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BDS4 Restorative Past Paper Questions > Indirect Restorations > Flashcards

Indirect Restorations Flashcards

1
Q

A 19-year-old patient attends your practise on Monday morning having sustained trauma to teeth 12 and 11 on
Saturday evening. Tooth 12 is completely missing the crown and has a sub-alveolar fracture. Tooth 11 has a pulpal
exposure of 2 mm. Both teeth are experiencing sensitivity.
Discuss FOUR steps in the immediate management of tooth 11 (4)

A

Locate the missing fragment of tooth, LA and rubber dam, Pulpotomy (tooth is sensitive) - Access, Remove coronal
pulp, Achieve haemostasis using cotton wool and water, If haemostasis achieved place CaOH in canal, Seal with GIC,
Composite dentine bandage, If unable to achieve haemostasis (i.e. non-vital) – pulpectomy, Restore in the same way
as above

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2
Q

Tooth 12 has a subalveolar fracture and is rendered Unrestorable. Why is a subalveolar fracture important in
making the tooth Unrestorable? (4)

A

Lack of coronal tissue to bond to/support restoration/retain restoration, Inability to achieve moisture control for
restoration, Inability to take impression for indirect restoration, Hard to establish marginal integrity/difficulty
cleaning

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3
Q

Name TWO alternatives to replace tooth 12 after extraction

A

Implant, Bridge, RPD

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4
Q

A new patient attends your practice complaining of pain from tooth 12 and a de-bonded bridge.
What is the likely design of the bridge? (1

A

Adhesive fixed-fixed bridge (RRB)

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5
Q

The bridge de-bonded on abutment tooth 12 but not on abutment tooth 21. The de-bonded wing on the 12
became a plaque trap leading to caries and ultimately causing pain. Name a better alternative bridge design for
this patient and explain why your design would be better. (2

A

Adhesive cantilever bridge from tooth 21
If this de-bonded it would fall out, it wouldn’t become a plaque trap and wouldn’t lead to caries

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6
Q

Name 4 factors that could cause a bridge to de-bond (4)

A

Poor moisture control during cementation, Unfavourable occlusion, Parafunction (bruxism), Trauma to front of face,
Poor OH.

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7
Q

What factors does an implantologist consider before placing an implant?

A

Smoking status, bone quality and quantity, oral hygiene, pt motivation, occlusion, aesthetic

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8
Q

What bone dimensions are required and how are they best measured?

A

1.5mm horizontal bone round implant, 3mm between implants, >5mm space for the papilla between bone crest and
contact point. Assessed w/ CBCT, 7mm spacing, 2mm from the adjacent structures (e.g. IAN, maxillary sinus)

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9
Q

Give three alternative treatment options for a space other than implants

A
  1. Accept space 2. RPD 3. Bridge
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10
Q

How can you check that a bridge has been debonded?

A

Probe, visually, mobility, push and check for air bubbles, floss

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11
Q

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

A

Occlusion/Parafunction, length of span, abutment health re: caries and perio, OH, quality of enamel

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12
Q

What alternatives are there to a bridge?

A

Nothing, RPD, implant, overdenture

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13
Q

A patient attends with trauma to 11 and 12 that happened 2 days ago. The 12 crown is completely missing and has
a fracture below bone. The 11 has a pulpal exposure of 2mm. Both teeth are +ve to vitality tests. What is your
immediate management of 11?

A

Local anaesthetic for pain relief. Radiograph to assess any other pathology. Check for soft tissue damage and account
for any missing bits of tooth. As the exposure is large and over 24 hours a direct pulp cap is NOT indicated →
pulpotomy or pulpectomy. Can remove coronal pulp and dress w/ setting calcium hydroxide and reassess at n/v

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14
Q

A patient attends with trauma to 11 and 12 that happened 2 days ago. The 12 crown is completely missing and has
a fracture below bone. The 11 has a pulpal exposure of 2mm. Both teeth are +ve to vitality tests. 12 is deemed unrestorable. Why?

A

Subcrestal fracture makes the tooth impossible to restore satisfactorily. It will be difficult to gain a suitable seal and
this will leave the tooth vulnerable to 2° caries and bacteria reaching the pulp space via dentinal tubules. The tooth
has a closed apex at 19 years old so is not very vascular and unlikely to regain vitality

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15
Q

Give 2 replacement options for 12

A

RPD, Implant, bridge.

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16
Q

17-year-old patient presents with congenitally missing 22 and 23.
The patient wants implants, what other treatment options could you advise? (2 marks)

A

Removable partial denture, Bridge (4 unit, fixed-fixed), Orthodontics, Combined orthodontics and restorativ

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17
Q

17-year-old patient presents with congenitally missing 22 and 23 Give a problem relating to aesthetics (1 mark

A

Patient may be being teased due to gap in teeth
Patient may be psychologically affected by missing teeth

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18
Q

17-year-old patient presents with congenitally missing 22 and 23 Give a problem relating to function (1 mark

A

Patient may have difficulty eating, speaking due to gap in teeth.

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19
Q

17-year-old patient presents with congenitally missing 22 and 23Give 3 things a dentist would check (generalised) before referral (3 marks

A

Periodontal disease, Smoking habit, Diabetes, Osteoporosis, Bisphosphonates, Blood clotting disorder

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20
Q

Give 3 things an implantologist checks (local) (3 marks

A

Quantity of bone, Position of existing teeth (rotations, angulations), Oral hygiene

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21
Q

What are the options for replacement of central incisor crown fractured completely off to the root at short notice?

A

Adhesive cantilever with fractured crown as pontic, Provisional overdenture, Provisional post crown, Vacuum formed
splint with tooth.

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22
Q

Name 3 post materials

A

gold, NiCr, ceramic, titanium, carbon fibre (not in anterior teeth), stainless steel (only provisional

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23
Q

4 Indications for size of post

A

4-5mm GP remaining, post <1/3 root width, post:crown >1:1, at least half of the post length into the subcrestal root,
1mm of circumferential dentine/root

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24
Q

What may be used to cement the post?

A

GI luting cement, comp resin luting cement

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25
Q

Give 6 methods for removing fractured post

A

Ultrasonic vibration, Masseran kit, cut out for fibre posts, Stieglitz forceps, Eggler Post Remover, Sliding Hammer

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26
Q

What are the 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

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27
Q

Causative factors of erosion

A

Exxtrinsic - diet (carbonated drinks & alcohol), alcohol containing MW, asthma inhaler. Intrinsic – GORD, bulimia
nervosa, persistent vomiting.

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28
Q

How is erosion managed

A

Removal of cause: Dietary advice, high fluoride TP, Cover sensitive exposed dentine e.g. Seal and Protect, GIC,
Composite. Rule out medical causes, or treat GORD etc (Omeprazole, refer to GP). Use straws. Sports drinks/gels

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29
Q

What are the characteristics of an ideal post?

A

Parallel, non-threaded, cement retained

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30
Q

How can a post be assessed for suitability

A

Tooth suitable e.g. molars better w/pulp chamber retention instead – Length – 4-5mm GP remaining – Width - <1/3
root – Ferrule – 1.5mm dentine encircling tooth – Bone - >half post length into tooth – Ratio – crown:root >1:1

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31
Q

Give 3 post material

A

fibre e.g. glass, quartz. Metal e.g. cast gold, NiCr. Ceramic e.g. zirconia, ceramic

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32
Q

Give 3 core materials

A

RMGIC, composite, amalgam

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33
Q

Debonded bridge - conventional and pain. What is the differential diagnosis for the pain?

A

reversible pulpitis.

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34
Q

Patient has gold post and core that has debonded several times.
3 reasons why it has debonded (3 marks)

A

Post fracture, Core fracture, Root fracture at post level when not attributed to trauma (stress release), Untreatable
caries, Traumatic fracture, Furcation perforation (due to dentine pins), Inadequate moisture control

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35
Q

Fracture occurs at the junction of the post and core, give 3 reasons why? (3 marks)

A

Tooth structure loss, Age induced change in dentine, Biocorrosion of metallic post-core, Restorations & restorative
procedures, Loss of free water from RC & dentine tubules, Effects of endodontic irrigants & medicaments on dentine,
Bacterial interaction, Inadequate ferrule, Trauma – bruxist patient

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36
Q

What are the key features of a Nayyar core? (3 marks

A

Root treatment removed from canals, Amalgam packed into root canals and tooth built up, provides retention for
amalgam, Cannot be prepared for 24 hours

37
Q

What are 3 ways of removing a fractured post that is visible? (3 marks)

A

Ultrasonic vibration, Masseran kit, cut out for fibre posts, Stieglitz forceps, Eggler Post Remover, Sliding Hammer

38
Q

Pt presents with MCC in hand from upper central
Features of tooth that will make it successful/ unsuccessful to treatment (4)

A

Quality of tooth tissue present, Amount of remaining tooth tissue, Mobility, Periodontal status, Pulp status,
Crown:root ratio (favourable).

39
Q

Pt presents with MCC in hand from upper central 3 short term options to replace tooth and explain (6)

A

Re-cement failed MCC as a temporary crown - protects remaining tooth structure while new crown is produced. Make
a provisional crown (Protemp) and use a temporary cement (non-eugenol temporary cement). Adhesive cantilever
temporary bridge. Preformed anterior provisional crown

40
Q

Missing upper laterals - Type of bridge you can use to replace teeth (2

A

Mesial cantilever resin bonded bridge, Fixed-fixed

41
Q

Missing upper laterals - Type of bridge you can use to replace teeth (2) Abutment teeth to be used (2)

A

Permanent canine, Central incisor

42
Q

Missing upper laterals - Type of bridge you can use to replace teeth (2) 4 pieces of information needed from patient for technician to make bridge (4

A

Bridge design, Master impressions, Bite registration, Shade of teeth

43
Q

2 other alternatives for replacing missing teeth (2)

A

URA type denture, Implant

44
Q

What are the indications for a resin retained bridge?

A

Replace missing tooth/teeth (usually single), good enamel quality - unrestored tooth, large abutment surface area for
bonding, minimal occlusal load

45
Q

What are the contraindications? Resin-retained bridge

A

Long span, poor/insufficient enamel, parafunction, perio involved abutment.

46
Q

How do you cement a porcelain bridge?

A

Silane coupling agent. Covalent bond to oxide groups on the porcelain surface, which is hydrophilic. Hydrophobic C=C
reacts with silane in composite.

47
Q

How do you cement a metal bridge

A

10-MDP or META in composite luting cement. C=C to C-OH

48
Q

A pt with a conventional bridge with retainers on 11 and 22 and a pontic of 21 complains it is loose. You suspect
the retainer on 22 has debonded.
How can you detect this clinically/ what might you see?

A

Check visually, floss, probe, push and check movement, push and look for bubbles. You may see secondary
caries/demineralisation

49
Q

A pt with a conventional bridge with retainers on 11 and 22 and a pontic of 21 complains it is loose. You suspect
the retainer on 22 has debonded. List 4 design/preparation features that may have led to its failure

A

Poor abutment health, unfavourable occlusion/parafunction, poor crown:root ratio, no parallelism, over-tapered prep

50
Q

A pt with a conventional bridge with retainers on 11 and 22 and a pontic of 21 complains it is loose. You suspect
the retainer on 22 has debonded. 2 alternative bridge designs for this scenario: a resin retained bridge is not an option as the adjacent teeth are
prepped

A

Conventional Cantilever, Spring cantilever

51
Q

A patient attends with a debonded cast gold post and core. Give 4 reasons for a debond

A

Incorrect cementation material, contamination during cementation, unfavourable occlusion, inadequate or
overtapered post preparation.

52
Q

The core has fractured from the post. Give 3 reasons why?

A

Casting error, inadequate ferrule, trauma, parafunction

53
Q

Give 3 methods of retrieving a fractured post

A

Ultrasonic vibration, Masseran kit, cut out for fibre posts, Stieglitz forceps, Eggler Post Remover, Sliding Hammer

54
Q

What are the principles of crown preparation?

A
  1. Preserve tooth structure. 2. Retention and resistance form. 3. Structural durability. 4. Marginal integrity. 5.
    Preserve periodontium. 6. Aesthetics
55
Q

What are the stages of crown preparation?

A
  1. Occlusal reduction 2. Separation 3. Buccal reduction 4. Palatal/lingual reduction 5. Finishing.
56
Q

Give reductions for:
All metal crown ​–
MCC ​–
All Ceramic

A

All metal crown ​– Ax 0.5mm, chamfer (0.5mm)
MCC ​– buccal shoulder (1.5mm), palatal chamfer (0.5mm)
All Ceramic ​– 1.0-1.5mm
Occlusal reduction: all 2.0mm

57
Q

A patient attends with a fractured 26 MOD amalgam which has also been root treated. - What are the restorative options for this tooth?

A
  • Onlay with cuspal coverage
  • MCC/GSC
  • indirect restoration
58
Q

A patient attends with a fractured 26 MOD amalgam which has also been root treated. - The GP has been exposed for 6 months; what is your new treatment plan and why?

A
  • Requires to be re-root treated when the root has been exposed to the oral environment for more than 3 months as it puts the tooth at risk of bacterial invasion.
59
Q
  • What are the features of Nayyar core?
A
  • Retention obtained from the undercuts in the divergent canals and pulp chamber
  • 2-4mm of Gp removed from the canal and replaced with amalgam
  • Immediate placement and coronal preparation can be done at the same appointment
60
Q
  • Name 2 restorative materials in dentistry that can bond amalgam to tooth?
A
  • RMGIC
  • GI
61
Q

. Fractured core and crown on non root treated tooth

  • What 4 features of the remaining tooth will determine prognosis of the tooth?
A
  • Size of exposure
  • Time of exposure
  • Vitality of the tooth
  • Remaining tooth tissue
62
Q

. Fractured core and crown on non root treated tooth - What is the temporary treatment options?

A
  • Provisional over denture
  • Provisional crown
  • Vacuum formed splint with tooth
63
Q

Patient attends with caries on palatal of 12; sensitive to sweet under bridge – - What pulpal diagnosis would you give this tooth?

A
  • Reversible pulpitis:
  • discomfort is experienced when a sweet stimulus is applied and goes away within couple of seconds.
  • Short, sharp pain (a-delta and A-beta fibres; hydrodynamic microleakage stimulations), stops when stimulus is removed
  • No TTP
  • Pain on cold
  • Well localised pain
64
Q
  • What types of bridges can you get anteriorly?
A
  • Adhesive cantilever bridges
  • Fixed-fixed bridge
  • Conventional spring cantilever for upper incisor teeth
65
Q
  • What design would you do to minimise the risk of de-bonding? Anterior bridge
A
  • An adhesive cantilever bridge from tooth 11. If this de-bonded it would fall out and wouldn’t become a plaque trap and less risk of it leading to caries. Also if an adhesive cantilever bridge fails it is less destructive than alternative bridge designs.
66
Q
  • What 4 faults can occur to cause a de-bond of bridge
A
  • Poor moisture control during cementation
  • Unfavourable occlusion
  • Parafunctional habits (bruxism)
  • Trauma to face/oral cavity
  • Poor oral hygiene
67
Q
  • What material is used in a metal wing bridge?
A
  • Cobalt chrome or nickel chromium wing
  • Can have all ceramic Pontic and wing
68
Q

A patient presents with an adhesive bridge, the Pontic is replacing the 11 and the 12 and 21 have adhesive wings bonded to them as abutments, you fitted the bridge 3 months ago and it has de bonded.

  • What are the 4 potential reasons for debonding of a bridge clinically?
A
  • Poor moisture control during cementation
  • Unfavourable occlusion
  • Parafunctional habits (bruxism)
  • Trauma to face/oral cavity
  • Poor abutment health
  • Over tapered preparations to the teeth
  • Poor oral hygiene
69
Q
  • Cite 4 methods of checking of bridge debonding clinically?
A
  • Use your probe to check around the bridge abutments, Pontic and wings
  • Check visually if you can see any areas that have debonded
  • Check mobility of the bridge
  • Push and check for any air bubbles that May appear
  • Floss around the bridge
70
Q
  • Give 2 alternative to replace this tooth other than a bridge and 2 alternative bridge design (resin retained bridge cannot be used as adjacent teeth are prepped)
A
  • Replacement – RPD our Implants
  • Bridge design – conventional cantilever or spring cantilever
71
Q
  • You review the case and decide the person would be a good case for implant. What factors should be checked by a dentist before placement of Implants. Give 2 general and 2 local
A
  • General – smoking status; medical history – bisphosphonate use
  • Local – alveolar bone quantity, quality and levels; suitable space to place the Implant 7mm between crowns
72
Q

Patient arrives with MCC from tooth 11, the dentine core has fractured off inside the crown. The retained root is restorable and the patient has requested a new crown is made. - What 2 temporary restorations can be used for 11 during the endo?

A
  • RMGIC
  • Polycarboxylate cements
73
Q
  • Name 4 post core materials
A
  • Post:
  • Cast metal (Type IV gold/Au, SS)
  • Ceramics (aluminia, Zirconia)
  • Fibre (Carbon/glass fibre)
  • Core:
  • Composite
  • Amalgam
  • Glass ionomer
74
Q
  • State 2 factors determining post length
A
  • Custom posts
  • Cast directly from pattern fabricated in a patient’s mouth as an impression of the post hole and wax up of post in lab occurs
  • Post placement:
  • 4-5mm of root filling should be left apically which should be known from the CWL and the post takes up the rest of the canal
  • For sufficient alveolar bone support
  • At last 1⁄2 of post length must go into the root
  • Maximum of 1:1 post length/crown height ratio
75
Q
  • Give 2 materials used to cement post and core
A
  • GI luting cement
  • Composite resin luting cement
76
Q

Patient has central incisors crown fractured completely off to the root surface
- What are the options for replacement of this tooth?

A
  • Provisional over denture
  • Provisional post crown
  • Vacuum formed splint with replacement tooth
  • Adhesive cantilever with fractured crown as Pontic
77
Q
  • 4 indications for size of post measurement
A
  • Root length: 4-5mm root filling left apically
  • Post width: No more than 1/3 of root width at narrowest point and 1mm of remaining circumferential coronal dentine
  • Sufficient alveolar bone support: At least 1⁄2 post length must go into root, Max 1:1 post length/crown height ratio
  • Ferrule: At least 1.5mm height and width of remaining coronal dentine
78
Q
  • Give 6 methods for removing fractured post?
A
  • Ultrasonic vibration
  • Use of a Masseran kit
  • Eggler post remover
  • Miskito forceps with screw retained
  • Sliding hammer
  • Cut out for fibre posts
79
Q
  • What are the characteristics of an ideal post?
A
  • Parallel sided – avoids wedging and more retentive than tapered
  • Non-threaded passive – smooth surface incorporates less stress to remaining tooth than threaded which are active. Sand blasted to increase S.A. and bond strength
  • Cement retained – cement acts as a buffer between masticatory forces and post/tooth
80
Q
  • How can a post be assessed for suitability?
A
  • Should be placed in widest canal and avoided in curved canals
  • Only 1 canal should be used if roots are adequately long, bulky and straight
81
Q
  • Give 3 post materials
A
  • Cast metals (Type IV gold, Au, SS)
  • Ceramics (zirconia, aluminia)
  • Fibres (glass, Carbon)
82
Q
  • Give 3 core materials
A
  • Composite
  • Amalgam
  • GIC
83
Q
  • What are the indications for resin retained bridge?
A
  • Young teeth as it is less destructive
  • Good enamel quality
  • Large abutment tooth surface area present as you need to keep supra-gingivally by 0.5mm
  • Minimal occlusal load
  • Good for single tooth replacement
84
Q
  • What are the contraindications for resin retained bridges?
A
  • When there is insufficient or poor quality enamel
  • Shouldn’t be used for long span bridgework
  • When there is gingival recession or hard tissue loss
  • Heavy occlusal forces or patient has bruxism
  • When teeth are badly aligned, tilted or spaced
85
Q
  • How do you cement a porcelain bridge?
A
  • Relyx unicern adhesive resin or nexus kit
86
Q
  • How do you cement a metal bridge?
A
  • RMGI: Relyx luring cement, adhesive resin cement, GI or zinc phosphate
87
Q
  • What are the principles of crown preparation?
A
  • Preservation/conservation of tooth structure
  • Avoid weakening tooth structure and damaging pulp
  • Balance between retention, resistant and structure durability
  • Retention and resistance
  • Retention prevents removal of restoration along path of insertion or long axis of tooth prep – improved by limiting number of paths of insertion
  • Resistance prevents dislodgement of restoration by forces directed in an apical or oblique direction and prevents any movement of restoration under occlusal forces
  • Tapering inclination of opposing walls 6o
  • Length of walls to prevent tipping displacement
  • Path of insertion should be set before prep has begun
  • Structural durability
  • Restoration must contain bulk of material adequate to withstand forces of occlusion. It must provide enough space for a crown to prevent fracture, distortion or perforation
  • Achieved through occlusal reduction; functional cusp bevel and axial reduction
  • Marginal integrity
  • Prepare finish line configurations to accommodate robust margin with close adaption to minimise microleakage (chafer or shoulder finish)
  • Preservation of the periodontium
  • Shape the preparation such that the crown is not over contoured, smooth and its margin is accessible for optimum oral hygiene
  • Aesthetic considerations
  • Create sufficient space for aesthetic veneers where indicated – colour of surrounding teeth and facial symmetry and lip line considerations
88
Q
  • What are the stages of crown preparation?
A
  • Occlusal reduction - Retain some occlusal morphology taking into consideration relative thickness of crown material using tapered fissure bur or rugby ball
  • Separation - Use long tapered bur to separate from adjacent teeth
  • Buccal reduction - Prepare in 2 planes; shoulder for 1st reduction and then the 2nd for 2nd reduction but reduction follows the incline of tooth ensuring to avoid buccal pulp horn and should follow gingival contour
  • Palatal or lingual reduction - Completed in 1 plane for posterior and follows palatal contour for anteriors using chamfer bur
  • Shoulder or chamfer finish - Tampered bur to finish margins and smooth any lips of enamel/dentine
  • Check occlusal surface and clearance - Occlusion should be in ICP and excursion movements and have sufficient occlusal clearance
89
Q
  • Give reductions for:
  • All metal crown
  • MCC
  • Ceramic
A
  • Give reductions for:
  • All metal crown
  • Thickness – atleast >0.5mm
  • Non -functional cusps – atleast >1mm
  • Functional cusps – atleast >1.5mm
  • Chamfer/shoulder/shoulder with bevel
  • MCC
  • Non-functional cusps – 2mm
  • Functional cusps – 2.5mm
  • Incisal – 2mm
  • Shoulder/heavy chamber = 1.2-1.3mm
  • Between 10-20o taper
  • Ceramic
  • Non-functional cusps – 2mm
  • Functional cusps – 2.5mm
  • Incisal – 1.5-2mm
  • Shoulder/heavy chamfer

BDS4 Restorative Past Paper Questions (2 decks)

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