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Fixed Prosthodontics > 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 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

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

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3
Q

According to central core guidelines auxiliary 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 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 restoration to use when LARGE DECAY has destroyed the tooth structure:

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 and loss of cuspal 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 & peripheral destruction -

A

core build up & crown (possible RCT/post)

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16
Q

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

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 & improve resistance form

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18
Q

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

A
  1. re-orientatino of sloping surfaces
  2. adding grooves
  3. adding box forms
  4. adding pins with a buildup
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19
Q

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

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 & create more retention & greater resistance form

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23
Q

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

A

parallel to long axis of tooth

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24
Q

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

A

1) at least 1mm wide & deep
2) 0.5-1.0mm away from 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 box are best placed ______ when in a short preparation with minimal occlusal clearance

A

perpendicular to the displacing forces

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27
Q
  • 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?

A

Box form used for retention

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28
Q

Why should the box form be placed well into 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? What should you do in this situation?

A

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

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31
Q

The following aid in _____

  1. sloping walls
  2. box form
  3. grooves
A

retention

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32
Q

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

A

avoid invading biological width

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33
Q

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

A

finish line; 2-3 mm

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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 the effect seen in the following image?

A

Crown lengthening

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37
Q

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

A

More apically (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 firms to the tooth & 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 to crown the tooth 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 the prep has short axial 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 build ups?

A

Amalgam core build ups= STRONG (but not retentive)

Composite core build ups= RETENTIVE (but 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

flattened

52
Q

Crowns 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 buildup?

A
  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
55
Q

List the mechanical properties of a composite core buildup:

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

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

A
  1. quick setting
  2. can be thinner than 2mm
  3. color of 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 one visit)

58
Q

Limitations to composite core buildups:

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 buildup support

A

resistance

61
Q

Where do pins increase the resistance of the core buildup?

A

Both internally & apically

62
Q

T/F: Pins should be placed parallel

A

False- they should be place 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 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
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) 0.5-1mm 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 & position
66
Q

-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:

A

Self-limiting twist drill (for pin placement)

67
Q

T/F: Pins often need to be bent to help created 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 buildup still around pin after prep is done

A

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

69
Q

What pin compilation is seen in the following image?

A

Fluted root shape

70
Q

What pin compilation is seen in the following image?

A

Furcation

71
Q

What pin compilation 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 & 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 larger size of pin

76
Q

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

A

bases

77
Q

When are bases used?

A

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

78
Q

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

A

undercuts

79
Q

Bases are ____ material 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 (CaOH)
  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 & endodontic health

88
Q

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

A

RCT

89
Q

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

A

remove all caries

90
Q
A

Fixed Prosthodontics (13 decks)

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