Fixed Pros/Implants Mock Oral Boards

Question 1

What’s the purpose/uses of a diagnostic mounting?

Answer 1

• Simulation of mandibular movement
• Occlusal plane analysis
• Space analysis
• Diagnostic preparations
• Diagnostic waxings
• Analysis of articulation and disclusion
• Evaluation of tissue and tooth morphology
• Evaluation of ridge relationship

Question 2

Describe a Celenza Class I…

Answer 2

• A simple holding instrunebt capable of acepting a single static registration
• Vertical motion is possible

Question 3

Describe a Celenza Class II…

Answer 3

• An instrument that permits horizontal as well as vertical motion but does not orient the motion to the temporomandibular joints

Question 4

Describe a Celenza Class III…

Answer 4

• An instrument that simulates condylar pathways by using averages or mechanical equivalents for all or part of the motion
• These instruments allow for orientation of the cast relative to the joints and may be arcon or nonarcon instruments

Question 5

What records do a Celenza Class 3a and 3b accept?

Answer 5

• 3a: Accepts protrusive record
• 3b: Accepts lateral records

Question 6

Describe a Celenza Class IV…

Answer 6

• An instrument that will accept three dimensional dynamic registrations
• These instruments allow for orientation of the cast to the temporomandibular joints and replication of all mandibular movement

Question 7

What is an ARCON type of articulator?

Answer 7

• The angle of the condylar inclination relative to the occlusal plane of the maxillary teeth remains constant for all interocclusal positions.
• Condyle on the mandibular element

Question 8

What is a NON-ARCON type of articulator?

Answer 8

• The angle changes constantly with changes in the interocclusal positions
• Condyle on the maxillary element

Question 9

What type of Articulator is a Whipmix and what records does it accept?

Answer 9

• Celenza 3B
• Arcon
• Semi-adjustable
• Accepts lateral and protrusive records

Question 10

What is the purpose of a facebow?

Answer 10

• Relate the maxillary arch to some anatomic reference point or points and transfer that relationship to an articulator
• Anatomic references are mandibualr condyles transverse horizontal axis and one other selected anterior (3rd) point
• Additionally provide an accurate transfer of occlusal and incisal planes to ensure that what the technician sees is the same as what the dentist sees clinically

Question 11

What is the definition of centric relation?

Answer 11

• A maxillo-mandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective disks with the complex in the anterior-superior position against the slopes of the articular eminences. This position is independent of tooth contact.

Question 12

Name 4 clinical techniques to obtain CR records…

Answer 12

1. Chin Point Guidance
2. Bimanual Manipulation
3. Leaf Gauge
4. Lucia Jig

Question 13

What is Centric Occlusion?

Answer 13

• Occlusion of opposing teeth when the mandible is in centric relation
• May or may not coincide with MI

Question 14

What is the ideal occlusal scheme for a dentate pt being restored with fixed restorations?

Answer 14

• Mutually protected articualtion in fixed restorations (anteriors protect posteriors in eccentric, posteriors protect anterior in MIP).
• Ideally centric occlusion and MIP should be coincident

Question 15

What factors do you consider when restoring a patient in CR vs. MI?

Answer 15

• MI
  
  • Single crown or limited number of fixed restorations
  • No change in incisal guidance, VDO, plane of occlusion
  • CR slide is not causing problems: minimal occlusal wear, absence of bruxism
• CR
  
  • CR slide is causing or could lead to significant problems:
    
    • wear
    • fractured teeth
    • fractured porcelain
  • When you have good control of occlusal scheme: extensive restorations planned
  • Minimal slide, easily corrected by equilibration

Question 16

What contacts make up tripodal contacts?

Answer 16

A, B, C

Question 17

Which combination of occlusal contacts provide occlusal stability?

Answer 17

• A & B
• B & C
• A, B, & C

Question 18

Define closure stoppers…

Answer 18

• Distal incline of maxillary posterior teeth
• Mesial inclinces of mandibular posterior teeth
• Stops closure of mandible

Question 19

Define Equalizers…

Answer 19

• Mesial incline of maxillary posterior teeth
• Distal inclines of mandibular posterior teeth
• Equalizes forces by CS

Question 20

What is the leading cause of failure in fixed prosthodontic restorations?

Answer 20

Caries

Question 21

What are the differences between the preparations for an FGC and an e.max crown?

Answer 21

• FGC
  
  • Margin: chamfer, bevel
  • Occlusal clearance: 1 mm minimum on non functional
  • Axial reduction: 1 mm min
• E.max
  
  • Margin: wide rounded chamfer
  • Occlusal clerance: 1.5 - 2.0 mm min
  • Axial reduction: 1 mm min

Question 22

Remember picture of implant going into a tooth?

What went wrong?

How could you avoid this?

What are your treatment options at this point?

What are the other possible complications?

Answer 22

• Taking conebeam, using surgical guide, take xray while placing implant
• Remove implant, graft
• Can place new implant, check vitality of premolar

Question 23

Talk to me about space requirements needed for implants and their restorations…

Answer 23

• @ CEJ 7 mm
• 1.5 - 2 mm between implant and root @ CEJ
• 3 mm between implants
• 7 mm from platform to occlusal surface (5 mm if screw retained)
• 2 mm from max sinus or IAN (depends on drill shape)
• 1-2 mm from platform edge to cortical plate
• 8-12 mm crest to occlusal plane (Misch), Max 15 mm (over consider implant supported overdenture)
• > 12 mm crest to occlusal plane for implant supported OD (Misch)
• Enough clearance for handpiece, drill

Question 24

What are the different timing options for implant placement following extraction?

Answer 24

• Immediate placement
  
  • 4 - 5 mm of implant in bone for stability (apical & palatal)
• Delayed immediate (8 weeks - 3 months) (allow oseoid component to develop)
• Delayed (3 + months)
  
  • Graft Materials
    
    • Autogenous - 6 months
    • DFDBA - 6 months healing prior to implant placement
    • FDBA - 4 months healing prior to implant placement
    • Bio-oss - 6 months
    • Bio-oss collagen - 6 - 12 months

Question 25

At what level should the implant platform be placed? Why?

Answer 25

* 3 - 4 mm apical to adjacent CEJ(s) * To allow for development of natural emergence profile

Question 26

When delivering an implant supported crown, how do you evaluate your occlusal and interproximal contacts? What's the goal?

Answer 26

* Occlusion: holds shim X 3, drags 1, no excursive contacts * Proximal: drag 1 shim

Question 27

What are common features of / guidelines for a successful post?

Answer 27

* Ferrule * Adequate length * 2/3 length of root, 1/2 length of root in bone, \> clinical crown * Anti-rotation (cast) * Minimal removal of radicular dentin

Question 28

What are the advantages and disadvantage of a Fiber post? Compare and contrast that to cast post-core...

Answer 28

* Carbon fiber - black and unaesthetic * Fiber reinforced composite post - tooth colored * Similar MOE as tooth * BUT question of flexibility of core on top - debonding, cement degraduation, recurrent caries * Bonded with resin cements * Difficulty with bonding resin cement in canal (except Rely-X Unicem) * Some are radiolucent * Most in vitro studies show more favorable fractures (i.e. potentially restorable) vs. metal * Retrospective studies show similar success rates as metal posts, just different failure modes (higher fractures, recurrent caries)

Question 29

What are the different pontic types, advantages of and where would they be used?

Answer 29

* Saddle/Ridge lap - shouldn't be used * Hygienic - have no contact w/ridge - Perel modification (arch), conventional - man molars * Conical (blunt bullet) - thin ridges, "nonappearance zone" * Modified ridge lap: Max anterior, posterior, Man anterior * Ovate: most esthetic: Max and Man anterior

Question 30

What location would you place the male and female components of a non-rigid connector in relation to a pier abutment?

Answer 30

* Avoid rigid splinting of the abutment, utilize a non-rigid connector in distal of pier abutment (Keyway in distal pier, Key in mesial pontic)

Question 31

What is this? What are its advantages? Disadvantages?

Answer 31

* Custom ti-base abutment and crown * Esthetic margin placement, adequate tisse support, Ease of cement cleanup * Cost, time, increased technical knowledge

Question 32

* A 21 year old pt presents to your clinic with CC: "This baby tooth is starting to bother me." Pain: 8/10 with chewing. * Clinically exam reveals #K Class 2 mobility, movement, palpation, percussion reproduce CC. No other problems are found upon your clinical exam * In order to help you decide which tx option to puruse you need some information * What information do youw want?

Answer 32

* Health hx: underlying med conditions to preclude implants, contraindications: uncontrolled DM, past use of IV bisphosphonates, immunosuppressive drugs (poor bone turnover), uncontrolled underlying systemic diseases, radiation to area, some chemotherapeutic drugs, relative contraindications: smoking, osteoporosis * Potential abutment teeth: Vitality tests, existing restorations, mobility, appropriateness for FPD abutments (angle, height) * Casts: restorative space M-D, interarch space, ridge space, ridge shape, ridge undercuts, can ridge map * Occlusion: mutually protected or at minimum providies for protection of implant restoration in excursions * Radiographs * Per XR * Pano * CBCT * Vital structures, adequate space, volume of bone

Question 33

What is the most important dimension of color?

Answer 33

Value

Question 34

Which value can you correct - High or low?

Answer 34

* High - stains or roughen surface

Question 35

What are the etiolgoies of a gummy smile? How do you correct each of them?

Answer 35

* Altered passive eruption: crown lengthening * Vertical maxillary excess: orthognathic surgery * Hyperactive lip/short lip - you can't very predictably, training, botox * Dentoalveolar extrusion: Ortho * Medication induced gingival overgrowth: change meds, SCRP, gingivectomy

Question 36

What is the correct term for the internal aspect of a crown? The external?

Answer 36

* Intaglio * Cameo