooth or composite
  • Doesnt bond to metal pins or posts
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16
Q

What can be used to increase the retention of your core

A
  • Undercuts in the remaining tooth tissue
  • Pins
  • Slots, grooves and amalgapins
  • Adhesives
17
Q

What are the 3 main types of dentine pins

A
  • Cemented
  • Friction
  • Self Tapping
18
Q

List the 3 main dentine pins in terms of amount of retention

A
  • Friction = high stress/high retention
  • Self Tapping = Medium stress/medium retention
  • Cemented = Least stress/Least retention
19
Q

What are the problems with using dentine pins

A
  • Cause stress in dentine leading to micro cracks, which can lead to micro leakage and then caries
  • Pins don’t bond with amalgam alloys or composite
  • Hole prep is 2mm deep so is near the pulp
  • Only go in about 50-70% of hole prep depth so a space is left where bacteria can build up
20
Q

What are amalgapins

A
  • These are small holes that are large enough to an instrument to place and pack amalgam, this must be in a safe position and 2mm deep
21
Q

What bur is often used to cut slots and grooves

A
  • A small pear shaped diamond bur
22
Q

Why are adhesives for amalgam not successful long term

A
  • They leak and can cause catastrophic failure
23
Q

SUMMARY POINTS FOR THE CORES OF TEETH WITH VITAL PULPS LECTURE

A
  • Avoid use of the dentine pins
  • Remove as little tooth tissue as possible
  • Use amalgam if possible
  • Remember poor cores are the biggest cause of mechanical crown failure

Fixed Prosthodontics (11 decks)

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