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APD > Interim restoration and protection of teeth > Flashcards

Interim restoration and protection of teeth Flashcards

1
Q

What does endodontic treatment aim to do?

How do you maintain them in the disinfected state?

A

Eliminate bacteria from the tooth

Maintained by preventing further ingress of bacteria during and after treatment or the treatment will fail

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2
Q

What would happen if you fail to keep the tooth sealed between appointments/

A

Will undo all of the disinfection undertaken in previous appointments

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3
Q

What are the 8 steps to successful endo?

A
  1. Diagnose and remove the cause of the disease
  2. Use aseptic technique
  3. Mechanically instrument the root canals to enlarge them
  4. Irrigate the canals with one or more antibacterial solution
  5. Medicate the canals with an antibacterial agent
  6. Temporarily restore the tooth to avoid bacterial ingress during and after treatment
  7. Fill the root canal system once disinfected
  8. Restore the tooth to normal funciton
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4
Q

What happens if you fail to comply to the 8 steps of successful endo?

A

Risk potential for bacterial already in the tooth to survive and proliferate or new organisms to enter the tooth and establish colonies

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5
Q

What is the result of bacterial already in the tooth surviving or new organisms entering?

A

Continuation of apical periodontitis which was already present or the development of a new apical periodontitis lesion

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6
Q

What is an interim restoration - prior to RCT?

A

A restoration already placed on the tooth after the previous restoration/caries/cracks have been removed
Such restoration will remain in place whilst the endodontic treatment is being performed and after the root canal filling has been completed until definitive coronal restoration is placed

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7
Q

What is a temporary restoration?

A

A restoration placed in an endodontic access

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8
Q

What is the main cause of pulp and periapical disease?

A

the presence of bacteria within the tooth
Need to consider how the bacteria entered the tooth initially - need to remove the path of entry to prevent further bacterial ingress

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9
Q

What are the most common paths of entry for bacteria?

A

Caries
Cracks
Exposed dentine
Broken down restoration margins

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10
Q

What do you do to be sure that the portals of entry for bacteria have been removed?
What does this allow investigation of?

A

The existing restoration should be replaced with a good quality, well-sealed restoration
Investigation of the tooth to assess restorability and overall prognosis

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11
Q

What should endo treatment never be preformed under?

A

failing or poor quality restorations or through temp restorations

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12
Q

What are the advantages of restoring with an interim restoration prior to endo treatment

A

Structural integrity
Support for weakend cusps
Coronal seal
RD easier for clamp to grip
An ideal access cavity will be cut
No risk of leakage through coronal restoration whenw using irrigant
A temp restoration will be retained better
A well restored tooth will be more comfortable and functional to the patient
The restoration can be used as core restoration if an indirect is required after

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13
Q

When may an interim restoration not be required?

A

If the tooth is unrestored or has a small intra-coronal restoration

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14
Q

What are the appropriate restorations for interims?

A

Composite
RMGIC
Amalgam

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15
Q

What materials shouldnt be used for interims?

A

IRM and GIC

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16
Q

What may large restorations or teeth with cracks need to be supported with?``

A

Metal band - orthodontic band or copper rings

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17
Q

What advantages does a metal band provide?

A

Support of weakened tooth structure, especially cusps

Prevention of progression of cracks

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18
Q

What principles should be applied when selecting a band to put on a tooth?

A

Ensure the band is the correct size for the tooth
A chemically curing cement should be used when luting the band (GIC or RMGIC)
Provide food margins to allow adequate OH
Ensure restoration harmonises with occlusion

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19
Q

What can be done instead of using a band to keep the heavily restored tooth intact?

A

Reduce the occlusal surface and rebuild the tooth using strong restorative material
Distrupt ICP forces so more evenly distributed
Options include amalgam or composite

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20
Q

What should ideally be done to teeth with crowns on before starting endo treatment?

A

Full coverage crowns should be removed prior to commencing endo treatment

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21
Q

If have good margins, can leave the crown on the tooth, what are the advantages of this?

A

Thorough assessment of underlying tooth structure
Identification of hidden pathology
Better orientation when undertaking endodontic treatment - follows anatomy better
Better coronal seal

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22
Q

When should crowns be left in situ?

A

If it is certain that there is no chance of coronal leakage or pathology hidden under the crown

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23
Q

How do you remove the crowns?

A

Take sectional putty impression of the tooth prior to removing the crown to use as stent to make temp rerstoration
Make a groove through the crown - through to tooth tissue/core material and twist an instrument into the groove
Porcelain need gauze ready as shatters

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24
Q

How do you make a provisional crown?

A

Use temporary crown compostie material e.g. Protemp or QuickTemp or cold cure acrylic in the putty stent
Ensure the crown is well fitting with excellent margins
Consider cementing with zinc phosphate not tempbond if retention not good
Consider sealing the dentinal tubules with dentine bonding agent
Alternatively - construct with a pre-formed metal crown adapted to fit with provisional crown material

25
Q

If have a provisional crown what should also be provided?

A

The access cavity should be restored with a temp restoration and not left open - so if the temp falls off the tooth will still be sealed

26
Q

How do you temporise teeth with post-crowns?

A

Prior to cementing a temp post-crown may be prudent to place cavit at the base of the crown - improves the seal
Best solution is to provide a temp post-crown and restor access with an adhesive restoration: GIC
Or a temp overdenture can be provided and access sealed with cavit

27
Q

What is the problem with temporising a tooth with post crown?

A

Can have as much contamination as teeth with no restoration in situ

28
Q

What does the temporary material do

A

Occupy the access cavity between appointments

29
Q

What is the main requirement of the temp material?

A

Provide effective and duable coronal seal

30
Q

What are the other properties of the temp material?

A

Ease of removal at next appointment
Obvious difference between the tooth tissue or interim restoration to allow removal without risking damage to tooth tissue
inexpensive

31
Q

What are potential temp materials

A

Zinc-oxide/calcium based materials e.g. cavit, coltisol
Zinc-oxide based reinforced intermediate restorative materials e.g. IRM
GIC
RMGIC
Reinforced GIC e.g. Ketac Fil, Ketac Silver
Composite

32
Q

How do you temporise the tooth between appointments?

A

Intermediate or provisional filling material e.g IRM or GIC
Then sponge or soft temp material e.g. cavit or soltosol
Then Calcium hydroxide paste in the canal

33
Q

how deep must the temporary material be in order to provide seal?

A

3mm in depth

34
Q

Why should cotton wool not be used under the temp restoration?

A

it wicks saliva and bacteria through the restoration

35
Q

What is the advantage and disadvantage of cavit?

A

Provides a better seal but can be difficult to remove

36
Q

What should be done on completion of treatment to stop contamination

A

Cut the GP back to the ADJ
Place GIC in the access cavity but leaving at least 3mm more coronally
Restore the coronal aspect with composite or amalgam
if an indirect restoration is required decide if it is to be undertaken immediately or following a period of monitoring

37
Q

Why do posterior teeth that have undergone endodontic therapy require protection?

A 
Reduced tooth structure
Access cavity 
Loss of marginal ridges
Axial forces can flex cusps
non-axial forces are more damaging
38
Q

Where does ICP direct forces?

A

Axially down posterior teeth

39
Q

What is lateral guidance in relation to root filled molars?

A

The teeth will either be involved in guiding lateral excursions - either canine or group guided

40
Q

Why is canine guidance preferred over group function?

A

Canine protects the posterior teeth

Group is damaging to posterior teeth especially if been root treated

41
Q

Why are premolars most at risk?

A

They are more commonly involved in group function compared to molars
Also weaker due to comparatively more tooth tissue loss

42
Q

What other forces are also extremely damaging for root treated teeth?

A

Non-working side interferences are

43
Q

What increases the risk of fracture?

A

As the tooth becomes more heavily restored

44
Q

Which is most at risk of fracture?

A

Occlusal access and both marginal ridges and MOD restoration and buccal/palatal restoration

45
Q

What do you need if have increasingly weakened tooth structures?

A

Cuspal coverage protection

46
Q

What are the 2 options for protecting posterior teeth with weakened structure?

A

Interim measures and definitive measures

47
Q

What are the different interim measures for protecting posterior teeth with weakened structure

A 
Occlusal adjustment to reduce loading 
Cusp reduction and overlay restoration long-term 
Cemented orthodontic band 
Interim crown (metal/composite/acrylic)
48
Q

What are the different definitive measures for protecting posterior teeth with weakened structure

A

Cusp reduction and overlay restoration
Onlay/Overlay indirect restorations
Full crown

49
Q

How do you carry out occlusal adjustment to reduce occlusal loading?

A

Use occlusal marking foil to highlight contacts in ICP
Use a different colour for marking foil to highlight contacts in lateral excursion
Then use diamond bur to keep ICP contacts - with opposing tooth and remove the lateral excursive contacts - reduces risk of cust fracture, when change guidance transfer to another tooth

50
Q

Why do you have to be careful when adjusting occlusal contacts?

A

Every change can have a knock on effect for other teeth; transfer of guidance to other teeth, introduction of interfering contacts, accidental loss of ICP contacts

51
Q

What should the occlusal adjustments be ideally fist be undertaken on?

A

study casts mounted on semi-adjustable articulator mouted with a facebow

52
Q

How do you go about cusp reduction and making an indirect restoration?

A 
Reduce cusps by 2-3mm with a bur
Use composite or amalgam to build tooth up
Ensure ICP contacts are restored
Keep excursive contacts to a minimum 
Onlay/overlay indirect restoration
53
Q

Why do cusp reduction and overlay restoration?

A

Provides strong, indirect restorative option whilst conserving tooth tissue compared to full coverage crown

54
Q

What are the onlay’s made from?

A

traditionally gold, but can also be constructed from high-strength porcelain or composite

55
Q

What can the onlays be cemented with?

A

Adhesive cement

56
Q

What is the advantage and disadvantages of using a crown for the posterior definitive restoration after being root filled?

A

Provides full coverage therefore, good seal
Remove more tooth tissue
Tooth will have an access restoration and full coverage prep - leaves very thin walls of dentine remaining

57
Q

Evidence for using crowns over direct restorations on root-treated teeth?

A

10 year survival of crowns (81%) compared to direct restorations (63%) on root-treated teeth Koidis 2007

58
Q

Evidence for how much more likely no indirect restorations likely to fail over crowns?

A

Root treated teeth without an indirect restoration 6x more likely to fail than crowns Aquilino, Caplan 2002

59
Q

Evidence for root treated with no crown failing in anterior teeth, premolars, molars

A

Anterior teeth - 4.8x higher
Premolars 5.8x higher
Molars 6.2x higher
compared to teeth with crowns - Salehrabi Rotstein 2004

APD (9 decks)

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