mini assessment 4

Question 1

1-Glass Ionomer

2-type 1

3-type 2

4-type 3

5-type 4

6-type 5

7-type 6

Answer 1

1-almost tooth colored

• reaction between silicate glass powder & polyacrylic acid
• releases fluoride
• chemically bonds to tooth—ions between ionomer & tooth structure

2-cement

3-restorative material

4-liner or base

5-fissure sealant

6-orthodontic cement

7-core build up material

Question 2

1-GI setting reaction

2-properties of GI

Answer 2

1-acid base reaction

• if material doesnt have reaction= not glass ionomer
• water is necessary for reaction—too much= material to be opaque w/ little strength
• –too light h20= cracking & crazing

2-coefficient of thermal expansion=like tooth
fluoride released
-bonds to tooth structure
-low thermal conductivity
-biocompatible
-not as esthetic as composite
-low resistance to wear
-low strength

Question 3

1-Adhesion

Answer 3

1-GI chemically bonds to tooth structure

• bond strength is low but durable
• ion exchange process
• polyacrylic acid displaces phosphate & Ca…enters hydroxyapatite structure= Ca polyacrylate
• –Ca & Al are polyacrylates are formed at tooth
• –secondary bond w/ collaged w/in dentin via H2 bonding
• bond is improved by preconditioning= polyacrylic acid
• –conditioning= use of less ionized acid to remove smear layer
• –etching= stronger acid, etching uses tooth surface

Question 4

1-fluoride release

2-indications for GI as restorative material

3-contraindication for GI as restorative material

Answer 4

1-released w/o affecting physical properties of material
-intial release is high but release dimishes—can be recharged w/ topical fluoride treatment

2-restoration of deciduous teeth
restoration of permanent teeth (anterior Class 3 or smooth surface Class 5)

3-restorations were there is a high load
large prep
cores when there is a little tooth remaining
where esthetics are of concern

Question 5

1-RMGI Liquid

2-RMGI Powder

3-RMGI Reaction

4-stages in RMGI reaction

Answer 5

1-polyacrylic acid copolymer

• methacrylate
• photo initiator

2-fluoraluminosilicate glass powder
photo sensitizer

3-acid base reaction—if not supplied= not glass ionomer
-polymerization of resin

4-acid= base reaction—begins w/ mixing
light activation= takes palce at end of palcememnt w/in 10 sec of light activation

Question 6

1-advantages of RMGI

2-disadvantages of RMGI

3-comparison of RMGI To GI

Answer 6

1-fluoride release

• early strength
• limited moisture sensitivity
• initial properties are better than those of GI
• can be finished immediately
• adhesive

2-polymerization shrinkage

• swelling of material= moisture uptake
• fully light cure for optimal properties= resin component, & depth of cure= considered

3-improved esthetics, H20 sensitivity = reduced
slightly less fluoride release
can be recharged w/ fluoride
inc in thermal expansion
inc polymerization shrinkage

Question 7

1-indications for RMGI

2-contraindications of RMGI

Answer 7

1-restoration of smooth surface & anterior proximal restorations

• sandwich technique
• restoration of deciduous teeth
• blocking out of undercuts for indirect restorations
• lining of cavity prep

2-esthetics= chief concert

• direct placement over pulp
• core builds up where more than 50% of tooth is missing

Question 8

comparison

1-resin composite

2-glass ionomer

3-resin modified

4-amalgam

Answer 8

1-esthetic, light cured, poly shrinkage
coefficient of thermal= greater than tooth
good wear resistance, no fluoride release

2-less esthetic, chemical cured, low shrinkage
coefficient of thermal= similar to tooth
low wear resistance, high fluoride release

3-more esthetic= conventional GI, but opaque
chemical & light cured
improved wear resistance
medium high fluoride release

4-not esthetic, not conservative, not technique sensitive

• no dimensional change upon setting
• no gap formation at gingival margin from poly shrinkage

Question 9

1-fluoride release esthetics

Answer 9

1-resin comp—no fluoride release= esthetic= high mechanical properties
RMGI—fluoride release, med-high, rechargable= improved esthetics
GI—fluoride release, high, rechargable= not esthetic = low mechanical properties

Question 10

1-esthetics necessary

2-fluoride release is desirable & esthetics doesnt matter

3-resin modified

4-esthetics isnt a concern but moisture & contamination= likely

Answer 10

1-resin composite

2-GI

3-less fluoride release but more esthetic & less technique sensitive

4-amalgam

Question 11

1-resin composite prep

2-beveled margins

3-butt joint margin

Answer 11

1-extent is determined by caries 
-cavosurface margins---beveled= enamel margins
butt joint (90 margin= dentin margin) 

2-only enamel margins are beveled

• bevels can blend the resin composite restoration into tooth structure
• bevels dont prevent microleakage
• should be in .5-1.0 width

3-dentin/cementum margins arent beveled

• enamel margins arent beveled if bevel would remove thin layer of enamel
• cervical margins (no enamel) of smooth surface restorations= more microleakage than enamel margins

Question 12

1-margins

2-enamel bevels

3-additional retention

Answer 12

1-enamel margins= beveled to blen the composite into tooth structure

• enamel margins can have long bevel to remove stained or unesthetic enamel or chalky decalcified
• margins apical to CEJ arent beveled= 90
• when little enamel then dont use bevel

2-enamel margins can be beveled
bevels are .5-1.0 but can be longer esthetics
bevels can be placed w/ finishing/diamond burs

3-retention grooves can be placed—in dentin

• –axioocclusal/incisal line angle
• –axiogingival/cervical line angle
• retention grooves are placed at axiogingival line angle in preps there are no enamel at cervical margin
• retention grooves can be placed if there are enamel margins, but arent required
• not at DEJ cause that would undermine enamel
• placed w/ 1/4 round bur in slow speed

Question 13

1-retention

2-restoration w/ resin composite

Answer 13

1-grooves arent placed at DEJ (undermines enamel rods)
-retention grooves arent placed so that they would encroach upon pulp

2-etch= 30-40% phosphoric, remove smear layer, demineralize superficial dentin

• rinse= 10 sec
• remove excess moisture= collagen is able to be infiltrated w/ bonding agent
• apply bonding agent= 10 s w/ agitation= infiltration of demin dentin
• cure= 20 s w/ hybrid layer
• –retention= micromechanical
• –primarily from hybril layer= remaining collagen infiltrated w/ bonding agent

Question 14

1-poly shrinkage

2-c factor

3-c factor ratio—occlusal

4-c factor ratio—smooth surface prep

Answer 14

1-resin composite materials shrink upon poly

• stresses from poly shrinkage can exceed bond strength
• when poly shrinkage exceeds the bond strength the result= gap formation & marginal leakage
• C factor= relationship between cavity config & shrinkage stress—higher C factor= bond disruption

2-# of bonded surfaces / # of unbonded surfaces of restoration
—greater the c factor, the greater the stresses at adhesive interfaces
1 bonded / 4 unbonded = .25= low
5 bonded/ 1 unbonded= 5= greater stress

3-5 bonded surfaces to 1 unbonded
unfavorable
causes stress

4-5 bonded surfaces to 1 unbonded surface
unfavorable
lower bond strength to cervical margin= no enamel
-if stress exceeds bond strength= gap formation—cervical margin where there is little/no enamel

Question 15

1-strategies to minimize stress & gap formation

2-reduction of mraginal gap

3-surface sealants

4-RMGI

5-cavosurface margins for RMGI

Answer 15

1-incremental placement= smaller layers reduce bonded SA

• maximize non bonded SA
• minimize effect of C factor

2-surface sealant after finishing & polishing of restoration—may reduce microleakage but is dependent upon composite used & margin design

3-low viscosity, lightly filled, no O2 inhibited layer
etch, rinse, apply, thin w/ air, cure

4-pumice, shade selection (limited), isolation

5-GI/RMGI = brittle…requires bulk of material at margins

• additional retention grooves arent required isnce GI/RMGI adhere to tooth structure
• retention groove can be placed

Question 16

1-RMGI

2-steps

3-comparison

Answer 16

1-dentin is conditioned= 20% polyacrylic acid, preps dentin surfaces w/o opening tubules

• rinse= leaves dentin moist
• apply RMGI= no bonding agent is used—use of bonding system would inc retention
• dec fluoride release to surrounding dentin

2-prep lesion, extent determined by extent & depth of lesion
-condition w/ 20% polyacrylic acid—removes smear layer & doesnt demin dentin
-mix RMGI exactly—fuji II LC capsules are mixed
placed and contour—cure for 20 s

3-RMGI will have rougher surface after finishing/polishing than resin composite

• glass particle size larger in RMGI
• surface sealants can reduce surface roughness

Question 17

1-sandwich technique advantages

2-sandwich technique disadv

3-sandwich

Answer 17

1-fluroide release

• better seals at non enamel margins= GI/RMGI = less poly shrinkage than composite
• coefficient of thermal expansion= similar to tooth structure
• reduce microleakage

2-prep must be deep for layers—ethetics may be compromised

3-prep is completed
GI/RMGI= placed on axial & gingival walls= thin layer
-enamel margins are etched= GI isnt etched—not necessary to etch RMGI bc resin in RMGI
-bonding agent applied over enamel, dentin, GI or RMGI
-composite over glass ionomer

Question 18

1-open sandwich

2-closed sandwich

3-sandwich tech used when

Answer 18

1-GI extends & visible at gingival cavosurface margin

2-GI doesnt extend to cavosurface margin
margins are resin composite

3-margins on dentin (non enamel)

where fluoride release= desired
prep are deep & high level esthetics isnt required

Question 19

Prep
1-amalgam

2-RMGI

3-composite

4-Smooth Surface Prep for Amalgam

Answer 19

1-outline determined by disease

• depth of 1-1.25 at occlusal
• depth=.75 at gingival if margin is apical to CEJ
• 90 margins
• requires mechanical retention—gingival & occlusal grooves 90 degree cavosurface margin

2-outline determined by disease

• depth can be shallow…retention by adhesion
• margins arent beveled
• retentive grooves can be placed, liner under composite

3-outline is determined by disease

• depth= shallow
• retention from adhesion
• all enamel margins are usually beveled
• cervical bevels w/ little to no enamel are not beveled
• retentive grooves arent necessary

4-depth= 1-1.2

• gingival margin is on cementum= shallow as .75
• mesial & distal walls= divergent as prep becomes wider mesiodistally
• bur= perpendicular to surface of tooth
• retention at axio-occlusal & axio-cervical line angles w/ 1/4 round bur—depth of grooves = 1/2 diameter of 1/4 round bur

Question 20

1-Dentin Hypersensitivity

2-prevalance

3-sensation

Answer 20

1-dentin is porous w/ connection w/ dental pulp

• fluid movement w/in tubules= stimulation of nerve fibers
• fluid movement = percevied as painful response
• anything w/ exposure of dentin= dentin hypersensitivity
• dentin sensitivity increases with increases in the number and size of tubules exposed ( tubule diameter increase as you move towards the pulp)
• Exposed Dentin + Stimulus=Tubule Fluid Movement —>Pain

2-1/7 = sensitivity

3-dentinal hypersensitivity =brief, sharp, well-localized pain in response to thermal, evaporative, tactile, osmotic, or chemical stimuli that cannot be described to any other form of dental defect or pathology.

Question 21

Causes
1-gingival recession

2-non carious cervical lesions

3-NCCL

Answer 21

1-perio disease
abrasian
-chewin tobacco, toothpicks, bristled tooth brushes, oral piercings, lead to loss of gingival tissue & create cervical defects in teeth

2-abrasion (physical wearing away)

• erosion (chemical wearing away/dissolution)
• abfraction- (micro-fracturing of tooth structure due to flexure) occlusal loads on teeth may produce stresses in the cervical region which results in fracturing away of tooth structure.

3-NCCLs are multifactorial—gingival recession & NCCL
-when gingival tissues recede= exposure of cementum & dentin With loss of cementum and dentin the dentinal tubules become shorter and the pulp more hypersensitive. If loss of tooth structure is rapid pulp exposure can occur.

Question 22

Prevention
1-erosion

2-abrasion

3-abfraction
4-periodontal disease

5-habit

Answer 22

1-Change of diet, Medication for GERD, Mental health care for bulimia, Recommend not brushing teeth for one hour after consuming acids, Drinking more water, Improved salivary flow for buffering

2-Change of diet, Change of toothbrush or brushing technique, Change of dentifrice, Removal of piercing

3-Occlusal guard, Stress reduction, Removal of hyper occlusion

4-Systemic health improvement, Change of diet, Oral hygiene improvement, Preventive care, Removal of plaque and calculus

5-Medication, Counseling, Behavioral therapies etc.

Question 23

Management

Answer 23

1. ) If patient discomfort is severe, recession minimal, and there is little loss of tooth structure, consider use of dentin desensitizers.
2. ) If there is no attached gingiva, NCCL is not in enamel, and esthetics are important, consider periodontal grafting.
3. ) If NCCL is in enamel only, greater in size than 2mm width, consider placing a restoration.
4. ) If there is both loss of enamel and gingival tissues, consider placing a graft over the exposed root surface and a restoration to restore lost enamel.

Question 24

1-densensitizing

2-benefits

3-disasvantages

4-soft tissue management

Answer 24

1-NaF or SnF gels and varnishes
HEMA
Adhesive Bonding Agents
Potassium containing dentifrices

2-low risk/low cost, significant reduction in symptoms
-reversible

3-not very long lasting, materials= high patient compliance over long periods of time to be effective

4-to replace the lost soft tissue via periodontal grafting and flap surgeries: can regain periodontal attachment, reduced sensitivity, improved esthetics.
Downsides are cost, time, and fear of surgery.
If there is little to no remaining attached gingiva, then this may be the only option which will produce a good prognosis.
Typically a direct restoration should not be placed in the NCCL if periodontal grafting is the intended treatment.

Question 25

1-hard tissue/ restorative management benefits

2-“ “ disadvantages

3-materials

4-RMGI

Answer 25

1-Relatively quick

• May reduce sensitivity & inexpensive
• Minimal surgery & may not need anesthesia

2-Will not address problems associated with lack of attached gingiva.

• Because of lesion location isolation, access and moisture control can be difficult.
• May have difficulty with retention of bonded restorations due to presence of sclerotic dentin (“re-restoration cycle”).
• Esthetics vary.

3-Composite Resin, Glass Ionomer, Composite Resin with Glass Ionomer (sandwich techniques), Amalgam, Resin Modified
-Glass Ionomer (Might be a good alternative to Composite Resin due to good retention rates (93-99% at 2 years)

4-RMGI can be placed just like composite but no need to bevel or place mechanical retention.
Less sensitive to moisture than composite resin during placement.
Has additional benefit of fluoride release and this can be “recharged” using subsequent topical fluoride applications.
Not as esthetic, strong, or abrasion resistant as composite resin.

Question 26

1-pillars of diagnosis

2-systematic approach

3-cardinal rules

4-subjective findings

5-obejective findings

Answer 26

1-chief complain

• health history
• symptoms
• clinical exam
• radiographic interpretation

2-chief complaint

• detailed medical & dental history
• objective & subjective examinations
• analyze date
• formulate pulpal & periradicular diagnosis
• wrong dx= wrong txt

3-dont jump to conclusions

• do diagnosis solely off radiograph
• no treatment w/o compelte dx
• no txt is better than wrong txt
• when in doubt= refer

4-data from patients description of an event or condition

5-data from direct exam & radiographic lab findings

Question 27

1-endodontic form on axium

2-cheif complaint

3-health history

Answer 27

1-under forms tab
—chief complaint, history, symptoms, exam, etiology, radiograph interpretation

2-axium—>gen questions—> chief complain

• reason prompted need for treatment
• first step= first piece of puzzle
• why come to clinic, tell me about the problem
• listen & record in patients words
• tests should dupiclate chief complaint

3-axium—>gen questions—>history
Medical
-defines risk of txt to pt
-warning of unsuspected general disease
-influence txt
-ID of medical conditions impacting treatment
Dental
-summary of present & past dental experiences
-dx & tx planning implications—clinical clues, ID of source of complains, insights to attitudes towards dental health & tx—>extraction? root canal
-subtle clinical findings—orthodontic Tx—presence of blunted roots & root resorption
-recently restored tooth & extensive perio tx

Question 28

1-current illness (patient symptoms)

Answer 28

1-Aspects of Pain

• –quality: dull, bright, sharp
• –intensity: mild, moderate, severe
• –onset: spontaneous, provoked…lingering & non lingering
• –duration: intermittent & continuous
• Pulpal pain: spontaneous, intensity, & persistence
• Severe Pain= recent origin, intermitten, not relieved by analgesics, gets patient to look for tx, irreversible pulpitis or acute apical periodontitis
• mild-moderate pain= patient symptoms= long standing pain, contiguous
• spontaneous pain-w/o stimulus, spontaneity + intense pain= severe pulpal + periradicular patho
• continuous pain- thermal stimulation= irreversible pulpitis, application of pressure= periradicular patho, symptomatic irreversible pulpitis= intense continuous pain relieved by cold

Question 29

Clinical Exam

1-pulp testing

2-cold

3-EPT

Answer 29

1-2 postiive tests are needed to confirm the diagnosis bc of high incidence of false positive

• patients= what to expect, dentist= how responds
• baseline

2-dichlorofluoromethan, compressed refrigerant spray on cotton pledget

• cold removed= lingering or non lingering
• cold response= normal/abnormal

3-electrical pulp testing—isolate teeth, coar the electroade fo test liberally w/ conductor

• place probe on dried enamel—avoid restorations
• optimal probe placement= posterior= MB cusp tip, anterior= incisal 1/3
• stimulates intact nerves by applying electric current to tooth structure
• ionic shift w/in tubules causes local depolarization & generation of action potential
• doesnt test vitality
• yes/no test
• technique sensitive—use mylar strip or rubber damn in prox contact

Question 30

1-EPT Variables

2-False Positive Reading

3-False Negative Response

4-EPT contraindications

Answer 30

1-thickness of enamel & dentin

• probe placement (between tip & pulp)
• conc of pulpal neural elements
• directions of dental tubules
• dental calcifications
• interfering restorations
• anxiety of patient

2-conductor/electrode in contact w/ large restoration or gingiva

• patient anxiety
• liquefaction necrosis
• failure to isolate & dry teeth

3-inadequate electrode contact

• excessive calcification in canal
• necrosis
• operator error
• **traumatized tooth
• erupted tooth w/ immature apex**
• heavily medicated patient

4-intra-corporeal electronic devices

• cardiac—ventricular assist device, pacemaker, intenral defibrillator
• electro-stimulator
• insulin pump
• EMI-electromagnetic interference

Question 31

1-information

2-patient history

3-where in axium

4-health medical history

5-dental history

6-medications

Answer 31

1-foundation of any treatment
-from patient history, radiographic exam, clinical exam & psychosocial history

2-most important source

• questionnaire & forms
• signs
• problems/symptoms (what patient says)
• chief complaint—reason for visit
• demographics (age, insurance, basic background)

3-forms then medical history

4-review of systems, note medication
found in forms & medical history

5-found in forms & dental history
-ask about past visit/treatments

6-forms & medications—lexicomp dental—click on links button
***can also use google, medline plus, merck manual, & medicinenet.com

Question 32

1-clinical exam. intra/extra oral

2-radiographs

3-risk indicators

4-risk factors

5-mutable risk factor

6-immutable

7- assessing risk

Answer 32

1-found in forms then extra/intra oral exams

2-based on age & oral history

3-identifiable conditions to be associated w/ higher probability of occurence

4-subset of risk indicator where there is a biological link

5-can be changed (diet, poor oral hygiene)

6-cant be changed

7-which patient is more likely to develop disease

• –degree of risk= high, moderate, low: (council, eliminate course, prevention, & therapeutic intervention)
• –found in forms and risk assessment

Question 33

1-once all the info is gathered

2-prognosis

3-treatment objectives

4-treatment planning

5-what modifies treatment sequence

Answer 33

1-list diagnoses & problems…i.e problem= caries, diagnosis= dental caries
found in tx plan, put in problems

2-estimation of the likelihood of a favorable outcome for a disease—multiple variables involved
condition= marginal gingivitis & factor= age, general history, tobacco use
—prognosis can change in relation to patient compliance

3-rational for treatment, solve patient problems, & clinicians/patient can ahve different prospective

• dentists should assess patients desires, expectation & perceptions
• repair treatment is effective as total repalcement of restorations w/ localized defects

4-consensus w/ recommendation, patient is more educated
group treatment interface:
-systemic phase= medical concern
-disease control phase=acute or emergent
-rehab phase
-maintenance phase

5-patient availability
chief complaint
finance/insurance
patient expectations

Question 34

1-behavior assessment

2-patient management considerations

3-contraindications to resin based resorative materials

Answer 34

1-observe behavior & assess potential cooperation

2-short appts, complete treatment w/ favorable experience (unless urgent care—begin w/ easier procedure), urgent treatment needs are priority, explain the procedure—tell, show, do

3-where tooth cant be isolated to obtain moisture control,
in individuals needing large multiple surface restoration in posterior primary dentition,
in high risk patients who have multiple caries and/or tooth demin and who exhibit poor oral hygiene & compliance w/ daily oral hygiene, and when maintenance is unlikely

Question 35

1-tooth morph considerations

2-rubber dam isolation

3-rubber dam clamps

Answer 35

1-primary teeth have thin enamel
pulps of primary teeth are larger in relation to crown size than permanent pulps
-pulp horns of primary teetha re closer to outer surface of tooth than permanent pulps—pulp horns are higher—-easy to expose when preparing teeth for restorations, less RDT w/ prep of equal depth, comparing primary molars to perm molars
-primary teeth have narrow occlusal surfaces in comparison w/ perm teeth

2-moisture control necessary for successful placement of resin
Adv= mositure control, better access/visualization, safety of kid improved (no aspiration), child is quiet, treatment less stressful

3-A clamps have jaws angled gingivally to seat below subgingival heights of contour…when teeth havent fully erupted

• –must seat apical to height of contour
• –27N clamp go primary 2nd molars

Question 36

1-isolation

2-mandibular moalrs

3-conservative adhesive restorations

4-preps

Answer 36

1-single tooth isolate is acceptable for pediatric patients where treatment involves occlusal surface of 1 tooth

2-occlusal anatomy= primary mandibular 2nd molar= perm mandibular 1st molar
-primary mandibular 1st molar has prominent transverse ridge…not crossed unless lesion involves ridge

3-preventive resin restoration or composite fissure sealant restoration

• external outline form is determined by extent of carious lesion
• remaining pits & grooves are sealed w/ sealant material

4-rounded cavosurface line angle

• rounded internal line angles
• walls of prep are convergent—follows direction of enamel rods
• shallow prep compared to perm teeth= enamel thinner, pulp horns higher & clinically there is a deeper pit, entire floor of prep isnt deepened, only area that had soft dentin
• depth determined by extent of lesion
• prep can be 1.5 mm w/ 330 bur

Question 37

1-restoration

2-finish & polish

Answer 37

1-layer of dentin bonding agent between etched enamel & sealant show dramatic reduction of failure for sealants

• incremental placememnt of composite if possible
• ball burnisher to create occlusal anatomy & smooth surface
• dont leave lots of excess composite around margins
• remove gross excess prior to curing

2-30 fluted finished bur
-abrasive points