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Final Flashcards > Endo/Restorative > Flashcards

Endo/Restorative Flashcards

1
Q

What three criteria must be fufilled before the root canal system of a tooth can be obturated?

A

* Asymptomatic, not TTP

* The canal must be able to be dried

* Full biomechanical cleaning

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2
Q

Give the steps used in a pulpotomy

A

* Remove all caries

*Cut access cavity into pulp chamber

*Remove roof of pulp chamber

*Arrest bleeding from root canal orifices using ferric sulphate

*Ferric sulphate saturated CWP packed into pulp chamber and left for 3-4 minutes

*Check for haemostasis. If not achieved, repeat. If still not achieved, consider pulpectomy/extraction

*Remove CWP

*Fill pulp chamber with thick mix of ZOE

*Restore tooth with SSC

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3
Q

Give the steps used in a pulpectomy

A

*Remove caries

*Cut access cavity

*Clean canals with k-file. Stopper set at 2mm short of WL

*Irrigate canals

*Dry canals with paper points

*Deliver vitapex into canals (stopper set on delivery system at 2mm short of WL)

*Fill pulp chamber with thick mix of ZOE

*Restore tooth with SSC

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4
Q

Give 3 constituents of GP in addition to gutta percha

A

Zinc oxide. Radiopacifiers. Plasticisers.

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5
Q

What is the function of a root canal sealer when used with GP cones?

A

Fills voids and irregularities in canal, lateral canals and between GP points. Seals space between dentinal wall and core. Lubricates during obturation.

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6
Q

Give three generic types of sealer that are commonly used in root canal obturation

A

Zinc oxide eugenol

Glass ionomer

Epoxy resin sealers

Calcium silicate

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7
Q

What concerns do patients commonly have about the use of amalgam?

A

* Aesthetics

* Discolouration of teeth

* Mercury poisoning

*Affects foetal development in pregnancy

* Environmental impact

* Radiotransmitter

* Metal allergies

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8
Q

State what reassurance you could give a patient about the safety of amalgam

A

* 350-400 surface amalgam restorations required to induce a mercury response

* Amalgam is a compound with other elements and therefore more stable than elemental mercury

* It is a historic material that has been used for many many years

* The practice has a safe waste disposal system

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9
Q

What aspects of cavity preparation ensure caries is adequately removed?

A

* Remove the enamel to identify the maximal extent of the lesion at the ADJ and smooth the enamel margins

* Progressively remove peripheral caries in dentine from the ADJ first, then circumferentially deeper only then remove deep caries over the pulp

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10
Q

What aspects of cavity preparation ensure the finished restoration margins are cleansable?

A

No overhangs

Smooth margins

Smooth occlusal surface

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11
Q

Describe the mechanism by which resin composite bonds to enamel

A

Micromechanical retention of composite to enamel after acid etch

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12
Q

Describe the mechanism by which resin composite bonds to dentine

A

Removal of the smear layer (1-5 microns), decalcifies dentine to expose the collagen network

Dentine coupling agent; hydrophillic end sticks to dentine through penetration and micromechanical retention into dentine tubules and exposed collagen. Hydrophobic end bonds to the resin in the adhesive

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13
Q

What are the ideal properties of a denture base?

A

Dimensionally accurate

High softening temperature

High hardness/abraision resistance

High thermal conductivity

Non toxic

Biocompatible

High proportional limit

High transverse strength

High fatigue strength

High impact strength

Easy/inexpensive to manufacture/repair

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14
Q

What are the constitutes of PMMA

A

Powder; Benzoyl peroxide (initiator), PMMA particles, Plasticisors, pigments, co-polymer

Liquid - Methacrylate monomer (polymerises), hydroquinone (inhibitor), co-polymer

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15
Q

Give four possible faults during production of acrylic denture and why they occur

A

Contraction porosity; too much monomer, insufficient pressure, insufficient excess material

Gaseous porosity; monomer boiling in bulkier parts of the denture

Granularity - not enough monomer

Crazing - internal stresses due to fast cooling rate

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16
Q

Give four advantages to using co/cr as a denture base

A

Less bulky

High YM (rigid)

High thermal conductivity

Radiopaque

High softening temperature

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17
Q

Give two disadvantages to co/cr as a denture base

A

More difficult to make

More expensive to make

More difficult to add teeth

Aesthetics

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18
Q
A
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19
Q

What undercuts are required for clasps of ss, gold and co/cr?

A

ss 0.75mm

gold 0.5mm

co/cr 0.25mm

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20
Q

What are the ideal properties of an impression material?

A

Low viscocity

High wettability

High tear strenght

100% elastic recovery

Biocompatible

Not unpleasant taste/smell

Convenient working and setting times

Dimensionally stable

Compatible with cast material

Inexpensive

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21
Q

Name 2 non elastic impression materials

A

Impression compound

Impression paste

ZOE

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22
Q

Name 4 elastomers

A

Polyether (impregum)

Silicones (addition and condensation)

Polysulphide

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23
Q

Name 2 hydrocolloids

A
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24
Q

What are the constituents of Alginate?

A

Sodium alginate

Calcium sulphate

Trisodium phosphate

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25
Q

What is the setting reaction of alginate?

A

Sodium alginate + calcium sulphate = sodium sulphate and calcium alginate

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26
Q

Give 2 advantages and 2 disadvantages of alginate

A

Nearly elastic

Accuracy ok

Easy to use

Acceptable taste and smell

Non toxic

Cheap

Poor tear strength

Storage; syneresis and imbibition

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27
Q

Give 3 advantages of elastomeric impression materials over alginate

A

Better accuracy

Better tear strength

Better surface detail reproduction

Better impression life - doesnt dry out

Limited permanent deformation

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28
Q

What is the composition of GI?

A

Powder; silica, aluminia, calcium fluoride, aluminium fluoride

Liquid; Polyacrylic acid (forms matrix), tartaric acid (ease of use)

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29
Q

What is the setting reaction of GI?

A

Acid-base reaction

  1. Dissolution - acid splits and realeases hydrogen
  2. Gelation - calcium ions form crosslinks, bivalent
  3. Hardening - aluminium forms trivalent bonds

Setting takes 30 minutes to 7 days

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30
Q

Give four uses for GIC

A

Luting cement

Temp restoration

Definitive restoration

Lining material

Fissure sealant

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31
Q

Give 4 properties of GIC

A

Fluoride release

Chemical bond

Low solubility/insoluble

Poor aesthetics

Mechanical properties ok

Handling good in moisture

Thermal expansion similar to dentine

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32
Q

How can a hypochlorite accident be prevented?

A

Careful preop radiographic assessment - ensure no open apices

Provide apron and eye protection

Dental dam

Use chlorhexidine to check integrety of dam

Ensure all syringes are labelled correctly

Don’t use LA; to assess if there is a perforation

Pre endo tooth build up, build up walls of fractured teeth

Do not wedge needle into canal

Silicone stopper on needle 2mm short of WL

Depress plunger with index finger rather than thumb

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33
Q

What are the options for replacing a central incisor fractured to the gingival margin at short notice?

A

Adhesive cantilever with fractured tooth as pontic

Provisional overdenture

Provisional post crown

Vacuum formed splint with tooth

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34
Q

Name 3 post materials

A

Gold

NiCr

Ceramic

Titanium

Carbon fibre (not in anterior teeth)

SS (temporary only)

35
Q

Give 6 methods for removing a fractured post

A

ultrasonic vibration

Masseran kit

Cut out for fibre posts

Stieglitz forceps

Eggler post remover

Sliding hammer

36
Q

What are the 6 clinical signs of erosion?

A

Loss of surface detail

Smooth or polished surfaces

Cupping (preferential dentine wear)

Raised restorations above tooth surfaces

Translucent incisal edges

37
Q

What are four indications for the size of a post?

A

4-5mm GP remaining

Post <1/3 of root width

Post to crown ratio >1:1

At least half of the post length into the subcrestal root

1mm of circumfrential dentine/root

38
Q

What materials can be used to cement a post?

A

GI luting cement

Composite resin luting cement

39
Q

What are some causative factors of erosion?

A

Extrinsic - diet (carbonated drinks/alcohol/highly acidic foods) alcohol containing mw, asthma inhaler

Intrinsic - GORD, builimia nervosa, persistent vomitting

40
Q

Pt congenitally missing 22, 23. Give problem relating to aesthetics

A

Pt may be being teased due to gap

Pt may be psychologically affected by missing teeth

41
Q

What 3 general things would a GDP check before referring pt re replacement of congenitally missing teeth?

A

Periodontal status

Smoking status

Diabetes

Osteoperosis

Bisphosphonates

Blood clotting disorder

42
Q

Signs and symptoms of reversible pulpitis?

A

Short, sharp pain (A beta and A delta fibres, hydrodynamic microleakage stimulation)

Stops when stimulus is removed

Not TTP

Pain to cold

Well localised

43
Q

How is reversible pulpitis managed?

A

Removal of caries, other causative factors, restore

44
Q

Signs and symptoms of irriversable pulpitis

A

Lingering pain after removal of stimulus

Dull ache (c-fibres)

Spontaneous pain

Sleep distrupted

Pain with heat

More generalised pain

45
Q

How is irreversible pulpitis mangaed?

A

RCT/extract

46
Q

Patient had large composite placed due to secondary caries. Pt still having sensitivity a week later, give reasons for transient sensitivity to thermal stimulus/biting

A

Insufficient cooling on prep

Uncured resins entering pulp

Pulp exposure

Fluid from tubules occupying space under restoration

Restoration high

Abraision

Gingival recession

Perio disease

Acid erosion - GORD

Dental bleaching

Smoking

Bruxism

Deep cavity

47
Q

Give 5 restorative management features to prevent post comp placement pain

A

Application of strontium TP

Provide pt with splint

Check occlusion

HPT

Gingival augmentation

Application of F varnish 22,600ppmF

Use lining RMGI/vitrebond

Pulp cap

Indirect restoration

Stepwise excavation

48
Q

Pt has gold post and core that has debonded several times, give potential reasons why

A

Post fractured

Core fractured

Root fractured at post level when not attributed to trauma

Untreatable caries

Traumatic fracture

Furcation perforation

Inadequate moisture control

49
Q

How is erosive toothwear managed?

A

Removal of cause; diet advice, ohi

High fluoride TP

Cover sensitive exposed dentine with seal and protect, GI, composite

Rule out medical cause, treat GORD, refer to GP

Recommend use of straws

50
Q

What factors does an implantologist consider before placing an implant?

A

Smoking status

Bone quality and quantitiy

OH

Pt motivation

Occlusion

Aesthetics

51
Q
A
52
Q

What bone dimensions are required for an implant?

A

1.5mm horizontal bone round implant

3mm between implants

>5mm space for the papilla between bone crest and contact point

Assessed with CBCT

7mm spacing

2mm from adjacent structures ie sinus/IAC

53
Q

How can you check if a brigde has debonded?

A

Probe

Check visually

Check mobility

Push and check for air bubbles

Floss

54
Q

What factors should be taken into consideration before placing a bridge?

A

Occlusion

Parafunction

Length of span

Abutment health - caries/perio

OH

Quality of enamel

55
Q

RMGI liner vs GI liner?

A

On demand set

Higher mechanical strength

Lower solubility

56
Q

What are four properties of GI?

A

Fluoride release

Chemical bond

low solubility/insoluble

Mechanical properties ok

Handling good in moisture

Thermal expansion similar to dentine

Poor aesthetics

57
Q

What are the five designs of pontic and retainer?

A

Wash through pontic,

Dome pontic

Modified ridge lap pontic

Full saddle pontic

Ovate pontic

58
Q

In fixed pros treatment planning, give the order of carrying out an examination

A

E/O;

TMJ

MoM

Lymph nodes

Symmetry

Lips (vermillion border, commissures, smile line)

I/O

STE; buccal mucosa, tongue, FoM, palate, lips

BPE

Teeth;

Missing, restorations, caries

Occlusion;

Excursions, canine guidance, group function, interarch space, intertooth space

59
Q

What special investigations are taken into consideration in the planning of fixed pros treatment?

A

Sensibility testing (EPT, ECl)

Radiographs; caries, restorability, pathology, bone levels, restorations, abutment teeth

Study models

Facebow

Diagnostic wax up

Additional; diet diary, PGI, Full mouth perio chart, Clinical photos, microbiology, biopsy, haematology

60
Q

Run through the order of treatment planning

A

IMMEDIATE

Relief of acute symptoms

Consider endo/extractions

Consider immediate denture/bridge

INITIAL (DISEASE CONTROL)

Extraction of hopeless teeth

OHI and diet advice

HPT

Management of carious lesions and defective restorations with direct or provisional restorations

Endo

Denture design, wax up for fixed pros

RE-EVALUATION

Re-assessment of perio status, confirm denture/bridge design

RECONSTRUCTIVE

Perio surgery

Fixed and removable pros

MAINTENANCE

Supportive perio care and review of restorations

61
Q
A
62
Q

When should veneers not be considered?

A

Poor OH

High caries rate

Interproximal caries/unsound restorations

Gingival recession

Root exposure

High lip line

Extensive prep

Labially positioned, severe rotation, overlap

Extensive TSL/insufficient bonding area

Heavy occlusal contacts

Severe discolouration

63
Q

What are the indications for inlays/onlays?

A

Tooth wear cases (increase OVD)

Fractured cusps

Restoration of root treated teeth

Replace failed direct restorations

64
Q

What are the contraindications for inlays/onlays

A

Active caries/perio disease

Time constraints

Cost

65
Q

Indications for crowns

A

Protect weakened tooth structure

To improve or restore aesthetics

For use as a retainer for fixed bridgework

When indicated by the design of an RPD (rest seats, guide planes, clasps)

To restore tooth funtion

66
Q

Contraindications for crowns

A

Active caries/perio disease

More conservative options are available

Lack of tooth tissue for preparation

Unable to provide post and core

Unfavourable occlusion

67
Q

Indications for bridges

A

Aesthetics

Occlusal stability (prevent tilting or over eruption of adjacent/opposing teeth)

Restore function (mastication, speech, wind instrument players)

Perio splinting

Restoring OVD

Pt preference

68
Q

What discussion should be had with a patient for informed consent for fixed pros?

A

invasiveness/reversibility

Likely longeviy and success rates

Time involved

Cost

Alernative options

What treatmnet involves

Why it’s necessary

Consequences of no treatment

69
Q

What is an abutment

A

tooth which seves as an attachement for a bridge

70
Q

What is a pontic

A

The artificial tooth which is suspended from the abutment tooth/teeth

71
Q

What is a retainer?

A

The extra or intracoronal restorations that are connected to the pontic and cemented to the prepared abutment tooth

72
Q

What is a connector?

A

Component which connects the pontic to the retainer

73
Q

What is the edentulous span?

A

Space between natural teeth that is likely to be filled by a bridge or partial denture

74
Q

What is a saddle?

A

Area of the edentulous ridge over which the pontic will lie

75
Q

What is a pier

A

An abutment tooth which stands between and is supporting two pontics, each pontic being attached to a further abutment tooth

76
Q

What are some advantages of a conventional bridge?

A

Robust design

Max retention and strength

Abutment teeth splinted together (perio cases)

Can be used in longer spans

Lab construction straight forward

77
Q

What are some disadvantages of conventional bridges?

A

Difficult prep (parallel prep needed)

Must be minimally tapered

Common path of insertion

Requires removal of tooth tissue

78
Q

What gingival clearance is needed for an adheive abutment?

A

0.5mm

79
Q

What are the requirements of an adhesive abutment?

A

Ideally sound enamel

Composite is ok, consider replacing prior to prep

Amalgam; compromised bond to chemically cured composite cement. Consider replacing

Retainer wing should be 0.7mm thick

80
Q

What is the 5 year survival rate for bridges?

A

Depending on design 80-95%

81
Q

What materials can be used in the manufacture of bridges?

A

All metal (gold, Nickel, co/cr)

Metal-ceramic

All ceramic (zirconia, lithium disilicate)

Ceromeric (BelleGlass)

82
Q

What materials are used in the cementation of bridges/crowns?

A

All metal or metal ceramic; aquacem (gi luting cement) or Rely-x (RMGI)

Adhesive/resin bonded; Panavia (anaerobic dual cure resin cement)

All ceramic (NEXUS; dual cure resin cement)

83
Q

What ‘rules’ apply to distal cantilever bridges?

A

Avoid if possible

Concern that occlusal forces on pontic will produce leverge forces on abutment tooth causing it to tilt

May consider distal cantilever from premolar abutment if unopposed or opposed by denture

Final Flashcards (13 decks)

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