Resotrative - revision notes Flashcards
Indications for veneers
discolouration
peg laterals
diastemas
enamel defects
crowding
poor aethetics
contraindications for veneers
high smile line
poor oh
gingi recession
nail biting
posterior crossbite
heavy occusal contacts
severe discolouration
Dimensions
buccally - cervical = 0.3mm, mid = 0.5mm, incisally = 0.7mm
ging - 0.5mm into saulcus
Incisal reduction types
feather - no incisal edge and prone to fracture
window - mos protective, poor aethetics and margins
incisal bevel
incisal overlap - chamfer on paltal surface, 2mm reduction, good strength and cementation, lots of tooth tissue removed
Cavity prep steps
identify and remove carious enamel
remove enamel to identify the extent of the carious enamel at the acj and smooth margins
remove carious from the perherial surface and slowly work circumfertianlly
remove caries over the pulp
outline form modification
internal design modification
A lining whyq
prevent secondary caries
pulpal protection
prevent enamel contamination
risk of microleakeage
effect on bonding
Wooden wedges purposes
to rovide temp seperation between teeth
to hold the matrix band in place
to prevent amg going ginginval
t oprovide a good wall for contouring
Advatnages of composite
good aesthetics
radiopaque
biocomopatible
low thermal conduction
good abrasion resistance
conservative of tooth strtucre
easily manipulated
no retentive features
Disadvantages of composite
technique sensitive
requires good mositure control
contraction on setting
expensive
easily stained
Componenets of composite
Filler particles
Bis gma
silane coupling agent
low weight dimethacylates
camphorquinone
Increasing the filler particle
increases the visocity - helps with polymerisation contraction stress and mechanical propterties - wear, resistance, fracture, rigity,, strength
Polymerisation stress can cause
flexure or crack of the tooth
a gap which can cause microleakage, sens, caries, fracture
Reduce polymerisation contraction
small increments placed
higher filler particle
configuration of cavity prep
Polymerisation shrinkage
the base of the cavity has a lower bond compared to the composite
the composite lifts away from the base and fluid enters the deintal tubules
the fluid bounces around in the deintinal tubles and can cause pain
Advatnages of amagam
radiopaque
easy to place and quick
econmical
resistance to corrosion
good for wear resistnace and toughness
less mositure control required and not tech sens
long lasting and durable
disadvatnages of amalgam
merctuy toxicity
colour -asthetics
lichenoid reaction
amalgam tatoo
takes 24hrs to set so potential for fracture straight after placement
requires undercuts so destruction of healthy tooth tissue
amaglgam consits of
an alloy with mercury, silver, tin, copper
high copper alloys used as they eliminate the weak gamma 2 phase recuding corrsion
Tools for implant placement
diagnostic wax up
study models
clinical photos
essex temp retainer
surgical guide and template
radiographs
Who can’t have implants placed
immunocompromised
bisphosphonates
diabetes
bleeding risk
smokers
hx of perio disease
significant loss of alveolar bone
congential cardiac defect
Ging biotype for implants
thick and low scalloped
Shape of crown best from implant placement
rectangular
Smile line types
high >2mm of soft itssue showing
med = <2mm of soft tissue showing
low - convers 25% of tooth surface
Implant types
removable - stud, magnet, bar
fixed - cement or screwed
Peri-mucisitiis
inflammation of the mucosa surround the implant
BOP
no alveloar or crestal bone loss present
Tx - non surgical mechanical debriement and chx provided
Peri -implantitis
inflammation of the mucosa surround the implant and loss of peri implant bone
tx - removal of abutment and non surgical debridement and OHI
Why does peri-implantitis occur
mechanical forces/overload
poor oh and inadequte cleaning
smoking
underlying health issue
poor design of implabt
Complications of implant placement
biomechanial - peri-mucisitis, peri-implantitis
Mechanical - abutment screw loose, fracture of tooth, soft tissue recession, trauma - bony fractures
GDP monitor the implant site
perio probing
bleeding
mobility
suppuration
OH
Recession
attirtions
the loss of tooth tissue substance due to physical cotnact either ebtween teeth or between teeth and restorations
Tx - soft or hard splints
can be related to bruxism
Abrasion
the loss of tooth subasance through an abnormal mechanicial process not involving the occulsion
toothbrushing, toothpaste, pipe smokers
Tx - change habits, change toothburhs or toothpaste
V shaeped notches on the teeth around the cervical margin area
Erosion
the loss of tooth substande due to a chemial process rather than a bacertial action
Intrisic - GORD or bullima
Extrisinci, carbonated drinks, gels, citric fruits, acids
Abfraction
loss of tooth substance that is a biomechanical force distant from the point of loading
brusism
sharp rim at the acj
Carbonated drinks casues
palatal erosion of uper incisors
incisir wear loss on centroals
posterio manidble cupping and facets
sensitivity
buccal white spots
Basic erosisve wear
split into sexants
0 = no toothwear
1= incisal loss of surface texture
2 = <50% hard tissue surface loss, defects appearing
3 = >50% hard tissue surface loss
<2=none
3-8=low
9-13=med
>14 = high
Info for pt following toothwear build up
soft diet for 1st weeks
speech may feel odd
occlusion and bite will feel strange
crowns or bridges may need replaced
may impinge on speech
front teeth only touch and could take 3-6months for posterioer ones to touch
Planning for toothwear
take a full medical, dental social history
understand the nature of the tooothwear adn casues
cause addressed
liase with pts about aesthetics and approach to tx
clinical photos
poteintal radiographs
diagnositc wax up
interoccusla record
casts mounted on a semi adjustable articulator
stents
temp entures
tx for lower ants wear
complete before the upper but hard
upper ants wear 5 factors
the type of wear
the space require
the interoccusal space
the pts wishes and aethetically demand
quantitiy and quality of enamel
contrsaindcations to the dahl tech
bisphosphonates
active perio
implants placed
tmj issues
exsiting convential bridges
post ortho
Dahl tech
generalised toothwear mainly ats with decreased in OVD
1. place an anterior bite plane
2. this allows the posterior teeth to overeupt into position
3. the bite plane is removed
4. takes 3-6months for the spcae to pen anteriorily
BEWE scores tx
<2 = routine maintance and oberservation at 3year intervals
3-8 = routine maintance and dietary advice, recall at 2 year intervals
9-13 = OHI and diet, routine maintance, fluoride delivery, avoid resotrations, 6-12month recall
>13 = OHI and diet, routine maintance, flurodie mesaures consider resotrations 6-12months interval recall
Suprahyoid muscles
diagastric and geniod - deppress the mandible and elevates the hyoid bone
stylohyoid - pulls hyoid bone posterior and superior for swallowing
mylohyoid - elevates the hyoid bone and floor of mouth
Temporalis
elevates and retracts mandible
inserts - the cornoid process
orgiin - the temoral fossa
Masseter
elevates and retracts the mandible
origin - superifcal - the maxiallary process of zygomatic arch, deep - zygomatic arch of temporal bone
inserts - the raumus of the mandible
Medial pteryogind
elevates and retracts mandible
inserts - ramus of mandible
origin - superifical - maxiallry tuberosity, deep - medial aspect of the lateral pertygoing plate of the sphenoid bone
Lateral pterygoid
depresses adn prtracts the mandible
inserts - neck of mandible
origin - inferior - lateral pterygoid plate of spehnoid bone, superior - greater wing of sphenoid
5 properties of occulsal forces
frequency
duration
direction
magnitiude
velocity
Posselts enevelope
broder movement in the sagittal plane
ICP - centric occulsion, comfortable bite for pt, teeth in contact
T - max opening
E -edge to edge - when teeth slide forward from ICP gliding on palatal surface of ants
Pr - protrusion - condylar moves forwards and downwards on the articular emeneice
R - retruded axis position - no tooth contact, reporoducible jaw position, the condylar is most superior anterior in the glenoid fossa
RCP - the first tooth cotact made when the person moes into the retrued position, about 1mm postieror to the ICP
Border position
one determined by the anatomy of the TMJ and the surround musculature involvment
Bennets angle
produced by the saggital place of the mandibluar condyle in lateral movements viewed in the porizontal plane
shows the noon working condyle
Fremitius
excessive vibration force that is produce by premature ocntact of teeth
When not to use the patient in ICP/conformative approach
when the pt wishes thier aethetics altered
when you want to increase the vertical facial height
occlusin of teeth severly out position
hx of occlusal fracture or fractures of resotrations
Facebow
records the relationship of the maxialla relative to the hinge axis of the mandible
the mandible is moutned in ICP or RCP
Christensons Phenomenon
a gap that appears between the posteiror ends of flat occlusal rims when the madnible is protruded
leads to instability
Inlay
indirect intracornal resotration boned into place
Onlay
an extracornal resotration which inlcudes proximal surface
Inidactions for inlay/onlay
heavily restored teeth
repeated fractrues of direct resotrations
to resotre a root trested tooth
to protect remaining tooth tissue
in patients whos occulsions are diffuclt to ontain
advatnages of inlays/onlays
good aethetics
strong
durable
cuspal protection
less polymerisation shrinkage, micro leakage, cusp fracture
disadvatanges of onlay/inlay
expensive and require lab fees
marginal ditching
ceramic can wear the opposing occlusion
debonding due to poor etch or occlusion
ceramic fracture due to lack of bluck
Materials used for inlays/onlays
Gold
ceramic
cermoer
composite
ideal taper for inlay/onlay
5-7degrees
indications for bridgework
speech and function
aesthetics
stability for occlusion
favourable occlusion
no caries/active perio
abutment teeth have no complaications
Contraindications for bridgeowrk
poor oh
active caries or perio
heavily rotate or tilited teeth as can’t achieve path of instertion
large pulps
poort occlusion/bruxists
un-coperative
overeuption of opposing teeth
Retetnion increased by
sandblasting the fitting surface of wing
having a large surafce area for bonding
placing rest seats on surface area of bonding
grooves ad notches
Material types
gold
ceramic
zirconica
metal ceramic
Ridge desings
wash throught - hygienei santitiary - no soft tisue contact - lower molars
dome shaped - torpedo/bullet - for lower incisors, premolars and upper molars
modified ridge lap - buccal surface normal, lingual surface cut away - for low smile line (good cleansibiity)
ridle lap saddle - contacts soft tissue - high smile line, ants, long span ants - unfavourable as hard to clean
Resin bonded retainer wing
non precious metal as ridig and can bond easily too
thin section - should be 0.7mm to reduce flexure
however
can shine through so can use zirconia
Cementation
metal ceramic - GI or RMGI
ceramic - dual cure resin
adhesvice - anaerobic dual cure resin with 10MDP
fixed fixed bridge
advantages - used in long spans of mssing teeth, robust, good retention and strenght
disadvatanges - requires removal of tooth tissues, difficult to achieve common path of insertion, prep difficult
Hybridge bridge
one side crown and other side adhsice resin cemented wing
Cantilever bridge
only a prep crown on one side
advantages - minimmal tooth prep and conservative, straightforward
disadvatanges - has to be rigid to prevent disortion, short span only
Adhesvice bridge
only single or short span
advatanges - lo la, no prep, conservative of tooth tissue, min surgery time, less cost
disadvaangtaes - can easily debond, metal shine through, no trail period, occulsal interfecnce
not used in long span - heavy occulsal forces, insuffient enamel
sprnig cantilever bridge
is when the pontic as a metal arm which runs across paaltal mucosa to a reatiner on the palatal side of another tooth
advantages - where adjacent teeth are not prepper, used in space incosrs, posterior teeth as good abutments
disadvantes - traumtises palatal mucosa, can be hard to clean underneath, only for upper incors, difficult to control pontic movement due to springness
abutment evaluation
crown:root 2:3
must be able to withstand foce
no active caries or perio
supporting tissue healthy and free from disease
