Fixed Q3 Flashcards by Tim Agee

The combined width of Connective Tissue and Junctional Epithelial attachment formed adjacent to a tooth and superior to the crestal bone.

Biological Width

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From top to bottom: 1mm

1mm

Gingival sulcus (pocket depth)

Junctional Epithelium

Connective Tissue attachment

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T/F

Biological width can vary from pt to pt

True

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How do you measure Biological Width?

Sound to Bone

(subtract sulcus depth)

***done under anesthesia

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If a crown prep does not follow soft tissue contour what might happen?

Violation of Biological Width by Crown Margin

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If a crown margin is placed within the Junctional Epithelium or Connective tissue what has occurred?

Violation of Biological Width

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2 Things happen if you violate Biological Width:

Inflammation

Bone Loss

*body will try to re-establish Bio Width

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What defines the bone loss in the case of an Iatrogenic violation of Biological Width?

Uncontrolled/unpredictable

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Where is unpredictable/uncontrolled bone loss more likely to occur in the case of Bio Width violation?

Thin Alveolar Bone

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What plays a major iatrogenic role in the recession of bone around thin areas?

Trauma from restorative procedures

*like BioWidth violation

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What are 2 factors inherent in the Pt that affect the outcome of iatrogenic trauma to the BioWidth?

If Gingiva Thick/Fibrotic or Thin/Fragile

Peridontium Scalloped or Flat

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What type of gingiva is more prone to recession?

What type is less prone?

Highly scalloped thin

Thick and Fibrous

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What factor correlates to the Thickness of the Alveolar Bone?

Gingival Biotype

thin gingiva = thin alveolar bone
thick gingiva = thick alveolar bone

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What is the simplest way to determine Gingival Biotype?

Metal Perio probe in the Sulcus

*if thin, probe visible through gingiva

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T/F

Thin biotype is more likely to recede, and is correlated to a highly scalloped gingiva

True

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What are the 2 ways to treat a Violation of BioWidth?

Orthodontic Extrusion

Crown Lengthening

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When a tooth is extruded via orthodontics to move the margin out of the the BioWidth, what is often indicated?

New Restoration

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What is the advantage to Crown Lengthening procedure as opposed to letting the bone loss resolve on its own?

Healing process of Crown Lengthening very predictable

*may lose more bone than you want if you let it resolve on its own

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Crown lengthening is a ____ method

Subtractive

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T/F
The re-establishment of health in a crown lengthening is predictable

Not treating BioWidth invasion may lead to unpredictable bone loss

True

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Average distance from the Bone to the height of the FGG? (not interproximal)

Height from bone to soft tissue Scallop? (interproximal)

3 mm

4.5 mm

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Papillary height is established by what 3 things?

Level of bone

Biological width

Form of the Gingival Embrasure

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T/F

Changes in the form of an embrasure can impact the height and form of the papilla

True

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The tip of the papilla behaves differently than the FGG on what aspect of the tooth?

Facial

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The FGG averages 3 mm above the facial alveolar bone, but the tip of the papilla averages _____ above the interproximal bone

4.5 - 5 mm

If the papilla is further away from the alveolar bone on the facial interproximal side but but has the same BioWidth as the rest of the surface, what must be deeper?

Sulcus *1 - 1.5 mm deeper

If the measurement is ___ to ____ mm, there is a full papilla

3 - 5

Who studied the relationship between the papilla and interproximal contact to the underlying bone to establish papillary height above bone?

Tarnow et al

When the interproximal contacts are _____ mm or less (to the alveolar bone), papilla always fill the space

5 mm

If the interproximal contact point is 6 mm above the alveolar bone, ____ % of the time the papilla fills the space

56%

If the interproximal contact point is 7 mm above the alveolar bone ______% of the time the papilla will fill the space

37%

T/F | On average females have a higher smile line

True

Maxillary incisal edge display at rest does what with age Mandibular?

Decreases Increases

What sex has a greater incisal edge display at rest?

Females

What do people notice about midline shift and cant?

Midline shift - no one notices Cant - everyone notices

T/F | Cant isn't as important as dental midline

False

How far does a midline shift have to deviate before Orthodontists notice? Everyone notices a ___mm incisor crown angulation

4 mm 2 mm

Anterior preparations have how much of an incisal reduction?

2 mm

Integrity is what kind of material? PMMA?

Bis-acryl Poly methyl methacrylate

PMMA goes through what kind of reaction? steps?

Polymerization rxn initiation, propagation, termination

Acrylics can be classified by their activation (initiation), which can be what 3 things?

Heat Chemical Light (400-500 wavelength) = camphroquinone

For PEMA (SNAP), what is the Initiator found in the Powder? What is the Activator found in the Liquid?

Benzoyl Peroxide Tertiary amine

PEMA = PMMA = Which is SNAP?

Poly ethyl methacrylate (SNAP) Poly methyl methacrylate (Jet)

PEMA vs PMMA - which one heats up more? What is it called?

PMMA - may traumatize pulp Jet acrylic

PEMA and PMMA are both chemically activated

True *by a Tertiary Amine

What is the main advantage to working with PEMA (SNAP) over PMMA (Jet)?

Low curing heat

What is Triad activated by? What is the Initiator?

Light (400-500 nm) Camphorquinone

T/F | Triad is activated by heat

False *Light 400-500 nm

Polyvinyl siloxane can go through a _____ rxn whose byproduct is ______

Condensation Ethanol

PVS that goes through a condensation rxn (2 types of putty squished together) has what advantage over condensation silicone impression materials?

Less polymerization shrinkage *highly filled

3 reasons for a beveled shoulder:

bend or burnish metal margin to tooth minimize marginal discrepancy if crown doesn't seat completely Protect chipping (by removing unsupported enamel)

A Heavy Chamfer is also referred to as a ________ and is achieved with the ________ bur

Deep Chamfer 856.025

T/F | Sharp corners are more prone to impression voids

True

For adequate resistance form, how high should Anterior preps be? Posterior?

3 mm axial wall height 4 mm

Teeth that have greater than ____ height to base ratio will have adequate resistance form

0.4

3 general esthetic considerations to keep in mind for All Ceramic restorations?

Pink framing Shade Translucency

When would metal show through a Metal-Ceramic restoration?

If prep too thin (so porcelain too thin)

T/F | A metal to porcelain (ceramic) crown is one of the Least conservative restorations available to the dental profession

True

A metal-porcelain crown will often look like what on the gingival border? (PFM) What might prevent this?

Gray New labial designs moving metal margin away from gingiva

3 indications for use of an all Ceramic restoration?

Single crown High Esthetic demand Metal allergy

T/F | Metal allergy includes those pts that can't wear metal jewelry - must ask the pt before Tx planning

True

T/F | An all ceramic is basically an all glass restoration, and most people are high Esthetic demand pts

True

All ceramic restorations - 4 Patient Selection Criteria:

Optimal Esthetics required and ACHIEVABLE ideal prep favorable occlusion compatible opposing dentition

6 important properties of Ceramic Materials:

Translucent Chemically stable Fluorescent Biocompatible High compression resistance CTE (coefficient of thermal expansion) similar to natural tooth

Advantages to Ceramic Crowns: Excellent ______ Good peripheral blend of _____ Luting material not _____ in oral fluids _______ margins Soft tissue _______

esthetics shade soluble Supra-gingival compatibility

T/F | PFM is not translucent, whilst all ceramic is

True

With some dark teeth, what can be used to mask the dark dentin?

Zirconia

Ceramics have less irritation/inflammation at the margins compared to metals

True

T/F | All ceramics have enhanced esthetics b/c of no metal and improved light transmission

True

All ceramics are most beneficial for those teeth that have what colored dentin? If dentin is dark, use what?

Normal Zirconia

T/F | Facial tooth reduction isn't as much using all ceramics (supra gingival)

True

T/F | ACC's can be technique sensitive and there is a time consuming luting procedure

True

T/F | ACC's can be brittle, fragile to occlusal adjustment, and have a lack of repair ability (if fracture, that's it)

True

What might cause gingival irritation in an ACC? Where would you not use an ACC?

rough margins - easy to do molars - greater potential for fracture (Empress)

Contraindications for ACC's include compromised teeth, bad habits, occlusal interferences, difficulty isolating, and if the margin is where?

Sub-gingival *not possible especially if restoring using resin cement

What are 2 Major problems with ACC's?

Brittle - a flaw will propagate along crack Abrasive to opposing tooth

The higher the _____ concentration of an ACC, the more wear there is

Leucite

2 General ways to classify dental ceramics:

Composition Lab processing

3 Types of ceramics (by composition):

Glass - looks great Glass infiltrated (particle filled glass) - stronger Polycrystaline - almost like metal

Glass ceramics are highly esthetic and best at mimicking what?

Optical properties of enamel/dentin

An example of a glass ceramic:

Feldspathic porcelain

Glass infiltrated ceramics (particle-filled glass) have what in them that improves their mechanical properties?

Filler particles

3 examples of the filler material in Glass infiltrated ceramics?

alumina magnesia-alumina alumina-zirconia

Polycrystalline materials have increased what? Reduced what? and No what?

strength translucency glassy components

What is the only way to process Polycrystalline ceramics into shapes?

computer-assisted machining

2 Examples of Polycrystalline ceramics?

Cercon Base DC-Zirkon

Where are Glassy materials most often used? (weak, translucent) Particle-filled glass? Polycrystalline?

Anteriors Anteriors/posteriors Posteriors (some anteriors)

3 Glassy materials: 3 Particle filled glasses: 4 Polycrystalline:

feldspathic, VMK95, Initial In-Ceram, Empress I/II, E max Lava, Everest, Cercon, Procera

Classification of ceramics according to Laboratory processing (4 ways)

Sintered conventional powder-slurry Castable/Pressable Machinable Infiltrated

What is the traditional method of fabricating an ACC?

Powder condensation *moist brush, compact, vacuum firing

Ceramics made by what technique are translucent and esthetic, used mostly for veneering layers

Powder condensation

What ceramic is used with an Aluminous Core w/ a platinum matrix heated to drive off dissolved gases and a core porcelain build up?

Conventional Powder-Slurry

Powder-Liquid ceramics have great translucency and can be as thin as _____ mm

0.2 mm

T/F | Dual cures can change colors, so if you want a highly translucent product use a light cure

True *zirconia = dual cure

When was the Porcelain Jacket Crown developed? Aluminous Porcelain Jacket Crown?

1800's 1965 - aluminous oxide strengthened

What is stronger than the Powder Liquid ceramic? 2 examples:

Pressed ceramic IPS Empress, IPS Empress 2

Y-TZP is an example of what?

Polycrystalline ceramic matl *YTTRIUM Tetragonal Zirconia Polycrystals

2 All ceramic products that can be used in Press Technology or CAD/CAM technology?

IPS Empress IPS E max

Leucite can be a filler for what? Lithium disilicate, alumina spinel, and zirconia can be a filler for what?

High glass content Low glass content

No glass content (polycrystalline) can be what 2 matls?

alumina zirconia

What IPS matl is Leucite Glass Ceramic, low flexural strength?

IPS Empress Esthetic *looks really good - highly translucent

What is the Improvement over IPS Empress Esthetic with increases strength, higher flexural strength, and in monochromatic?

Empress 2 (pressed ceramic)

IPS Empress Esthetic is what matl? Empress 2 is what matl? IPS E max?

Leucite glass disilicate glass Lithium-disilicate

IPS E max press (Ivoclar Vivadent) was introduced in 05 and uses what type of cement?

Resin cement

IPS E max has better physical properties and improved esthetics

True

What high strength ceramic with a superior marginal fit has 2 fabrication methods and must be bonded?

Pressed

Under or Over etching will do what to bond strength?

Decrease

T/F | HF acid has better bonding properties than phosphoric

True

What creates a bond between the HF etched teeth and an ACC?

Monobond-S

With IPS Empress, when should you adjust occlusion?

After bonding

IPS Empress is very esthetic and translucent and must be ______ to the tooth However, it is relatively ______ and ______ *use for esthetic restoration

bonded weak, expensive

Lithium disilicate, titanium, zirconium, alumina, inflitrated Al/Zr, glass ceramics, composite, and castable plastic are used for what?

CAD/CAM matls

The Alumina CAD/CAM matl is known as what?

Procera

T/F | Procera crowns are digitized and emailed to Sweden or NJ

True

What type of cement is used for Zirconia or Crystalline crowns?

Glassionomer *no need for translucency

What type of cement is used if you need translucency?

Resin (acid etch then bond) *more difficult to use

Any substructure =

coping

What is the strongest laminate w/ great esthetics on the market? (must be bonded - translucent - resin)

Procera Laminate

Procera AllCeram system using glass free high strength ceramic core, used ant/post, CAD/CAM

Densely sintered high-purity Aluminum Oxide

Aluminum Oxide sinters at _____degrees C ___% shrinkage upon sintering

1650 20% ***remember, Aluminum Oxide = Procera

In the Procera system why is the die enlarged?

Compensates for sintering shrinkage

Review: Glass powder liquid Pressor matls (2): CAD/CAM =

Empress, Emax CAD/CAM

What is the strongest matl (but not very esthetic)?

Zirconia system

What type of cement do you use with Zirconia?

Conventional cement

T/F | Removing Zirconia is easy

False *very strong

How is Zirconia cured?

Dual *as opposed to light

What product cleans after try-in of pretreated restoration? What is the universal Restorative Primer? Applied for _____ secs then air dried Next step? ***then?

Ivoclean Monobond Plus, 60 seconds Cement into restoration (dual cure) ***then seat, clean up, and Final Cure 20 secs/side

IPS Empress, when adjust Occlusion? Zirconia, when adjust Occlusion?

After bonding Before bonding (high strength means cracks won't go further)

Glass Ceramics used in Anteriors for forces of ____ N Alumina used on Premolars for forces of _____ N Metal ceramics, zirconia, and gold (3M) are used in the Molars for forces of ____ N

150 300 400-800

7 ACC matls from least to highest strength

Feldspathic porcelain IPS Empress IPS E max In-ceram Alumina In-ceram Zirconia Alumina (Procera) Zirconia (Cercon, LAVA)

Incisal reduction for ACC: The rest:

1.5 mm 1 - 1.2mm axial, 1.0 mm marginal

2 systems to describe color:

Munsell (hue, chroma, value) CIELAB

Visible light spectrum:

380-750 nm (violet - red)

Northern-exposure sunlight in the middle of the day that is slightly overcast.

Standard daylight | or northern daylight

The reproducing capacity of artificial light to mimic natural daylight is measured by what 3 things?

color temperature spectral reflectance curves CRI- color rendering index

The CRI is on a scale of 0-100 and indicates what?

color rendering of artificial light source | compared to standard Northern Daylight

Incandescent lights emit higher concentrations of _____ light waves and has what CRI? Fluorescent lights emit higher concentrations of _____ waves, has what CRI?

Yellow, low CRI Blue, 50-80 CRI

T/F | Incandescent and Fluorescent lights are suitable for shad matching

False

What type of artificial light provides the best color matching? Can these be used alone?

Color corrected fluorescent lamps w/ CRI over 90 Should use multiple sources

What is the phenomenon when objects match color under one light source but not another?

Metamerism

Dental offices should use color corrected lights and others for shade matching

True

What 2 types of lighting are commonly used in the home and office and should be used to match shade (along with color corrected source)?

Incandescent cool white fluorescent

T/F | Shade match with the dental operating light

False *only use ambient lighting

T/F | A CRI of around 90 should be used to shade match

True

What 3 factors determine color?

Hue Chroma Value

3 primary subtractive colors

Blue Red Yellow

What are the primary Additive Colors?

Red Blue Green

Hue: Chroma: Value:

color (determined by wavelength) color intensity (saturation) light from dark (black and white grayscale)

What is the most important factor in color?

Value

Value is measured on a scale from _______

0 - 10

What is a common color matching mistake in metal-ceramic prosth?

Restoration too high in Value

T/F | Objects of different chroma/hue can have the same value

True

CIELAB is better than Munsell and distinguishes color space by what 3 coordinates?

L a b

In CIELAB, L = a = b =

lightness red-purple/blue-green axis yellow/purple-blue axis

L, a, and b correspond to Munsell's Hue and Chroma

False

What in the eye interprets brightness? What interprets color?

Rods (no color) cones (only active under high lighting conditions)

Rods are used for _____ vision Cones are used for ______ vision

Scotopic Photopic

Rods have highest concentration where? Cones?

peripheral retina central retina *remember, rods for brightness, cones for color

Because color vision decreases rapidly, what should you look at between shade matching to restore color vision?

Pale blue or Gray surface

When should the color be matched during an appointment?

Beginning *tooth still hydrated - take off lipstick, try to have neutral background colors

What is the best background to use for color matching?

N7 - N9 gray *high value pastels also recommended

The portion of the ceiling not occupied by lighting should be what value? Large vertical surfaces?

9 or more 8 or more *also, avoid high gloss

Color blindness affects what % males? Females?

8% 0.5%

3 types of color blindness:

Achromatism - no hue Dichromatism - 2 primary hues Anomalous Trichromatism - all 3 hues, but retinal cones affect one primary pigment

How long should you wait after bleaching to match color for a crown?

10 days

3 types of commercial shade guides:

Vita classic Vitapan 3D master Extended Range Shade Guides

What does A3 mean in the Vita Classic shade guide?

A - red-yellow 3 - chroma

Vita Classic shade guide colors A: B C D

red-yellow yellow grey red-yellow-gray

Vita Classic shade guide sequence for shade match (4 steps):

Hue (A, B, C, D) Chroma Value Final check, revision

How is value best determined?

squinting @ arms length *increases rod sensitivity

Would it be better to err on high value or low?

High *low can't be stained up in value

Trying to increase value through staining will increase what? Decrease what?

opacity light transmission

What shade guide starts with the Value?

Vitapan 3D master

4 steps with Vitapan 3D master?

Value Chroma Hue Final check/revision

T/F | Extended range shade guides will cover bleached, dentin, and custom shades

True

What 2 materials, when preparing for an ACC, would need a Stump Guide? (match dentin)

Feldspathic porcelain IPS Empress

T/F | Stains increase surface reflections and prevent light from being transmitted through porcelain

True

When a tooth is divided into 3 regions w/ 9 segments:

Shad mapping

3 types of color measuring instruments:

Spectrophotometers Spectroradiometers Colorimeters

A standardized image capture environment for shade matching using a full spectrum 7 band LED light

Crystaleye

What is the default sequence at ASDOH for preparation of the tooth for a crown?

build up first preparation

A crown prep followed by a build up has what disadvantage?

temporize is difficult if non-restorable

Amalgam, composite, and Glassionomer can all be used to build up a crown

True

What is the dual cure composite material for crown build up?

Paracore

Tooth in tooth relationship

MIP - max. Intercuspal position

CR (centric relation) definition:

Condyles in most Anterior/Superior

90% of people in MIP...

Are not in CR

MIP = CR

10%

MIP: CR: Centric Occlusion:

Max intercuspal position Centric Relation (condylar) Where the teeth touch first

When would you restore the arch so MIP = CR

Teeth ground down Endentulous Full arch/mouth rehab

If MIP and CR differ, there is a ______ to _______ slide

Centric Occlusion (where teeth meet first) MIP

If MIP and CR differ greatly, the resulting CO to MIP slide can result in what?

Parafunction

The complete intercuspation of opposing teeth INDEPENDENT of condylar position

MIP *he writes it as 'maximum intercuspation position'

Centric Relation is independent of what?

MIP and tooth contact

The maxillomandibular relationship, condyles most Anterior and Superior, articulating with the thinnest avascular portion of the disk

Centric Relation

In Centric Relation, the condyles articulate with what? They are in what position against the articular eminence?

Thinnest avascular portion of disc most Anterior and Superior position

T/F | Centric Relation depends on tooth contact

False

What type of movement is allowed when in Centric Relation?

Rotational *any translation will get you out of CR

CR, aka...

Terminal hinge axis

Measured between the incisal edges, how far can CR rotate before translation occurs?

20-25 mm

After 20-25 mm of CR rotation (measured incisally), what ligament tightens? What direction do the condyles translate?

TemporoMandibular Ligament Anterior and Inferior

The occlusion of opposing teeth when the mandible is in Centric Relation:

Centric Occlusion

Centric Occlusion is normally found where?

Posterior teeth

A slide from CR to MIP is present in ____% of the population. Average distance of slide:

90% 1 - 1.25 mm

If the occlusion is stable, prosthetics are mounted in relation to what?

MIP *existing occlusal scheme - most fall into this category

If you want to perform an occlusal equilibration how should you mount the case?

Centric Relation

A theory is that Interferences between what creates neuromuscular disharmony, resulting in parafunctional activity?

CO and MIP

Unrestricted movement between CO and MIP is considered ideal when?

If there's no change in Vertical Dimension

T/F | The majority of cases can be restored to the pt's MIP

True

What are 2 common reasons to mount a case in CR?

No MIP - endendulous, full arch prep CR to MIP slide interference

Prep paramaters in CEREC are determined by what? | 2 things

Material properties Manufacturing process

CEREC prep minimum shoulder thickness: min. axial wall: min. thickness under fissure: min. thickness under cusp (ant/post):

1. 0 mm 1. 5 mm 1. 5 - 2.0 mm 1. 5 (anterior) 2.0 (posterior)

3 aspects important to evaluate when acquiring an image:

distinct separation from adjacent teeth all margins clearly visible even amount of shadowing on adjacent teeth

What are 2 ways to fix CEREC crowns to teeth? | each has 2 names

Cementation (luting) Bonding (resin)

What are the pros/cons to Luting a CEREC crown? | cementation

Cleans easily, no anesthesia, fast Doesn't increase restoration strength, dependent on surface area, can't use w/ all matls

Pros/Cons of Bonding (resin):

Strong w/ enamel, strengthens matl, good esthetics, don't need retention features in prep Isolation needed, not predictable, needs anesthesia, difficult clean up, technique/time

When placing a crown clean the tooth with what? Next 5 steps: *last step allowed to react for how long?

Proxyt fluoride-free paste try on Etch (5% hydrofluoric acid) rinse dry Monobond Plus *60 secs

For Luting (cementation) use what conditioner? Rins with water then dry (what is important here?) Coat inside restoration, seat - what's the working time? Remove excess cement w/ scaler when? Finishing can be started how long after seating?

GC Fuji Plus conditioner don't dessicate 2 min 15 secs rubbery 4 min 30 secs

What Resin Cement Bonding do we use?

Maxcem Elite

Maxcem Elite - should do what after seating?

light cure 2-3 secs to achieve gel state

After light curing Maxcem Elite for 2-3 secs to achieve gel state and after excess cement has been cleaned off, light cure all surfaces for how long? For metal based/opaque restorations, let set for how long after seating

10 seconds 4 minutes

What duplicates the anterior guidance of a patient? *thereby reproducing excursive movements

Custom Incisal Guide Table

When would a custom incisal guide table be indicated?

When pt's existing anterior guidance is acceptable

If the pt's existing anterior guidance is UNacceptable, what 5 steps should be taken?

Diagnostic wax up Provisional restorations (adjust intraorally) Impression Cast Mount on Articulator

When does a Custom Incisal Guide Table need to be used?

If one/more guiding teeth are prepared *and want to preserve guidance

What matl is used for a Custom Incisal Guide Table? Setting time?

DuraLay - chemically activated PMMA 5 minutes

A retention groove effectively does what?

Increases H/B ratio

T/F | A CEREC prep should have smooth flowing transitions and a sharp cavo surface

True

How will CEREC mill if there is a sharp jump in the margin?

Under mill - won't seat

T/F | High noble metals are more Castable

True

Term for how tight a crown fits onto a preparation: | less rotational movement

Adaptation

What 2 types of crowns have a better adaptation than a Milled Crown?

Pressed Casted