Maintenance and monitoring

Question 1

What does dental care involve?

Answer 1

more than the treatment of the consequence of disease

Concerns preventing disease, repair when necessary, and monitoring the restored state to ensure health is maintained

Question 2

What is maintenance?

Answer 2

Plan for it from the outset
Part of the prognosis
Pt to understand limited life for all restorations
Pt to commit to the time and financial commitment for life

Question 3

What 4 factors determine survival?

Answer 3

Build quality
Environment
Product handling
Maintenance

Question 4

What influences the build quality: intra-oral assembly?

Answer 4

The biological substrate and quality of building materials
Operator skill-set
Facilities and time

Question 5

What are the 2 types of loading?

Answer 5

Functional and para-functional

Question 6

What environmental factors can have an influence?

Answer 6

Bacterial biofilm 
Variable pH 
Constantly wet 
Temp changes
Tooth-material inteactions

Question 7

What is the order for treating the patient?

Answer 7

Emergency treatment 
Disease control and stabilisation 
evaluation of outcomes
Rehabilitation - advanced restorative care
Evaluation of outcomes
Maintenance

Question 8

What is the key to prognosis?

Answer 8

Maintenance

Question 9

What implications does the patient need to understand?

Answer 9

Time
finances
Own health
OH - now and later

Question 10

What are the fatigue related biological or structural failure?

Answer 10

RCT
Root caries
Porcelain chipping
Cusp fracture

Question 11

What is catastrophic biological or structural failure?

Answer 11

Post-perforation 
Inadequate aesthetics 
Occlusal interference 
Pulpitis
De-bonding

Question 12

What 5 things do you need to understand and plan?

Answer 12

1. Quality of build - biological substrate and materials, operator skills, facilities and time to provide treatment
2. Handling - what type of service will it see?
3. Environment - understand the reality of the harsh environment of the mouth
4. Maintenance - key to survival of any treatment modality, plan from outset

Question 13

What do you do at the review?

Answer 13

Check new or continuing disease - plan remedial therapy and maintenance
Check adequacy of existing restorations - plan repair or replacement when required, may need specialist care by referral
Check compliance with maintenance protocol
Determine future recall periods

Question 14

What is wear of adjacent and opposing teeth a problem with?

Answer 14

Ceramics in group function

Question 15

What could new perio disease at maintenance be due to?

Answer 15

Poor plaque control
Failure to treat established disease
Failure to maintain treated disease
Endo/perio problems

Question 16

What are the technical failures?

Answer 16

Fractured restorations
Marginal breakdown
Tooth fracture 
Defective contour 
Appearance 
Retention failure

Question 17

How do you plan for failure when prognosis is guarded?

Answer 17

Use restorations and prostheses that can easily be modified and maintained
Anticipate tooth loss in cases with advanced perio disease and doubtful plaque control

Question 18

What is the difference between maintenance and emergencies?

Answer 18

Failures at recall can be serviced before they become emergencies
Early observation of faillure may facilitate cheaper repair rather than expensive replacement