Restoration of Extensively Damaged Vital Teeth Flashcards by Annabella Moody

According to central core guidelines, the pulp and ____mm of surrounding _____ should be preserved

1mm; dentin

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

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

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According to central core guidelines auxiliary retentive features should ideally be kept in:

“safe zone”

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

filled with base

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Avoid excessive tooth removal in the name of:

retention

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Describe what happens to the pulp as we age?

shrinks

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List the five categories to consider in decision making:

type of restoration
using defects as retentive features
pin placement & retention
bases & cores
tooth preparation procedures

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What questions should you ask yourself to determine the type of restoration to use when LARGE DECAY has destroyed the tooth structure:

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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Extensive peripheral damage =

Full crown

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What restoration would you choose based on the following image?

Full crown (extensive peripheral damage)

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Isthmus destruction greater than 1/2 intercuspal width =

inlay or onlay

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More than 50% of tooth structure is gone and loss of cuspal support =

crown (& likely a core build up too)

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Less destructive central lesion =

inlay or onlay

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Large central lesion =

build up & crown

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Combined central & peripheral destruction -

core build up & crown (possible RCT/post)

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When would you decide you needed RCT with combined central & peripheral damage?

if pulp is exposed
if post is needed for retention of build up

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

increase retention & improve resistance form

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

re-orientatino of sloping surfaces
adding grooves
adding box forms
adding pins with a buildup

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

True

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

Reduce TOC of axial walls
Add grooves
Add box forms
Increase wall height

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

place finish line more apical
pin retained core
crown-lengthening
orthodontic extrusion

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

Reduce taper & create more retention & greater resistance form

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

parallel to long axis of tooth

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

1) at least 1mm wide & deep
2) 0.5-1.0mm away from finish line
3) spaced around the tooth

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Proximal grooves _____ the radius of the arc of rotation

shorten

Walls of a groove or box are best placed ______ when in a short preparation with minimal occlusal clearance

perpendicular to the displacing forces

- Remove caries - Convert caries removal into a box for by squaring walls - Not need on intact walls - Box should be well into dentin (deep enough) to resist displacing forces What is being described? What is this used for?

Box form used for retention

Why should the box form be placed well into dentin?

To resist displacing forces

Box forms can aid in:

Retention & resistance

When two boxes are needed, less than 180 degrees of tooth circumference remains. Why is this significant? What should you do in this situation?

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

The following aid in _____ 1. sloping walls 2. box form 3. grooves

retention

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

avoid invading biological width

When adding material to "build up" the tooth, this can give more wall. Remember the ____ needs to be on tooth structure & you still need at minimum ____ of ferrule

finish line; 2-3 mm

How might you remove the biological width restriction?

Crown lengthening

Extruding the tooth out of the bone to gain height:

Orthodontic extrusion

What procedure had the effect seen in the following image?

Crown lengthening

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

More apically (below gingival line)

Also called a foundation restoration:

Core build up

Replaces lost tooth structure to improve retention of a crown:

Core build up

A _____ must be anchored firms to the tooth & not just be placed to fill the void

Core build up

Retention for a core is often with the use of:

pins

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

more than 50%

What would be needed to crown the tooth in the following image?

Core build up

Describe what is occurring in the following images:

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

What happens to a crown when the prep has short axial walls?

Repeated de-cementation

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

pin-retained core

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

sound tooth structure

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

Amalgam core build ups= STRONG (but not retentive) Composite core build ups= RETENTIVE (but not as strong)

Use of pins is recommended when:

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

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

shortened or removed

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

flattened

Crowns margins should be at a minimum _______ to build up material margin

1mm apical

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

1. compressive strength 2. dimensional stability 3. corrosion- sealing

What are the limitations to an amalgam core buildup?

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

List the mechanical properties of a composite core buildup:

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

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

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

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

Composite (Amalgam takes more than one visit)

Limitations to composite core buildups:

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

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

pins

pins increase _____ for buildup support

resistance

Where do pins increase the resistance of the core buildup?

Both internally & apically

T/F: Pins should be placed parallel

False- they should be place non-parallel

What are the guidelines for pin placement?

1. place in sound, healthy dentin 2. do not damage or undermine nearby enamel 3. avoid perforation of pins into pulp 4. best used in line angle of posterior teeth 5. 1 pin per missing cups, line angle or axial wall 6. atleast 5 mm of space between pins 7. max of 4 pins per tooth

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

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

Pin placement procedure: 1. use ____ to make ____ 2. used with ____ hand piece 3. watch ____ & ____

1. pilot drill; pilot hole 2. slow speed 3. angulation & position

-cutting tip & 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 this describes:

Self-limiting twist drill (for pin placement)

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

True

Pins placed into dentin should be 1) _____ deep into the dentin 2) _____ coronal into buildup 3) minimum ____ radius of buildup still around pin after prep is done

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

What pin compilation is seen in the following image?

Fluted root shape

What pin compilation is seen in the following image?

Furcation

What pin compilation is seen in the following image?

Pulp penetration (RCT needed)

How would you resolve the following pin complication? -Pin into pulp

RCT needed

How would you resolve the following pin complication? -Pin exits tooth surface above bone

Flap & smooth to tooth contour

How would you resolve the following pin complication? -Fractured pin

Move to another location 1.5mm away

How would you resolve the following pin complication? -Stripped pin (loose pin)

Use larger size of pin

______ are used only to protect pulp in teeth that have excavation that are deep & near the pulp

bases

When are bases used?

Only to protect pulp in teeth that have deep excavation near the pulp

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

undercuts

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

Weaker; strength

Bases are NOT strong enough to:

support grooves, boxes or other retentive features

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

base

What materials are used as bases? (4)

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

CaOH (Dycal) is an example of a:

liner

If used, a liner is placed:

under base

Give an example of the common protocol used with bases:

1. gluma (gluteraldehyde) 2x60 seconds 2. Dycal (CaOH) 3. Vitrebond 4. Glass ionomer 5. Routine restoration steps

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

Orthodontic extrusion - increase in wall height for retention

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

Evaluate periodontal & endodontic health

In the process of restoring extensively damaged vital teeth, prior to prep, if periodontal & endodontic health is nonvital, what should be done?

RCT

In the process of restoring extensively damaged vital teeth, prior to prep, after evaluating periodontal & endodontic health:

remove all caries