Intro to Operative Dentistry

Question 1

What are the 2 types of resorations and what is the one which therapists do?

Answer 1

Direct

–Soft malleable material

–Tooth built up before the material sets

–Single procedure

Indirect

–Fabricated outside the mouth, using an impression of the prepared tooth, gold /ceramics

–Inlays, onlays, crowns, bridges, veneers – when less tooth tissue remaining, strength required

–Bonded permanently with a cement

Therapists do DIRECT!

Question 2

What are the 4 reasons for restoring teeth?

Answer 2

• Caries
• Non-Carious Tooth Substance Loss (tooth wear)
• Replacement of previously failed restorations
• Aesthetics

Question 3

What are teh aims of restorations?

(4)

Answer 3

• To restore the integrity of the tooth surface
• To restore the function of the tooth
• To remove diseased tissue as necessary
• To restore the appearance of the tooth

Question 4

What is the aim in dentistry of restorations?

Answer 4

A healthy comfortable mouth with sound intact teeth. Restorations must be designed to prevent future problems & facilitate maintenance of this healthy environment.

Question 5

Be familiar with the Restoritive Cycle..

Answer 5

Question 6

When do you intervene a carious lession?

Answer 6

• Important to get right – tooth preparation is irreversible!!! (restorative cycle)
• Caries risk a factor
• Depends on extent of caries (e.g. affected but not infected dentine should be left)

Question 7

Whe do you place a fissure sealent?

Answer 7

Patient has High/medium risk of caries or special needs and Tooth within 2 years of eruption.

Any more than 2 years and DO NOT fissure seal just moniter.

Question 8

In occlusal carries if patient is Low risk/no other active lesions/regular attender whatdo you do?

Answer 8

Yes – Option 1. If radiographic evidence of dentine involvement – Sealant Restoration

Yes – Option 2. No radiographic evidence of dentine involvement - Monitor

No – Restore.

Question 9

In occlusal carries what do you do if it is cavitated?

Answer 9

Restore

Question 10

With Aproximal caries what do you do with the following situations?

• sound?
• RADIOGRAPHIC EVIDENCE

enamel only

reached ADJ

Dentine Involvement

• cavitated

Answer 10

• Sound – Leave
• Radiographic Evidence of a Lesion?

Enamel Only – Monitor & PREVENTION

Reached ADJ – Monitor & PREVENTION

Dentine Involvement

• Outer 50% of dentine with no cavitation. – Monitor & PREVENTION
• Inner 50% and/or cavitation - Restore

•Cavitated?? – Restore!!!!

Question 11

How can we tell if a proximal lesion os cavitated?

Answer 11

Separators and direct vision – no probing!!

Question 12

In cervical caries what do you do in the following situations?

• sound and stained
• stained and decalcified
• cavitated

Answer 12

• Sound and Stained – Leave
• Stained and Decalcified

Arrestable? Yes – Monitor

No – Restore

•Cavitated?? – Restore!!

Question 13

what are the 4 differnt ways of Non-carious Tooth Substance Loss?

Answer 13

• Attrition
• Abrasion
• Erosion
• Abfraction

Question 14

Attrition e.g. grinding tooth to tooth

(what is looks like)

Answer 14

Question 15

Abrasion •Tooth (mechanical habit)

(what is looks like)

Answer 15

Question 16

Erosion •Acid - Tooth

(what is looks like)

Answer 16

Question 17

Abfraction

• Tensile stresses from occlusal overload – increased susceptibility to abrasion and erosion.
• Loss of tooth

structure due to

flexural forces.

•Enamel rods #

and dislodge, tooth flexure

increases. V-shaped notch.

(what is looks like)

Answer 17

Question 18

What is the main aim of cavity preperation?

Answer 18

• Main aim is to remove infected dentine, and seal in the dentine tubules, thus preventing further micro leakage
• N.B. All cavity preparations should be kept as minimal as possible! Preserving as much sound tooth structure as possible.

Question 19

What are the different possibilities for preparing for a restoration?

Answer 19

• Traditionally -MAIN ONE
• Micro-preparation techniques
• Chemomechanical caries removal
• Sonic tooth preparation
• Air abrasion
• Lasers
• Ozone
• ART (Atraumatic Restorative Treatment)

Question 20

What is Micro-Preparation?

Answer 20

• Handpieces and burs of reduced size
• Aids in keeping any preparation cavities to minimum
• Should be used with magnification

Question 21

What is Chemo-Mechanical Caries Removal?

Answer 21

• An alternative to burs
• Application of Sodium hypochlorite (0.5%) (Carisolv)
• Advantages – ideal for nervous patients/ children
• Disadvantages – may not remove enough carious tissue, time consuming

Question 22

What is Sonic Preperation?

Answer 22

• Handpiece works by vibration rather than rotation
• Can be ‘safe sided’ diamonds
• Can make tooth preparation very precise
• Promising, more research required

Question 23

What is Air Abbrasion?

Answer 23

• Specific units needed
• Spray aluminium oxide particles through a fine angled nozzle – cuts through tooth tissue
• Advent 1940’s
• Reintroduced in 1980’s with bonded restorations.

Question 24

What is Lasers?

Answer 24

• Ideally can be used for soft and hard tissue removal
• Early stages – already used for soft tissue removal, although more evidence required for hard tissue removal

Question 25

What is Ozone?

Answer 25

• Relatively new concept
• Bacteria in caries identified with help of a laser
• Delivers ‘active’ oxygen molecules through suction cup to desired area
• Kills certain types of acidogenic bacteria – 1000x more powerful than bleach
• Advantages: quick, painless, initial studies – 10 sec – kills 99% of bacteria, viruses and fungi in a tooth
• Disadvantages: not much scientific evidence, only for single surfaces

Question 26

What is Atraumatic Restorative Treatment?

Answer 26

• Hand excavation
• Then restore with adhesive material (currently reinforced GI)
• •Adv: Ideal for under-developed countries, very nervous patients, children.*
• •Disadvantage – often not all caries is removed*