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BOARDs > Operative > Flashcards

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
Q

What bacteria can cause cavities? (Cariogenic Bacteria)

A
  1. Streptococcus mutans
  2. Lactobacillus
  3. Actinomyces
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26
Q

Streptoccocus mutans

A

ENAMEL CARIES

  • Glucosyltransferase (GTF):
  • Acidogenic
  • Acidureic
    bacteriocin
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27
Q

Lactobaccilus

A

Dentin caries

28
Q

Actinomyces

A

Root Caries

29
Q

Saliva

A

Main Natural protective agent

Contains:
* Glycoproteins:
* Lysozyme
* Lactoferrin: Inactivate iron
* Lactoperoxidase: inactive enzymes (-ases)
* sIgA: Salivary antibody against bacteria

30
Q

Clinical Exam for caries consists of:

A
  1. Visual Changes in tooth surface texture or color
  2. Tactile sensation w/explorer
  3. Radiographs
  4. Transillumination
31
Q

Clinical Exam: Visual changes in tooth surface texture or color

A

always in dry, well-lit field

Incipient caries:
* partially or totally disappear from vision by wetting
* hypocalcification/decalcification does not

32
Q

Clinical Exam: Tactile sensation w/explorer

A
  • Place cotton rolls in vestibules
  • remove excess saliva w/suction
  • be careful to not cavitate incipient lesions
33
Q

Clinical Exam: Radiographs

A

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
Q

Clinical Exam: Transillumination

A

Anterior Teeth: Shadow=interproximal caries

craze lines: whole tooth lights up
Fracture: Bocks light from shining through

35
Q

Amalgam Exam consists of: (What to look for)

A

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
Q

Erosion

A

chemical loss of tooth structure w/o bacteria
*cause=Acidic foods/drinks or gastric acid
* NOT caused by bacteria
* Manifests as “Cupping”

37
Q

Abrasion

A

Loss of tooth structure by mechanical wear
* ex: aggressive tooth brushing
* most common=porcelain or ceramic crowns against teeth

38
Q

Attrition

A

Loss of tooth structure due to:
* Occlusal wear from functional contacts w/opposing teeth
* bruxism

39
Q

Abfraction

A

Loss of tooth structure in cervical 1/3
* due to tooth flexure
* multifactorial: Tooth flexure, toothpaste, abrasion, chemical erosion

40
Q

Hypersensitivity:

A
  • due to exposed dentin tubules in root surface
41
Q

Hydrodynamic Theory

A

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
Q

Treatment Plan Sequencing

A

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
Q

Criteria for restoring teeth/Restorations

A

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
Q

Define Preventative Dentistry

A

Encourage Remineralization
* incipient smooth-surface lesions
* Fl use
* Decrease caries risk factors

Sealants:
* Deep pits and fissues

45
Q

What is the critical pH of enamel?

A

5.5

46
Q

What are the steps required in a tooth prep?

A
  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
Q

Outline Form

A

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
Q

Friable Enamel

A

Demineralized
* bonding is not as effective

49
Q

Unsupported Enamel

A

Undermined & Weaker
* high possibility for fracture

50
Q

Define Resistance Form

A

Shape and placement of adjacent walls
* Tooth and restoration withstand masticatory forces
* Prevent fracture

51
Q

Define Retention Form

A

prevent displacement of restorative material
* Convergent walls: Prevent occlusal displacement
Dove tail: Prevent proximal displacement

Composite=rely on bonding

52
Q

Convenience Form

A

Improve access and visibility as needed

53
Q

Caries Removal

A
  • Remove ALL infected Dentin
54
Q

Pulp Protection

A

If you are close to the pulp=Indirect pulp cap (Base)

< 1mm exposure & asymptomatic –> Direct Pulp Cap (Liner + Base)

> 1mm exposure & symptomatic–> RCT

55
Q

GLUMA

A

Sealer/Desensitizer

Used for sensitivity: Occludes dentin tubules
* need 2+ mm of Dentin to pulp

56
Q

GLUMA consists of:

A

Consists of:
* 5% Glutaraldehyde
* 35% HEMA
* Water

57
Q

Liner

A

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
Q

Base

A

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
Q

What is indicated for Amalgam and RDT (Remaining Dentin Thickness)

A

> /= 2mm: Sealer
0.5-2.0: Base + sealer
< 0.5 mm: Liner + Base + Sealer

60
Q

What is indicated for Composite and RDT (Remaining Dentin Thickness)

A

> /= 0.5 mm: Bond
< 0.5 mm: Liner + base + bond

61
Q

What is indicated for Gold or Ceramic and RDT (Remaining Dentin Thickness)

A

> /= 2.0 mm: Cement

0.5-2.0 mm: Cement (2mm thick)

<0.5 mm: liner, base, cement

62
Q

Secondary Resistance & Retention Form

A

Retentive Grooves
Beveled Enamel Margins
Slots
Pins

63
Q

Amalgam Preparation

A

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
Q

Composite Preparation:

A

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
Q

Gold Onlay Preparation

A

Collar
* beveled shoulder around capped cusp for bracing

Skirt
* Feather edged margin around capped cusp

Provides Secondary R&R FORM

66
Q

Slots

A

at least 1 mm Deep & Long
* 0.5 mm inside DEJ

67
Q

Pins

A

Self threaded pin=most common
* Missing vertical wall

BOARDs (47 decks)

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