Diagnosis & Treatment Planning for Single Fixed Restorations Flashcards
Treatment planning for single tooth restorations begins with:
- Analysis of each individual tooth
- Analysis of the patient as whole
What are some factors to think about when considered treatment planning for single tooth restorations?
-home care
-tooth wear
-existing restorations (a lot?)
-pain
-financial abilities for treatment
-will treatment maintain the tooth
-will treatment strengthen the tooth
-whats in the existing tooth already
-patient goals
-esthetic concerns
-is the tooth periodontically stable
-what additional treatment needs to be done? (crown lengthening, RCT, Build up, pins)
What is the first step in treatment planning?
Complete medical & dental history
When taking a complete medical & dental history, what are we looking for?
Contra-indications to beginning dental treatment
What are some examples of contra-indications to dental treatment?
Cardiac issues
Patients stability with DM or other disease
Patients home care
What is the second step in treatment planning (after obtaining medical & dental history)?
Gather further data about the tooth in question- radiographs & periodontal charting
What are we evaluating on the radiographs prior to treatment?
-bone level
-extent of decay or tooth destruction
-endodontic condition
What are we evaluating when periodontal charting?
-bone level
-tissue condition (inflammation level, bleeding level, recession)
What is the third step in treatment planning (following getting a medical & dental history & then evaluating further with radiographs & periodontal charting)?
Look at the tooth in question to analyze what might be needed to restore it
What should you immediately do when you see a silver filling?
Dry it with air to look for fracture lines
If you see fracture lines in an already existing filling, what should you do?
Remove the filling and get rid of the fracture lines
If the isthmus destruction is greater than 1/2 intercuspal width you would lean towards what treatment?
Crown or onlay
If there is more than 50% of the tooth structure is gone and loss of cusp support (cusp is gone), what treatment would you do?
Crown (likely a core buildup too)
Combined central & peripheral destruction results in what treatment?
Core build up and crown (possible RCT/Post/core/crown)
Every time you cut a tooth, you:
Weaken a tooth
The fourth step in treatment planning is asking:
What are the options for treatment planning for this particular tooth?
The fifth step in treatment planning is to:
Put the options into categories
During the fifth step in treatment planning, what are the categories that you should put the treatment options into?
- best
- better
- acceptable
- not recommended
List examples/definitions of the best, better, acceptable & not reccomended:
Best- strengthen tooth and provides excellent esthetics
Better- strengthen the tooth
Acceptable- repair the tooth, but not necessarily improve its strength
Not recommended- not an option for this patients tooth
During the fifth step of treatment planning present the options to your patient discussing the risks, benefits, and alternatives of each option, including:
NO TREATMENT
Loss of cuspal support = what treatment?
crown
What are types of materials used for fixed restorations?
-gold
-ceramic (E.Max, empress)
-zirconia
-zirconia fused to porcelain (PFZ)
-composite formulations (CEREC)
-metal
-metal-ceramic (Porcelain Fused to Metal) (PFM)
What are the pros of gold crowns (similar for non-gold metal crowns):
- gentle on gingiva
- low wear on opposing teeth
- longest lasting restoration we have in dentistry so far
- can be burnished to seal smallest of margins
- contacts can be added
- easily polished
What are the cons for gold crowns (similar for non-gold metal crowns):
- not esthetic
- labor intensive for lab tech
What are the pros for ceramic crowns:
- tooth colored
- still stronger than enamel by 2x
- most realistic and beautiful of all crown materials
What are the cons for ceramic crowns:
- must use resin cements 90% of the time
- careful patient selection needed for molar crowns
- require thicker margins as ceramics need a minimum amount of material to prevent fracture
- fracture risk
What are the pros for zirconia crowns:
- tooth colored
- some iterations are 4x as strong as enamel
- becoming more esthetic
- easy for lab tech to fabricate
What are the cons for zirconia crowns:
- not all zirconias are the same
- cannot easily add materials to establish contacts
- crown preparation design still key for longevity
- fracture risk with some formulations
What are the pros for porcelain fused to zirconia crowns:
- tooth colored
- some iterations are 4x as strong as enamel
- becoming more esthetic
- no dark metal (like PFM) to cover
- White substructure enhances esthetics with porcelain providing high esthetics
What are the cons for porcelain fused to zirconia crowns:
- not all zirconias are the same
- cannot easily add material to establish contacts
- crown preparation design still key for longevity
What are the pros of CEREC Composite formulation crowns:
- tooth colored
- easy for lab tech to fabricate
- milled restorations
- mixture of composite and ceramic
What are the cons of CEREC Composite formulation crowns:
- longevity still in research
- cannot easily add material to establish contacts
- crown preparation design still key for longevity
- esthetics still challenging
What are the pros of PFM crowns:
- tooth colored
- metal substructure adds 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
What are the cons of PFM crowns:
- porcelain can fracture if not prepared correctly
- metal collars can be unesthetic
- porcelain can stain yellow over time
- preparation is technique sensitive due to metal and porcelain components
Types of crown include:
- single crowns
- bridges (multiple crowns with Pontic)
- implant crowns
- partial crowns
Fixed restorations other than crowns include:
- veneers
- other implant prosthesis (“all on 4”)
- inlay/onlay
How long do single crowns last?
average single crown lasts 10-15 years
(some material have a longer life span than this)
List the longevities on average of crowns, conservative amalgams, and conservative composites:
Crown: 10-15 years
Conservative amalgam: 10-15 years
Conservative composite: up to 10 years, but average of 6 years
Treatment planning a crown begins with:
Patient history
Prior to working on a patient what should be taken?
A global analysis of patients overall all oral health
Following a global analysis of patients overall oral health, you should:
Analyze the tooth to be treated
What are two questions you should ask yourself in regards to analysis of the tooth to be treated?
- how much of the tooth is compromised
- what is needed to restore the tooth
When identifying options to restore the tooth, the
- best option=
- better=
- acceptable=
- not an option=
- esthetics & strength
- strength
- repair the tooth but not necessarily strengthen it
- not a reasonable option for the patient
Patient presents to your office with no pain or sensitivity. You notice decay on the buccal of #30 which compromises the integrity of the existing amalgam.
What information do you need to gather in order to treatment plan #30 for a new restoration?
What are the options available here for this patient?
Can you list the best, better, acceptable, and not an option for this patient?
X
Patient presents to your office with no pain or sensitivity. You notice decay on the occlusal of #30 which compromises the integrity of the existing amalgam.
What information do you need to gather in order to treatment plan #30 for a new restoration?
What are the options available here for this patient?
Can you list the best, better, acceptable, and not an option for this patient?
X
What type of damage is seen in this image? How would you treat this patient?
Combined central & peripheral destruction; core build up & crown (possibly RCT/post/core/crown)
-Patient presents to your office with a broken tooth
-No significant medical/dental history
-Bitewing radiograph taken
-Patient reports no pain, but tooth is sharp to his tongue
-Patient home care is in stable condition
What additional information do you need?
- PA radiograph to see apex
- Perio charting
-Patient presents to your office with a broken tooth
-No significant medical/dental history
-Bitewing radiograph taken
-Patient reports no pain, but tooth is sharp to his tongue
-Patient home care is in stable condition
-What does this image reveal?
Loss of cusp and greater than 50% of tooth structure compromised
-Patient presents to your office with a broken tooth
-No significant medical/dental history
-Bitewing radiograph taken
-Patient reports no pain, but tooth is sharp to his tongue
-Patient home care is in stable condition
Upon examination it is noted that the tooth in question has loss of a cusp and greater than 50% tooth structure compromise. What is the best/ideal choice for this patient?
Crown is the best/ideal choice
