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Operative Flashcards

1
Q

Hydroxyapatite (HA)

A

Ca10(PO4)6(OH)2
* Hexagonal
* White Power
* Low Bioresorption rate: Doesn’t mimic inorganic portion of teeth

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2
Q

Carbonate-Substituted Hydroxyapatite (CHA)

A

Main component of enamel & dentin

Carbonate increases sollubility of HA=easier to decay
* mostly found at DEJ, (Fluoroapatite on surface of tooth mostly)
* enamel rod=Keyhole pattern
* Head
* Tail=more organic, less mineral content=more susceptible to decay

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3
Q

Describe the structure/composition of enamel

A

More FA near the outside
More CHA near the DEJ(Deeper enamel)

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4
Q

What are the 3 ways that Fl can prevent decay?

A
  1. Remineralization of tooth structure
  2. Decreasing Enamel Solubility (lower critical pH)
  3. Interfering w/metabolic activity of cariogenic bacteria
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5
Q

What is the critical pH?

A

equilibrium b/w demineralization & remineralization
* the lower the critical pH the more resistant to demineralization

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6
Q

What is the critical pH of enamel (FA) vs Enamel (CHA) vs Dentin/Cementum

A

Enamel (FA)=4.5
Enamel (CHA)= 5.5
Dentin/Cementum: 6.2-6.7

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7
Q

What is caries?

A

Multifctorial transmissible infectious dynamic oral disease
* result from interaction b/w: Biofilm, Diet, Host Factors, & Time

  • Modeled by: Modified Keyes-Jordan Diagram-added time
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8
Q

What is the shape of pit and fissure lesions?

A

Inverted V-Shape

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9
Q

What is the shape of Smooth Surface lesions?

A

V-Shaped (Double arrow head)
* spreads wide again at DEJ

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10
Q

What is the shape of root surface lesions?

A

V-shaped
* Rapid progression bc no enamel

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11
Q

Infected vs Affected Dentin

A

Infected Dentin:
* Superficial layer
* Wet, soft, Mushy
* Necrotic
* bacteria present=active infection

Affected Dentin:
* deeper
* dry
* leathery
* demineralized but NO bacteria

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12
Q

Progress of Lesions

A

Intact surface
* enamel
* required for remineralization

Cavitation
* irreversible
* requires restorative tx

Takes 1-2 years to form an enamel cavitation (Cavity)
* white spot to cavitation

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13
Q

What are the steps in cavity formation?

A
  1. Enamel Demineralization
  2. Dentin Demineralization
  3. Enamel Cavitation (irreversible)
  4. Dentin Cavitation
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14
Q

Incipient Lesion

A

Aka Reversible
* smooth surface
* appears white when dried and disappears when wet (NOT Hypocalcification)

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15
Q

Cavitated Lesion

A
  • irreversible
  • broken enamel surface (not intact)
  • advanced into dentin
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16
Q

Simple carious lesion

A

covers 1 surface of tooth
* O

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17
Q

Compound Carious Lesion

A

Covers 2 surfaces of a tooth
* MO, DO

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18
Q

Complex Carious Lesion

A

Covers 3+ surfaces
* MOD, MODFL

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19
Q

Primary caries

A

Original Lesion

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20
Q

Secondary caries

A
  • aka recurrent caries
  • occurs at jxn of tooth and restoration
  • indicates microleakage
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21
Q

Residual Caries

A
  • caries that are still in a completed tooth prep
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22
Q

Acute Caries

A

Aka Rampant Caries
* rapid tooth damage
* light-colored
* soft
* infectious

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23
Q

Chronic Caries

A

Aka Slow Caries
* Demineralized but almost remineralized
* discolored
* fairly hard

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24
Q

Arrested Caries

A
  • Brown/black appearance
  • hard
  • if exposed to Fl=Caries resistant (dentin has sclerotic dentin)
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25
What bacteria can cause cavities? (Cariogenic Bacteria)
1. Streptococcus mutans 2. Lactobacillus 3. Actinomyces
26
Streptoccocus mutans
**ENAMEL CARIES** * **Glucosyltransferase (GTF):** * Acidogenic * Acidureic bacteriocin
27
Lactobaccilus
Dentin caries
28
Actinomyces
Root Caries
29
Saliva
Main Natural protective agent Contains: * Glycoproteins: * Lysozyme * Lactoferrin: Inactivate iron * Lactoperoxidase: inactive enzymes (-ases) * sIgA: Salivary antibody against bacteria
30
Clinical Exam for caries consists of:
1. Visual Changes in tooth surface texture or color 2. Tactile sensation w/explorer 3. Radiographs 4. Transillumination
31
Clinical Exam: Visual changes in tooth surface texture or color
always in dry, well-lit field Incipient caries: * partially or totally disappear from vision by wetting * hypocalcification/decalcification does not
32
Clinical Exam: Tactile sensation w/explorer
* Place cotton rolls in vestibules * remove excess saliva w/suction * be careful to not cavitate incipient lesions
33
Clinical Exam: Radiographs
White Spot: Hardly visible Enamel Cavitation: Evident Dentinal Lesion: Clearly evident Lesions are **smaller** on radiograph than clinically * requires **30-40% mineral loss** to be detected by radiographs
34
Clinical Exam: Transillumination
Anterior Teeth: Shadow=interproximal caries craze lines: whole tooth lights up Fracture: Bocks light from shining through
35
Amalgam Exam consists of: (What to look for)
Do NOT Replace: **Bluish Hue**: * due to corrosion * not defective Needs to be redone if: Voids Fracture lines Proximal & Margin Overhang **Marginal Gap or ditching >0.5 mm**=caries prone
36
Erosion
chemical loss of tooth structure w/o bacteria *cause=Acidic foods/drinks or gastric acid * NOT caused by bacteria * Manifests as "Cupping"
37
Abrasion
Loss of tooth structure by mechanical wear * ex: aggressive tooth brushing * most common=porcelain or ceramic crowns against teeth
38
Attrition
Loss of tooth structure due to: * Occlusal wear from functional contacts w/opposing teeth * bruxism
39
Abfraction
Loss of tooth structure in cervical 1/3 * due to tooth flexure * multifactorial: Tooth flexure, toothpaste, abrasion, chemical erosion
40
Hypersensitivity:
* due to exposed dentin tubules in root surface
41
Hydrodynamic Theory
**Root Hypersensitivity** Pain is due to dentin fluid movement that stimulates mechanoreceptors near predentin Causes of fluid shift: * Temp change * air-drying * osmotic pressure
42
Treatment Plan Sequencing
What the pt needs most is what needs to be done 1st 1. Urgent Phase: Acute infection, pain, swelling 2. Control phase: Caries, oral hygiene 3. Re-evaluation phase 4. Definitive phase: ortho, prosth, surgery (establish optimal esthetics) 5. Maintenance phase
43
Criteria for restoring teeth/Restorations
**High Caries Risk** * 2+ active caries * large number of restorations * Poor dietary habits * low salivary flow * poor OH * low FL exposure * Unusual tooth morphology Lesion extends to DEJ Cavitation
44
Define Preventative Dentistry
**Encourage Remineralization** * incipient smooth-surface lesions * Fl use * Decrease caries risk factors Sealants: * Deep pits and fissues
45
What is the critical pH of enamel?
5.5
46
What are the steps required in a tooth prep?
1. Outline Form 2. Primary Resistance Form 3. Primary Retention Form 4. Convenience Form 5. Remove caries 6. Pulp Protection 7. Secondary Retention & Resistance Forms 8. Finishing External Walls
47
Outline Form
external outline of prep * along **cavosurface margin** * Defined by extent of the carious lesion * remove all unsupported enamel Extend to sound tooth structure * initial depth of **0.2 mm into dentin** * gingival floor: **0.5 mm clearance** ALWAYS * F & L Proximal walls: **0.5 mm clearance** EXCEPT if you would remove sound tooth to break contact
48
Friable Enamel
Demineralized * bonding is not as effective
49
Unsupported Enamel
Undermined & Weaker * high possibility for fracture
50
Define Resistance Form
Shape and placement of adjacent walls * Tooth and restoration withstand masticatory forces * Prevent fracture
51
Define Retention Form
prevent displacement of restorative material * Convergent walls: Prevent occlusal displacement Dove tail: Prevent proximal displacement Composite=rely on bonding
52
Convenience Form
Improve access and visibility as needed
53
Caries Removal
* Remove ALL infected Dentin
54
Pulp Protection
If you are close to the pulp=Indirect pulp cap (Base) < 1mm exposure & asymptomatic --> Direct Pulp Cap (Liner + Base) > 1mm exposure & symptomatic--> RCT
55
GLUMA
Sealer/Desensitizer Used for sensitivity: Occludes dentin tubules * need 2+ mm of Dentin to pulp
56
GLUMA consists of:
Consists of: * 5% Glutaraldehyde * 35% HEMA * Water
57
Liner
Used for direct pulp cap or near pulp exposure * Barrier=Protect dentin from residual reactants of restoration & oral fluid Electrical Insulation Thermal Protection Form Tertiary Dentin Ex: **CaOH** or RMGI
58
Base
Used for metal restorations or w/a liner * prevents liner from being washed out * Thermal protection (under amalgam or gold) Distributes local stresses across **RMGI** or GI Cement * Ex: Vitrebond
59
What is indicated for Amalgam and RDT (Remaining Dentin Thickness)
>/= 2mm: Sealer 0.5-2.0: Base + sealer < 0.5 mm: Liner + Base + Sealer
60
What is indicated for Composite and RDT (Remaining Dentin Thickness)
>/= 0.5 mm: Bond < 0.5 mm: Liner + base + bond
61
What is indicated for Gold or Ceramic and RDT (Remaining Dentin Thickness)
>/= 2.0 mm: Cement 0.5-2.0 mm: Cement (2mm thick) <0.5 mm: liner, base, cement
62
Secondary Resistance & Retention Form
Retentive Grooves Beveled Enamel Margins Slots Pins
63
Amalgam Preparation
**Carbide Burs**: creates smoothest walls Retention: * **occlusal convergance** * Grooves, slots, pins (secondary) if needed Resistance for Tooth: * **90 degree cavosurface margin** * Maintain cusps and marginal ridges * Remove unsupported enamel * Flat floors * Rounded internal line angles * Pins Resistance for Amalgam: * **90 degree amalgam margin** * **1.5-2.0 mm depth** for adequate thickness of amalgam
64
Composite Preparation:
Use **Coarse diamond** -->rough walls=micromechanical retention Same as amalgam except NO need for: * retentive features * occlusal convergence * can be shallower: **1-1.5 mm**
65
Gold Onlay Preparation
**Collar** * beveled shoulder around capped cusp for bracing **Skirt** * Feather edged margin around capped cusp Provides Secondary R&R FORM
66
Slots
at least 1 mm Deep & Long * 0.5 mm inside DEJ
67
Pins
Self threaded pin=most common * Missing vertical wall

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