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Restoration of extensively damaged vital teeth Flashcards

1
Q

What is the central core concept guidelines?

A
  • Pulp and 1 mm thick surrounding layer of dentin should be preserved
  • 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 and ___ mm thick surrounding layer of dentin should be preserved if possible

A

1

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3
Q

Retentive features should not be cut deeper than ____mm at cervical line or central fossa

A

1.5

  • central fossa more like 2 mm
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4
Q

Caries removal on a crown prep: deeper areas filled with ____

A

base

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5
Q

Avoid excessive tooth removal in the name of __________!

A

retention

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6
Q

Central Core (Pulp Chamber) shrinks and recedes…

A

as we age

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7
Q

What are the 5 categories involved in decision making for extensively damaged vital teeth?

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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8
Q

To determine the type of restoration to use when large decay has destroyed tooth structure what questions do we need to 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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9
Q

What is restoration selection?

A

Determine if a filling or a crown is needed

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10
Q

If there is extensive peripheral destruction what restoration do you do?

A

Full Crown

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11
Q

If there is extensive central destruction greater than 1/2 intercuspal width: what restoration?

A

Crown or onlay

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12
Q

If there is extensive central destruction that is more than 50% of tooth structure and loss of cuspal support: what restoration?

A

Crown (and likely a core build up too)

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13
Q

If there is combined central and peripheral destruction what do you do?

A

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

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14
Q

When would you decide you needed
Root Canal Treatment?

A
  • If pulp is exposed
  • If post is needed for retention of Build up
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15
Q

What ways can you add retentive features to increase retention and improve resistance form?

A
  • Re-orientation of sloping surfaces
  • Adding Grooves
  • Adding Box forms
  • Adding Pins with a Build up
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16
Q

T/F: Sometimes it is ok to leave a crown preparation without a build up and leave it ugly.

A

True! It can help with resistance and retention

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17
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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18
Q

What are ways to increase the wall height of a crown prep?

A

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

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19
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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20
Q

________ surfaces left after cusp fracture or caries removal need retention

A

Sloping

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21
Q

How do you change a sloping surface to add retention?

A

Break slope into vertical and horizontal components

  • do not change into one large vertical wall because it weakens tooth and endangers vital core
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22
Q

What should you do if greater than 3mm of vertical wall length is apical to the fractured cusp?

A

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

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23
Q

Grooves placed _______ to the long axis of the tooth

A

parallel

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24
Q

Grooves are at least ___mm wide and deep

A

1 mm

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25
Q

Grooves are placed ______ mm away from the finish line

A

0.5-1.0

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26
Q

Grooves used in short preparation walls with minimal occlusal clearance do what…

A

-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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27
Q

Box forms can be used for retention in what cases?

A

-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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28
Q

When two boxes are needed, less than 180 degrees of tooth circumference remains; why is this a problem?

A

-This poses a great risk for cuspal fracture
-Use a Build Up and full crown to protect against fracture

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29
Q

When increasing the wall height by placing the finish line more apically what do you need to watch out for?

A

breaking into biological width

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30
Q

What is important to know about a build up?

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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31
Q

Remove biological width restriction with ___

A

crown lengthening

32
Q

Pull the tooth out of the bone with _____

A

orthodontic extrusion

33
Q

What is a core build up?

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
34
Q

A Build Up is needed when more than ___% of the tooth structure is lost

A

50%

35
Q

What are the reasons for a build up?

A
  • short axial walls
  • excessive interocclusal distance (tall crown height)
36
Q

What are the differences between an amalgam core build up and a composite resin build up?

A

Amalgam Core Build Up
- Not retentive, but strong

Composite Resin materials
- Retentive, but not as strong

37
Q

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

A

½

38
Q

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

A

½

39
Q

For amalgam core, the cavity floors and walls should be __________.

A

flattened

40
Q

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

A

1.0

41
Q

What are the limitations of an amalgam core build up?

A
  • Matrix placement can be difficult if tooth is severely broken down
  • Slow setting material
  • 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
42
Q

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

A
  • Compressive strength
  • Dimensional stability
43
Q

What are the characteristics of an amalgam core build up?

A
  • Isolation less technique sensitive
  • Matrix placement can be difficult if tooth is severely broken down.
  • Often used in RCT teeth into canal for strength
44
Q

What are the mechanical properties of a composite core build up?

A
  • Bonds to tooth structure (still needs help with pins)
  • Quick setting (tooth prep at same visit and ease of manipulation)
  • Can be thinner than 2mm
  • Color of material aids in crown matching
45
Q

What are the limitations of a composite core build up?

A
  • Technique sensitive
  • Microleakage possible as material shrinks when cured
  • Isolation can be challenging
46
Q

What are the main guidelines for a build up?

A

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

47
Q

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

A

Pins

48
Q

Pins should be placed…

A

non-parallel

49
Q

Pins increase __________ for build up both internally and apically

A

resistance

50
Q

What are the general guidelines for pin placement?

A

-Place in sound, healthy dentin
-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 surroundthe pin
-Angulation can create problems. Avoid perforations or pins into the pulp!

51
Q

What happens if you try to put a pin in not sound dentin?

A

the threaded pin will not “bite” and will just spin in the hole and/or fall out

52
Q

A pin must be _____ mm from DEJ or axial wall

A

0.5-1.0 mm

53
Q

A pin have at least ____mm of dentin surrounding it

A

0.5 mm

54
Q

What is the risk of pins?

A
  • Pins introduce dentin stresses creating micro fractures
  • Also introduces microleakage around the pin
  • Solid dentin is a must!
55
Q

What are the specific guidelines for the number of 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, oraxial wall
-At least 5mm of space between pins
-Max of 4 pins per tooth

56
Q

There should be at least ___ mm of space between each pin

A

5.0

57
Q

There is a max of ___ pins per tooth

A

4

58
Q

___ pin(s) per missing cusp, line angle, or axial wall

A

1

59
Q

Where do the pins go for a maxillary second molar?

A
60
Q

Where do the pins go for a maxillary first molar?

A
61
Q

Where do the pins go for a maxillary second premolar?

A
62
Q

Where do the pins go for a maxillary first premolar?

A
63
Q

Where do the pins go for a mandibular second molar?

A
64
Q

Where do the pins go for a mandibular first molar?

A
65
Q

Where do the pins go for a mandibular second premolar?

A
66
Q

Where do the pins go for a mandibular first premolar?

A
67
Q

What is the pin placement procedure?

A

-Use Pilot drill to make pilot hole. Depth gauge is on the drill!
-Used with slow speed hand piece
-Watch angulation and position
-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.
- Bend pins if needed to create more retention.

68
Q

Pins place should be ___mm deep into dentin

A

2.0

69
Q

Pins should be ____mm coronal into build up

A

2.0

70
Q

What are complications that can occur with pins?

A
  • fluted root shape
  • furcation
  • pulp penetration (RCT needed)
71
Q

What do you do if you have a stripped pin?

A

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

72
Q

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

A

Bases

73
Q

Bases can be used to fill in _________ when an entire Build up is not needed

A

undercuts

74
Q

Bases are not strong enough to support

A

grooves, boxes or other retentive features

75
Q

What is a common protocol for using base?

A
  1. Gluma (Gluteraldehyde)
    -2x60 second coats
  2. Dycal / Calcium Hydroxide
  3. Vitrebond
  4. Glass Ionomer?
  5. Routine restoration steps
76
Q

What is the sequence of treatment for extensively damaged vital teeth?

A

-Evaluate periodontal and endodontic health (if non-vital, RCT)
- Remove all caries. Often, but not always, you will remove any prior materials like old restorations or previous bases.
- Re-evaluate your prep
—-HOW MUCH TOOTH STRUCTURE IS REMAINING??
—-Can the defects made from caries removal beincorporated into prep for retention?
—-Do you need a Build Up? or Base? or Pins? or a Post?
- Proceed with Resoration

Fixed (19 decks)

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