Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

fixed pros. > Restoration of extensively damaged vital teeth > Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

pulp chamber with age

A

shrinks as we edge, less so at canine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Extensive Peripheral destruction indicates what restoration

A

full crown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Combined Central and Peripheral destruction indicates:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

methods to increase wall height

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

amalgam removal and retention

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how to remove bio width restriction

A

crown lengthning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

orthodontic extrusion.

A

Pull the tooth out of the bone with orthodontic extrusion.

26
Q

Core Build up
Replaces? to improve what quality? must be anchored?
Retention for a core is often with?

A

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
Q

when is a build up needed

A

when more than
50% of the tooth structure is lost

28
Q

Build up Guidelines-
First reason for Build up –
Second reason for a Build up –

A

First reason for Build up – Short axial walls
Second reason for a Build up – Excessive interocclusal distance (tall crown height without=decreased strength)

29
Q

amalgam core build up qualities

A

Not retentive, but strong

30
Q

compositie core build up qualties

A

retentive but weaker

31
Q

Use of pins recommended when?

A

Use of pins recommended if ½ or more of the clinical crown has been destroyed.

32
Q

Cusps thinner than ½ their height are? and should be?

A

Cusps thinner than ½ their height are weak and should either be shortened or removed.

33
Q

cavity floors and walls with amalgam cores

A

should be flat

34
Q

Crown margins should be at minimum________ mm apical to build up material margin.

A

Crown margins should be at minimum 1 mm
apical to build up material margin.

35
Q

Amalgam Core
Mechanical properties?
Isolation?
Matrix placement ?
Often used in?

A

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
Q

limitations of the amalgam core
Matrix placement?
set time?
bonding/retention?
thickness?
Color?
Final crown prep occurs?

A

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
Q

Composite Core
Mechanical properties
Bonds to?
Still needs help with?
setting?
Tooth prep when?
Ease of?
Can be thinner?
Color?

A

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
Q

limitations to composite core
technique?
leaks?
isolation?

A

Technique sensitive
Microleakage: possible as material shrinks when cured
Isolation can be challenging

39
Q

where must the crown margin be on buildups

A

Crown margin (finish line) needs to be on sound tooth structure or life of crown
restoration is compromised.

40
Q

can crown margin be on non sound tooth structure

A

Rule is rarely broken, but some science
suggests it is possible to for this to occur successfully.

41
Q

how are pins helpful with build ups

A

Pins are helpful to support the Build
Up material when residual tooth
structure does not provide adequate
retention itself.

42
Q

Pins increase? for?
The resistance is where?
Pins should be placed?

A

Pins increase resistance for Build up
support
The resistance is both internally and
apically
Pins should be placed non-parallel.

43
Q

where to place pins in teeth, if not accomplished what happens

A

-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
Q

enamel undermining and pins
are of placement?
distance from DEJ/axial wall?
dentin around pin?

A

-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
Q

angulations of pins?

A

-Angulation can create problems. Avoid
perforations or pins into the pulp!

46
Q

pins and microfractures

A

Pins introduce dentin stresses creating micro fractures
Also introduces microleakage around the pin
Solid dentin is a must!

47
Q

Guidelines for Pin placement
-Best used where in posterior?
-1 pin per?
-At least __mm of space between pins
-Max pins per tooth?

A

-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
Q

making pilot hole for pin
tool?
handpiece?
watch what?

A

-Use Pilot drill to make pilot hole. Depth gauge is on the drill!
-Used with slow speed hand piece
-Watch angulation and position

49
Q

pin placement with flipin

A

-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
Q

bending of pins
why?
tool?
pins should remain where?

A

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
Q

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

A

-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
Q

how to make a perfect pilot hole? if not done?

A

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
Q

what do you do once pns are placed?

A

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
Q

pin placement complications

A
55
Q

if pin enters pulp what do you do?

A

RCT

56
Q

Pin exits tooth surface above bone – solution?

A

flap and smooth to tooth contour

57
Q

-Stripped pin (threads don’t bite) – solution?

A

move to another location at least 1.5 mm away or use a larger sized pin

58
Q

uses for bases with build ups

A

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
Q

are bases strong?

A

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
Q

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?

A

*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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions