Operative II E3 Flashcards
3 general types of materials for Inlays/Onlays:
Direct composites
Indirect composites
Indirect Ceramics
Advantages to Direct Composites:
Disadvantages
Less cost/time, simple technique, repairable
Tech. sensitive, isolation, matls not fully set
Advantages to Indirect Composites:
Disadvantages:
Control contours, Better Wear resist, repairable, flexible
Cost/time, isolation
Advantages to Indirect Ceramics:
Disadvantages:
Control contours, Best wear resist, better bond to enamel
Most cost/time, brittle, isolation, NOT repairable
Indirect Composite Advantages are ______ physical/chemical properties
______ polymerization shrinkage
Predictably better ______
*also great esthetics and matl advancements
increased
Zero
contacts/contours
Indirect Composites are _______, improving pretty much all properties over Direct Composites
Silanated
A big advantage to Indirect Composites is that they are compatible with what?
Enamel
*Ceramics can be abrasive
What has better plaque resistance, composite or ceramics?
Ceramics
Describe Steps to make Indirect Composite - chairside:
Prep
Impression
Silicone die (Mach III)
*make composite on silicone die
4 Steps Lab takes to make Indirect Composite:
after Prep/Impression
PVS Impression
Model poured
Separating liquid
Composite placed
When building up an Indirect Composite, mark borders of die red and add what?
Color, Dentin shades in layers, then Enamel shades
Trim an Indirect Composite build up (on die) with what?
Then add…
Then is the final ______ cycle
diamond burs
stains
polymerization
Final polymerization of Indirect Composites is done under what?
why?
Vacuum
Increases hardness and polishability
Describe Mechanical Retention method for Delivering Indirect Composites?
Roughen internal surface
Sandblast
Describe Mechanical/Chemical retention method for Delivering Indirect Composites?
SiO2 impregnation
Silane
T/F
The fastest growing segment of the dental Tx market is All ceramic restorations - annual growth of 20%
True
All Ceramic CAD crowns have similar success rate to what?
PFM
List 4 all ceramic matls of increasing strength
Hand condensation
Silica CAD blocks
LiDisilicate (Emax)
Zirconia alumina
Ceramics are durable but ________
Brittle
T/F
Ceramics are more costly than gold
False
Ceramics have low _______ strength
Edge
3 General Ceramic choices:
w/ 3 specific products
High glass (silica - highly esthetic)
Low Glass (LiDisilicate - Emax)
No glass (Zirconium)
MCC’s (PFMs) are weak when…
hand layered
What is the main advantage of a Monolithic Restoration matl vs. a Layered?
Chipping can occur along layer lines.
*milled ceramic blocks are monolithic
Emax (LiDisilicate) has what intrinsic property allowing for increased flexural strength?
Large crystals
LiDisilicate wears similarly to what?
Enamel
What product is milled in a softer Blue State?
After milling, what is done?
IPS Emax CAD
Sintered, glazed, recrystallized into stronger structure
What all ceramic product is pressed into a Lost Wax Casting?
IPS Emax Press
Zirconia is very opaque, durable, can be made thinner,, wears _____ heavily, and is not ______, therefore there is little _______
Enamel
Etchable
Bonding
What is the advantage to bonding an all ceramic restoration?
Micro-mechanical bonding
AND
Chemical bonding via Silane coupler
Would you use Bond or Cement for all ceramics?
Bond
Should Posts be bonded or cemented?
Bonded - reduces fracture
Bonded ceramics allow us to be more_______ b/c of micromechanical bonding and Chemical bonding via silane coupler
Conservative w/ preps
All ceramic preps are similar to what 2 preps?
Zirconia/Gold
T/F
Zirconia can be bonded
False
List 3 prep designs for All Ceramics in increasing strength:
Full Wall defect (one wall)
Inlay (MOD)
Full Onlay (MOD and both L and F cusps reduced)
Where are the margins (in the Hood region) in All Ceramic Inlay/Onlay preps?
The Box margins are what?
All axial _____
All other walls ______
Facial and lingual walls diverge ____ degrees per side
Supragingival
Butt Joint Margins
Converge
Diverge
6-8 degrees
Onlay prep - Functional cusp reduction:
Non-functional cusp reduction:
- 5 - 2.0 mm
1. 5 mm
Onlay Isthmus width minimum:
1.5 mm
The milling software will ______ the inside of a crown prep if there are sharp angles, etc
Over mill
*so it will seat
The milling software will _____ the marging
Under mill
*so will not seat
T/F
Best to have a roller coaster effect on Onlay preps
True
T/F
There is no retention/resistance form in on Onlay prep
True
*modern bonding allows for this
The butt joint in bonding an Onlay should be ____ degrees
80-90
Why is a 2nd plane of reduction important to in a Ceramic Onlay prep?
maintains thickness of restoration - avoids fracture
ACC prep design (Crown!) Anterior incisal:
Posterior fissure:
Posterior cusp:
- 5 mm
- 5 mm
- 0 mm
What shouldn’t you use on Provisionals for All ceramic Onlays?
No eugenol
CAD CAM takes the place of what 3 traditional lab steps?
Models, dies, wax ups
Before Isolate/Bond an Onlay:
Try in
HF acid only works on _______
So, wouldn’t work on what?
Glass
Zirconia
3 Bonding materials, starting with the best one:
Total Etch bonding resins
Self Etch bonding resins
Glassionomers
What bonding system allows for the most conservative, highly tapered prep?
1 Brand name?
Total Etch
Nexus III
What would you use Glass-Ionomer bonding system with?
Zirconia
After try-in, what has the Ceramic Onlay been contaminated with?
salivary phospholipid biofilm
Zirconia has a strong affinity to bind with what?
phosphate
To clean after Try In, use ultrasound for ___ minutes and Ivoclean for ___ seconds
2 minutes
20 secs
T/F
Ivoclean creates a larger surface by adding small metal oxide particles and has a high affinity for proteins
True
Pre-bonding, what not to use with Silica based ceramics?
Sandblasters
Only use sandblasters with what?
Zirconia
Do not clean the inside of a ceramic with _____ to remove biofilm
Use _____ to before applying Silane agent
phosphoric acid
Ethyl alcohol
What product has added dopants to Zirconia for better translucency?
BruxZir
How long should Silane be applied?
Keep excess within the ____ of the crown
60 secs
margins
In a Selective Etch Technique, etch enamel margins only _____ secs
Use ______
Lastly apply 1 layer of ______
20
CHS
SE primer
Tack cure CAD restoration for how long?
Then remove doughy flash with what?
Final cure how long?
1 second
floss
60 secs
What is recommended post cementation?
Radiographs
*find IP resin flash
Total etch systems are what generations?
Self etch systems are what generations?
4th, 5th
6th, 7th
4th Gen has how many steps?
5th gen?
3 - Etch, primer, bond
2 - Etch, primer/bond
What is the 4th Gen system we used?
Optibond FL
All in One Self Etch systems (6th gen), what can be lowered enough to etch undercut enamel?
What is retained?
What might be entrapped into the hybrid layer?
pH
Smear layer - this is a con
Water
T/F
6th gen systems are Prompt L-Pop, One-Up Bond F
True
The single component system (7th gen) is convenient and less technique sensitive but has what disadvantages?
Smear layer retained
Water absorbed into resin
T/F
There is no pH incompatibility with resin cements
True
Bonding Adhesive systems remove the smear layer with what?
pre conditioning gel
Everything we restore eventually fails due to what?
Hydrostatic pressure
Dentin Bonding Primers denature what?
Collagen
Resins have what relationship with water?
Hydrophobic
Because Intertubular dentin is the majority of Dentin Bonding, seal with what to avoid water/hydrostatic pressure?
*peritubular dentin more mineralized
GI liner
What is in the smear layer?
Can you rinse it away?
Debris, bacteria
NO
What removes the smear layer?
What bonding system does not?
Etch and rinse steps
Self etch
What binds the restorative matl to normal dentin?
Hybrid layer
T/F
Over time water trees develop
True
What activity increases hydrolysis of Collagen, causes Gap Separation?
MMP
What can you decrease MMP wit to increase bonding longevity?
CHX
T/F
Polymerization shrinkage can lead to restoration failure
True
Bonded resin surface / un-bonded resin surface
C factor
What does a high C factor mean?
more shrinkage/strain
T/F
Composite curing pulls away from the tooth
True
The filler in Optibond solo plus makes it milky and does what?
Increases elasticity
Why don’t you wet your instrument with a bonding agent during placement?
Resins contain HEMA - will discolor composite
For deep restorations, what 4 steps?
Liner
Etch
Gluma - 20 secs
Optibond solo plus - 15 secs
Gluma is a ________ made specifically for ______
desensitizer
dentin
T/F
Gluma is made from glutaraldehyde
True
Research reveals the 2 most important things to do when curing are:
Correct light placement
Finger rest
4 curing light systems by cure time (start with fastest)
Lasers
Xenon Plasma Arc
Metal Halide
LED
3 ways to reduce internal stresses:
soft-start polymerization
Incremental additions
Stres breaking liner
A modified flowable composite that can fill the entire gingival and pulpal floor before being cured:
*up to 4 mm
Bulk Fill Composites
If Bulk Fill is the new paradigm, why are we still doing layered technique?
3 reasons
Wear resistance is poor
Shrinkage greater than conventional composites (increases C factor)
Microleakage greater
What is the main advantage to Bulk Fill (up to 4mm) technique?
Best marginal adaption
T/F
Best technique is still to use Flowable 1st, then add layers - will get best marginal adaption
True
What are the BioActive restoratives?
Giomers
Giomers have a surface property that does what?
Is bio-reactive
*neutralizes acids, etc
T/F
The future may be Giomers with Surface Sealers with nano-fillers
True
Each tooth should appear ____ times narrower than its mesial neighbor from the frontal view
_____ in California
- 618
1. 4
The top of the smile line:
Zenith
Face height is the Rule of…
1/3rds
Lower Face height is the rule of …
- 3rds
* upper lip 1/3, lower lip to chin 2/3
T/F
Youthful teeth have Prikymata and Mamelons
True
T/F
A rounded face will have wider teeth proportionally and a longer face will have narrower teeth proportionally
True
Esthetic inclinations: CI’s
LI’s:
Canines:
vertical
mesially inclined
vertical
T/F
Primary planes align with the long axis of the tooth and have a slight mesial prominence
True
T/F
With a normal smile, pts maxillary incisal edge should just lightly touch or miss lower lip
True
T/F
The Zenith of each tooth should be slightly distal to the center
True
Tx sequence basics Perio Health:
Caries Control:
TMJ/Occlusal Stability:
Specialty Tx:
Color:
Fixed/removeable Tx:
Ceramics:
Composites:
Maintenance:
Phase 1
Phase 1
Phase 2
Phase 2
Phase 3
Phase 4
Phase 5
Phase 5
Phase 6
The Smear Layer may reduce dentin permeability be as much as ___%
86
What bur creates a very thick smear layer?
Diamond