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restorative > key Rx things to learn > Flashcards

key Rx things to learn Flashcards

1
Q

determinants of cavity design

A

structure and properties of dental tissues
diseases
properties of Rx materials

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2
Q

principles of cavity design

A

1 - identify and remove carious E
2 - remove E to identify max extent of lesion at ADJ and smooth E margins
3 - progressively remove peripheral caries in D - from ADJ first and then circumferentially deeper
4 - only then remove caries over pulp
5 - outline form mod: E finishing, occlusion, requirements of Rx material
6 - internal design mod: internal line and point angles, requirements of Rx material

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3
Q

in what instances can you leave a small amount of carious D overlying the pulp?

A

risk of pulpal exposure high
good Rx seal can be achieved
pulp asymptomatic

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4
Q

affected D

A

softened
various levels of demineralised D that is not yet invaded by bacteria
inner carious D (does not require removal)
has sensitivity more pulpally
does not stain acid red with propylene glycol
should be left to remineralise

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5
Q

infected D

A 
outer carious D, bacterial plaque
softened and contaminated with bacteria
highly demineralised, lacks sensation
stains acid red colour with propylene glycol
should be excavated
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6
Q

when to intervene in a lesion

A 
if cavitated
pt can't access it for prevention
aesthetics
causing pulpitis
into D on xray
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7
Q

aims of cutting through E to gain access to carious D

A

1 - gain visual access to carious D requiring removal
2 - remove demineralised and often unsightly carious E
3 - create a sound peripheral E margin to which adhesive Rx can form seal

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8
Q

composite cavity design

A

no US E
no sharp internal LAs
bevel CSMA to increase area for bonding - composites adhere and support E
- so a light bevel increases SA for bonding and removes any US E at cavity edge

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9
Q

2 types of extent of D caries

A

anatomical extent of lesion - peripheral caries to caries overlying pulp at level of ADJ
histological depth of lesion - collagen and mineral content of carious D

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10
Q

peripheral caries and why should you never leave necrotic D at ADJ?

A

prevention of secondary caries entirely dependent on seal between Rx material and tooth at cavity periphery
should never leave necrotic D at ADJ - can’t be adhered to

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11
Q

configuration factor

A

ratio of bonded to unbonded surfaces

high = increased polymerisation contraction stress

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12
Q

contraction stress consequences

A

poor E prep margin
composite dimensional change
etch bond stronger than interstitial E strength
composite will fracture with weak E and D attached

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13
Q

cavity toilet phenomenon

A

cavity will contain loose E and D chippings following prep
wash out mix air, water, CHX
rinse and leave moist

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14
Q

CSMA

A

angle of tooth structure formed by the jct of a prepared (cut) wall and the external surface of a tooth
- jct - CSM

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15
Q

line angle

A

jct of 2 surfaces

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16
Q

point angle

A

jct of 3 surfaces

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17
Q

hybrid layer

A

resin impregnated D layer

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18
Q

5 requirements of occ stability

A

1 - stable contacts on all teeth of equal intensity and centric relation
2 - anterior guidance in harmony with envelope of fct
3 - disclusion of all posterior teeth during mandibular protrusive movement
4 - disclusion of posterior teeth on NWS during mandibular lat movement
- disclusion of posterior teeth on WS during mandibular lat movement

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19
Q

subalveolar fracture makes tooth unrestorable

A

lack of coronal tissue to bond to/support/retain Rx
inability to achieve moisture control for Rx
inability to take imp for indirect Rx
hard to establish marginal integrity
difficulty cleaning

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20
Q

causes of secondary caries

A 
marginal failure of an existing Rx
poor adaptation of Rx material
fracture of US E leaving exposed area
amalgam ditching of margins
failure to remove all of initial lesion
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21
Q

reasons Rx fail

A

poor material selection
- e.g. amalgam and gold Rxs near each other can cause corrosion due to galvanic activity
incorrect cavity rep
material manipulation
oral env
- access, thermal changes, forces, microbes, aq

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22
Q

manifestations from a traumatic occlusion

A 
fracture of Rxs/teeth
mobility
odontogenic pain not from infection
TW
may be associated with TMD
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23
Q

Nayyar core

A

retention obtained from the UCs in the divergent canals and pulp chamber
2-4mm GP removed from canal and replaced with amalgam
immediate placement and coronal prep can be done at same appt

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24
Q

methods for fractured post removal

A 
US
masseran kit
cut out for fibre posts
stieglitz forceps
eggler post remover
sliding hammer
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25
Q

3 types of contact

A

cusp tip to base of fossa
tripod contacts
- 3 points on the cusp engage 3 points around the fossa
unfavourable contacts
- on cuspal inclines (induces unfavourable lateral forces on teeth)
- none at all

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26
Q

options for immediate anterior tooth replacement

A

adhesive cantilever with fractured tooth as pontic
provisional overdenture
provisional post-crown
vacuum formed splint w tooth

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27
Q

what is cracked tooth syndrome

A

tooth cracked but nothing has broken off

technically a type of GS fracture

28
Q

S+S of cracked tooth syndrome

A 
sharp pain when biting
rebound pain when pressure released
pain when in occlusion and excursion
pain to cold but not to heat
eating/drinking sugary
not always able to localise to one tooth
29
Q

cracked tooth syndrome investigations

A

tooth sleuth
gentian violet/methylene blue stain (2-5 days to work)
transillumination
radiographs - not v beneficial but good for pulpal and perio

30
Q

cracked tooth syndrome tx

A 
composite Rx/bond
fixed ortho band round tooth
core build up and crown
RCT
XLA
31
Q

why obturate?

A

seal remaining bacteria
provide apical and coronal seal
prevent reinfection

32
Q

primary D

A

laid down during development
good for bonding
open tubules

33
Q

secondary D

A

laid down during fct

ok to bond to

34
Q

tertiary D

A

reactionary due to mild stimuli and reparative due to intense stimuli
poor for bonding due to poorly organised/sclerosed tubules

35
Q

transient sensitivity to thermal stimuli and pain on biting after large composite Rx

A 
polymerisation contraction stress
soggy bottom
insufficient coolant on prep
uncured resins entering pulp and causing irritation
high in occlusion
no lining
pulp exposure
fluid from tubules occupying space under Rx
36
Q

debonded post

A 
post fracture
core fracture
root fracture at post level when not attributed to trauma (stress release)
untreatable caries
traumatic fracture
inadequate moisture control
furcation perforation (due to D pins)
37
Q

fracture at jct of post and core

A 
tooth structure loss
age induced changes in D
biocorrosion of metallic post-core
Rxs and restorative procedures
loss of free water from RC snd dentinal tubules
effects of endo irrigants and medicaments on D
bacterial interaction
inadequate ferrule
trauma - bruxist pt
38
Q

criteria before obturating

A

asymptomatic
canal must be able to be dried
full biomechanical cleaning

39
Q

composite techniques

A

flowable at base to reduce contraction stress
incremental placement - low CF
2mm or less increments to avoid soggy bottom

40
Q

amalgam cavity

A 
UCs for retention
other retentive features e.g. lock and key, grooves, dovetail, isthmus
>2mm depth for sufficient strength
flat occlusal floor
CSMA 90 degrees
no US enamel
41
Q

causes of debonded post

A

incorrect cement
contamination during cementation
unfavourable occlusion
inadequate or over-tapered post prep

42
Q

detecting debonded bridge

A

check visually
floss
probe
push on it and check for movement/bubbles
may see secondary caries/demineralisation

43
Q

core fractured from post

A

casting error
inadequate ferrule
trauma
parafct

44
Q

Hanau’s quint

A

used for setting teeth

45
Q

handpiece safety

A

check backcap secure
tug tubing
pull bur hard

no lat movement/wobbliness of bur
smooth and no friction
run for 5s - sound

46
Q

why not ledermix for direct pulp cap?

A

devitalising agent

47
Q

consequences of high polymerisation contraction stress composite and how to avoid

A

shrinks
etch bond is stronger than interstitial E strength - leads to E fracture and failure
successive increments touching as few surfaces as possible - note final increments do not join E margins

48
Q

CF

A

ratio of bonded to unbonded surfaces

49
Q

stepwise

A 
remove caries at periphery and ADJ
remove infected D if you can
give pulp time to repair and lay down D
RMGI/GI over caries
6m later re-enter, remove hardened D (caries arrested as good seal), restore
50
Q

why place flowable at base?

A

good adaptation and mediate contraction stresses

51
Q

advantages of composite inlays/onlays

A

avoids open/poor contacts and poor proximal/occlusal morphology
avoids polymerisation contraction and stresses
avoids cuspal flexure

52
Q

disadvantages of composite inlays/onlays

A

more destructive - UCs must be removed/blocked out

53
Q

astringent

A

ferric sulphate

54
Q

how to differentiate the 2 layers of dentine caries

A

solution of basic fuchsin

55
Q

if pulp exposed?

A

caoh

56
Q

if pulp not exposed?

A

RMGI

57
Q

aims of caries removal

A

maintain pulp vitality
eliminate D infections by removing, deactivating or sealing in bacteria
conservation of intact tooth structure

58
Q

should you bevel boxes for amalgam?

A

no

59
Q

should you probe uncavitated carious E?

A

no

60
Q

when can you leave a stain?

A

only if hard to probe - but must remove from ADJ

61
Q

where is tubule density higher?

A

by pulp

62
Q

composite where should you avoid CSMs?

A

in areas of occlusal contact

63
Q

removing a Rx

A

never remove by cutting around the edges - excessively increase size of cavity
start from centre of Rx and cut towards edge

64
Q

never remove healthy tooth tissue unless:

A

material for Rx requires it
margins of cavity in contact with another tooth surface
margins of cavity cross an occlusal contact

65
Q

which fibres are stimulated in reversible pulpitis?

A

A fibres

66
Q

which fibres are stimulated in irreversible pulpitis?

A

C-fibres

67
Q

how do D tubules change as they approach the pulp

A

they increase in number and diameter

so deeper cavity = increased D permeability

restorative (12 decks)

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