Final Test Review Flashcards
How long can interim prostheses remain in place for?
From 2 weeks to 1 month
What is an Inlay?
-does not include any cusps
-involves the proximal surface and occlusal surface
-stronger than a resin/amalgam restoration. Can be made out of metal (gold or porcelain)
-placed posterior
What is an Onlay?
-cusps are involved
-involves atleast one cusp and most of the occlusal surface
-stronger than a resin/amalgam restoration. Can be made out of metal (gold or porcelain)
-placed posterior
What is a Veneer?
Veener is a thin shell of tooth coloured-material. Used to improve esthetics due to chipping, excessive wear, heavy staining, to close diastema spacing
What is a direct veneer
created directly in the patient’s mouth by applying resin material to the facial surface
What is an indirect veneer?
created in the dental laboratory on the basis of an impression taken of the prepared tooth. Porcelain material is used not resin.
What is a Crown?
Crowns are indirect restorations that replace severe damage tooth structure due to decay or fracture. Often done after root canal treatment. Crown is cemeneted permanently into place and cannot be removed by the patient. Various materials can be sued including metals (gold), porcelain, etc. Crown provides full coverage, adds strength to teeth.
What types of Crowns are available?
Full Crown
Three-quarter Crown
Porcelain Fused to Metal
What are Full Crowns?
-used when a tooth has decay so severe, or a fracture that reconstruction cannot be performed with the use of a direct restoration
-Completely covers the anatomic crown of an individual tooth. Provide full coverage to add strength to a tooth
-various materials can be used including metal, porcelain or combination of both
What is a three-quarter crown?
Covers the anatomic crown of a tooth but facial or buccal portion is unchanged
What is a PFM Crown?
Porcelain Fused to Metal / Gold
- full metal crown with outer surfaces covered with a layer of porcelain (for esthetic reasons) and inner layer covered with metal
- Metal is added for strength and to prevent crown from fractures due to heavy mastication (biting forces)
What is a bridge?
- Bridge is an indirect restoration that replace either one or multiple teeth that are
missing within the same quadrant or sextant. - Bridge consists of a series of units joined together for greater strength.
- The bridge is cemented permanently into place and cannot be removed bythe
patient. - Various materials can be used including metals (gold), porcelain etc. Provides full
coverage, adds strength to teeth, replaces at least one missing tooth.
What are the components of a fixed bridge?
Unit, Pontic and Abutment
What is a Unit (bridge)?
Units are used to describe bridge. ( 4 unit or 3 unit, etc)
What is a Pontic?
Missing tooth/artificial tooth
What is the Abutment?
Tooth anchoring the bridge are referred to as Abutment. This tooth
should be stable and strong to withstands bridge forces. Outer layer of enamel
will be removed, tooth will be reduced in size all circumference (all directions) by
use of dental high-speed handpiece and bur.
What types of fixed bridges are available?
Cantilever bridge
Maryland bridge
What is a Cantilever Bridge?
“fifth wheel”
- does not have an abutment on one end
-various materials can be used including metal/gold porcelain
What is a Mary land bridge?
“wings”
- consists of a pontic with wing like extensions from the mesial and distal sides on the LINGUAL
-bonding of these extensions to the lingual surfaces of the adjacent teeth supports the pontic. Various materials can be used including metal, gold or porcelain
What is an implant supported indirect restoration?
-refers to artificial “root” replaced with the titanium component
-Titanium is anchored surgically into the bone
-implant supported indirect restoration incorporates principles from both fixed and removable prosthodontics in conjunction with the use of bone-anchored implants
What type of implants are available?
Endosteal implant
Subperiosteal implant
Transosteal implant
What is an endosteal implant?
The most common placed type of implant - surgically placed into jawbone
What is a subperiosteal implant?
Placed under the periosteum and on top of the bone (indicated for patients who do not have sufficient alveolar ridge remaining to support the endosteal-type implant)
What is a Transosteal implant?
Inserted through the inferior border of the mandible. (These implants are primarily used in patients with severely resorbed ridges)
Overview of a Crown Procedure - 3 appointments
- First appointment involves: Records (x-rays/impressions for study models collected) and treatment
discussed, cost - Second appointment involves: Tooth shade selection, preliminary impressions (unless done in 1st
app), preparation of the area, final impressions, and placement of provisional coverage. - Third appointment involves: Involves the try-in, permanent cementation, and permanent
placement.
Indirect restoration/Fixed Prosthodontics - What happens during the 1st appointment?
- Records (x-rays/impressions for study models collected, pictures, maybe face bow records and articulator are requested) and treatment discussed, cost
- Send information to dental insurance prior
Indirect restoration/Fixed Prosthodontics - What happens during the 2nd appointment?
- Medical/Dental History reviewed
- Topical/Local placed
- Ensure you have imprint of original tooth
- Determine shade (under natural light)
- Isolation placed
- Dentist prepares tooth using carbride & diamond burs
- Isolation Removed
- Gingival retraction cord is placed to temporarily enlarge sulcus
- Gingival retraction cord removed
- final impression is taken / bite registration is taken
- Temporary coverage is made and temporary cemented
- POIG verbal & written
- PARTS done
- Patient is booked for delivery and cementation in approx 1 week
- Dentist completes Lab Rx with details for the fabrication
- Dental impressions are sent to lab
Indirect restoration/Fixed Prosthodontics - What happens at the 3rd appointment? Delivery appointment steps
- The patient is seated and anesthetized if deemed necessary. (sensitive vital teeth)
- The provisional crown or restoration isremoved. All temporary cement must be removed from the prepared tooth. The tooth is then thoroughly cleaned and dried.
- The prosthetic is disinfected and then placed on the tooth for a ‘try-in’.
- Adjustments are made as necessary. If the prosthetic cannot be satisfactorily adjusted within the office, it may be necessary to take a new impression and re-fabricate the prosthetic.
- The area is isolated with cotton rolls to maintain a dry field.
- The assistant prepares the permanent luting cement or bonding system and applies it to the inner surface of the prosthetic. – RDA Passes prosthetic to the DDS
- The dentist seats the prosthetic. The patient may be asked to assist with the seating by applying force to the prosthetic via a bite stick or cotton roll. The dentist ensures seating is ideal using the mirror and explorer to assess the margins. The patient applies biting pressure until the cement or banding system is set.
- Once the cementation (luting) agent has completely set, the excess cement is removed from all areas and isolation is removed
- Post-operative instructions written and verbal are provided to the patient.
Steps in a CEREC Digital Restorative Technology Appointment
- Anesthetic
- Scan digital impression
- Area preparation
- Mill Crown
- Try in
- Cement permanently
What is an advantage of CEREC?
Less time spent in the dental office for the patient
What is a disadvantage of CEREC?
Costly for dental practice to buy
If a patient has periodontal disease but good dental hygeine habits, is fixed prosthodontics indicateD?
no, because of the perodontal disease
How many appointments are commonly required for a crown or bridge?
Two appointments are commonly required
What is the difference between an onlay and a three-quarter crown?
An onlay covers most of the occlusal and proximal surfaces (involves at least 1 cusp)
A three-quarter crown covers other surfaces such as the facial or buccal surfae
How does a dentist convey to a dental laboratory technician the type of crown or bridge that should be made?
Laboratory prescription
What type of indirect restoration is placed to improve the appearance of the facial surfaces of teeth?
Veeners
this describes a stable tooth to support the
bridge
abutment
What is another name used for permanent cement?
Luting agent
When is a temporary cement used instead of a permanent cement?
Temporary cement is used for provisional coverage or for cases in which the dentist needs to remove the indirect restoration at a later date, there is concern about sensitivity or other symptoms that might require removal of the cast restoration, or when temporary cementation is required while the patient waits until the laboratory technician completes the cast restoration.
What variable affects the addition or loss of water in dental cement?
Humidity affects the addition or loss of water in a material.
Can Glass Ionomer cement be used as a restoration material?
Yes - glass ionomer cement can be used as a restoration material.
What ingredient in the powder of glass ionomer cement helps to inhibit recurrent decay?
Acid-soluble calcium slowly releases fluoride to help inhibit recurrent decay.
Can resin cements be used under metal castings?
Yes, resin cements may be used under metal castings.
In the composite resin cementation procedure, what step is important to complete on the tooth surface before cementation of the material?
In the composite resin cementation procedure, the tooth must be free of all plaque and debris and must be prepared by etching or by treatment with a bonding system before cementation.
What type of ZOE is used for permanent cementation?
Type II ZOE is used for permanent cementation.
On what mixing surface is ZOE mixed?
ZOE is mixed on an oil-resistant paper pad or a glass slab.
How is TempBond Supplied?
TempBond is supplied in two tubes of paste.
In what two forms is the polycarboxylate cement liquid supplied?
Polycarboxylate cement is supplied as powder or liquid
How should polycarboxylate cement appear after the mixing process?
It should appear glossy after mixing.
What is the main component in the liquid form of zinc phosphate cement?
The main component of the liquid of zinc phosphate cement is phosphoric acid.
How do you dissipate the heat from zinc phosphate during the mixing process?
To dissipate the heat, spatulate over a large area of a cool glass slab.
What size of powder increment is first brought into the liquid of zinc phosphate during mixing?
The smallest icrement of powder is first brought into the liquid during mixing.
Do you “fill” or “line” a crown with permanent cement?
You “line” a crown with permanent cement.
________ is the method of mixing a cement by using a flat flexible metal or plastic instrument.
Spatulate
_____ is a type of reaction or process in the release of heat.
Exothermic
A(n) _____ refers to a temporary type of tooth coverage used for a short time.
Provisional
_____ is a type of dental material that is designed to temporarily or permanently hold an indirect restoration in place.
Cement
To ______ is to slow down the process of something.
retard
Another name for a type I dental cement is _______.
luting agent
Another name used to describe a permanent cement is _________.
luting agent
Which of the folllowing procedures would you include a temporary cement on the tray setup?
Provisional coverage
Which variable can affect the addition or loss of water in a material?
Humidity
What type of zinc oxide-eugenol (ZOE) is used for permanent cementation?
Type II
On what type of mixing paid is ZOE mixed?
Treated paper pad
Temp bond is supplied as _________.
Two tubes of paste
The main ingredient in the liquid of zinc phosphate is ______.
phosphoric acid
How do you dissipate the heat from zinc phosphate in the mixing process?
Use a cool glass slab
If the powder of a dental material is dispersed in increments, what size increment is commonly brought into the liquid first?
Smallest
How is the liquid portion of polycarboxylate cement supplied?
Squeeze bottle and calibrated syringe
At the completion of the process for mixing polycarboxylate cement, the end product should appear ____.
glossy
Can a glass ionomer material be used as a restorative material?
Yes
What unique ingredient in the powder of glass ionomer cement helps inhibit recurrent decay?
Calcium
Can a resin cement be used with a metal casting?
Yes
Are stainless steel crowns considered provisional or permanent when placed on primary teeth?
Permanent
What type of cement is Duralon?
Duralon is a polycarbocylate
What are the 3 Types of Impressions?
Preliminary Impression (Reproduction)
Final Detail
Record of occlusion (bite registration)
What are the 4 forms of materials?
Light Body - very thin, records fine tooth detail, wash or syringe
Regular Body - medium viscosity, tray filler
Heavy Body - thick viscosity, tray filler
Putty - thickest/highest viscosity, tray filler
How long can non-treated gingival cords stay in the mouth/gingival sulcus?
15 mins
How long can treated gingival cords stay in the mouth/gingival sulcus?
Up to 7 mins
What are the 4 types of Elastomeric Impression Materials?
- Polysulfide
- Polyether
- Condensation Silicone
- Addition Silicone (polyvinyl siloxane)
What are the 3 curing stages?
- Initial - able to mix, getting stiff
- Final set - changes from elastic to solid to rubber
- Final cure - 1 to 24 hours
What are the 4 Dispensing Methods?
- Paste systems (manual mix)
- Automix system (dispensing gun)
- Mixing unit systems (self mix)
- Putty system (manual mix)
What are Adhesives used for?
to keep the impression material in the tray
specific types are used with specific impression materials..
-polyvinyl siloxane and polyether impression
-rubber base impression
- silicone impression
What do Digital Impressions do?
Scans teeth and surrounding tissues: lasers/light sources
2 methods:
* Digital photo
* Digital video
IPC to follow for impressions?
use clean gloves/ clean hands when dispensing
* double wipe all Always !
Can a DA take final impressions for crown/bridge preps?
Yes! The dentist should be evaluting final impressions obtained by a dental assistant
How do you know which material type you are working with?
READ the product label - read the manufacture instructions
What is the next step within prosthodontic appointment.. you just finished placement of retraction cord. What should you do next?
correct Final Impression materials are ready as per dentist
Is elastomeric impression used for prelim or final impressions?
Final impressions - used to produce the most accurate final impressions
In which ways is elastomeric material supplied?
Auto-mix gun
manual mix
- Light body
- Regular Body
- Heavy Body
- Putty
What technique method is used to place light body material around the tooth?
Syringe method or wash type method***
What impression material will the dentist first appy to a prepared tooth: the light body or heavy body?
light body
What is another name for Polysulfide?
Rubber base
What can CEREC Digital dentistry be used for?
For.. full porcelain crowns
inlays
onlays
Can be completed in 1 visit
What type of preliminary impressions are available?
-Alginate (Irreversible Hydrocolloid)
- Reversible Hydrocolloid
What diagnostic tools are available?
Wax up
Facial measurements with face bow
Articulator for bite
What methods are available to record tooth colour?
Shade matching with shade guide
Digital scanner that will tell you the shade
Use natural light
Do in morning so eyes are fresh
Look at something blue to cleanse eyes
Do not do with dental dam on
What isolation methods are available?
-Cotton Rolls
-Dry angles
-dental dams
-HVE/LVE
-Isolite
What dental burs are typically used with prostho appointments?
Diamond Burs
Carbite burs (less expensive but more are needed)
What type of handpiece(s) is a dental assistant not allowed to use?
High speed
Also… Slow speed straight is NOT to be used in the mouth
What retraction methods are available?
Gingival cord (single or double)
Laser to trim gums
Electrosurgery
What type of methods are available to record final impressions?
Digital impression
Physical impression (Auto-mix with gun or manual mix)
What type of impression material will most likely be used to record final impression?
PVS - polyvinyl siloane
What is the impression material that will least likely to be used to record final impression?
Polysulfide (egg smelling ones)
What is the next step after the final impressions?
Temporary restoration
… with automix gun, template, slowspeed handpiece, mandrel with disc, round slow speed bur, articulating paper, floss, floss threader, mirror, explorer, forceps, cotton rolls, HVE/LVE….
How many appointments are typically required to fabricate Cerec crown/inlay or onlay?
1 appointment!
What types of temporary cement types are available?
Eugenol
Non-Eugenol
What are the post op instructions given after temporary restorations are cemented?
-Local Anesthetic will wear off in 2-4 hours avoid biting or poking at the tissues.
-Also avoid sticky, chewy food
-The teeth and gingival tissue may be sensitive – can use an OTC pain medication but if the pain persists, call the office.
-If the temporary restoration falls out, please call the office immediately.
-You must brush and floss the area gently.
-Remember to not pull the floss through the contact, but through the embrasure.
-This is temporary and must be replaced within 90 days.
What type of permanent cements are available?
Glass Ionomer
Zinc Phosphate
Polycarboxylate
Bonding **CHECK THESE
What type of material should be used to cement porcelain full crowns?
Nexus - bonding has colours to match
What type of material should be used to cement porcelain fused to metal full crowns?
Not Luting - cannot light cure through metal
Glass Ionomer of Zinc Phosphate - does not need to be light cured
What are the post op instructions given after restorations are permanently cemented?
Everything for temporary except 90 days!!!
How are dental cements classified?
Into 3 types:
Type I - luting agents (act as an adhesive - glue)
Type II - used as restorative materials and intermediate restorative materials
Type III - Used as liners & bases when cavity is deep and close to the pulp
When cementing a PFM crown, what type of cement will be required?
Type I luting agent is required
When patient asks you why temporary cementation is used with the permanent crown, what would your response be?
Due to tooth sensitivity for example, dentist may choose to use tempoary cement on permanent crown or continue to use provisional coverage with temporary cement. Either way provisional/temp coverage will be provided as long as the dentist is unsure if permanent cementation cn be used. Until then the area will be monitored.
Regardless of the product used.. what guidelines must be followed to ensure the material is mixed correctly?
-Always follow manufacture instructions, do not alter rations, mixing times, etc.
-Know the reson cement is used as this will determine the type needed
Rules for dispensing/mixing cement materials..
-Always dispense powder first than liquid second
-Always fluff the powder
-Hold liquid vertical for correct amount
- divide powder into smaller section if required
-mix throughout, do not leave loose powders unless specified by the manufactures
-Be aware of temperature setting as some cements produce heat known as exothermic reaction. OFten cool glass slb (retrieved from the fridge) will be used.
Why should you have moist 2x2 gauze prepared when mixing cements?
Have moist gauze in hand while mixing cements as wiping cement off the spatula should be completed immediately
What other cement systems are available and often used in dentistry - and what is the advantage of them?
Auto-mix system and the advantage is that it provides the exact rations for application
Patient is scheduled for a 4.6 PFM permanent crown. What type of cement will be most suitable?
Glass Ionomer
Patient is scheduled for 1.3 to 2.3 veneer bonding. What type of cement will be most suitable?
Composite resin cement/bonding due to shade matching availability
Patient is scheduled for 2.5 porcelain crown. What type of cement will be most suitable?
Glass Ionomer or Composite Resin Cement/bonding
What technique is required/used to mix Zinc Phosphate?
Figure 8 mixing techniques
What instrument is used to line cement inside the cast?
PFI
What is the proper amount of cement needed to line the internal walls of the crown?
The cement should cover all the walls - MDBL and O - not a thick amount
Is it within the scope of practice in Alberta for RDA’s to remove temporary and permanent cement subgingival?
A DA can only remove cement from SUPRA gingival
What type of cement can be both temporary & permanent?
Zinc Oxide / ZOE Eugenol cement - 4 types available
What types of cements have a soothing effect on the tooth/pulp?
Zinc Oxide/ ZOE Eugenol cement
&
Polycarboxylate cement
What type of cement releases fluoride?
Glass Ionomer Cement
What is the makeup of Glass Ionomer cement?
Polyacrylic acid, copolymer and water
What type of cure is Glass Ionomer cement?
Self-curing, or light curing
powder and liquid or capsules
What type of cures is Composite resin cement available in?
Light cure or dual cured systems
powderand liquid or syringe
What is the chemical make up of Composite resin cement ?
Similar to composite resin (etch, primer, bond)
What is the chemical make up of ZOE cement?
Eugenol, water, acetic acid, zinc acetate, calcium chloride
What is the make up of Polycarboxylate cement?
Polyacrylic acid, itaconic acid, maleic acid, tartaric acid and water (syrup like constancy)
What is the make up of Zinc Phosphate cement?
50% phosphoric acid in water, aluminum phosphate and zinc slats to control PH
What is used to mix ZOE cement?
Use resistant mixing pad due to oil content or glass slab
Paste of base and catalyst.
Supplied with or without eugenol
What is used to mix Polycarboxylate cement?
Powder and liquid, use nonabsorbent paper pad
Cool glass slab can be used
What is used to mix Zinc Phosphate cement?
Cool glass slab is used
What type of preliminary impression materials are available to use?
Alginate
Elastomeric Putty
(Irreversible Hydrocolloid)
What type of dental waxes are available and which one will be used to modify impression tray?
Boxing Wax
Bite Registration / Baseplate
Utility wax - used to modify impression tray
Casting wax
What diagnostic tools are available?
Face Bow - meassures the distance from TMJ to maxillary midline
Articulator - simulates the bite of a patient
If Tooth 2.5 is missing, what type of fixed restoration can be considered?
Crown supported implant
If Teeth 1.4 to 2.5 have fluorosis like staining visible, what type of fixed restoration can be considered?
Veneers
If tooth 1.5 has a large DO amalgam restoration (cusps are involved) what type of fixed restoration can be considered?
Onlay
If Tooth 4.6 is missing, what type of fixed restoration can be considered?
Implant supported Crown or 3 unit bridge or cantelever bridge
What methods are available to record teeth colour?
shade guide
teeth color comparator
What isolation methods are available?
Dental Dam
Cotton Rolls
Isolite
Dri Angle
What dental burs are typically used with prostho appointments?
Diamond burs
What type of handpiece(s) is the dental assistant not allowed to use?
High Speed Handpiece
Air abrasion / Ultrasonic
Laser
What type of retraction methods are available?
Mechanical - Surgical (electro-laser)
Physical/Chemical - Cord / Solution
What type of cement is most suitable for a PFM Crown?
Type 1 Luting Agent - Glass Ionomer
What type of methods are available to record final impressions?
Auto-Mix / Auto-Tip
Manual Mix w/ spatula
Dispenser (like ice cream machine)
If Tooth 1.4 has a small DO amalgam restoration (cusps are not involved) what type of fixed restorations can be considered?
Inlay
What type of impression material will most likely be used to record final impression?
PVS (Polyvinyl Siloxane)
What type of impression material will be LEAST likely used to record final impressions?
Poly ether / Poly sulfide (smelly)
What is the next step after the final impressions?
Temporary restoration placed
Lab RX is sent to make prostho
When would a stainless steel crown be commonly selected for use as a provisional?
When primary teeth are part of a treatment
What type of material is used for final impressions?
elastomeric material
How many appointments are normally required for a 3-unit fixed bridge?
2 appointments
What should be placed between the maxillary and mandibular cast when trimming them together?
Wax bite
Before an impression is taken with reversible hydrocolloid, where is the material kept?
the material is kept in a conditioning bath
What impression material will the dentist first apply to a prepared tooth: the heavy body or the light body?
Light body is placed first on the tooth, heavy body goes on tray and is placed second
What is the most common wax used to create a pattern for an indirect restoration?
inlay casting wax
What is the BEST retention option(s) available for extensively vital decayed tooth?
Pins and Core Buildup
(Post is for NONVITAL tooth)
What dental stone has the least amount of expansion?
High-strength stone
How long should you wait before you separated the model from the impression?
45-60 mins
Which of the three classifications of impressions is used for occlusal relationships
bite registration
What is used to extend the length of a tray?
utility wax
How do you dissipate the heat from zinc phosphate during the mixing process?
Spatulate over a large area of a cool glass slab (figure eight motions)
What is the organic substance within hydrocolloid materials?
seaweed
How should polycarboxylate cement appear after the mixing process?
glossy
What is another term for poysulfide?
rubber base
On what mixing surface is ZOE mixed?
OIL resistant mixing pad
What is the difference beteen an onlay and a three-quarter crown?
An onlay covers most of the occlusal and proximal surfaces: a three-quarer crown covers all but the facial or buccal surface
What is another term for a dental model?
Study cast
