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BDS3 - CDS > Endo > Flashcards

Endo Flashcards

1
Q

restoration of endodontically treated tooth
radiographic assessment

A
  • inadequate root fillings should be re-treated before restoration
  • root filling length, quality of obturation etc - any voids
  • unfilled/missed root canals
  • shape of canal
  • patency - fracture instruments, posts, sclerosis
  • bone support - mild, moderate, severe
  • crown to root ratio
  • any pathology - is periapical radiolucency healing, resorption, perforations
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2
Q

problems after RCT/re-RCT

A
  • amount of remaining tooth structure - externally or internally
  • restoration type
  • lack or no ferrule - fastening/joining object
  • wide post holes eg re-RCT
  • endo complications - fractured instruments, perforations, short/long root fillings
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3
Q

are teeth brittle after RCT and are root treated teeth more prone to fracture

A
  • teeth do not become more brittle
  • a root filled tooth with minimal loss of dentine is not more likely to fracture than a vital tooth
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4
Q

after RCT are teeth as hard as non root treated teeth
does dehydration affect the hardness of a RCT tooth

A
  • dentine hardness is not altered after endodontic tx
  • dehydration does not appear to weaken dentine structure in terms of strength or toughness
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5
Q

RCT describe coronal microleakage and timing for completing restoration

A
  • ingress of oral micro-organisms into the root canal system
  • important cause of RCT failure
  • root filled teeth unrestored for >3 months should generally be re-RCT
  • coronal seal very important - more important that technical quality of RCT
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6
Q

summary of coronal restoration on RCT

A
  • trim GP to ACJ
  • place RMGI over pulp floor and root canal openings
  • lining should not be too thick - allowing remainder of pulp chamber for retention and restoration
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7
Q

restoration of endodontically treated tooth
anterior restoration options

A
  • intact marginal ridges - composite restoration, (veneer)
  • inact marginal ridge and discoloured crown - bleaching or veneer, (crown)
  • marginal ridges destroyed - core build-up with crown, post crown
  • direct posts - ferrule required
  • cast post and cores - no ferrule - not ideal
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8
Q

what is a post/core

A
  • function - salvage tooth which has lost significant amount of internal structure, helps anchor crown to tooth
  • core provides retention for a crownv- what the prosthesis is cemented onto
  • posts retain the core - they do not strengthen or reinforce teeth - placed in the root canal
  • gains intraradicular support for a definitive restoration
  • preparation of the root canal for a post weakens the tooth
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9
Q

guidelines for post placement
tooth type

A
  • incisors and canines - post unnecessary if sufficient coronal dentine is present
  • avoid in mandibular incisors due to thin/tapering/narrow roots
  • premolars - if post to be placed then place in widest canal - small/thin pulp chambers and tapering roots - AVOID in curved canals to avoid perforations
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10
Q

guidelines for post placement
root filling length/post width and length/ferrule

A
  • root filling length - 4-5mm of root filling apically
  • post width - no more than 1/3 root width at narrowest point
  • 1mm of remaining circumferential coronal dentine
  • sufficient alveolar bone support requires - as at least half of post length into root
  • minimum 1:1 post length/crown length ratio
  • ferrule at least 1.5mm height and width of remaining coronal dentine
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11
Q

what is a ferrule

A
  • the amount of tooth structure on the buccal and lingual walls of the prep
  • encirclement of 1-2mm of vertical axial tooth structure within walls of a crown
  • prevents tooth fracture
  • if crown margin is not placed onto solid tooth - root fracture significantly increased
  • orthodontic extrusion or crown lengthening may be necessary to achieve this
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12
Q

restoration of endodontically treated tooth
dimensions of restorable tooth

A
  • post length below crown equals crown length
  • 1mm minimum thickness of dentine
  • 3.5mm prep length - 1.5mm core lengt + 2mm post length above crown/dentine height
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13
Q

the ideal post

A
  • parallel sided - avoids wedging and more retentive than tapered
  • non-threaded (passive) - smooth surface ensures less stress to remaining tooth than threaded (active)
  • cement retained - less retentive than threaded posts but cement acts as buffer between masticatory forces and post/tooth
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14
Q

classification of posts

A
  • manufacture - pre-formed/prefabricated or custom made
  • material - cast metal, steel, zirconia, carbon/glass fibre
  • shape - parallel sided or tapered
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15
Q

prefabricated posts summary

A
  • only 1 visit required
  • no impressions and lab visit required
  • chairside core build up
  • post and core are different materials
  • immediate preparation of core
  • large selection of designs and materials
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16
Q

custom posts summary

A
  • cast from direct pattern fabricated in pt mouth - eg duralay
  • indirect pattern can be fabricated in the lab - impression of post hole and wax-ip of post and core in lab (most common method)
  • post and core made of same material
  • 2 visits required - impression and fit
  • temporisation between visits and lab stages required - risk of contamination of root canal between visits
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17
Q

post material

A
  • metal - cast gold, stainless steel, titanium - poor aesthetics, root fracture, corrosion, radiopaque
  • ceramics - alumina, zirconia - high flexural strength and fracture toughness, good aesthetics, difficult retrievability and root fracture common
  • fibre - glass, quarz, carbon - flexible, similar properties to dentine, aesthetic, retrievable, radiolucent
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18
Q

what is a core build-up

A
  • internal part of tooth is built-up with restorative material to replace the lost tooth structure
  • provides retention and resistance for definitive restorations
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19
Q

core materials

A
  • composite - most commonly used, good aesthetics, bonds to tooth, moisture control required, used with fibre posts
  • amalgam - tend to avoid as retention required, poor aesthetic, core cannot be prepared straight away as needs 24h to set
  • glass ionomer - not really used as absorbs water and core expands in size
20
Q

describe nayyar core

A
  • root treatment is removed from root canals
  • amalgam is packed into root canals and tooth built up
  • this provides retention for the amalgam
  • cannor be prepared for 24hours until amalgam sets
21
Q

restoration of endodontically treated tooth
design of restoration considerations

A
  • how long will post be
  • have you got a ferrule
  • how wide
  • 3-5mm remaining GP
  • is the canal straight
  • how much space for the core - factor in type of crown to be placed
22
Q

restoration of endodontically treated tooth
core design

A
  • core taper and length important
  • 6 degree taper
  • length required - to allow 2mm clearance for MCC
23
Q

restoration of endodontically treated tooth
provisional restoration

A
  • provisional post core crown (temp bond)
  • dressing - not aesthetic but might prevent leakage
  • essex retainer
24
Q

restoration of endodontically treated tooth
gutta perchal removal summary

A
  • pros and cons of dental dam
  • soften GP - heat/solvent
  • gates gliden to minimum size 3 - straight part of canal only
  • use working length and rubber stop on gates glidden
  • leave 3-5mm GP in apical third
  • check GP plug remains - loupes, microscope, periapical
25
Q

restoration of endodontically treated tooth
anti rotation notch/groove

A
  • if coronal dentine absent then a small vertical groove in the canal can be an antirotational element
  • located in the bulkiest area of the root - usually lingual
26
Q

restoration of endodontically treated tooth
lab prescription

A
  • please construct cast post and core
  • tell lab para post colour (temp post size)
  • core 6 degree taper
  • please leave 2mm space in occlusion for crown
  • enclosed registration/opposing impression/shade
27
Q

restoration of endodontically treated tooth
lab post and core try in

A
  • check post space for temp bond
  • irrigate chlorhexidine 0.2%
  • dry with paper points
  • ensure fits around prep
  • do you have enough occlusal clearance for crown - min 2mm
28
Q

restoration of endodontically treated tooth
fitting lab post and core

A
  • careful not to fill post space with cement - may prevent seating
  • use firm apical pressure
  • get rid of excess cement
  • can then ask lab for provisional acrylic crown
  • make sure no excess around when taking crown impression/fitting MCC
  • practice fit sequence
29
Q

problems with posts

A
  • perforation
  • core fracture
  • root fracture or crack
  • post fracture
30
Q

restoration of endodontically treated tooth
post removal equiptment

A
  • ultrasonics
  • masseran kit
  • eggler
  • moskito forceps
31
Q

post failure stats

A
  • 60% due to restorative reasons
  • 32% due to periodontal problems
  • 85% due to endodontic reasons
32
Q

restoration of endodontically treated tooth
post and core summary

A
  • proper assessment of tooth is required - clinically and radiographically
  • not all RCT that require a crown need a post and core - avoid if at all possible
  • unified post and core preferred - avoids material interfaces
  • not all cores need a post
36
Q

direct pulp cap
indications

A
  • dentine surrounding exposure is sound
  • red, homogenous and blood filled tissue is observed on pulp wound surface
  • no yellowish liquefied areas or dark non-bleeding zones
  • no dentine chips present on wound
  • haemostasis can be achieved within 2-3 minutes after rinsing with mild disinectant - chlorhexidine or 1% sodium hypochlorite - apply on sterile cotton pellet
37
Q

direct pulp cap
process/materials

A
  • pulp covered with biocompatible/possibly bioactive restorative material
  • extended to dentine surrounding exposure
  • calcium hydroxide/CaOh containing bases
  • mineral trioxide aggregate (MTA)
  • calcium silicate cements
38
Q

direct pulp cap
RMGI

A
  • may be used to cover CaOH
  • not in contact with pulp
  • remaining dentine thickness
39
Q

direct pulp cap
provisional restorations

A
  • RMGI
  • zinc oxide eugenol
40
Q

biodentine constituents/function

A
  • calcium silicate
  • powder mainly tricalcium and dicalcium silicate
  • zorconium diozide serves as a contrast medium
  • positive effect on vital pulp cells
  • stimulates tertiary dentine formation
  • can be used as direct pulp cap following dentine exposure
41
Q

biodentine
mixing/process

A
  • open capsule - 5 drops of liquid into capsule and close
  • mix in vibrating mixer for 30 seconds
  • options:
    1. fill entire cavity with biodentine to then reduce to base/dentin level in 2nd visit (48h-6months later)
    1. fill to base/dentin layer and restore with composite 15-20 mins later same appt
  • sets in about 12-15 minutes
42
Q

biodentine comparison to CaOH

A
  • CaOH does not prevent microleakage due to porosities in newly formed hard tissue (tunnel defects)
  • high pH of CaOH causes liquefaction necrosis at surface of pulp tissue
  • biodentine handles easily
  • mechanically stronger
  • less soluble
  • produces tighter seal
43
Q

types of CaOH

A
  • ultracal - non setting
  • dycal - setting
44
Q

what is ledermix

A
  • dental treatment which combines the antibiotic action of demeclocycline with the anti-inflammatory action of triamcinolone acetonide.
  • Ledermix is indicated in pulpitis, periapical periodontitis, and hypersensitive dentine.

BDS3 - CDS (13 decks)

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