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Fixed Prosthodontics I > Restoration of Extensively Damaged Vital Teeth > Flashcards

Restoration of Extensively Damaged Vital Teeth Flashcards

1
Q

According to central core guidelines the pulp and ___mm thick of surrounding ____ should be preserved

A

1mm; dentin

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2
Q

According to central core guidelines, retentive features should not be cut deeper than:

A

1.5 mm at cervical line or central fossa (2mm)

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3
Q

According to central core guidelines, the auxillary retentive features should ideally be kept in:

A

“safe zone”

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4
Q

According to central core guidelines, for caries removal, deeper areas should be:

A

filled with base

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5
Q

Avoid excessive tooth removal in the name of:

A

retention

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6
Q

Describe what happens to the pulp chamber as we age?

A

shrinks

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7
Q

List the five categories to consider in decision making:

A
  1. Type of restoration
  2. Using defects as retentive features
  3. Pin placement & retention
  4. Bases & cores
  5. Tooth preparation procedures
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8
Q

What questions should you ask yourself to determine the type of restorations to use when LARGE DECAY has destroyed tooth structure? (5)

A
  1. WHERE is the decay?
  2. How much tooth structure is remaining?
  3. WHERE is the remaining tooth structure?
  4. Can I restore this?
  5. Should I restore this?
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9
Q

Extensive peripheral damage =

A

full crown

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10
Q

What restoration would you choose based on the following image?

A

full crown (extensive peripheral damage)

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11
Q

Isthmus destruction greater than 1/2 intercuspal width=

A

Inlay or onlay

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12
Q

More than 50% of tooth structure is gone an floss of cusps support=

A

crown (likely a core build up too)

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13
Q

Less destructive central lesion =

A

inlay or onlay

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14
Q

Large central lesion =

A

build up & crown

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15
Q

Combined central and peripheral destruction =

A

core build up and crown (possible RCT/post)

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16
Q

When would you decide you needed root canal treatment with combined central and peripheral destruction?

A
  1. if pulp is exposed
  2. if post is needed for retention of build up
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17
Q

Often, a tooth preparation will need to be modified by adding retentive features to:

A

increase retention and improve resistance form

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18
Q

List some examples of retentive features used to modify a prep:

A
  1. re-orinetation of sloping surface
  2. adding grooves
  3. adding box forms
  4. adding pins with a build up
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19
Q

T/F: There are times when leaving a crown prep without a build up can help with retention too. Sometimes, you need to leave it ugly

A

True

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20
Q

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

A
  1. reduce TOC of axial walls
  2. add grooves
  3. add box forms
  4. increase wall height
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21
Q

What are ways to increase wall height of a prep, in order to increase resistance form with less-than-ideal tooth structure remaining?

A
  1. place finish line more apical
  2. pin retained core
  3. crown-lengthening
  4. orthodontic extrusion
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22
Q

Increased axial reduction in the cervical 1/2 of the preparation wall will:

A

reduce taper and create more retention and greater resistance form

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23
Q

Grooves should be placed ____ when trying to increase retention & resistance

A

parallel to the long axis of the tooth

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24
Q

Grooves should be placed parallel to the long axis of the tooth with the following requirements: (3)

A

1) atleast 1mm wide and deep
2) 0.5 to 1.0mm away from the finish line
3) spaced around the tooth

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25
Q

Proximal grooves ____ the radius of the arc of rotation

A

shorten

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26
Q

Walls of a groove or a box are best placed ___ when in a short prep with minimal occlusal clearance.

A

perpendicular to the displacing forces

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27
Q
  • 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

What is being described? What is this used for?

A

Box form- used for retentionW

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28
Q

Why should the box form be placed well into the dentin?

A

to resist displacing forces

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29
Q

Box forms can aid in:

A

retention & resistance

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30
Q

When two boxes are needed, less than 180 degrees of tooth circumference remains.

Why is this significant and what should you do in this situation?

A

Great risk for cuspal fracture; use a build up and full crown to protect against fracture

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31
Q

The following aid in ____.

  • sloping walls
  • box form
  • grooves
A

retention

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32
Q

When increasing the wall height by placing the margin more apically often this is below the gingiva, however, we must:

A

avoid invading the biological width

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33
Q

When adding materials to “build up” the tooth, this can give more wall. Remember, the ___ needs to be on tooth structure and you still need a minimum of _____ of ferrule

A

finish line; 2-3mm

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34
Q

How might you remove the biological width restriction?

A

crown lengthening

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35
Q

extruding the tooth out of the bone to gain height:

A

orthodontic extrusion

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36
Q

What procedure had this effect?

A

crown lengthening

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37
Q

Where can the margin be placed if you are trying to increase wall height?

A

more apically and below gingival line

38
Q

Also called a foundation restoration:

A

core build up

39
Q

Replaces lost tooth structure to improve retention of a crown:

A

core build up

40
Q

a ___ must be anchored firmly to the tooth and not just be placed to fill the void:

A

core build up

41
Q

Retention for a core is often with the use of:

A

pins

42
Q

A build up is needed when ___ of the tooth structure is lost

A

more than 50%

43
Q

What would be needed in the following image?

A

core build up

44
Q

Describe what is occurring in the following images:

A
  1. not enough tooth structure for crown retention
  2. build up added after crown lengthening
  3. success
45
Q

What happens to a crown when a prep has short axially walls?

A

repeated de-cementation

46
Q

When there is excessive interocclusal distance (tall crown height), this needs:

A

pin-retained core

47
Q

Crown margin (finish line) needs to be on ____ or prognosis of restoration will be compromised

A

sound tooth structure

48
Q

What is the difference between amalgam core build ups and composite core buildups?

A

amalgam core build ups = STRONG (but not retentive)

composite core bud ups = RETENTIVE (not as strong)

49
Q

Use of pins is recommended when:

A

1/2 or more of the clinical crown has been destroyed

50
Q

Cusps thinner than 1/2 their height are considered weak and should either be:

A

shortened or removed

51
Q

For amalgam core, the cavity floors and walls should be:

A

flattenedC

52
Q

Crown margins should be at a minimum ____ to build up material margin

A

1mm apical

53
Q

What are the mechanical properties of an amalgam core build up?

A
  1. compressive strength
  2. dimensional stability
  3. corrosion- sealing
54
Q

What are the limitations to an amalgam core build up?

A
  1. matrix placement can be difficult
  2. slow setting material
  3. no bonding or natural
  4. requires atleast 2 mm thickness
  5. color shows through some ceramic crowns
  6. final crown prep occurs another day
55
Q

List the mechanical properties of a composite core build up:

A
  1. bonds to tooth structure
  2. still needs help with pins
56
Q

Three advantages to a composite core build up (compared to an amalgam core build up include):

A
  1. quick setting
  2. can be thinner than 2 mm
  3. color in material aids in crown matching
57
Q

Your patient needs a core build up and crown in the same day. What material will you use?

A

composite (amalgam takes more than 1 visit)

58
Q

The limitations to composite core build ups include: (3)

A
  1. technique sensitive
  2. isolation can be challenging
  3. micro leakage possible as material shrinks when cured
59
Q

____ are helpful to support the build up material when residual tooth structure does not provide adequate retention itself.

A

Pins

60
Q

Pins increase ___ for build up support

A

resistance

61
Q

Where do pins increase the resistance of the core build up?

A

both internally and apically

62
Q

T/F: Pins should be placed parallel

A

False- They should be placed non-parallel

63
Q

What are the guidelines for pin placement?

A
  1. Place in sound, healthy dentin
  2. Do not damage or undermine nearby enamel
  3. Avoid perforations of pin into pulp
  4. Best used in line angles of posterior teeth
  5. 1 pin per missing cusp, line angle, or axial wall
  6. atleast 5mm of space between pins
  7. max of 4 pins per tooth
64
Q

It is important to not damage or undermine nearby enamel when placing a pin. How can this be accomplished?

A

1) flat area of placement
2) 0.5-1.0 mm from DEJ or axial wall
3) atleast 0.5 mm of dentin should surround the pin

65
Q

Pin placement procedure:

  1. Use ___ to make ____.
  2. Used with ____ hand piece
  3. Watch ____ & ____
A
  1. pilot drill; pilot hole
  2. slow speed
  3. angulation and position
66
Q
  • cutting tip and helical flutes
  • 2mm deep (threaded pins)
  • one motion without stopping
  • too much wobble or imperfect handpiece technique creates a pilot hole that is too wide

These steps describe:

A

Self- limiting twist drill (for pin placement)

67
Q

T/F: Pins often need to be bent to help create non-parallelism and to create even more retention

A

true

68
Q

Pins placed into dentin should be:

1) _____ deep into the dentin
2) _____ coronal into buildup
3) minimum ___ radius of build up still around pin after prep is done

A

1) 2mm
2) 2mm
3) 1 mm

69
Q

What pin complication is seen in the following image?

A

fluted root shape

70
Q

What pin complication is seen in the following image?

A

furcation

71
Q

What pin complication is seen in the following image?

A

Pulp penetration (RCT needed)

72
Q

How would you resolve the following pin complication?

  • Pin into pulp
A

RCT needed

73
Q

How would you resolve the following pin complication?

  • Pin exits tooth surface above bone
A

flap and smooth to tooth contour

74
Q

How would you resolve the following pin complication?

  • Fractured pin
A

Move to another location 1.5mm away

75
Q

How would you resolve the following pin complication?

  • Stripped pin (loose pin)
A

Use a larger size of pin

76
Q

_____ are used only to protect pulp in teeth that have excavations that are deep and near the pulp

A

bases

77
Q

When are bases used?

A

only to protect pulp in teeth that have have deep excavations near pulp

78
Q

Bases can be used to fill in ____ when an entire build up is NOT needed

A

undercuts

79
Q

Bases are ____ materials that do NOT provide ____ like a build up

A

weaker; strength

80
Q

Bases are NOT strong enough to:

A

support grooves, boxes, or other retentive features

81
Q

_____ material protects the pulp and provides smooth, flat pulpal floor

A

base

82
Q

What materials are used as bases? (4)

A
  1. Polycarboxylate cement
  2. Glass ionomer cement
  3. Resin-modified glass ionomer cement (RMGI)
  4. Silver-reinforced glass ionomer cement (Ketac-silver)
83
Q

CaOH (Dycal) is an example of a:

A

liner

84
Q

If used, a liner is placed:

A

under base

85
Q

Give an example of the common protocol used with bases:

A
  1. gluma (gluteraldehyde) 2x60 seconds
  2. Dycal (calcium hydroxide)
  3. Vitrebond
  4. Glass Ionomer
  5. Routine restoration steps
86
Q

What can be seen in the following images? What does this aid in?

A

Orthodontic extrusion- increase in wall height for retention

87
Q

In the process of restoring extensively damaged vital teeth, prior to prep:

A

evaluate periodontal and endodontic health

88
Q

In the process of restoring extensively damaged vital teeth, if periodontal & endodontic health is non-vital, what should be done?

A

RCT

89
Q

In the process of restoring extensively damaged vital teeth, after evaluating periodontal and endodontics health:

A

remove all caries

90
Q
A

Fixed Prosthodontics I (13 decks)

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