Midterm

Question 1

1-Prosthodontic care

2-prosthodontics

3-prosthesis

4-goals in prosthetic tx

Answer 1

1-exploring options available for patients missing 1 tooth: FPD—tooth supported FPD,
implant rehab
removable partial denture prostheses
do nothing

2-dental specialty pertaining to dx, tx planning rehabilitation & maintenance of oral function, health, appearance of patients w/ missing or deficient teeth

3-artificial replacement of an absent part of the human body

• therapeutic device to improve or alter function
• i.e. heart valves, joint replacement & tooth replacement

4-treat diseased/damaged teeth
restore or improve oral function
restore or improve oral esthetics
prevent future oral disease/dysfunction

Question 2

1-responsibilities as dental healthcare provider

2-further responsibilities “informed consent”

3-single missing tooth

Answer 2

1-guide patients through decision process
establish a communication between yourself & patient that results in agreement for a specific tx

2-provide dx
state nature & purpose of proposed tx
present risks & benefits of proposed tx
present alternative tx options
present risk & benefits of alternative tx
present risk & benefits of not undergoing any tx

3-masticatory dysfunction
speech dysfunction
loss of esthetics
instability of dentition
***adverse events may not definitiy occur but CAN occur

Question 3

1-masticatory dysfunction

2-speech dysfunction

3-loss of esthetics

4-instability of remaining dentition

Answer 3

1-correlated w/ reduction in consumption of fruits, veggies & inc intake of high caloric foods

• hard time chewing
• might not have adverse impact on mastication
• comparison of patients w/ shortened dental arches (premolar/occlusion) & those w/ complete arches showed that there were no actual differences when it came to mastication—some preferred shortened dental arches

2-degradation of speech immediately after tooth extraction
-altered speech functions= transient—rapid adaptation resulting in a return to a normal speech function

3-beauty is in eye of beholder—up to the patient

4-loss of teeth can be bc of drifting & supra-eruption of remaining teeth into edentulous spaces

Question 4

1-removable partial denture prosthesis

2-denture base

3-metal framework

4-clasps

5-indications

6-disadv

Answer 4

1-any prosthesis that replaces teeth can be removed from the mouth & replaced at will by patient

2-provides support & retention for porsthesis

3-strenght & rigidity for the prosthesis

4-on metal framework, clip onto the teeth for retention

5-long span edentulous site
replacement of lost supporting oral structures
specific esthetic situations
interim restorations
patient preferences

6-can feel like a mouthful—feels bulky
-cant be worn 24/7

Question 5

1-implant rehab

2-categories

3-adv

4-disadv

Answer 5

1-what we can offer patients to give them back their original teeth

2-subperiosteal
transosteal
endosseous—blade & rate form

3-procedure is easy to learn & perform…can be done by general dentist

• restorative dentists feel that the prosthetic tx easier than for prepping a tooth for a crown
• wider application for use in prosthetic rehab
• retain both fixed & removable prostheses
• predictable tx w/ excellent long-term outcome

4-requires surgery= pain
extra tx time= many mo to complete…provisional are immediately after implant & cement in 6 wks
cost= expensive

Question 6

1-fixed partial denture

2-retainers

3-pontics

4-conical pontics

5-modified ridge lap

6-connector

7-ADV

8-DISADV

Answer 6

1-dental prosthesis that is luted, mechanically attached to natural teeth
-prostheses attached to prepped natural teeth adjacent to edentulous site

2-cemented onto the adjacent prepped teeth (abutments) to retain FPD (like crowns)
-differ from crowns by planning the path of insertion—no axial wall undercuts present between “both teeth”

3-artificial tooth replacement & have many designs. Want to maximize function & esthetics while maintaining access for hygiene

4-egg/bullet shaped contact at tissue surface= convex & smooth surface, allows efficient cleaning of area w/ floss

5-laps over facial surface of soft tissue—the facial portion can be lengthened to harmonize with the length of adjacent teeth. The tissue surface contact can still remain convex & smooth

6-connect retainer to the pontic=1 piece prosthesis

7-ease of fabrication & excellent function & esthetic outcomes

8-requires tooth prep regardless of tooth health
-susceptible to caries/perio disease if not maintained well by patient—long term survival isnt as good as implant rehab

Question 7

1-CAD/Cam Process

2-CEREC

3-Why ceramics ideal for dental restoration?

Answer 7

1-ceramic prep design
powder coat the prep
image the prep & opposing cast
import image into the comp
trim/define margins
virtual design of restoration
mill restoration
remove sprue & adjust
polish & adjust it
etch ceramic/bond to tooth
lute & clean up/check occlusion

2-CEramic REConstruction
chairside, economical, restoration, esthetics, ceramics

3-structurally similar to natural tooth enamel
stain resistant
insoluble in acidic intraoral environment
high biocompatible
tooth color
translucent
natural aesthetics
stable dimensions
abrasion resistant
adhesively bond to tooth
low thermal conductivity
insulatory between metal restorations
plaque resistant
durable

Question 8

1-silica ceramic

2-lithium disilicate

3-aluminum oxide/zirconium oxide

4-CAD/CAM produces

5-how it works

Answer 8

1-highly aesthetics for inlays, onlays, partial crowns, veneers, anterior/posterior crowns

2-high strength alt for partial crown

3-white steel for crowns, bridge frameworks, implants, & primary crowns

4-indirect restorations: inlays/onlays/crowns/veneers

5-prep—most important aspect, prepping for machine

CEREC process relies on optical rather than physical impression
prepping for glass
shoulder margin—reduction of at least 2 mm

Question 9

1-CAD/CAM guidelines

Answer 9

1-smooth, tapered walls= good internal adaptation

• smooth, well-defined margins= in margin detection & fit
• rounded internal angles= passive seating & prevents fractures
• exit angles & margines= close to 90= bulk of ceramic at margins for strength
• adequate reducation= strength of ceramic material
• recommendations based on requirements for all-ceramic strength
• stress bearing (occlusal) vs non-stress-bearing (axial) areas
• 2nd plane of reduction in occlusal 1/3 prevents overthinning of crown

Question 10

1-milling

2-powdering

3-digital impressions

Answer 10

1-mills from outside in—prep should be flat to make it easier for machine to mill

2-light is reflected off of powder—giving CEREC info

• powdering equalizes everything—gingiva, enamel, amalgam
• bad powdering= bad data/restoration
• some stone models dont need powder
• camera needs uniform surface
• uniform=even layer, covering entiring surface
• all sides of teeth must be covered along with some gingival tissue

3-immediate feedback of details
-easier to determine proper reduction
-corrections of mistakes w/ patient in chair
-accurate than conventional impressions & dies
problems:
—alignment problems
—angulations problems=path of insertion, draw
—focus & image contrast & camera movement

Question 11

1-Camera

2-pitch

3-yaw/roll

Answer 11

1-CDMI has CEREC red light camera—4.0 milling/design

• 3 images of buccal bite —camera steady w/ no movements
• pen grasp w/ finger rest for max control
• avoid extraneous items in pic
• no cotton rolls, fingers, wedges
• *-hand piece type grip*****
• cameral held flat , slightly angled at heel= 10 degrees

2-controlled by solid rest on an adjacent tooth

3-determined by path of insertion

Question 12

1-1st digital image

2-2nd digital image

3-3rd digital image

4-4th digital image

5-digital bite registration

Answer 12

1-center crosshair on prep

• be sure of path of insertion
• hold still & it will move to dock

2-center crosshair on tooth, overlap by 1/3

3-center crosshair on prepped tooth, overlap by 8mm

4-center crosshair on mesial tooth, overlab by 8 mm

5-take digital of prep, opposing & from buccal w/ patient closed
-grab bite & pull down to occlusal

Question 13

1-summary of digital impression

2-glass ceramics block

2-high strength lithium disilicate

4-composite resin

Answer 13

1-tooth prep completed
isolated
powdering
imaging in line w/ 1 rolled to buccal shot outside prep
opposing teeth imaged the same way
buccal images taken
digital models articulated

2-traditional, used by dentists

3-newly introduced, blue block, high strength material

4-high pressure treated/ high heat cured composited in block

Question 14

1-polishing

2-finishing

Answer 14

1-remove sprue w/ lab diamond, polish away from margins/contacts

• final luster & polish of margins/contact done w/ diasheen on stiff bristle brush
• polish intraoral—dont to touch up if occlusal adjustments necessary—polishing porcelain= time & heat
• 6-8 min

2-etch ceramic crown…then check bond & occlusions

Question 15

1-clinica evidence on effectiveness of CEREC

2-disadv of CAD CAM

Answer 15

1-25 yr time frame
blue camera= better milling
bonding w/ dentin is more successful than gold crowns
-high strength—flexural strength-forece taken to fracture a specimen over fixed pt

Wear= gold has least amt of wear—machinable ceramics= less abrasive/more resistant than conventional

post op sensitivity=dec in post due to improved adhesive materials/luting—isolate carefully, single appt

2-esthetics may not be best

• some need sending to lab
• $$$$
• chairtime?
• price & effort illusion

Question 16

1-#30 abutment

2-#28

Answer 16

1-margin design= chamfer
-curved margin beginning at axial wall and extending to the cavosurface of tooth
-keep bur in proper position to create correct axial taper, keep handpiece parallel to occlusal surface
-ideal width= 0.5 mm
-avoid creating J margin= lip of unsupported enamel
-margin= .5 above gingiva
-occlusal= 1.5 mm
-occlusal convergence= 6-16
buccal= reduction cusps in 2 planes, cervical & occlusal portion

2-buccal margin= shoulder= right angle margin at axial wall extending to cavosurface of tooth
width= 1 mm
extend shoulder margin into interproximal contact areas
switch shoulder to chamfer as continue to lingual surface at the contact areas
-margin location= 0.5 mm above gingiva
-occlusal reduce= 2 mm
-occlusal convergence= 6-16
-reduce facial cusp in 2 place

Question 17

1-path of insertion

2-matrix fabrication

3-FPD prep

Answer 17

1-need to assess both abutment teeth together, need to be able to see all margins in 1 visual plane

2-use matrix as occlusal reduction guide for 28 & 30

3-prep 28 & 30 at same time
-depth cuts, occlusal reduction & buccal reduction
-complete conservative rough preps for each tooth so you can refine & smooth
-gross interproximal= 012 diamond 699 carbide taper
tips= slow rpm during interproximal reduction
-look at both at same time for undercuts

Question 18

1-bridge provisional

Answer 18

1-versatemp, bis GMA composite

• insert matrix over teeth= 1.5 min, remove matrix, allow material to set, add material if needed (flowable
• smooth & polish, remove gross material & open embrasures
• allow floss to pass under FPD & under pontic
• FPD 28-30= conical shape= conical shape for tissue of pontic, to permit flossing
• –conical= egg/bullet shaped contact at tissue surface, convex & smooth
• –convex surface= efficient cleaning area w/ floss
• –check marginal fit= excessive occlusal contacts
• –cement

Question 19

1-ortho

2-team concept

3-patient type

4-effect of reduced perio support

5-common adjunctive procedures

Answer 19

1-reposition teeth to facilitate other dental procedures, not to correct malocclusion—restore function & control disease

• limited
• not always ideal occlusion/alignment

2-adjunctive ortho therapy= inderdisciplinary

• restorative dentist/prostho/implantologist
• perio
• OMFS
• endo

3-adults, w/ underlying dental disease

• sequencing care is critical
• control/eliminate disease process
• altered biomechanics

4-amt of perio support loss

• center of resistance
• amt of ortho force

5-team= ortho, restorative DDS, #of teeth, anchorage

Question 20

1-uprighting molars

2-distal crown tip vs mesial tip vs combo

Answer 20

1-lodd of lower molar= tipping & drifting of adjacent teeth, poor interproximal contacts, poor gingival contour, reduced interradicular bone, supraeruption of unopposed teeth—-bone contour follows CEJ
-pseudopockets form adjacent to tipped

2-distal crown tip= leads to inc pontic space but easier to perform

• mesial root movement= dec edentulous space/pontic space & elim need for prosthesis but is more difficult to achieve
• uprighting a tipped molar by distal crown movement leads to inc pontic space
• uptighiting molar by mesial root movement reduces pontic space= elim prosthesis—but can be hard if bone is resorbed

Question 21

1-extrusion permissible? occlusal antagonist

2-distal crown tip w/ extrusive component of force

Answer 21

1-uprighting tipped molar leads to slight eruption of tooth w/ inc height of crown, while reducing depth of mesial pocket

2-segmental approach: bond bicuspids & cuspids as anchor teeth w/ band on molars & heavy arch wire

• –uprights the molar & close off spaces b/w abutment
• –lateral incisors arent binded so dont use much force so contact between cuspids & laterals not affected

Question 22

controlled ortho mechanics

1-t-loop springs

2-distal crown tip w/ intrusion

3-TADS

Answer 22

distal crown tip vs mesial root tip w/ intrusion

1- active they can upright the tooth by distal crown tippin
-opening of t loop in combination w/ pulling distal of wire through molar tube will upright mesial root w/ space closure

2-plaque harboring areas are a combo of inaccessibility of mesial surface of a tipped molar & excess/redundant tissue compromises patients ability to clean, compromising long term perio health/prognosis

3-enhanving anchorage for controlled space closure
—move molar into space

Question 23

1-forced eruption

2-extrusions vs rapid extrusion

3-intrusion

Answer 23

1-subG tooth fracture
perio disease & vertical bony defect
tx= perio crown lengthening—limitation is crown to root ratio
ortho rapid extrusion

2-ortho extrusion uses ortho forces—PDL including alveolar bone follows extruding tooth

• rapid extrusion uses heavier forces, more frequent activations = extruding tooth beyond PDL= lengthen clinical crown
• retention period & technique

3-supraerupted teeth—missing occlusal counterpart

• anterior tooth intrusion= difficult but possible w/ conventional techniques
• posterior tooth intrusion= ONLY possible w/ reinforced anchorage systems (TADS or implants)

Question 24

1-alignment of teeth

2-tx planning

3-conclusions

Answer 24

1-redistribution of spaces

• open space for implant placement
• improve gingival esthetics

2-diagnostic wax up
golden proportion
ideal proportions

3-interdisciplinary work= educational

• team approach= best results for patient
• utilize peers experience
• know the goals of adjunctive tx is imp bc they provide you with general guidelines as to how ortho interventionc an facilitate long term dental health for patient

Question 25

1-caries management plan

2-plan

Answer 25

1- goal of caries mgt plan is to treat dental caries—the disease & prevent future progression of dental caries—the disease
-restorative tx may be a part of the pts caries mgt plan but the restorative tx plan isnt the goal of the caries mgt plan

2-documentation of lesions & lesion activity
risk assessment
preventative therapy
hx mod
patient specific
detailed description of material, delivery system, dosage frequency & instructions

Question 26

1-reevaluate

2-risk indicators

3-disease indicators

4-phase 2 tx

5-clinically

Answer 26

1-usuallty approx 3 mo for pt w/ high risk determination for caries

• re-eval pts hx/compliance
• evaluate lesion activity
• reevaluate remin of lesions & presence of new lesions

2-oral hygiene & diet

3-presence of lesions & restorations placed recently

4-rehab tx
prior to phase 2, a thorough phase 1 re-eval
—reeval of caries management plan, perio reeval, reeval of oral path, reeval patients objective
-phase 2 initiated when disease is under control

5-pt could ask about certain symptoms—so develop a PICO question
-Rx/OTC medications could be recommended for this

Question 27

1-system B

2-anterior endo

mistakes w/ anterior preps

3-assymetrical prep

4-over-extended access

5-under extended access

Answer 27

1-200 degree

2-access to pulp chamber, remove pulp horns & achieve straight line access to canal

• identify cingulum notch & use marginal ridges as lateral borders & parallel incisal edge
• –penetrate lingual surface w/ tapered bur to dept of 3 mm
• –direct bur to CEF from CN
• –smooth internal walls w/ #6 slow speed

3-happens bc of excessive removal of tooth structure on 1 of the marginal ridges…not accurately locating cingulum notch

4-happens bc prep was extended too far incisally

5-happens bc prep doesnt extend to cingulum notch

Question 28

1-maxillary 1st endo

mistakes w/ molar preps

2-excessive flaring

3-lack of striaght light access

4-hornectomy

5-gouged floor of chamber

6-etc

Answer 28

1-complete access to pulp chamber, ID canal orifices, & achieve straight line access to canal

• preserve occlusal anatomy of cusp tips, oblique ridge & mesial marginal ridge
• –Dot 1= halfway up triangular ridge & slightly distal= MB
• –Dot 2= distal to buccal groove—DB
• –Dot 3= halway up triangular ridge & slightly distal–P
• penetrate central pit to a depth of 4+ mm then follow it up to the DB dot to the MB dot & to the P dot (following contour of tooth)
• make sure long axis of bur is perp. to occlusal plane

2-happens bc there is a failure to keep the long access of bur perp to occlusal plane

3-fix by selective filling to remove dentin triangles

4-happens bc there is a failure to maintain depth of bur resulting in partial removal of roof of pulp chamber

5-happens bc bur is being taken too far passed roof of chamber

6-over/under extended prep &&& access not over pulp