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Operative > Principles of Operative Dentistry > Flashcards

Principles of Operative Dentistry Flashcards

1
Q

what is operative dentistry?

A

treatment of disease/defect of hard tissues of teeth that do not require full coverage restoration

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2
Q

what does operative dentistry do?

A

restores form, function, and esthetics

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3
Q

enamel thickness varies by (2)

A

location

tooth type

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4
Q

enamel is –% hydroxyapatite

A

90-92

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5
Q

enamel is (2)

A

strong and brittle

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6
Q

enamel rod diameter

A

larger near surface, smaller near dentin borders

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7
Q

how are enamel rods oriented?

A

perpendicular to long axis, radiate outward (like spokes on a wheel)

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8
Q

do not leave — enamel

A

unsupported

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9
Q

grooves and fissures can act as a

A

food/bacteria trap (leads to decay)

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10
Q

Enamel Tufts (2)

A

◦Hypomineralized

◦Extend into enamel

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11
Q

Enamel lamellae (2)

A

◦Thin faults between enamel rod groups

◦ Extend from enamel toward DEJ

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12
Q

Enamel Spindles

A

◦Odontoblastic process crossed into enamel

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13
Q

Dentino-Enamel Junction

A

◦Hypomineralized Zone where dentin meets enamel

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14
Q

enamel solubility

A

more soluble as your approach DEJ

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15
Q

how does fluoride impact acid solubility of enamel?

A

it lowers acid solubility, important to remember both when considering caries and when considering bonded restorations

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16
Q

pulp-dentin complex (2)

A

stron and resilient

living tissue

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17
Q

pulp-dentin complex (2)

A

stron and resilient

living tissue

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18
Q

largest portion of the tooth

A

dentin

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19
Q

dentin is located in both

A

coronal and root portions of tooth

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20
Q

dentin forms the walls of

A

pulp chamber

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21
Q

dentin is formed immediately — to enamel

A

prior

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22
Q

dentin formation continues throughout the

A

life of the pulp

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23
Q

dentinal tubules canals extend from

A

DEJ/CEJ to pulp

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24
Q

dentinal tubules are lined with

A

peritubular dentin

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25
Q

— is located between dentinal tubules

A

interdentin

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26
Q

diameter of dentinal tubules is largest at the

A

pulp

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27
Q

number of dentinal tubules/square mm is greatest at the

A

pulp

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28
Q

reparative dentin is formed by

A

secondary odontoblasts

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29
Q

reparative dentin is a response to

A

moderate irritant

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30
Q

sclerotic dentin (2)

A

primary dentin that has changed

peritubular dentin widens and fills with calcified material

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31
Q

dentin hardness

A

averages 1/5 that of enamel

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32
Q

dentin is harder near

A

DEJ than pulp (3x)

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33
Q

dentin is –% hydroxyapatite

A

50

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34
Q

dentinal sensitivity

A

fluid movement in tubules

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35
Q

Hydrodynamic Theory of Pain Transmission

A

◦Odontoblastic process wrapped in nerves and fluid in dentinal tubules
◦Enamel/cementum removed during preparation= seal is lost
◦ Causing small fluid movements in tubules= distortions in nerve endings
◦ = PAIN

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36
Q

smear layer is created whenever

A

tooth is cut/prepared

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37
Q

smear layer plugs

A

dentinal tubules

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38
Q

enamel (4)

A

◦Gray, semi-translucent
◦Color depends on underlying dentin
◦Becomes temporarily whiter when dehydrated
◦Shiny

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39
Q

dentin color (2)

A

◦Yellow-white

◦Dull, opaque

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40
Q

cementum (3)

A
  • Covers root surface
  • Softer than dentin
  • Formed continually
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41
Q

CONTOURS

A

Curve or shape of something

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42
Q

Overcontour vs overcontoured

A

Overcontour: flat
overcontoured: bulky

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43
Q

PROXIMAL CONTACT

A

Where two adjacent teeth contact (Vs occlusal contact)

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44
Q

EMBRASURES

A

an opening with sides flaring outward

In dentistry, V-shaped valleys between adjacent teeth
◦ Gingival usually fills in this space

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45
Q

SKIPPED

Objectives of Tooth Preparation (6)

A
  • Resistance Form, Retention Form, Convenience form
  • Remove defects
  • Provide necessary protection to pulp
  • Extend restoration as conservatively as possible
  • Resist fracture when chewing
  • Restore esthetics and function
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46
Q

tooth prep should be precise, especially for

A

amalgam

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47
Q

GV black

A

prep design and principles

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48
Q

preparations for composite restorations incorporate

A

bonding

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49
Q

Preparation

A

Extend to sound tooth structure in all directions

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50
Q

Prep walls are designed to (2)

A

◦ RETAIN restoration

◦ RESIST fracture

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51
Q

Preparation (5)

A
  • Remove remaining caries or old restorative material
  • Protect pulp
  • Minimize fracture, maximize retention
  • Finish walls and margins
  • Final cleaning, inspection, sealing prep
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52
Q

Factors to consider (5)

A 
Esthetics
Economics
Medical Condition
Age
Caries risk
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53
Q

Dental Anatomy (4)

A

◦Enamel Rod orientation
◦Thickness of enamel and dentin
◦Size, location of pulp
◦Relationship of tooth to periodontium

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54
Q

Factors to consider (3)

A
  • Caries
  • Fractured teeth
  • Improve form and function
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55
Q

Conservation of Tooth Structure

A

Repair damage but preserve vitality

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56
Q

Locations of Primary Caries (3)

A

pit and fissure
enamel smooth surface
root surface

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57
Q

Pit and Fissure occur from

A

imperfect coalescence of developmental enamel lobe

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58
Q

Area left unclean chronically

A

Enamel Smooth Surface

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59
Q

Locations of Primary Caries (3)

A

pit and fissure
enamel smooth surface
root surface

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60
Q

Locations of Primary Caries (3)

A

pit and fissure
enamel smooth surface
root surface

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61
Q

residual caries

A

caries left by operator (intentional or accident)

62
Q

never ideal to leave caries, especially when left at the

A

DEJ or on prepared enamel wall

63
Q

residual caries may be acceptable in rare instances to

A

avoid pulp exposure (when left has affected dentin near the pulp)

64
Q

Recurrent Caries

A

Microleakage present at the junction between restoration and tooth

65
Q

Recurrent Caries may progress under or behind restoration so it can’t be

A

seen with a radiograph

66
Q

Reparative Dentin

A

Formed by odontoblasts at end of tubules at surface of pulp

67
Q

Reparative Dentin is formed in response to

A

irritation

68
Q

rate of caries (2)

A

acute

chronic

69
Q

acute (3)

A

◦Or “rampant”
◦Light color
◦Appears dull, mushy

70
Q

chronic (3)

A

◦Slow or arrested
◦Dark color
◦Appears shiny, solid

71
Q

Dentists formerly practiced “extension for prevention.”

This meant

A

taking away unnecessary tooth structure and is no longer practiced

72
Q

Better preventative measures available (4)

A

Enameloplasty,
sealant,
preventive resin
or conservative composite restoration instead

73
Q

Simple -

A

one surface involved

74
Q

Compound -

A

two surfaces

75
Q

Complex -

A

three or more surfaces of tooth involved

76
Q

O =

A

occlusal

77
Q

MO or DO or MOD -

A

mesial occlusal or distal occlusal, mesial-occlusal distal

78
Q

F or B -

A

facial or buccal

79
Q

L –

A

lingual

80
Q

Internal Walls (2)

A

◦ Axial Wall

◦ Pulpal Wall or Floor

81
Q

Axial wall is — to long axis of tooth

A

PARALLEL

82
Q

PULPAL WALL/FLOOR

A

wall closest to pulp

83
Q

PULPAL WALL/FLOOR is — to long axis of tooth in Class I and II preparations

A

PERPENDICULAR

84
Q

Floor (4)

A

◦PREPARED (cut) wall
◦FLAT
◦PERPENDICULAR to occlusal forces
◦Pulpal and gingival floor/walls

85
Q

Pulpal and gingival floors/walls provide (1) and distribute (1)

A

Provide stabilizing seats for restoration

distribute stresses in tooth

86
Q

Line Angle

A

Junction of two walls/surfaces along a line

87
Q

Internal-

A

apex points AWAY from observer

88
Q

External-

A

apex points TOWARD observer

89
Q

Point angle

A

Junction of three surfaces

90
Q

CAVOSURFACE angle or margin

A

◦ Junction of PREPARED cavity wall and EXTERNAL surface of tooth
◦ Keep in mind: location of tooth, direction of enamel rods, material you will be using

91
Q

types of CAVOSURFACE angle or margin (3)

A

◦ Bevel
◦ 90 ̊
◦ Chamfer

92
Q

CEJ◦ Cementoenamel Junction

A

◦ Where cementum meets enamel

93
Q

Enamel Margin Strength is formed by

A

full length enamel rods

94
Q

Enamel Margin Strength

A

Enamel rods’ inner ends are on sound dentin

95
Q

UNSUPPORTED ENAMEL

A

When enamel rods are not

supported by sound dentin

96
Q

what to do with unsupported enamel

A

remove from prep, brittle and fracture easily

97
Q

Classifications of Tooth Preparations name is based on

A

anatomy involved

98
Q

Class I (2)

A

◦ Occlusal surface of posterior teeth

◦ May include lingual/buccal grooves and pits

99
Q

Class II

A

◦ Proximal surfaces of premolars and molars

100
Q

Class III

A

◦ Proximal surfaces of incisors and canines

◦ That do not involve incisal edge

101
Q

Class IV

A

◦ (See Class III, add incisal edge)

102
Q

Class V

A

◦ Gingival 1/3 of smooth surfaces

◦ Buccal, lingual

103
Q

Class VI

A

◦ Incisal edge or cusp

104
Q

Initial Stage (5)

A
  • Outline Form
  • Initial depth
  • Primary resistance form
  • Primary retention form
  • Convenience form
105
Q

Visualize OUTLINE FORM (2)

A

◦smooth and flowing

106
Q

Undermined enamel —

A

removed

107
Q

— placed where you can finish restoration

A

Margins

108
Q

No — on margins of preparation

A

occlusion

109
Q

Preserve strength-

A

cusps and marginal ridges

110
Q

Minimize extensions —

A

faciolingually

111
Q

Connect two preps that are

A

0.5

112
Q

Class I- Depth of pit and fissure maximum –mm (in lab setting)

A

2.0

113
Q

extend class 1 to

A

sound tooth structure

114
Q

extend class 1 when (2)

A

◦ Fissures cannot be eliminated by enameloplasty

◦ Two cavities have <0.5mm between them

115
Q

Do not terminate class 1 on (2)

A

cusp height or ridge crest

116
Q

Allow sufficient access for class 1 (2)

A

placement and finishing

117
Q

Class II- extend gingival margins —, extend interproximal margins to —

A

apical to contact

embrasures

118
Q

class 2 Axial Wall Depth

A

0.2-0.8mm INTO DENTIN

◦ 1.0-1.5 mm on manikin

119
Q

Axial Wall Depth is measured from the

A

tooth (proximal surface) to the axial wall

◦ It is NOT a typical depth measurement from the top of something to the bottom

120
Q

Enameloplasty

A

Remove shallow enamel fissure or pit
◦ Creates smooth, saucer shaped surface= self-cleansing
◦ NO MORE THAN 1/3 ENAMEL THICKNESS REMOVED

121
Q

RESISTANCE TO FRACTURE

A

• Objectives are to resist fracturing the tooth or restorative material

122
Q

Need to resist or withstand — forces

A

occlusal

123
Q

Conservative extension-

A

leave strong tooth

• Remember dentin support

124
Q

Preserve (2)

A

cusps and marginal ridges

125
Q

When margin exceeds 2/3 of the distance between central groove and cusp tip

A

MUST CAP WEAK CUSPS

126
Q

When margins end ½ distance between central groove and cusp tip

A

CONSIDER CAPPING WEAK CUSPS

127
Q

Resistance Form (3)

A
  • Internal line angles slightly rounded
  • External line angles slightly rounded
    • Accomplish with bevel at axiopulpal line angle
    • = LESS STRESS CONCENTRATION
  • Flat floors
    • Prevents movement
128
Q

Allow for sufficient thickness of restorative material
◦Amalgam —mm minimum
◦Gold —mm minimum depending on area
◦Porcelain —mm minimum

A

1.5
1-2
2.0

129
Q

Bevels when needed to (2)

A

◦ Remove unsupported enamel

◦ Reduce stress concentration

130
Q

Margins- – ̊ in amalgam

A

90

131
Q

RETAIN THE RESTORATION

◦Objectives of this are to

A

keep restoration in the tooth

132
Q

Dovetail prevents (2)

A

tipping and proximal displacement

133
Q

retention form (3)

A

wall length
converenge
parallelism

134
Q

Wall length

A

• Taller wall = resists pull of sticky foods

135
Q

Convergence (2)

A
  • Walls slant toward each other

* Especially important with amalgam

136
Q

retention form (3)

A

wall length
converenge
parallelism

137
Q

What about bonded restorations? (2)

A
  • Micromechanical retention between adhesive and tooth

* Some of these principals become less important, but are still followed

138
Q

Convenience Form

A

FORM THAT ALLOWS YOU TO ACCESS THE DEFECT

139
Q

Convenience Form allows you to

A

see what youre doing, ideally with perfect ergonomics

140
Q

Once outline form, primary resistance, and primary retention form are
complete, caries may

A

remain- REMOVE THE CARIES

141
Q

Final stage of Tooth Preparation: (6)

A
  • Remove remaining infected dentin
  • Remove remaining old restoration
  • Pulp protection
  • Secondary resistance and retention forms
  • Finish external walls and margins
  • Final cleaning, inspecting, and sealing
142
Q

Affected dentin-

A

demineralized
◦ Usually discolored but NOT soft
◦ OK to leave

143
Q

Infected dentin-

A

microorganisms present
◦ Soft
◦ May or may not be stained
◦ MUST REMOVE. (there are MICROORGANISMS PRESENT.)

144
Q

How to tell the difference between affected and infected dentin?

A

◦ Not always possible

145
Q

Retention grooves, points

A

Areas for restorative material to “lock”into, results in improved retention

146
Q

Secondary Resistance fewer

A

extensions

147
Q

secondary resistance

Bevel for rounded axiopulpal line angle to

A

increase bulk of restorative material, disperse concentration of forces

148
Q

8:00 position (4)

A

◦ Slightly to the patient’s right and front
◦ Patient tilting head slightly to right
◦ Buccal sides of patient’s UL
◦ Lingual sides of patient’s LR

149
Q

11:00 position (4)

A

◦ Slightly to the patient’s right and behind
◦ Patient tilting head slightly to left
◦ Buccal sides of patient’s UR
◦ Lingual sides of patient’s LL

150
Q

12:00-1:00 position (4)

A

◦ Slightly to the patient’s left and behind
◦ Patient’s head tilted back
◦ Buccal sides of patient’s R and L anterior
◦ Lingual sides of patient’s R and L anterior

Operative (11 decks)

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