ISCE Flashcards
What diet advice can you give to a patient?
- limit consumption of food and drinks containing sugar
- drink only water in between meals
- snack on foods which are low in sugar e.g., fresh fruit, carrot sticks, breadsticks, cheese
- do not eat or drink after brushing at night
- be aware of hidden sugars in foods and the acid content of drinks
explain to a patient how sugar contributes to caries and further pulp infection
sugar fuels the growth of harmful bacteria in the mouth which produce acid that damages tooth enamel
demineralisation of enamel occurs and if the acid attacks are frequent it doesnt have the time to repair itself so it weakens. this eventually forms cavities in the teeth
if left untreated the decay can progress to the softer layer under enamel and further reach the pulp where the nerve of the tooth is. this will cause pain and infection
what is the fluoride concentrations for toothpaste for children at low risk of caries?
under 3 years old - 1000ppm smear
3-9 years old - 1000-1500ppm pea size
10+ years old - 1450ppm pea sized
what is the recommended fluoride concentration in toothpaste for children at a high risk of caries?
under 3 years old - smear of 1450ppm
3-9 years old: pea sized 1450ppm
10+ years old: pea sized 2800ppm
when do we place fissure sealants?
as soon as the permanent molars erupt
what types of fissure sealants are available and why may you use each type?
resin based (1st choice) - child is cooperative, seal all buccal bits and fissured
GI - precooperative child
what are the recommendations for fluoride varnish application?
for children aged 2+: apply 2 times a year
for children aged 2+ at high risk of caries: apply 4 times a year
2-5 years: 0.25ml
5-7 years: 0.4ml
what fluoride strength if fluoride varnish?
22600ppm
fluoride varnish contraindications?
elastoplast/ colophony allergy
hospitalisation due to asthma
what is the general guidance for treatment of children at high risk of caries?
- hands on toothbrushing advice at every recall
- provide diet advice at every recall
- recommend the use of higher fluoride toothpaste (can prescribe 2800ppm for aged 10+)
- fissure seal palatal pits on upper laterals, occlusal surfaces of Ds, Es, 6s and 7s
- optimal fluoride varnish application -4xyear
what are the indications for hall crowns?
- interproximal caries
- multisurface caries
- pulp treated teeth
- retaining MIH molars
must be a clear band of dentine between caries and pulp
what are the contraindications for hall crowns?
- pulpal symptoms or caries close/ in pulp
- patients at risk of infective endocarditis
- insufficient tooth remaining to retain crown
how do you choose the correct size of hall crown?
you will feel a spring back when seating on tooth
what are hall crowns cemented with? and what may you want to warn the child of when cementing the crown?
GI cement - salty taste
what is your post op advice for hall crowns?
a high bite is normal and will settle
post op pain relief may be needed
recall in 3 months
how long are separators placed for prior to hall crown?
3-5 days
when may you refer a child patient with a full deciduous dentition to ortho?
severe skeletal discrepancies
delayed dental development
missing/ supplemental teeth
advice for balancing/ compensating extractions
when may you refer a child patient with mixed dentition to ortho?
- severe skeletal patterns where early treatment may be appropriate e.g., developing class II/III
- dental anomalies
- teeth in unfavourable conditions e.g., canines
- impacted 6s
- infraoccluded teeth
- crossbites
- FPMs have poor prognosis
- advice following trauma of permanent teeth
what is the general signs of normal development in the mixed dentition?
normal eruption pattern
contralateral teeth erupt within 6/12
midline diastema normal
maxillary canines palpable at 10 years old
why is a history of trauma important to an orthodontist?
ankylosed teeth will not comply with ortho treatment
aetiology of hypodontia?
single gene defect - MSX1
sequelae of severe disease and cancer tx in early childhood
syndromes: ectodermal dysplasia, downs syndrome, cleft lip/palate
what teeth are most commonly affected by hypodontia?
lower 5s
upper 2s
upper 5s
lower 1s
what teeth should a child have at 6months old - 1 year?
upper and lower As
what teeth should a child have at age 9 months - 1.5years?
upper and lower As
upper and lower Bs
what teeth should a child have from the age 1 year - 18 months?
upper and lower As
upper and lower Bs
upper and lower Ds
what teeth should a child have from the age 1.5year - 2 years old?
upper and lower As
upper and lower Bs
upper and lower Ds
upper and lower Cs
what teeth should a child have by the age 2- 2.5 years?
full dentition
what permanent teeth should a child aged 6 have?
upper and lower 6s
lower 1s
what permanent teeth should a child age 9 have?
upper and lower 6s
upper and lower 1s
upper and lower 2s
lower 3s coming in
what permanent teeth should a child aged 7 have?
upper and lower 6s
upper and lower 1s
lower 2s coming in
what permanent teeth should a child aged 8 have?
upper and lower 6s
upper and lower 1s
lower 2s
upper 2s coming in
what permanent teeth should a child aged 10 have?
upper and lower 6s
upper and lower 1s
upper and lower 2s
lower 3s
4s and upper 5s coming in
what permanent teeth should a child aged 11 have?
upper and lower 6s
upper and lower 1s
upper and lower 2s
lower 3s, upper 3s coming in
upper and lower 4s
upper and lower 5s coming in
upper and lower 7s coming in
what permanent teeth should a child aged 12 have?
everything bar 8s and maybe 7s
at what age do we palpate the buccal sulcus for upper canines?
8-9
how do we classify supernumerary teeth?
by position and/or shape
position: mesiodens, paramolar
shape: conical, tuberculate, supplemental, odontoma
what supernumerary teeth are found in the midline maxilla? are they of concern?
conical mesiodens
often impede eruption
describe tuberculate supernumerary teeth? are they of concern?
barrel shaped teeth which dont usually erupt
often impede eruption of others
what are supplemental teeth?
supernumerary teeth of normal anatomy
tend to erupt
often extra lateral, premolar
what are odontomes?
benign odontogenic tumours which dont erupt
complex or compound types
what is the most common microdont? is it of concern?
a peg lateral
normally associated with palatally ectopic canines
what are the 2 types of macrodonts?
gemination
fusion
what is of concern with a tooth which has dens evaginatus?
the dentine on the additional cusp may become exposed as it is worn down
the extra cusp contains pulp horn so there is an increased risk of the tooth losing vitality
aetiology of dilaceration?
acquired defect
trauma to the primary tooth - avulsion/ intrusion
aetiology of MIH?
early childhood illness - high fevers, infections, hypoxia
during birth - prematurity, assisted delivery, SCBU
genetic predisposition
what questions may you ask to differentiate MIH from AI from fluorosis?
AI - family history, primary dentition affected too
fluorosis - excessive toothpaste consumption, water source what country
clinical appearance of MIH?
affects cusps and smooth surfaces
white - yellow - beige - brown
fractures cusps (PEB)
variation in severity
symptoms of MIH?
sensitivity
what are treatment options for MIH molars?
fissure seal
hall crown
onlays cuspal coverage
restoration
xla
what are treatment options for MIH incisors?
microabrasion
whitening
composite camouflage/ veneer
do nothing
resin infiltration
what are the considerations for xla of MIH FPMs?
restorability
age of pt and dental development: bifurcation of 7s
symptoms - infection
xray - presence of 8s and 5s
crowding/ class I (ideal)
what is a balancing extraction?
taking teeth from same arch
what is compensating extractions?
take teeth from upper and lower arch on same side
when may you want to use SDF?
pt high risk of caries and precooperative
treatment is challenged by medical conditions
pt has several carious lesions that cant be treated in 1 visit
pts without access to dental care
how often are bitewings taken?
high caries risk - 6/12
low caries risk (primary dentition) - annual
low caries risk (permanent dentition) - 2 yearly
why can immature teeth withstand trauma better?
open apex - larger vascular supply
what are the trauma investigations?
sinus
colour
TTP
mobility
EPT
ethyl chloride
percussion note
radiograph
what signs may imply a safeguarding issue?
swellings
back of neck bruising
multiple bruises at different healing stages
frenum injury
black eye
lacerations
a tooth has been traumatised.
it is displaced with mobility and there are signs of root fracture.
diagnosis and treatment?
diagnosis: root fracture
treatment:
if coronal segment is displaced, reposition and splint for 4 weeks
if cervical fracture, splint for 4 months
monitor pulp status for 1 year
in mature teeth, if fracture is above alveolar crest, consider post core and crown
a tooth has been traumatised.
it is displaced with mobility but no signs of root fracture.
diagnosis and treatment?
diagnosis: extrusion
treatment:
reposition under LA and splint for 2 weeks
monitor pulp status
a tooth has been traumatised.
it is displaced but has no mobility. multiple teeth are moving as a unit.
diagnosis and treatment?
diagnosis: alveolar fracture
treatment:
reposition segment and splint for 4 weeks
suture any gingival lacerations
monitor pulp status
a tooth has been traumatised.
it is displaced but has no mobility. multiple teeth do not move as a unit. it looks infraoccluded.
diagnosis and treatment?
diagnosis: intrusion
treatment (incomplete root formation):
allow for re-eruption without intervention for 4 weeks. no re-eruption = ortho
monitor pulp status
treatment (complete root formation):
<3mm - allow re-eruption
3-7mm - surgical/ ortho
>7mm - surgical
pulp death is likely: initiate RCT at 2 weeks with calcium hydroxide
a tooth has been traumatised.
it shows no displacement and has mobility. It is TTP.
diagnosis and treatment?
diagnosis: subluxation
treatment: splint for 2 weeks for comfort and monitor pulp status for 1 year
a tooth has been traumatised.
it is not displaced and has no mobility.
diagnosis and treatment?
diagnosis: concussion
treatment: monitor pulp status for 1 year
treatment for enamel fracture?
bond fragment back on or restore with composite
treatment for enamel dentine fracture?
bond fragment back on after rehydrating in saline for 20 mins
restore with GIC/ composite
place CaOH liner if close to pulp
treatment for enamel-dentine-pulp fracture?
partial pulpotomy/ pulp cap followed by restoration
treatment for crown-root fracture with no pulp exposure?
stabilise mobile fragment
if not possible, extract and cover with GIC
ortho extrusion of non mobile fragment, RCT, and crown lengthen etc
treatment for a crown-root fracture with pulp exposure?
stabilise of extract mobile fragment
immature root: pulpotomy
mature root: pulpectomy + GIC/ composite
what advice should you give to parent/ teacher/ gaurdian on the phone if a childs tooth has been avulsed?
- reassure the patient
- hold the tooth by the crown (white part) and avoid touching the root
- if the tooth is dirty, rinse with milk, saline or the pts saliva, avoid scrubbing
- if possible, replant tooth immediately into socket and get pt to gently bite down on a handkerchief/ napkin
- if replantation not possible, store the tooth in milk, saliva or saline. if these are unavailable store in water
- visit dentist asap
what are the steps in replanting an avulsed tooth?
- clean and soak tooth in saline to remove dead cells from root surface
- LA
- irrigate socket with saline
- reposition any socket fracture
- replant tooth with gentle pressure
- suture any gingival lacerations
- take xray
- apply 2 week splint
- prescribe abx
- if tooth came in contact with soil - refer to GP for tetanus booster
- start RCT after 7-10 days
- 2 week follow up, remove splint
review 1,3,6,12 months then annually for 5 years
what are some considerations if an avulsed tooth has been out the mouth for more than 60 minutes?
removal of non-viable tissue
consider RCT prior to replanting
warn pt of ankylosis
how does treatment of an avulsed tooth differ if it has an open apex?
same steps to reimplantation but avoid RCT unless evidence of necrosis
post op advice for a reimplanted avulsed tooth?
avoid contact sports
soft diet for 2 weeks
brush teeth after every meal with a soft toothbrush
chlorhexidine mouthwash 2xday for 7 days
what type of trauma would you use a rigid/ flexible splint?
alveolar fracture
when would you perform a direct pulp cap?
immediate pinpoint exposures
how would you treat a tooth with signs of pulpal necrosis?
primary tooth: xla
permanent tooth with closed apex: RCT
permanent tooth with open apex: RCT with MTA apical stop
how would you treat a tooth with pulpal obliteration?
primary tooth: no rx unless sympotmatic, xla
permanent tooth: no rx unless symptomatic, RCT but very difficult
how would you treat a tooth with external inflammatory resorption?
RCT
how would you treat a tooth with cervical resorption?
RCT if necrotic
how would you treat a tooth with internal inflammatory resorption?
RCT
how would you treat a tooth with replacement resorption?
monitor
what are treatment options for infraoccluded teeth?
decoronation: allow root to bury beneath mucosa and resorb into bone then implant
when would you decide to use an active clamp for rubber dam?
if the tooth is badly broken down or partially erupted
when would you decide to use an anterior clamp?
teeth with minimal coronal structure or retraction of gingival tissues for placement of composite/ GI cervically
what shape is the access cavity for incisors? how many canals would you find?
triangle (base at the incisal edge)
1 canal
what shape is the access cavity for canines? how many canals would you find?
oval
1 canal
what shape is the access cavity for premolars? how many canals would you find?
oval
1 canal except for upper 4 has 2 (P and B)
what shape is access cavity for maxillary first molars? how many canals would you find?
triangle in mesial section of tooth - base is buccal and point extends down to palatal
4 canals (MB1 MB2 DB P)
what shape is the access cavity for maxillary second molars? how many canals would you find?
triangle in mesial portion of tooth
3 canals (MB DB P)
what shape is access cavity in mandibular first molars? how many canals would you find?
triangle mesial to distal
3 canals (MB ML D)
what shape is access cavity in mandibular second molars? how many canals would you find?
triangle mesial to distal
3 canals (MB ML D)
what are the properties of GP?
biocompatible
thermoplastic
radioopaque
insoluble
does not support bacterial growth
easy to manipulate and adapts well with compaction in canals
what do you use for interappointment medicament for RCT? what are its properties?
non setting calcium hydroxide
- kills bacterial
- reduces inflammation
- helps eliminate apical exudate
- controls inflammatory root resorption
what are the 4 irrigants that can be used for RCT? what are their properties?
sodium hypochlorite - bactericidal and dissolves organic debris
10% citric acid - removes organic material
17% EDTA - softens dentine and removes inorganic material
2% chlorhexidine - antimicrobial and removes smear layer
what are the available hand instruments for endo and what are they made from?
stainless steel
- K file
- Flexofile
- Hedstrom file
what are the properties of rotary NiTi files with added M wire?
super elasticity
shape memory
what is the aim of a pulpotomy?
to remove infected pulp and treat remaining healthy pulp to maintain a tooths vitality and to allow root development if an immature tooth
what are the stages of a pulpotomy?
- local
- rubber dam
- amputate pulp with high speed until you see bleeding
- arrest bleeding with cotton wool soaked in saline/ LA
- dress exposed pulp with non setting CaOH/ MTA
- cover with RMGI cement only covering dentine and light cure
- composite restoration
what is the aim of an immediate composite banadage?
seal over exposed dentine tubules - typically for pts with poor cooperation, limited time, purposely restoring a tooth short of occlusion
what are the stages in an immediate composite bandage?
- moisture control
- etch, prime and bond
- pre rolled composite to cover pulp cap and exposed dentine
what are the stages placing a post?
- remove GP from pulp chamber
- remove GP with gates gliden leaving 4-6mm apically
- shape post hole with twist drill series, ensuring diameter no greater than 1/3 root
- relyX light and chemically cured
- place post
when preping a tooth for a crown what is the desired taper?
6 degree
what are the functioning cusps?
FLUP (facial lower upper palatal)
what are the reductions and margins for a metal crown?
occlusal 1mm
axial 0.5mm
any finishing margin
what are the reduction and margins for metal ceramic crown?
occlusal 1mm, axial 0.5mm, chamfer
occlusal 2mm, axial 1.5mm, shoulder
what are the reductions and margins for ceramic crown?
occlusal 1.5mm
axial 1mm
chamfer
what is the ideal pontic design?
modified ridge lap
what type of bridge may you want to use when there are unrestored/ minimally restored teeth with good quality enamel? why?
resin retained cantilever
minimal prep required: cingulum rests, mesial slots, occlusal rests
where is nasion?
the most anterior point of the frontonasal suture in the median plane
where is sella?
mid point of the pituitary fossa (sella turcica)
where is point A?
deepest concavity on the maxilla
where is point B?
deepest concavity of the mandibular symphysis
where is ANS?
tip of the bony anterior nasal spine in the median plane
where is PNS?
tip of the posterior nasal spine
where is Pognion?
most anterior point on the mandibular symphysis
where is menton?
most inferior point on the mandibular symphysis
where is gonion?
most posterior and inferior point on the angle of the mandible (intersection of ramus plane and mandibular plane)
what plane lines are drawn on a lat ceph?
S-N (cranial base)
ANS-PNS (maxilla)
Go-Me (mandible)
N-A
N-B
Upper and Lower incisor
what does the SNA angle measure?
maxilla in relation to cranial base
what does the SNB angle measure?
mandible in relation to cranial base
what does the ANB angle measure?
maxilla and mandible in relation to each other
what does MMPA measure?
intersection of mandibular and maxillary plane
what is the rickets esthetic plane?
soft tissue chin and nose tip
what does MOCDO stand for?
missing
overjet
crossbite
displacement
overbite
what comes under missing and scores 5?
Cleft lip/palate
Impacted teeth
Hypodontia >4 teeth
what overjet scores 5?
overjet >9mm
reverse overjet >3.5mm with masticatory issues
what overjet scores 4?
> 6mm overjet
3.5mm reverse overjet w/o masticatory issues
what overjet scores 3?
> 3.5mm overjet with incompetent lips
1mm reverse overjet
what overjet scores 2?
> 3.5mm overjet with competent lips
what crossbite scores 4?
crossbite with >2mm displacement
what crossbite scores 3?
crossbite with >1mm displacement
what crossbite scores 2?
crossbite with <1mm displacement
what displacement scores 4?
> 4mm contact point displacement
what displacement scores 3?
> 2mm contact point displacement
what displacement scores 2?
> 1mm contact point displacement
what overbite scores 4?
increased and complete overbite with trauma
>4mm openbite
what overbite scores 3?
increased and complete overbite no trauma
>2mm openbite
what overbite scores 2?
> 3.5mm overbite
1mm openbite
describe Kennedy class I?
bilateral free end saddles
describe kennedy class II?
unilateral free end saddle
describe Kennedy class III?
bounded saddle not crossing the midline
describe Kennedy class IV?
unilateral saddle crossing the midline
what tool is used to assess anxiety?
MDAS
MCDAS (for children)
what is used for inhalation sedation and how is it administered?
nitrous oxide/ oxygen - through a small nasal mask
what state is the patient put in with inhalation sedation?
a state of relaxation and mild euphoria
quick onset and recovery
patient remains conscious and responsive throughout
what drug is used for intravenous sedation and how is it adminstered?
midazolam - administered through a vein in arm/ hand
what state is the patient in with IV sedation?
deeper level of sedation
patient is conscious but may have little to no memory of the procedure (amnesia)
may last several hours
what drug is used for oral sedation and how is it administered?
diazepam - taken as tablet/ liquid form before dental appt
what state is the patient in with oral sedation?
calm drowsy state
takes 30-60 mins to take effect
what drug is used for GA and how is it administered?
propofol - administered by an anaesthetist in hospital
what state is the patient in under GA?
completely unconscious
will be completely unaware of procedure
what is the sequence of burs used to create an access cavity?
round diamond high speed - 1mm into enamel for the outline
long fissure diamond high speed - deepen access toward roof
gates glidden (slow speed long shank) - remove roof of pulp chamber
non end cutting high speed - flare and finish axial walls
what is present in anterior teeth that must be removed with the gates glidden during access cavity?
palatal shelf
what does the shape of an access cavity depend on?
position of canal orifices and pulp horns
how is the long shanked round bur used for enlargement of the access cavity?
it works on the dentinal walls with a brushing motion to remove all dentine overhangs
explain access cavity prep for a canine?
initial outline cut at 45 degrees to palatal/lingual surface (1mm deep)
change to fissure bur and proceed down the long axis of the tooth
use long shank to remove roof of pulp chamber and palatal shelf with an upward stroke movement
what rpm and torque are protaper gold files used at?
300rpm
torque 4
what is the sequence of instrumentation?
- locate canals
- coronal flare with SX
- initial negotiation and measure WL, confirm apical patency
- create glide path
- shape canal to working length with protaper gold s1 and s2
- complete apical prep using sizes F1-F5 as determined by apical gauging
what instrument do you use to negotiate the canal?
size 10 ss flexofile
(can drop down sizes if toot tight)
if using radiograph to determine WL, what do you measure?
1mm within radiographic apex
at what point can you start creating the macro glide path?
once a size 10 file has reached WL and feels ‘loose’
what is used to enhance the glide path?
proglider
what rpm and torque is proglider used at?
300rpm
torque 2
list important guidelines for safe use of rotary instruments?
constant speed of rotation with torque control
irrigation before engaging file
light pressure and progress slowly, withdraw when resistance is felt
do not stop/start in the canal
clean files regularly during use
irrigate, recapitulate, and irrigate between each rotary file
what rpm and torque are the shaping files used at?
300rpm
torque 4
what does apical preparation determine? and what process is used?
the diameter of the canal at the apical constriction
apical gauging
what do finishing files do?
shape the apical 1/3
what is a reproducible reference point when determining the WL?
cusp tip
what is the apical constriction?
the narrowest part of the junction between pulpal and periodontal tissue
how do you use the EAL?
size 10 file
irrigant in canal but not pulp chamber
ask pt to wet lip clip with tongue
ensure no contact with metal restorations
use a little glyde to improve conductivity
what is apical patency?
the ability to pass a small flexofile passively through the apical constriction without widening it
what is used for final irrigation?
3ml sodium hypochlorite
3ml citric acid
3ml sodium hypochlorite
what are the stages after final irrigation?
dry canals with corresponding size of paper points
dress with non setting calcium hydroxide
cotton wool/ spongue/ septotape
coltisol
GI
what is used instead of non setting calcium hydroxide for an emergency pulpotomy?
ledermix/ odontopaste
contraindications for ledermix/ odontopaste?
pregnancy and breast feeding
known hypersensitivity to corticoids and clindamycins
what is retention form?
retain restoration in an occlusal direction
what is resistance form?
prevent dislodgement to lateral and oblique forces
what are the reductions and finishing margins for an all metal crown?
0.5mm axial
1mm occlusal
any margin
what are the reductions and finishing margins for ceramic bonded to metal crown?
0.5mm for metal + 1mm for ceramic = 1.5mm axial
1mm occlusal for metal
2mm occlusal for ceramic
chamfer for metal
shoulder for ceramic
what are the reductions for a full ceramic/ composite crown?
0.6-1mm axial
1-1.5mm occlusal
chamfer margin
what is the crown prep sequence?
- occlusal reduction
- axial reductions
- finishing line
- smoothing
how is the labial surface of an anterior tooth prepped for a crown?
2 plane reduction
what is the wing retainer on a resin retained bridge made from?
metal allow or fibre impregnated resin
what preparations can be performed for a resin retained bridge?
cingulum rest
gingival finish line
removal of undercuts
occlusal rests
where does a cingulum rest lie?
between the mesial and distal marginal grooves
how deep are resin retained bridge preps?
0.5mm into enamel
list some paediatric behaviour management techniques?
tell, show, do
behaviour shaping
reinforcement
modelling
desensitisation
what age must you be for IV sedation?
> 12 years
is midazolam still used for sedation?
no longer indicated in the UK
list some local causes of delayed eruption?
congential absence
crowding
retained primary tooth
supernumeraries
crown/ root dilaceration
dentigerous cyst
trauma to primary tooth
difference between type I and II DI?
I - associated with osteogenesis imperfecta
II - teeth only
what are the sequelae of trauma to primary teeth?
discolouration
- grey/reddish (this can be reversible)
- grey (necrosis)
- yellow (pulp obliteration)
ankylosis
pulp necrosis
max dose of LA for a child pt?
4.4mg/kg
what file is used to locate the canals?
DG16
what files are used to negotiate canals and determine WL?
08 and 10 flexofiles
what file is used to verify apical patency and confirm glide path?
flexofile
what file is used to enhance the glide path?
proglider
what speed and torque is proglider used at?
300rpm
2Ncm
what are the properties of non setting calcium hydroxide?
- kills bacteria and inactivates endotoxin
- reduces inflammation
- helps eliminate apical exudate
- controls inflammatory root resorpiton
what type of sealer is used for cold lateral compaction?
resin based (AH plus)
what is MTA?
calcium silicate cement
what are the properties of MTA?
- used as a root end filling material (apexification)
- creates a physical barrier
- releases calcium hydroxide when it sets
- biocompatible and can set in the presence of moisture
what is odontopaste?
antibiotic/ steroid paste
what are the properties of odontopaste?
- used for hyperaemic pulp
- decreases inflammation
- contains calcium hydroxide, clindamycin and a steroid
what is hypocal/ ultracal used for?
an interappointment medicament where there is persistent inflammatory exudate from periapical tissues
what does diagnostic mounting for conventional bridgework involve?
- imps of both arches
- facebow record
- casts mounted on a semi-adjustable articulator in ICP/RCP
what does diagnostic waxing for conventional bridgework involve?
- assess aesthetics and occlusion
- an impression of the wax up can be taken in silicone putty
- finalise the design
what must you ensure when doing conventional bridgework preparations?
parallel preps
how is the temporary bridge for conventional bridgework constructed?
- using the putty impression of the wax up
- fill with protemp
- cement with tempbond
when would you take occlusal registration for conventional bridgework?
if the casts couldn’t be mounted in ICP
for PFM bridgework what must you do before the porcelain is added?
try in the metal framework
what cement is used for trial cementation of conventional bridgework?
tempbond
what cement is used for permanent cementation of conventional bridgework?
traditional
RMGIC
what are causes of bridge failure?
loss of retention
mechanical failure
abutment issues (perio disease/ loss of vitality)
what design is usually used for a resin bonded bridge?
cantilever
how are resin bonded bridges classified?
by retention:
Rochette - perforated (macromechanical)
Maryland - electrolytically etched (micromechanical)
sandblasted (chemical)
what are sandblasted resin bonded bridges cemented with?
dual affinity cement (panavia) - chemical bond to enamel and the non precious alloy
advantages of resin bonded bridges?
- less expensive
- minimal/ no tooth prep
- no LA required
- potential for rebond if debond occurs
when would you consider a resin bonded bridge?
short-span single tooth edentulous spaces
sound abutment teeth
favourable occlusion
what are natal teeth?
teeth erupted at birth
what risks are associated with natal teeth? what must you warn the patient?
if they are excessively mobile they will need to be extracted due to aspiration risk.
likewise if they are impending a baby’s ability to feed.
removing this means that the child wont have incisors until they are 6 (permanents)
at what age should a child be aided with toothbrushing?
7
what is MIH?
molar incisor hypomineralisation
an qualitative enamel defect - enamel is of normal thickness but it is not mineralised.
you suspect a child has MIH, what questions should you ask?
are the teeth sensitive to hot/ cold?
is there pain on brushing?
any childhood illness: high fevers, hypoxia, infections?
did mum have illness in the last trimester of pregnancy?
any issues during birth: prematurity, assisted delivery, SCBU?
family history?
what are differential diagnoses if you suspect MIH?
Fluorosis
amelogenesis imperfecta
chronological hypoplasia
trauma
what is the clinical appearance of MIH?
affects smooth surfaces and cusps
PEB
white-yellow-beige-brown
symptoms of MIH?
sensitivity to cold drinks and brushing
what are treatment options for MIH molars?
- do nothing
- xla (if infected/ pain)
- fissure seal (tricky due to poor bond)
- cuspal coverage
- hall crown (only temporary)
- restoration
what are treatment options for MIH incisors?
- microabrasion
- bleaching
- restoration
- composite camouflage
- traditional veneer
what scores IOTN5 for missing?
cleft lip/ palate
impacted teeth
hypodontia >4 teeth in a quadrant
what overjet scores IOTN5?
> 9mm overjet
3.5 reverse overjet w masticatory issues
what overjet scores IOTN4?
> 6mm overjet
3.5 reverse overjet no masticatory issues
what overjet scores IOTN3?
> 3.5mm overjet with incompetent lips
1mm reverse overjet
what overjet scores IOTN2?
> 3.5 overjet with competent lips
what crossbite scores IOTN4?
cross bite with >2mm displacement
what crossbite scores IOTN3?
cross bite with >1mm displacement
what crossbite scores IOTN2?
crossbite with <1mm displacement
what displacement scores IOTN4?
> 4mm contact point displacement
what displacement scores IOTN3?
> 2mm contact point displacement
what displacement scores IOTN2?
> 1mm contact point displacement
what overbite scores IOTN4?
increased and complete with trauma
>4mm openbite
what overbite scores IOTN3?
increased and complete without trauma
>2mm openbite
what overbite scores IOTN2?
> 3.5mm overbite
1mm openbite
