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OPERATIVE II > operative final study guide material > Flashcards

operative final study guide material Flashcards

1
Q

Class III:

A

Interproximal caries on anterior tooth

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2
Q

class IV

A

“chipped tooth” (fractured incisal edge)
III and IV similar but IV missing incisal edge

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3
Q

which III or IV
more extensive bevel to increase retention and esthetics

A

IV
Bevel must cover at minimum the same amount of enamel that is missing due to the fracture
ground(bevel) enamel improves the adhesive bond to enamel by 18% over unground enamel

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4
Q

lingual enamel margins not beveled in class IV when:

instead:

A

heavy centric contact on margin

Use dovetail with no bevel on lingual to compensate for retention without beveling

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5
Q

thin covering (often to hide under layer)

A

veneer

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6
Q

Direct Veneer Preparation (composite):
1
2

A
  1. incisal lapping preparation
  2. window preparation
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7
Q

Preparation includes incisal edge
Indicated when tooth needs to be lengthened or incisal defect is present and needs to be correct
(some clinicians do minimal tooth preps, which result in overcontoured (bulky) veneers)

A

incisal lapping preparation
-direct veneer prep (composite)

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8
Q

type of direct veneer:
(what we did)
Most often recommended
Remove only enough tooth structure to achieve optimal contours with final restoration
Incisal edge remains intact

A

window preparation

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9
Q

Intra-enamel preparation with window prep in direct veneer

A

Necessary to provide space for materials to achieve max esthetics
Removes outer, fluoride rich layer (resistant to etching)
Roughens surface for improved bonding
Establishes definite finish line

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10
Q

Identify common mistakes associated with veneers:

A

-Failure to do wax-up prior to prepping
-Failure to address gingival asymmetry
-Failure to communicate effectively with patient
-Everyone must have same expectations
-Dont start a case that should have never been started (learn to say no)

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11
Q

made OUTSIDE of mouth):
Porcelain

A

indirect veneer

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12
Q

indirect porcelain veneer adv

A

Excellent aesthetics
Color match
High bond strength
Conducive with periodontal health
Low wear/abrasion on porcelain restoration

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13
Q

indirect porcelain veneer disadv

A

Multiple appointments
Expensive
Must have adequate room for preparation
Requires laboratory involvement and fee
Difficult to keep provisional seated

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14
Q

made in mouth veneer

A

direct composite

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15
Q

adv of direct comp veneer

A

Mask discoloration
Cheaper than indirect
Can easily correct rotated tooth or diastema
One appointment

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16
Q

direct comp veneer disadv

A

Susceptible to wear
Margin fracture/stain
Discoloration
contours

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17
Q

Understand which materials will give a better esthetic result

A

porcelain
has better esthetics and color match compared to composite veneer

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18
Q

different treatments available to help patients with esthetic concerns and tools for communicating with them

A

Alternate treatment:
-Bleaching for discoloration
-Microabrasion and macroabrasion (polishing) for discoloration
-Direct composite veneers
Microfill composite resin polishes best
-Full coverage porcelain crown or porcelain veneer
-Orthodontics (rotation or diastema)

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19
Q

veneer indications

A

Intrinsic stain
(Tetracyclie, fluorsis)
Extrinsic stain
(Coffee, wine, smoking)
Wear patterns
Poor restorations
Diastema closure
Rotated and misaligned teeth

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20
Q

Veneer contraindications

A

Severely malpositioned teeth
Ortho
Denuded dentin (from bruxism)
Poor oral hygiene
Beware of highly fluoridated teeth
Issue with bonding
No primary teeth!
Pregnancy
Oral habits
Bruxism

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21
Q

used with LARGE restorations and less than ideal supporting tooth structure
Typically amalgam (because it relies on mechanical retention)

A

accessory retention
(Understand the purpose of pin placement and when it is appropriate or inappropriate to place a pin)

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22
Q

Indications for pins:

A

Improve retention as a last resort
Large restorative that are missing cusp(s)
Prognosis of tooth is uncertain (unstable perio)
Unable to access pulp canals (sclerosed tooth) for needed additional retention

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23
Q

Contraindications for pins:

A

Severe loss of tooth structure
Endodontically treated teeth
-Teeth too brittle
-Alternatively use post or amalgam core
Large pulp canals (children)
Difficult access for placement
Tooth serves as abutment for RPD

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24
Q

Self threading Pin (size, depth, properties)

A

Pin hole 0.002” smaller than pin
Pin self-threads into dentin (with hand wrench or latch grip on slow speed 5000rpm)
2 mm in dentin, 2 mm outside of dentin

5-6 times as retentive as cemented pin
High crestal and apical stresses; crazing and microleakage
-greater stresses in dentin
Also, SELF SHEARING: break off on own as you turn them

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25
Q

Know where pins should be placed in relation to tooth structures and in relation to other pins

A

-Pin is always placed in DENTIN
-At least 1 mm of dentin around pin hole (0.5mm both sides)
-2mm deep into dentin
-Should be placed 5mm apart from each other
-(Minimum of 3mm apart)
-Should be 1mm from wall of prep
-(Minimum 0.5mm from wall to allow for room for condensation of amalgam around pin)
-Place in line angle
-Placed along long axis of tooth
-If using multiple, angle in slightly different directions
-AVOID bending pins

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26
Q

Twist drill sizes

A

Regular: 0.027 (gold)
minim : 0.021 (silver) most frequent used
Minikin: 0.017 (red)
Minutia 0.013 (pink)

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27
Q

Types of twist drills

A

Standard
Self-limiting: drill stops itself from drilling too deep of a pilot hole

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28
Q

how to know if pin is the correct height and how to troubleshoot if not

A

Must be 2mm of amalgam over top of pin
If not: amalgam will fracture

Too tall:
-reduce with handpiece stabilized by forceps to cut perpendicular to pin
-Check when done to make sure not lose
-Bend slightly using provided pin tool (preferred)
-Helps avoid excessive stress

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29
Q

Where not to place pins:

A

Avoid pulp exposure:
-MF (MB) corner of max and mand 1st molar
-D mand molars
-L max molars
-mid-F, mid-M, mid-D furcations of max 1st and 2nd molars

Concavities:
-M over max 1st PM
-mid-L and mid-F of mand 1st and 2 molars
-Mid-F, Mid-M, and Mid-D furcations of max 1st and 2nd molars

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30
Q

Disadvantages of pins:

A
  1. Introduces stress into dentin which can lead to fracture
  2. Pins reduce the compressive and transverse strength of amalgam
  3. Possibility of pulp or PDL perforation
    -Pulpal exposure is preferred to PDL exposure
    a. Pulpal
    -Direct pulp cap with calcium hydroxide or endo
    b. PDL
    -Results in abscess
    -Treated by removing pin that is perforating tooth and plugging with amalgam
    -Less predictable prognosis
  4. Microleakage around pin
  5. More difficult to restore and carve anatomy
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31
Q

Know advantages and disadvantages of indirect restorations

A

Advantages:
Esthetics
Better control of restoration contours
Strength of material

Disadvantages:
Expensive
Requires two appointments (if sent to lab)
Impression needed (digital or with impression material)

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32
Q

Indication for inlay:

A
  1. Indirect restoration that is placed within the cusp tips
  2. NO cuspal protection
  3. Used on teeth with minimal caries
    -Occlusal must be acceptable
    -Buccal and lingual cusps must be strong
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33
Q

Indications for onlay:

A
  1. Large carious lesions or existing defective restorations
  2. Cracked teeth
  3. Endodontically treated teeth
    -Must have sufficient tooth structure to retain the only and allow for removal of undercuts
    -When enough facial and lingual are relatively intact; otherwise do a crown
34
Q

Why use an ONLAY instead of Inlay:

A
  1. When the bucco-lingual width of the cavity preparation is:
    ½ way between central groove and cusp tip- CONSIDER ONLAY

⅔ way between central groove and cusp tip-SHOULD ONLAY

  1. Where cusps are undermined after caries removal
  2. Where occlusion of tooth must be altered

(inlay acts as wedge, onlay protects)

35
Q

Advantages of gold:

A

Strength
Wear resistance
Will maintain smooth surface (no tarnish or corrosion)
Better control of contact and contour
Potential for greater longevity

36
Q

disadv of gold

A

esthetics

37
Q

Advantages of ceramic:

A

Esthetics
Wear resistance
Reduced polymerization shrinkage compared to direct composite restoration

38
Q

disadv of ceramic

A

Require removal of more tooth structure for adequate material bulk
Ceramics require dry field to bond
Expense (compared to direct composite)
TECHNIQUE SENSITIVE
Wears on opposing dentition
Low potential for repair

39
Q

Inlay preparations:

A

Cannot have any undercuts (walls are DIVERGENT)
Restoration fits PASSIVELY
NO SHARP LINE ANGLES

40
Q

gold inlay prep

A

-If walls are longer: more divergence acceptable (5-7 degrees)
-If walls are shorter: walls should be closer to parallel (2 degrees)
-Bevel gold inlay preparations
-Occlusal, axiopulpal, gingival bevels
-1mm bevel at 45 degree
Flared exit angles
-Contacts broken at least 0.5mm
I-f 2 surface (MO or DO)
-Dovetail is present
-No reverse S curve (gold strong enough)

41
Q

Ceramic Inlay preparation:

A

-Occlusal depth: 1.5-2.0mm
-Isthmus 2.0mm
-NO BEVEL
-Flared exit angles
-Contacts broken at least 0.5mm
-No sharp line angles
-Smooth, flat walls
-If 2 surface (MO or DO)
Dovetail is present

42
Q

Gold onlay preparation:

A
  1. Cut depth cuts into cusp
    1.5mm reduction on functional cusp
    1.0mm reduction on nonfunctional cusp
  2. Add bevels
    1mm functional cusp
    0.5mm nonfunctional cusp
  3. Ferrule margin (same as light chamfer?)
43
Q

Ceramic onlay:
specifications

A

2mm reduction functional cusp
1.5mm reduction nonfunctional cusp
90 degree cavosurface angles
Smooth line angles
No external bevels
Need adequate (0.5mm) clearance from adjacent teeth for die separation

44
Q

ceramic materials used at UMKC and their basic properties

A

Nano resin ceramic (weakest)
Enamic, lava ultimate
140-200 MPa

Feldspathic porcelain
Vita and Sirona blocks
154 +/- 15 MPa

Leucite Reinforced
IPS Empress
160 MPa

Lithium Disilicate
Ivoclar e.max
Starts in an intermediate phase and must be crystalized
Flexural strength 360 MPa
Shortened firing cycle may cause loss of strength and color shift

Zirconia (strongest)
Flexural strength 600-900 MPa
Strong, less aesthetic (very opaque)

45
Q

Inlay seating:

A

-Cannot have any undercuts (walls are DIVERGENT)
-Restoration fits PASSIVELY
-NO SHARP LINE ANGLES

46
Q

Very predictable bonding= 25-30MPa

A

enamel

47
Q

Chemical drilling
30-40% phosphoric acid most effective for enamel retention

Removes about 10 um enamel

A

enamel etching

48
Q

enamel etching:

Place for ___ seconds prior to rinsing
Creates porous layer 5-50 microns deep
Rinse with water for ___seconds after etching
To remove acid and leave enamel surface clean for bond

A

15 seconds
rinse 10 seconds

49
Q

Etching raises the surface free energy to exceed the surface tension of bonding material
Produces spaces where resin can penetrate to form resin tags

A

micromechanical bond

50
Q

Mechanical interlocking is formed between polymerized resin and porosities in etched enamel

A

micromechanical bond

51
Q

Flows into microporosities
Polymerizes to micromechanical bond

A

after etching, you apply bond agent resin (low viscosity)

52
Q

Variation in enamel bonding

A

Incisal third and middle third enamel
Predictable and strong

Cervical enamel
Less strong
Shorter and fewer enamel tags
Due to presence of prismless enamel

53
Q

Bond strength perpendicular to enamel

A

ends of enamel rods 25MPa

54
Q

Bond strength parallel to enamel

A

sides of rods 7-10 MPa

55
Q

Challenging bonding= bond strengths vary

A

dentin

56
Q

______dentin has higher bond strength than ___ dentin

A

superfical dentin than deeper dentin (near pulp)

57
Q

if you don’t use____, you are not getting smear layer off)

A

etch

58
Q

bond systems

A

Etch and rinse (total etch)
1. etch separate
2. prime
3. bond
(or prime and bond together- do at UMKC)

3 step (2 bottle) total etch
Etchant
Primer
Bond agent
2 step (1 bottle) total etch
Etchant
Primer and bond agent combined

self etch
-no phsophoric acid etch step
-acid part of primer or primer/bond agent

2 step:
Acidic primer
Bonding agents
Acidic primer partially dissolves smear layer, allows penetration of bond resin
1 step:
All in one (most variable/least predictable)
Acidic primer and bond resin, one solution
Many require mixing

selective etch : etches enamel only with phos. acid

59
Q

adv of total etch

A

More predictable, stronger bond
Enamel adequately prepared

60
Q

disadv of total etch

A

-Collagen collapse is possible (user error)
-Etched zone is often deeper than hybrid layer
Exposed demineralized, collagen fibrils
Post-operative sensitivity

61
Q

self etch adv

A

No separate etch: overdried demineralized collagen not a problem
Etched zone and hybrid layer comparable width; however, some exposed collagen
Low post operative sens
Time efficient

62
Q

self etch disadvan

A

-Not compatible with self-cure, dual cure composite
Acidic monomers, low pH, kills basic amine activator

-Will not etch unprepared enamel

-Self etch primer systems
Long term bond strength questionable

-Self etch adhesives (all in one)
Lower bond strength
Long term breakdown
Collagen degradation overtime

63
Q

Primary bacteria in caries

A

S. mutans (initiator)
Lactobacillus (responsoble for progression of caries)
Actinomyces V.

64
Q

Where caries progresses most rapidly in tooth

A

hydroxyapatite(enamel) demineralizes at pH<5.5

Dentin demineralizes at pH<6.2
Proteolytic enzymes (MMPs) removed organic partition (collagen) so remineralization may not be possible

Fluorapatite demineralizes at pH<4.5

65
Q

Dietary habits that affect caries

A

Frequent snacking/drinking of carbohydrates(primarily sucrose) in between meals increases caries risk
Consuming sugar without chewing does not stimulate saliva and increases caries risk

66
Q

When to place sealants

A

Sealants are placed on pit and fissure areas on NON CAVITATED TEETH

PRR(preventive resin restorations) done on teeth that have initial caries but NOT in dentin
Caries must be removed first

67
Q

Be able to describe a properly placed rubber dam system

A

Prep work:
1. Punch holes in rubber dam
2. Check contacts for floss shredding
Smooth contacts if necessary
3. Mark occlusion before placing dam
4. Place clamp on tooth
5. Place dam over entire clamp
Can do with or without frame in place
6. Stretch dam through contacts
Floss between contacts
7. Invert dam
Delicately blow air around cervical area and push rubber into sulcus with plastic instrument
8. Ligate anterior tooth
Ligate with ligatures or piece of rubber dam cut and placed interproximal
9. Rubber dam is optimal method of isolation

68
Q

enamel rod orientation

§ Including in relation to one another

A

Larger diameter near surface, smaller near dentin borders
DO NOT LEAVE UNSUPPORTED ENAMEL

Enamel rods are perpendicular to long axis and radiate outward from dentin

69
Q

Thickness varies by location and tooth types
90-92% hydroxyapatite
STRONG AND BRITTLE

A

enamel

70
Q

Largest portion of tooth
Located in both coronal and root portions of tooth
50% hydroxpap

A

dentin

71
Q

dentin harder near ____

A

near DEJ than at pulp

larger and more at pulp than DEJ

72
Q

Fluid movement in tubules=

A

dentinal sensitivity

73
Q

Class III preps

A
  1. approach from lingual when possible (esthetics)
    May be acceptable to leave unsupported enamel facial or incisal
  2. Preserve a portion of incisal contact
  3. Outline form is created PERPENDICULAR to long axis of tooth (not lingual surface)
  4. Inciso gingival height
    1.5mm on lateral
    2.0mm on central
  5. Mesial distal width
    1.0mm on lateral
    1.5mm on central
  6. Gingival contact broken
  7. Retention points/groove added only in dentin at depth of ¼ round bur
    Point is incisal
    Groove is gingival
  8. 1 mm, 45 degree bevel placed on lingual (or facial)
  9. Facial contact is minimally broken so it can be seen slightly from facial
74
Q

importance of axis of entry on preparations

A

Important for retention form to insure proper convergence
Also important to ensure that enamel rods are not undermined

75
Q

Recall the purpose of the reverse S in amalgam preparations

A

helps resist fracture of amalgam restoration by increasing the bulk of amalgam, reducing its brittleness and increasing its strength

76
Q

proper tofflemire retainer and matrix band placement

A

Slots face gingiva
Choice 1
Retainer on the buccal side
Band emerges from one of the side guide channels
MOST COMMON

77
Q

Obtaining good contact with toffle

A

Loosen band quarter turn after wedging
Burnish band against proximal surface of adjacent tooth
Pack material hard against matric band in contact area

78
Q

proper Class II composite placement and why

A

Place composite incrementally to achieve proper contact and maintain good margins

79
Q

problems that may occur if occlusion is not considered when restoring a tooth

A

Pain on biting
Fractured cusp
Fractured restoration
Premature wear on tooth
Trauma to PDL
Trauma to TMJ

80
Q

identify cause of amalgam marginal ridge failure after matrix band removal

A

Premature removal of matrix band can cause marginal ridge fracture

removing matrix band occlusal and not taking off tofflemire first

81
Q

now where the handpiece motor is located

A

in the actual handpiece

OPERATIVE II (11 decks)

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