Diagnosis and treatment planning

Question 1

what would radiographs tell you about a tooth

Answer 1

• bone level
• extent of decay
• endo condition

Question 2

what would perio charting show about a tooth

Answer 2

• bone level
• tissue condition
• inflammation level
• bleeding level
• recession

Question 3

what would indicate a crown or onlay

Answer 3

isthmus destruction greater than 1/2 intercuspal width

Question 4

what would indicate a crown and likely a core build up

Answer 4

more than 50% of tooth structure is gone and loss of cuspal support

Question 5

what are the treatment options for combined central and peripheral destruction of a tooth

Answer 5

• core build up and corwn
• possible RCT/post/ core/ crown

Question 6

what would the “best” treatment option provide a patient

Answer 6

strengthen the tooth and provide excellent esthetics

Question 7

what would the “better” treatment option provide a patient

Answer 7

strengthen the tooth

Question 8

what would the “acceptable” treatment option provide a patient

Answer 8

repair the tooth but not necessarily improve the strength

Question 9

how should you present treatment options

Answer 9

discuss risks, benefits, and alternative to each option including NO TX

Question 10

what are the types of materials used for fixed restorations

Answer 10

• gold
• ceramic (eMax and Empress)
• zirconia
• zirconia fused to porcelain (PFZ)
• composite formulations (CEREC)
• metal
• metal- ceramic (Porcelain fused to metal (PFM))

Question 11

what are the pros and cons to gold

Answer 11

• pros: gentle on gingiva, low wear on opposing teeth, longest lasting restoration material we have, can be burnished to seal small margins, very low risk of crown fracture, contacts can be added, easily polished
• cons: not esthetic, labor intensive for lab tech

Question 12

what are the pros and cons for ceramic crown

Answer 12

• pros: tooth colored, still stronger than enamel by ~2x, most realistic and beautiful of all crown materials
• cons: must use resin cements 90% of time, careful patient selection needed for molar corwns, require thicker margins as ceramics need a minumum amount of material to prevent fracture, fracture risk

Question 13

what are the pros and cons of zirconia

Answer 13

• pros: tooth colored, some iteratoins are 4x as strong as enamel, becoming more esthetic, easy for lab tech to make
• cons: not all zirconia are the same, cannot easily add material to establish contacts, crown prep design still key for longevity, fracture risk with some formulations

Question 14

what are the pros and cons to porcelain fused to zirconia

Answer 14

• pros: tooth colored, some iterations are 4x as strong as enamel, becoming more esthetic, no dark metal to cover, white substance enhances esthetics with porcelain providing high esthetics
• cons: not all zirconias are the same, cannot easily add material to establish contacts, crown preparation design still key for longevity

Question 15

what are the pros and cons to CEREC composite formulations

Answer 15

• pros: tooth colored, easy for the lab to make, milled restorations, mixture of composite and ceramic
• cons: longevity still in research, cannot easily add material to establish contacts, crown prep design still key for longevity, esthetics still challenging

Question 16

what are the pros and cons for PFM crowns

Answer 16

• pros: tooth colored, metal substructure add strength, metal substructure enables PFMs to be used in longer bridges, can design where porcelain covers metal to provide excellent flexibility in design, metal substructure protects tooth even if porcelain fractures
• cons: porcelain can fracture if not prepared correctly, metal collars can be unesthetic, porcelain can yellow over time
• preparation is technique sensitie due to metal and porcelain components

Question 17

how long do single crowns last

Answer 17

average of 10-15 years depending on material

Question 18

how long does a conservative amalgam last

Answer 18

10-15 years

Question 19

how long does a conservative composite last

Answer 19

up to 10 years years

Question 20

what does treatment planning of a crown begin with

Answer 20

patient history

Question 21

what are the steps to diagnosis and treatment planning of a crown

Answer 21

• patient hisotry
• analyze patients overall oral health
• analysis of tooth to be treated
• identify options to restore the tooth
• communicate and educate the patient
• perform treatment

Question 22

how long does the average composite last

Answer 22

6 years