Dental Demolition and Managing Failure in Tooth Wear Flashcards
What are the reasons for needing to carry out dental demolition?
As a result of high failure rates caused by:
Teeth already heavily restored
Affected by previous failure
Small teeth (short OG height)
High occlusal loads/bruxism
Vitality loss
Root fractures
What damage can wear patients cause in common restorations?
- Long span bridges (even with metal backings)- cycles of grinding has destroyed silver joints
- Porcelain in anterior regions can fail due to continuous bruxist load
- If amalgam has no cuspal protection we can get longitudinal root fractures
- Fractured restoration- can bring cusps with it (can leave tooth unrestorable)
What should be considered when carrying out dental demolition?
- Be clear on benefit- health or appearance
- Understand risk- think of appearance and health
- Should you be extracting or retaining tooth- risk assessment
- Valid consent- be clear about longevity and cycles of replacement (provide all info required)
- Whether this is beyond scope of practice
- Whether treatment is possible
How is operator safety achieved in dental demolition?
- Eye protection- beware of porcelain fragments, plaque, debris, infection
- Wear surgical gloves and consider handling- sharp edges
- Dispose of old restorations as for sharps
How is patient safety achieved in dental demolition?
Airway protection
-> Dam
-> Suction
Superfloss around pontics can be helpful if long span bridges
Eye protection
Examples of situations requiring dental demolition and what to do:
- Perforation and fractured instrument (symptom free)- monitor and extract when symptoms present
- Teeth with apical areas below a bridge (poor RCT)- access through bridge and ReRCT
- Double post retained crown with apical area with short root canal filling- refer to specialist endodontist or extract
- Periapical area with silver points in root canals- if corroded they can be difficult to remove, if they are not then RCT
What is the issue with radiographic washout when assessing whether a patient needs restorations removed?
Can make assessment of core or caries under crowns impossible
-> Warn patient that you may remove restoration and the tooth may be unrestorable
What instrument is used for cutting porcelain?
Tapered coarse diamond bur
*Zirconia may require multiple burs
What instrument is used for cutting metal restorations?
Gold cutting bur (cutting edges are at 90 degrees- vibration)
-> These only last once or twice
What is the basic technique for removing indirect restorations?
Drill up buccal surface Vertically and then use chisel to split (place in channel and twist clockwise)
-> Use high volume suction, stop periodically
What approaches may be used if a buccal section does not remove the restoration?
Go onto occlusal and palatal surface
Consider horizontal section
How is a sliding hammer used to remove problematic indirect restorations?
Place under margin and use weight to knock restoration off
- High risk of core fracture
- Consider airway- don’t lie patient flat
- Matrix band may be used to aid this (over tighten), use hammer to knock holder part
What should be done after removing an indirect restoration?
Critically appraise core and decide whether it needs redone
What are the considerations when removing long span bridge with only a few abutment teeth?
- Consider if patient needs temporary denture
- Consider what teeth you can keep and utilise (some teeth may have no future)
- Consider if you can keep any of the crowns from sectioned bridge as temporaries
Which factors would contraindicate repeat Endodontics in a failed indirectly restored tooth?
Subgingival caries
Insufficient dentine
Lack of tooth structure
-> do not spend time treating an unrestorable tooth
