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Restoration of extensively damaged vital teeth Flashcards

1
Q

-Central Core Guidelines
what should be preserved?
how deep should retentive features be (cervical line/central fossa)?
where are auxillary features?
caries removal?

A

Pulp and 1 mm thick surrounding layer of dentin should be preserved if possible
Retentive features should not be cut deeper than 1.5mm at cervical line or central fossa (2mm)
Auxiliary retentive features ideally kept in “safe zone”
Caries removal: deeper areas filled with base

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2
Q

pulp chamber with age

A

shrinks as we edge, less so at canine

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3
Q

5 Categories involved in decision making for restoring the damaged tooth
type of?
defects used as?
pin?
bases/cores?
procedure?

A

-Deciding on the type of restoration to use-Crown, Filling, or other
-Using defects as retentive features-Do I need a build up?
-Pin placement and retention-Will a build up stay put?
-Bases and Cores-Do I need to protect the pulp?
-Tooth preparation procedures

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4
Q

To determine the type of restoration to use when large decay has destroyed tooth structure what should we ask?

A

Where is the decay?
How much tooth structure is remaining?
Where is the remaining tooth structure?
Can I restore this?
Should I restore this?

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5
Q

Extensive Peripheral destruction indicates what restoration

A

full crown

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6
Q

more/less destruction

Extensive Central destruction indicates what restoration

A

Less destructive central lesion: Isthmus destruction greater than ½ intercuspal width – Crown or Onlay/inlay

Large central lesion: More that 50% of tooth structure is gone and loss of cuspal suport– Crown (and likely a core build up too)

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7
Q

Combined Central and Peripheral destruction indicates:

A

-Core Build up and Crown
-Possible RCT/Post/Core/Crown

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8
Q

When would you decide you needed
Root Canal Treatment?
exposed? post?

A

If pulp is exposed
If post is needed for retention of
Build up

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9
Q

Extensive Peripheral and Central destruction
%vital core?
indicated?

A

more than 50% vital core lost
usually RCT with post and build up indicated

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10
Q

retentive features of the prep

A

a tooth preparation will need to be modified by adding retentive features to increase retention and improve the resistance form:
Re-orientation of sloping surfaces
Adding Grooves
Adding Box forms
Adding Pins with a Build up

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11
Q

why would a prep be left without a build up

A

**There are also times when leaving a crown preparation without a Build up can help with retention too. Sometimes, you need to leave it ugly.

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12
Q

What can we do to increase resistance form with less than ideal tooth structure
remaining?

A

-Reshape axial walls to reduce convergence
-Add grooves
-Add Box forms
-increase wall height

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13
Q

methods to increase wall height

A

-place finish line more apical
-Pin retained core
-Crown-lengthening
-Orthodontic extrusion

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14
Q

Reshaping axial walls purpose

A

Increased axial reduction in the cervical 1/2 of the preparation wall will
reduce taper and create more retention and greater resistance form.

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15
Q

sloped walls and retention

A

Sloping surfaces left after cusp fracture or caries removal need retention
Break slope into vertical and horizontal
components
Conversion into one large vertical wall
weakens tooth with too much removal
and endangers the vital core of the
tooth.

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16
Q

If greater than 3mm of vertical wall length is apical to the fractured cusp on a sloped wall what should be done

A

-A facial shoulder with axial wall reduction leaves adequate wall length for resistance form.

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17
Q

how to place retention grooves

A

Grooves placed parallel to the long axis of the tooth
-at least 1mm wide and deep
-0.5 to 1mm away from the finish line
-Spaced around the tooth

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18
Q

when are grooves used? why? best placed where?

A

Grooves used in short preparation walls
with minimal occlusal clearance:
-Proximal grooves shorten the radius
of the arc of rotation
-Walls of a groove or a box are best
placed perpendicular to the displacing
force

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19
Q

box forms for retention
removal of?
converison to retentive feature?
not needed where?
where located?

A

Box form can be used for retention
-Remove caries
-Convert caries removal into a box form by squaring walls
-Not needed on intact walls
-Box should be well into dentin (deep enough) to resist displacing forces

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20
Q

When two boxes are needed how does this affect the tooth? counter?

A

Less than 180 degrees of tooth
circumference remains.
-This poses a great risk for cuspal fracture
-Use a Build Up and full crown to protect against fracture

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21
Q

amalgam removal and retention

A

Amalgam removed
Boxes and grooves placed
Axial walls prepared in apical ½ to reduce converging walls

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22
Q

placing margin more apical

A

-Place margin more apically. Often this is below the gingiva. However, we must avoid breaking into biological width.

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23
Q

-Add materials to “Build Up” the tooth, why?
where is finish line?
minimum ferrel?

A

Core build up can give more wall. Remember, the finish line needs to be on tooth structure and you still need at minimum 2-3mm of ferrel.

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24
Q

how to remove bio width restriction

A

crown lengthning

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25
orthodontic extrusion.
Pull the tooth out of the bone with orthodontic extrusion.
26
Core Build up Replaces? to improve what quality? must be anchored? Retention for a core is often with?
Replaces lost tooth structure to improve retention of a crown A core must be anchored firmly to the tooth and not just placed to fill the void Retention for a core is often with the use of pins
27
when is a build up needed
when more than 50% of the tooth structure is lost
28
Build up Guidelines- First reason for Build up – Second reason for a Build up –
First reason for Build up – Short axial walls Second reason for a Build up – Excessive interocclusal distance (tall crown height without=decreased strength)
29
amalgam core build up qualities
Not retentive, but strong
30
compositie core build up qualties
retentive but weaker
31
Use of pins recommended when?
Use of pins recommended if ½ or more of the clinical crown has been destroyed.
32
Cusps thinner than ½ their height are? and should be?
Cusps thinner than ½ their height are weak and should either be shortened or removed.
33
cavity floors and walls with amalgam cores
should be flat
34
Crown margins should be at minimum________ mm apical to build up material margin.
Crown margins should be at minimum 1 mm apical to build up material margin.
35
Amalgam Core Mechanical properties? Isolation? Matrix placement ? Often used in?
Mechanical properties: Compressive strength Dimensional stability Isolation less technique sensitive Matrix placement can be difficult if tooth is severely broken down. Often used in RCT teeth into canal for strength
36
limitations of the amalgam core Matrix placement? set time? bonding/retention? thickness? Color? Final crown prep occurs?
Matrix placement can be difficult if tooth is severely broken down Slow setting material (10-15 minutes before band removal) No bonding or natural retention Requires at least 2mm thickness Color shows through some ceramic crowns Final crown prep occurs another day Not used to a great extent any longer.
37
Composite Core Mechanical properties Bonds to? Still needs help with? setting? Tooth prep when? Ease of? Can be thinner? Color?
Mechanical properties: Bonds to tooth structure Still needs help with pins Quick setting Tooth prep at same visit Ease of manipulation Can be thinner than 2mm Color of material aids in crown matching
38
limitations to composite core technique? leaks? isolation?
Technique sensitive Microleakage: possible as material shrinks when cured Isolation can be challenging
39
where must the crown margin be on buildups
Crown margin (finish line) needs to be on sound tooth structure or life of crown restoration is compromised.
40
can crown margin be on non sound tooth structure
Rule is rarely broken, but some science suggests it is possible to for this to occur successfully.
41
how are pins helpful with build ups
Pins are helpful to support the Build Up material when residual tooth structure does not provide adequate retention itself.
42
Pins increase? for? The resistance is where? Pins should be placed?
Pins increase resistance for Build up support The resistance is both internally and apically Pins should be placed non-parallel.
43
where to place pins in teeth, if not accomplished what happens
-Place in sound, healthy dentin -If the dentin is not sound, the threaded pin will not “bite” and will just spin in the hole and/or fall out
44
enamel undermining and pins are of placement? distance from DEJ/axial wall? dentin around pin?
-Do not damage or undermine nearby enamel -Flat area of placement -0.5 to 1mm from DEJ or axial wall -at least 0.5 mm of dentin should surround the pin
45
angulations of pins?
-Angulation can create problems. Avoid perforations or pins into the pulp!
46
pins and microfractures
Pins introduce dentin stresses creating micro fractures Also introduces microleakage around the pin Solid dentin is a must!
47
Guidelines for Pin placement -Best used where in posterior? -1 pin per? -At least __mm of space between pins -Max pins per tooth?
-Best used in line angles of posterior teeth to avoid furcations, perforations and the pulp! -1 pin per missing cusp, line angle, or axial wall -At least 5mm of space between pins -Max of 4 pins per tooth
48
making pilot hole for pin tool? handpiece? watch what?
-Use Pilot drill to make pilot hole. Depth gauge is on the drill! -Used with slow speed hand piece -Watch angulation and position
49
pin placement with flipin
-Using Filpin latch pin and slow speed handpiece, place pin just in hole, then full rheostat power. -The pin will snap off at the area of the shaft that has been scored. -The teeth of the pin should “bite” in the dentin. -The pin should not be mobile or able to be easily pulled out. -If the pin is mobile or pulled out, the dentin is either still decayed or too soft to support a pin (can be the case in RCT teeth).
50
bending of pins why? tool? pins should remain where?
Pins often then need to be bent to help create non-parallelism and to create even more retention forceps can be used to bend the pins Pin should remain in dentin during bending
51
Pins placed into dentin should: -Be __ mm deep into dentin -Be ___mm coronal into Build up -Minimum ___mm radius of Build up still around pin after preparation is done
-Be 2 mm deep into dentin -Be 2mm coronal into Build up -Minimum 1mm radius of Build up still around pin after preparation is done
52
how to make a perfect pilot hole? if not done?
Drills have a cutting tip and helical flutes Drill down in one motion without additional movement to create a tight perfect pilot hole for the pin. Too much wobble or imperfect handpiece technique creates a pilot hole that is too wide for the pin threads to properly bind into.
53
what do you do once pns are placed?
Once the pins are placed and bent if necessary, a matrix is placed around the prep Then Build up can be placed using techniques required of them Matrix is removed and now crown prep can proceed as normal
54
pin placement complications
55
if pin enters pulp what do you do?
RCT
56
Pin exits tooth surface above bone – solution?
flap and smooth to tooth contour
57
-Stripped pin (threads don’t bite) – solution?
move to another location at least 1.5 mm away or use a larger sized pin
58
uses for bases with build ups
Bases are used only to protect pulp in teeth that are have excavations that are deep and near the pulp. Bases can be used to fill in undercuts when an entire Build up is not needed.
59
are bases strong?
Bases are weaker materials that do not provide strength like a Build up. Bases are not strong enough to support grooves, boxes or other retentive features.
60
Restoration of extensively damaged vital teeth-Sequence of Treatment prior to prep evaluate what? remove all what? when is this not the case? evaluation of prep?
*Prior to prep: -Evaluate periodontal and endodontic health -If non-vital, RCT is needed *Remove all caries. Often, but not always, you will remove any prior materials like old restorations or previous bases. **You may not need to remove all caries. If you determine that the tooth is non-restorable, you may not need to excavate everything prior to extraction or RCT. *Re-evaluate your prep. -HOW MUCH TOOTH STRUCTURE IS REMAINING?? -Is there enough tooth to restore this tooth well? -Can the defects made from caries removal be incorporated into prep for retention? -Do you need a Build Up? or Base? or Pins? or a Post? Proceed with restoration

fixed pros. (11 decks)

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