MA 1 Flashcards
1-Which of the following statements is true regarding the choice between doing a composite or amalgam restorations?
2-In comparison to amalgam restorations, composite restorations are:
3-Inter-rate reliability
4-research papers
5-performance of dental restorations
1-composite= more conservative
2-more technique sensitive but are more esthetically appealing
3-amt of agreement among raters, if high agreement= good
4-dont always describe calibration process
5-influenced by material used, level of experience, type of tooth, tooths position in arch, restorations design, restorations size, # of restored surfaces
—-#of surfaces restored & risk factor may influence the longevity of restoration
4-bleeding gums
5-sweet sensitivity
6-joint plain
7-slight dry mouth
4-gingivitis so restore gingival health
5-caries, so remove and restore
6-muscle sprain/TMD—relieve muscle discomfort
7-possible allergy induced—eval in the off allergy season & after use of biotene
1-bite block
2-night guard
3-constant contraindication of composite
4-restoration of appropriate proximal contact in all of the following but
1-child or regular adult—opening of mouth can be significant
2-bruxing appliance…splint—approx 2-3 mm in thickness
3-inability to isolate
4-inc retention form for restoration
1-Composite Indication
1- bonded composite= retained to tooth & strengthens unprepped tooth
- shrinkage from poly = stress
- incremental curing= max composite curing & min shrinkage
- wedge for proximal
- composite= bonded so prep= conservative, bulk isnt critical
- prep=unique, so findings directed towards final prep
- composite= insulative so doesnt need much protection w/ bases as other materials may
1-counterindications comp
2-indications comp
3-advantages
4-disadv
1-isolation= inadequare
- restorations onto root (cementum binding is poor)
- heavy occlusal stresses
- denture clasps engage composite material
2-small, moderate restorations w/ enamel margin
- esthetics considered for premolar/1st molar
- w/o heavy occlusal contact
- appropriate isolation
- build ups prior to future crowns
3-esthetics, conservative remocal, less complex prep, benefits of bonding (dec microleakage, strengthen tooth)
4-wear/shrinkage, more time for placement, more technique sensitive than allow etching, bonding & curing, more expensive than allow restorations
1-automatrix band system
2-sectional matrix systems
3-conical light tips
4-max thickness of a composite incrememnt
1-circumferential system (tofflemire)
2-composi-tight—garrison
3-translumination tips—inesrted into composite while curing, push composite proximally to help create contact
4-1-2 mm
1-single tooth indirect restorations
2-crowns
3-restorative dentistry
4-indirect restorations via crown fabrications
1-artificial replacement that restores missing tooth structure by surrounding part or all of the remaining structure w/ a material such as cast metals, porcelain or a combo of materials
2-restorations that fully or partially cover the tooth. “caps”
-indirect restorations because they are fabricated outside of the oral cavity
3-art & science of proper tooth form, function & esthetics while maintaining the physiologic integrity of the teeth
—but the restorative needs cant always be met w/ the use of direct restorative materials/techniques which is why indirect is commonly used
4-allows us to fabricate a restoration that meets the functional/esthetic needs of the patient through a combination of the preparation design, restorative materials & improve the strength/esthetics of compromised teeth.
1- not crown treatment plans
2-your job
3-emptor decernit
4-medical history
1-only patient care treatment plans that may include crowns
2-Find out the chief complaint/what the patient wants before making a treatment plan
- —your job is to correlate your finding w/ your patients chief complaint in order to determine the appropriate treatment plan
- –don’t make treatment plan decisions based on clinical impressions w/o clarifications from your patient
3-customer is always right….we, as dentists, need to provide quality patient care while also satisfying our customers
4-the need to correlate the dental treatment plan w/ the overall health status of the patient
i. e.= cardiovascular disease, diabetes mellitus, oncologic disease, pulmonary disease, & surgical hx
- medication list, h/o allergies to medications, recreational drug use, tobacco product use
- –usually controlled medical conditions aren’t typically contradicted to restorative treatment
1-dental history
2-dental examination
3-range of mandibular motion-opening
4-range of mand. motion-protrusive
4-range of mand. motion- lateral
1-the need to correlate the dental treatment plan w/ overall dental health care history as expressed by the patient
—dental care, periodontal disease, pulpal disease, & of caries
2-the need to correlate the treatment plan w/ your examination findings—head & neck exam, oral & oropharyngeal exam, exam of dentition & supporting structures
3-opening
- 15-20 mm of hinge opening
- 25-40 mm if translational opening
- 40-60 mm is normal maximal opening of an adult
4-protrusive
-8-11 mm
5–10-12 mm of max lateral translational movement in the frontal plane
1-lesion detection
2-restorative treatments indicated
3-material selection
4-composite
1-visual= cavitated & non cavitated
radiographic= E lesion, D1, & D2
transillumination- fiber optic (FOTI), operatory light
2-poor contour
- caries under/around restorations
- unaesthetic restorations
3-resin-esthetics—bonds to tooth structure, good wear resistance
RMGI-not as esthetic, bonds to tooth, lower wear resistance, Fl release
4-inorganic filler= quartz, silica, & glasses
coupling agent- silane
resin matrix- BIS GMA, UDMA
initiator= camphoroquinone (light activatior
1-inorganic filler
2-microfine fillers
3-radiopaque
4-not radiopaque
1-qurtz, lithium, aluminum, silicate, barium, strontium, zinc, ytterbium glasses = fine filler
2-colloidal silical particles
3-barium, strontium, zinc or yetterbium
—degree of radiopacity is proportional to the volume of the filler
4-quartz, lithium, and aluminum
1-macrofil
2-microfil
3-nanofil
4-hybrid
5-properties of composite
6-coefficient of thermal expansion
1-10-100 um
2-.01-.1 um
3-.005-.1 um
4- .4-1 um (small particle & microfill)
—nano hybrid= .005-.1 (tetric evo ceram)
5-poly shrinkage (caused by resin)
-gap formation in dentin margin—minimize by increment placement & curing in between
-wear resistance—infleunced by filler particle size/location/occlusion
-modulus of elasticity—stiffness, high module= stiff
microfill has lower module of elasticity than hybrid
6-dimensional change per unit change in temp
composite= 1-4 x’s coeff of thermal
Glass ionomer coefficient= same as tooth (better)
1-hybrid composite
2-microfil composite
3-microhybrid
4-nanofil
1-microfil + small particle
- inorganic filler content= 75-90% weight 60-80% vol
- surface = smooth patina surface texture
- improved mechanical properties
2-smooth, lustrous surface
- wear resistant/ less receptive to plaque
- filler content= 35-70% weight 20-60% vol
- mechanical= inferior, graeter poly shrinkage, more thermal expansion, low H20 sorption, low modulus of elasticity
- cervical lesions, flexure nder occlusal forces
- layered over hybrid
3-fine & microfine particles
85% by weight
4-80% by weight, high filler content
-highly polishable…& most popular compousre in use
***hybrid= good immediate & 12 mo color match
nano & microfilm= best surface appearance after 12 mo
1-classification of handling characteristics
2-flowable
3-packable
4-shade selection
5-lingual approach for prep
6-facial approach for prep
1-flowable & packable
2-low viscosity, .4-3 nanometers
- 30-55% vol w/ low modulus of elasticity
- high poly shrinkage
- low wear resistance
- cervical lesions & pediatric restorations
- low stress bearing restorations & liners under hybrid
3-high viscosity, 50-70% by vol
- low wear resistance (like enamel)
- posterior & proximal restorations…like handling of amalgam but may be more difficult to adapt to margins
4-prior to rubber damn bc dehydration= lighter tooth color
- composite changes color after polymerization
- –natural light, upright, no distracting makeup
5-lingual= preferred, conserves facial enamel…some unssupported, not friable enamel can remain
-additional enamel for bonding & shade selection isnt critical
6-lesion is facial, teeth are irregularly aligned & if facial access conserves teeth
1-access to prep
2-pulpal protection
3-pulpal exposure
1-direct bur towards lesion, perp to enamel surface
- entry angle puts bur as far into embrasure
- outline form to include peripheral exten, some undermined enamel is okay
- should not include prox contact area, or extend onto facial surface & sub gingival
2-small to moderate—no liner, bonding agent will seal dentin
3-direct cap, CAOH2, GI/RMGI linger bonding agent
composite
pink dentin= little RDT= indirect pulp cap, liner over pink area, DONT PUT LINER ON FACIAL SURFACE
1-bond enamel, not dentin
2-contraindications of bevel
3-large lesions
4-adjacent lesion prep
1-bc enamel has less h20 content & is highly mineralized
- greater H20 content, more organic & differences w/in dentin
- enamel & strength greater
2-dont remove prox contact
- lingual bevel not placed in heavy occlusal area
- margins apical to CEJ, w/ no enamel or little remaining enamel
- facial approach= same as lingual
3-retention pt can be placed at axioincisal
retention groove= axiocervical line angles in dentin if needed
4-PREP large surfaces first & then small but
restore small surfaces first & then large
1-restoration
1-mylar matrix for anterior composite
- confines restorative material, reduces excess material, assists w/ contours & protects adjacent tooth
- interproximal wedge= provents overhang
- etch—remove smear layer, open dentin tubulues, demineralizes dentin, leaving collagen
- dentin= moist for bonding
- bonding agent applied w/ agitation, light cured & hybrid layer formed
- incremental placement of composite= 2.0 (complete curing= less poly shrinkage & less gap formation= less micro leakage)
- gap formation & microleakage = greatest at margins w/ no enamel (cervical, apical to CEJ)
- stress from poly shrinkage exceeds bond strenght= gap formation
- immediate gap= white line margin
1-finishing & polishing
1-scalar for excess at gingival margin
30 fluted for gross reduction
points for concave areas
-interproximal strips can cause damage to tissue & gingival
- polishing done w/ abrasive pt or disc rotation from composite to tooth
- enhance pt
- brasler (green white)
- abrasive disc—-not usefule for concave, used to shape proximal line angle…but can damage tissue
- final polishing= silicone carbide brush
1-quality of image
2-radiographs your using
3-looking at radiographs
4-identifying radiographs
5-systematic process
1-contrast/density
region of interest
normal tissue that surrounds
geometric distortion
2-periapical, bitewing, occlusal, panoramic, CBCT
3-room should be dimly lit
- bright view box
- mask extra light
- use magnifying glass
4-look at normal anatomy and see variations
pathology
5-anatomical landmarks
normal anatomy: bones, canals, foramina, cortices
-look at radiographs in order through quadrants (upper right to lower left)
-symmetry
1-when looking at quadrants, checking for
2-checking height of interdental bone
3-checking teeth
1-normal
- symmetry
- sparse
- dense
- in direction of anatomical stress
- altered
2–can use Bitewings (alveolar bone heights)
cortication, bone height and shape of alveolar crest
3-count, check enamel/dentin/pulp
- count roots
- compare anatomy
- check existing restorations
analyzing intraosseous lesions
1-localize abnormality
2-periphery
3-shape
4-size
1-look at anatomic position (epicenter)—
above mandibular canal= odontogenic
below mandibular canal= unlikely odontogenic
w/in mandibular canal= vascular or neural
epicenter of lesion= in sinus, not odontogenic in origin
-cartilaginous lesions are found nearer to condyle
-is it localized or generalized/ unilateral bilateral
2-well defined= punched out/corticated or sclerotic
ill defined= blended appearance & invasive
3-oval/circular
scalloped borders
multiocular
4-measure lesion in 2 dimensions= width & height
-surrounding structures to help estimate measurement
1-analyze internal structures
2-analyze effect of lesions on structures
1-totally radiolucent
mixed lucen opaque
totally radiopaque
2-teeth, lamina dura, perio membrane space
iferior alveolar nerve canal/mental foramen
maxillary antrum
surrounding bone density & trabecular pattern
outer cortical bone & periosteal reactions
—displaced teeth, root resorption, expansion, perforation & destroy
1-pediatric dentistry
2-individual levels
3-prevention
4-disease management
5-access to dental care services
6-systems of integration & coordination
1-age degined speciality that provides primary & comprehensive preventative & therapeutic oral health care for infants & children through adolescence, including those w/ special needs
2-observe, assess, detect, diagnose, educate, motivate, prevent, treat, manage/recall, re-assess, fine tune, learn from errors
3-fluoride, reduction of bacteria that cause toot decay, & education/anticipatroy guidance for parents & caregivers:
quality improvement markers for 0-6, 6-12, & 13-18 age groups
4-risk assessment for tooth decay & spectrum of dental treatment: acct for lag time b/w diagnosis to treatment
5-age 1 dental visit, dental home, & dental workforce/professional development
-age 1 & other dental marker visits
6-parternership w/ health & childcare providers
state & local dental public health programs
policy development
-w/ medical record
1-considerations in pediatric dentistry
2-baby bottle
3-initial dental visit
4-early childhood caries
1-child isnt a small adult
- modes of managing child patient are age related
- consider fluorides, pulpal therapy, instrumentation, dental materials oral surgery, ortho, nutrition, growth/development, oral medicine & path
2-infants dont go to sleep w/ bottle & nocturnal breast feeding be restricted after eruption of 1st primary tooth
3-w/in 6 mo of age after eruption of 1st tooth but before 12 mo of age
40baby bottle tooth decay/nursing bottle caries
- 1 decayed/filled tooth surface of primary tooth in kid under 6
- severe ecc= cavitated or non cavitated smooth surface caries in kid under 13
- b/w 3-5 severe ECC+ 1 or more cavitated missing or filled smooth surface in primary maxillary ant teeth or dmf greater than 4(age 3) 5(age 4) 6(age 5)
1-transmission of s mutans in kids
2-behavioral changes w/ kids
3-basics in managing child patients
4-critical moments in appt
1-vertical= mom—direct via saliva & kissing child
-indirect via spoons/pacifiers
-reduced w/ various techniques
horizontal= nursery/preschool
2-emotionally compormised bc of home environment
- shy —cry to avoid
- frightened—negative light
- averse to authority
3-short appts…tell, show, do
voice control
praise/communication
start w/ easy procedure
4-separation from parent
getting into chair
the injection
1-primary molars
2-mandibular primary molar root
3-mandibular primary first molar
4-mand primary 2nd molar
5-max prim 1st molar
6-max prim 2nd molar
1-smaller, narrow oclusal table
greater buccal lingual width @ cervical
-enamel + dentin thinner, w/ bigger pulp horns (long, thin horns…follow cuspal outline)
-not as extensive preps
2-primary roots flare out mesial-distally= for bicuspid to erupt
perm. molar roots= straight
3-mesial surface= straight, distal surface converges towards cervical line
4 cusps, 2 buccal (developmental depression)
no dev. groove in between…mesial cusp= larger
-prominent transverse ridge
4-resembles 1 perm molar
5-bucall convexity at cervical third
2 cusps, = perm max premolar
6-resemebles max 1st perm molar
4 cusps w/ buccal developmental groove, maybe carabelli
lingual groove= present
ML cusp is largest
1-material choices for pedo
2-goals of prep designs
3-burr selection
1-GI/compomer= for higher caries rate
amalgam= difficult w/ isolate/cooperation
composite
stainless steel crowns= higher caries rate/durability
RMGI= bonds to tooth, wears more, technique sensitive, releases fluoride not as long lasting
2-access to caries, smooth surface or pit/fissure
-modify by anatomical differences
resistance & retention—holds materials
3-smaller = better bc teeth/preps are smaller
1.5-1.8 long, .75 mm wide—-330
rounded internal line angles & removes friable enamel rods
1-considerations w/ proximal box tooth diameter
2-occlusal key
1-buccal lingual walls of prox box are parallel to external tooth surfaces
buccolingual diameter of occlusal surface is less than cervical diameter
-proximal extensions are wider at gingival
-converge at occlusal
-establish box outline into cleansbale areas w/ rounded axial pulpal lines to reduce stress on dental material
-internal line angles are rounded
-reverse s not required bc contacts are mid proximally
2-small occulsal key into prep—mainly w/ amalgam
mechanical lock, unlike regular rententive grooces
-less chance of pulpal exposure
-bur into enamel beyond axial wal to get dovetail facially & lingually, dept= 1.25-1.5 mm
-bevel axiopulpal line angle
1-if gingival wall is over extended…
2-dilemma of large pulps in primary teeth
1-obtaining adequate axial wall depth w/o endangering pulp is difficult
2-extensive caries axially/gingivally compromises pulpal health wen preps are extended
***Dont give xylitol candy til anesthetic wears off
1-crowns
2-dental exam
3-crown preop
4-foundation failure
1-form, function, esthetics
crowns= inc demand for tooth restoration
2-head & neck exam (symmetry)
oral & oropharayngeal exam (symmetry)
-path, pulpal disease, caries, perio, fractures
-make cast
put together= treatment plan
3-perio health, pulpal health, condition of tooth
4-common source of crown failure and tooth loss= our failure if not diagnosed initially.
ANY COMPROMISED IN FOUNDATION OF TOOTH NEED TO BE ADDRESSED BEFORE CROWN FABRICATION.
1-perio considerations
2-crown fabrication goals
3-soft tissue
1-perio disease= cyclical inflamm host response to bacteria= tooth los
- cant proceed w/ treatment w/ crown fabrication w/ tooth which has chronic perio disease
- treat via oral home care, scaling/root planing, or extraction
2-good period health before crowning, make crown that maintains perio health & needs
—need patient compliance
3-affects crown design & where crown margins are put—margins put too deeply into sulcus = elicit adverse perio tissue response
…assess biolgical width (CT & junctional epithelium)
healthy sulcus= 1-3 mm
bio width= 2 mm
if affect bio width= inflam, attachment loss, alveolar bone loss
1-gingival sulcus
2-managing sub gingival margins
3-crown lengthening
4-benefits for crown lengthing
1-avoid placing crown margins at base of gingival sulcus
- supra gingival crown margins better than sub gingival, so place crown margin at or just below the crest of the gingival margin
- –no more than 1/2 the depth of the base of the gingival sulcus…use probe to figure it out
2-extensive caries & fracture
3-surgical procedure repositions the attachment in a controlled manner to reestablish a biological width in harmony with our crowns.
4-
- Expose more tooth for better crown prep
- Permit crown margin placement
- Margin placement without violating biological width
- Improve crown esthetics
1-marginal gaps
2-marginal overhang
3-decrease adaptation discrepancies
4-pulpal considerations
1-space created vertically between the crown margin & the prepped tooth
2-amt the crown margin extends horizontally beyond the tooth
3-good tooth prep design
good impression technique
quality dental lab work
acceptable gap discrepancy= 40-70 um
4-caries removal, conserve tooth structure, good temp control during prep
- –incomplete caries removal= tooth damage & pulpal infection
- –extensive caries= endo before crown
- –restorative can proceed on presence of incomplete removal w/o endo, thin layer of denton overling pulp—pinpoint expousre of pulp and apply CaOH2 to affected area, isolating pulp from infection…
- do pulp test before fabrication
- if tooth non vital= endo therapy before crown fabrication
- conserve as much tooth as possible, remove path
- crown prep leads to damage of endoblasts= irreversibly damage to pulp
- heat= damage to pulp
if you cant treat pulp or periodontiumt he tooth may not be restorable
1-viral diseases
2-autoimmune
1-primary herpes
recurrent herpes
varicella
herpes zoster
hand-foot-and mouth disease
herpangina
measles
2-pemphigus vulgaris
mucous membrane pemphigoid
Primary Herpes
- caused by HSV-1
- top half of body
- seronergative host—direct contact w. HSV
- 6 mo to 5 yr—not seen before 6 mo bc of moms immunity
- 95% affected by 15
- chills, lymphadenopathy, fever, nausea, anorexia
- enlarged red painful gingiva
- pinhead vesicles, lesions enlarge & develop central ulceration
- lip vermillion, satellite vesicles on skin, self-inoculation
- treatment= 7-14 days, symptomatic treatment
1-Recurrent Herpes (secondary)
2-herpetic whitlow
3-herpes gladiatorum
- caused HSV-1
- 15-45% of US population has history
- multiple trigger reactivation—stress, UV, illness (occurs at primary inocculation)
- Pain, burning, itching, tingling, warmth, redness> 6-24 hrs > clusters of fluid filled vesicles > 2 days > rupture and crust > 7-10 days > healing
- intraoral lesions= keratinized mucosa, less symptoms
- tzanck cell —multinucleated giant cell—floating epithelial cell
- resolves 7-10 days
- chronic herpetic infection in immunocompromised hosts
- –topical, systemic or prophylaxis therapy: treatment in 48 hrs
- no biopsy
2-due to self innoculation
3-scrumpox—wrestlers
1-Varicella
2- oral varicella
- varicella zoster virus HHV3
- via salivary droplets or direct contact
- 5-9 yrs, 90% infected by age 15
- malaise pharyngitis rhinitis>Pruritic exanthema, face, trunk, extremities> vesicle> pustule >crust
- Lesions in different stages often seen
- Perioral lesions, intra-oral lesions
- treatment= symptomatic…goes away in a couple of weeks:
- Exposure>heal> virus goes into latency. When the virus reactivates develops zoster
2-white opaque vesicles which rupture and ulcerate
1-herpes zoster
2-hand food & mouth disease
1-reactivation of varicella zoster virus
-virus latent in nerves where its protected from immune system
-spinal cord segment or nerve hides in dermatome affected in outbreak
-more prevalent in elderly
-confined to an area, not usually spread, unilateral
-face= trigem nerve
treatment= antiviral
2-cocksackie A16 or enterovirus 71
-kids under 5
oral lesions precede skin changes
-sometimes not all 3 areas are affected but clasically all 3
-oral lesions occur anywhere in mouth, number arises 1-30, vesicles that become ulcers
-few to dozen skin lesions…palms & soles, vesicles that ulcerate
-treatment—not needed, dont give aspirin to kids bc of reyes disease
1-herpangia
2-measles
1-coxsackie A1-6, A8, A10, B3
- similar to HFM but lesions at back of month
- history & clinical diagnosis
- no treatment since it is self limiting
2-measles virus—paramyxovirus
-salivary droplests
9 days: Day 0 = 3 Cs: coryza, cough, conjunctivitis
Day 3= fever
Day 6-9= fever ends rash fades
-kopliks spot= white macules over area of erythema
-treatment= prevention, fluids & non sapirin antipyretics
1-pemphigus vulgaris
2-mucous membrane pemphigoid
1-little yellow circles: desmoglein 3 keeps cells together so Ab attacking wil end up having cells split
- mediterranean & jewish origin
- 1:1 gender ratio, adults over 50
- flacid vesicles & bulla which rupture quickly
- all patients develop oral diseases
- bulla rupture & have large red painful ulcer
- nikolskis sign= induction of bulla upon pressure, normal skin & apply pressure that makes bulla, not 100% specific
- intraepithelial split= NEED BIPOSY for diagnosis—proteins are gone so cells arent held together
- treatment= systemic corticoid, mortality = 60-90%
2-BP180 & laminin 5= diff disease & diff protein attacked, between cells & CT
- cicatrical pemphigoid= lots of scarring, not in pemphigoid
- older adults: 2:1 women to men
- vesicles—>bullae—>ulcers
- desquamative gingivitis= diffuse gingival erythema
- symblepharon= adhesion between bulbar & palpebral conjunctivae
- subepithelial split= entire epithelia is detached
- treatment= referally to ophthalmologist= topical/systemic corticoids
1-direct pulp cap
2-goals of pulp capping
3-indirect pulp cap
4-thermal protection
5-materials for pulp capping
1-vital pulp
previously asymptomatic tooth w/ small exposure
exposure occurd in a clean uncontaminated environment
-hemorrhage is controlled
-restoration is well sealed
2-maintain a healthy pulp
stimulate dentin bridge formation
3-less than .5 mm remainign dentin thickness
4-under amalgam, reduce effects of thermoconductivity
5-MTA, CaOH, Calcium Silicate, GI/RMGI
1-CaOH
1-gold standard, both direct/indirect capping
- stimulates dentin formation
- antimicrobial
- alkaline
- poor physical properties—soluble in H20, poor compressive strength, limit placememnt to smallest area as possible, away from margins
- powder in solven= thin film of CaOH—Dycal
- paste system–base= Ca tunstate and catalyst= CaOH
- –mix equal parts of both: 2 min 20 s working time, 2.5-2.5 min setting time
- placed on exposure or pink dentin, only on axial or pulpal floor
- soluble, must not extend onto margins—wash out of material = open margins, low compressive strength
GI/RMGI
1-linear not a pulp
-not be used directly over pulp or if RDT is <.5
-over pulp capping materials…sandwich technique
-fluoride release
-can be used under amalgan as line for thermal protection
closed samich= restorative material at all cavosurface margins
open samic= GI/RMGI exposed at cervical margins
—samich used for composite