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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
Q

How may a ferrule be achieved if there isnt one present

A

ortho extrusion
crown lengthening
not v common

26
Q

How much ferrule do we want

A

at least 1.5mm in height and width of remaining coronal dentine

27
Q

What are the features of an ideal post

A
  • parallel sided
  • non-threaded (passive)
  • cement reteained
28
Q

What is the benefit of a parallel sided post

A

avoids weding
more retentive than tapered
less flexing on loading

29
Q

What is the benefit of a non-threaded post

A

smooth surface incorporates less stress to remaining tooth than threaded

30
Q

What is the benefit of a cement retained post

A
  • less retentive than threaded
  • acts as a buffer between masticatory forces and post/tooth
31
Q

What are the benefits of a prefrabricated post

A
  • 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
Q

What are the post materials

A
  • metal
  • ceramics
  • fibre
33
Q

What metals are used for posts

A
  • cast gold
  • stainless steel
  • brass
  • titanium
34
Q

What are the advantages of metal posts

A
  • radiopaque
35
Q

What are the disadvantages of metal posts

A
  • poor aesthetics
  • root fracture
  • corrosion
  • nickel sensitivity
36
Q

What are the ceramic post materials

A
  • alumina
  • zirconia
37
Q

What are the advantages of ceramic posts

A

high flexural strength
fracture toughness
favourable aesthetics

38
Q

What are the disadvantages of ceramic posts

A

difficult retrievability
root fracture common

39
Q

What are the different fibre posts material

A

glass
quartz
carbon

40
Q

What are the advantages of fibre posts

A
  • flexible
  • similar properties to dentine
  • aesthetic
  • retrievable
  • bond to dentine via DBA
41
Q

What are the disadvantages of fibre posts

A
  • radiolucent on xray
42
Q

Here is a table of the adv vs disadv of differnet post types

A
43
Q

What type of restoration do we restore posterior endodontically tx tooth with

A
  • cuspal coverage
  • usually massive loss in coronal fracture
44
Q

What restorations provide cuspal coverage

A

onlay
crown

45
Q

What does cuspal coverage prevent

A

coronal leakage
catostrophic fracture

46
Q

How does cuspal coverage prevent fracture

A

during loading, forces directed downward

47
Q

What is a core build up

A

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
Q

Should you use posts in posterior teeth

A

avoid
only long straight canals
high risk of perf

49
Q

What are the 3 main core materials

A
  • composite
  • amalgam
  • GI
50
Q

What are the advantages of a composite core

A
  • most commonly used
  • tooth coloured so good aesthetics
  • bonds to tooth structure
  • used with fibre posts
51
Q

What is the disadvantage of an amalgam core

A
  • retention required
  • poor aesthetics
  • core cannot be prepared straight away
  • need 24h to set
  • avoid pinned amalgams
52
Q

What is the disadvantage of GI core

A
  • absorbs water
  • core expands
53
Q

What is a nayyar core

A

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
Q

Why is doing a nayyar core with composite risky

A
  • if requires removal, can be hard to cut out the root canal as difficult to visualise
  • increases risk of perf
55
Q

What are the methods of post removal

A
  • ultrasonic
  • tephan
  • eggler device
  • moskito forceps (screw retained)
  • sliding hammer
56
Q

What are post removal problems

A
  • root fracture
  • render tooth unrestorable
  • post space too wide
  • break post
57
Q

What are some risks with posts

A
  • perf
  • core fracture
  • root fracture/crack
  • post fracture
58
Q

How do you manage a post perforation

A

XLA
repair (internal or external)

59
Q

What is the main cause of post failure

A

restorative reasons

BDS4 Operative Dentistry (10 decks)

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