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BDS4 Operative Dentistry > Restoration of endodontically treated tooth > Flashcards

Restoration of endodontically treated tooth Flashcards

1
Q

How do we clinically assess an endodontically treated tooth

A
  • assess coronal seal
  • assess remaining tooth structure
  • is the tooth restorable and can it be isolated
  • swelling
  • sinus
  • TTP
  • tender to palpation at apice
  • mobility
  • increased pocketing - perio disease/root fractures
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2
Q

How do we radiographically assess a root treatment

A
  • root filling, length, quality
  • unfilled/missed root canals
  • patency - instrument fracture, post, sclerosis
  • bone support - mild, moderate, severe
  • crown to root ratio 1:1.5
  • pathology

inadequate root fillings should be re-treated prior to restoration

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3
Q

What are problems after root canal treatment

A
  • structural integrity lost both internally and externally
  • lack of / no ferrule
  • wide post holes (re-rct)
  • endodontic complications e.g fractured instruments, perfs etc
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4
Q

If a root filled tooth has bene unrestored, after how long should you consider re-RCT

A

> 3 months

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5
Q

If root tx teeth are unrestored for <3 months, what can you do

A
  • trim the gp
  • place RMGI over pulp floor and root canal openings
  • linings should not be too thick to allow for the remainder of the pulp chamber for retention and restoration
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6
Q

How can you restore anterior teeth with intact marginal ridges (access cavity only)

A
  • composite or veneer
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7
Q

How do you restore anterior teeth with intact margin ridges and discoloured crown

A
  • bleaching
  • veneer
  • crown
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8
Q

How do you restore anterior teeth with marginal ridges destroyed

A

core build up with crown
post crown

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9
Q

What are direct posts made of

A

fibre posts usually

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10
Q

What do fibreposts/direct posts require

A

ferrule

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11
Q

If there is no ferrule, what type of post is required

A
  • cast post and core
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12
Q

What is the function of a post and core

A

gains intraradicular support for definitive restoration

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13
Q

What is the function of the core

A

provides retention for the crown

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14
Q

What is the function of a post

A

retains the core

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15
Q

Do posts strengthen or weaken

A

weaken the tooth
prep for the post is damaging

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16
Q

What are the guidelines for post placement in incisiors and canines

A

post unnecessary if sufficient coronal dentine present
avoid in mandibular incisors

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17
Q

Why should we avoid posts in mandibular incisors

A

they have thin/tapering/narrow mesiodistal roots

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18
Q

What is the anatomy of premolars

A

small pulp chambers
tapering roots
thin in mesiodistal cross section and proximal invaginations
place post in widest canal and avoid in curved ones

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19
Q

How much root filling is required to be left to maintain apical seal

A

4-5mm

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20
Q

How wide should the post be

A
  • no more than 1/3 of root width at narrowest point
  • 1mm of remaining circumferential dentine
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21
Q

What should the length of the post be

A

minimum 1:1 post length:crown ratio
want sufficient alveolar bone support so half of the length should be into the root

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22
Q

What is a ferrule

A

a dentine collar
it is the encirclement of 1-2mm of vertical axial tooth structure within the walls of a crown

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23
Q

What is the function of a ferrule

A

prevents tooth fracture

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24
Q

How does a ferrule prevent tooth fracture

A
  • the crown margins are braced on the neck of the tooth and resistance is provided
25
How may a ferrule be achieved if there isnt one present
ortho extrusion crown lengthening not v common
26
How much ferrule do we want
at least 1.5mm in height and width of remaining coronal dentine
27
What are the features of an ideal post
* parallel sided * non-threaded (passive) * cement reteained
28
What is the benefit of a parallel sided post
avoids weding more retentive than tapered less flexing on loading
29
What is the benefit of a non-threaded post
smooth surface incorporates less stress to remaining tooth than threaded
30
What is the benefit of a cement retained post
* less retentive than threaded * acts as a buffer between masticatory forces and post/tooth
31
What are the benefits of a prefrabricated post
* only 1 visit required * no impression and lab visits chairside core build up * post and cores are different materials * immediate preparation of core * large selection of designs and materials
32
What are the post materials
* metal * ceramics * fibre
33
What metals are used for posts
* cast gold * stainless steel * brass * titanium
34
What are the advantages of metal posts
* radiopaque
35
What are the disadvantages of metal posts
* poor aesthetics * root fracture * corrosion * nickel sensitivity
36
What are the ceramic post materials
* alumina * zirconia
37
What are the advantages of ceramic posts
high flexural strength fracture toughness favourable aesthetics
38
What are the disadvantages of ceramic posts
difficult retrievability root fracture common
39
What are the different fibre posts material
glass quartz carbon
40
What are the advantages of fibre posts
* flexible * similar properties to dentine * aesthetic * retrievable * bond to dentine via DBA
41
What are the disadvantages of fibre posts
* radiolucent on xray
42
Here is a table of the adv vs disadv of differnet post types
43
What type of restoration do we restore posterior endodontically tx tooth with
* cuspal coverage * usually massive loss in coronal fracture
44
What restorations provide cuspal coverage
onlay crown
45
What does cuspal coverage prevent
coronal leakage catostrophic fracture
46
How does cuspal coverage prevent fracture
during loading, forces directed downward
47
What is a core build up
internal part of tooth is built up with restorative material to replace lost tooth tissue core is prepared provides retention and resistance for definitive restorations
48
Should you use posts in posterior teeth
avoid only long straight canals high risk of perf
49
What are the 3 main core materials
* composite * amalgam * GI
50
What are the advantages of a composite core
* most commonly used * tooth coloured so good aesthetics * bonds to tooth structure * used with fibre posts
51
What is the disadvantage of an amalgam core
* retention required * poor aesthetics * core cannot be prepared straight away * need 24h to set * avoid pinned amalgams
52
What is the disadvantage of GI core
* absorbs water * core expands
53
What is a nayyar core
root tx is partially removed from root canals material packed into root canals and tooth built up traditionally done with amalgam as this provides retention for it with amalgam, it cannot be prepared for 24h until it sets
54
Why is doing a nayyar core with composite risky
* if requires removal, can be hard to cut out the root canal as difficult to visualise * increases risk of perf
55
What are the methods of post removal
* ultrasonic * tephan * eggler device * moskito forceps (screw retained) * sliding hammer
56
What are post removal problems
* root fracture * render tooth unrestorable * post space too wide * break post
57
What are some risks with posts
* perf * core fracture * root fracture/crack * post fracture
58
How do you manage a post perforation
XLA repair (internal or external)
59
What is the main cause of post failure
restorative reasons

BDS4 Operative Dentistry (10 decks)

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