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BDS3 ENDODONTICS > Restoration of the Endodontically Restored Tooth > Flashcards

Restoration of the Endodontically Restored Tooth Flashcards

1
Q

What are you looking for in a tooth that potentially needs to be endodontically treated?

A
  • caries
  • how much tooth structure is left
  • able to be isolated?
  • swelling/sinus
  • ttp
  • buccal sulcus tender to palpation?
  • mobility
  • increased pocketing
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2
Q

When assessing a radiograph of an endodontically restored tooth, what are you looking for?

A
  • root filling voids/quality of obturation
  • unfilled/missed canals
  • patency (fractured instruments/posts/sclerosis)
  • bone support
  • crown to root ratio
  • pathology
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3
Q

What are some problems of restoring RCT teeth?

A
  • lack of remaining tooth structure
  • fractured endo instruments
  • perforations
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4
Q

What is coronal microleakage?

A

Ingress of micro-organisms into the root canal system
- important cause of RCT failure

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5
Q

What is the choice of restoration for a RCT anterior tooth with intact marginal ridges?

A

composite restoration veneer

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6
Q

What is the choice of restoration for a RCT anterior tooth with intact marginal ridges + discoloured crown?

A

bleaching or veneer (crown)

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7
Q

What is the choice of restoration for a RCT anterior tooth with destroyed marginal ridges?

A
  • core build-up with crown
  • post crown
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8
Q

what is a post/core?

A
  • Core provides retention for crown
  • Post retains the core
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9
Q

Do posts strengthen/reinforce teeth?

A

NO
- they simply retain the core
- preparation of root canal for a post weakens the tooth

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10
Q

Where is a post located?

A

Post placed in the root canal

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11
Q

What is a core? (RCT reference)

A

The core is what the prosthesis is cemented to

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12
Q

Should posts be placed in incisors or canines?

A

post unnecessary if sufficient coronal dentine is present

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13
Q

In which teeth should post placement be avoided?

A

Mandibular incisors due to thin/tapering/narrow mesiodistal roots

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14
Q

Why should you avoid placing a post in a curved canal?

A

Can cause perforation

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15
Q

What is the guideline root filling length for placement of a post?

A

4-5mm root filling apically

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16
Q

Why is coronal seal during RCT important?

A

good coronal seal will lead to healthier apical periodontal health as it prevents microbial leakage into the canals

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17
Q

What is the guidelines for post width in RCT teeth?

A

No more than 1/3rd of root width at narrowest point and 1mm of remaining circumferential coronal dentine

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18
Q

How much alveolar bone support is required for placement of a post?

A

At least half of post length into the root

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19
Q

what are examples of posts

A

Fiberglass
carbon fibre posts

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20
Q

What is the guidelines for post placement in terms of ferrule size?

A

at least 1.5mm height and width of remaining coronal dentine

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21
Q

What is a ferrule?

A

A dentine collar!
- encirclement of 1-2mm of vertical axial tooth structure within walls of a crown
- prevents tooth fracture

22
Q

Crown margin has not been placed onto solid tooth, what is likely to occur?

A

root fracture significantly increased

23
Q

What can be done to a tooth to achieve a ferrule before placement of a crown?

A

orthodontic extrusion or crown lengthening

24
Q

What are the aspects of ‘the ideal post’?

A
  • parallel sided
  • non-threaded (passive, all posts are slightly threaded)
  • cement retained
25
Q

Why is it important that a post is parallel sided?

A
  • avoids ‘wedging’
  • more retentive than tapered
26
Q

Why is it important that a post is non-threaded (passive)?

A

Smooth surface incorporates less stress to reminding tooth than threaded (active)

27
Q

Why is it important that a post is cement retained?

A

Less retentive than threaded posts but cement acts as buffer between masticatory forces and post/tooth

28
Q

How can posts be manufactured?

A
  • pre-formed
  • prefabricated
  • custom made
29
Q

What materials can posts be made of?

A
  • cast metal
  • steel
  • zirconia
  • carbon/glass fibre
30
Q

What shape can posts be?

A

parallel sided or tapered

31
Q

What are the benefits of prefabricated posts?

A
  • only 1 visit required
  • no impressions and lab visit required
  • immediate prep of core
  • large selections of designs and materials
32
Q

How are custom posts made?

A
  • cast from direct pattern fabricated in patients mouth (duralay)
  • 2 visits required = impressions and fit
33
Q

What is the minimal standard restoration for a posterior endodontically treated tooth?

A

cuspal protection restoration (minimal standard restoration for a posterior endodontically treated tooth)
- prevent microbial ingress
- prevent catastrophic fracture (eg tooth splitting through furcation or buccal wall coming off tooth and taking cementum with it)

34
Q

What is a core build up?

A

Internal part of tooth is built-up with restorative material to replace the lost tooth tissue
- can provide retention and resistance for permanent restorations

35
Q

Where should you try not to place a post in the mouth?

A

Posterior tooth
- difficult access
- likely to cause perforation

36
Q

What core materials are used?

A
  1. Composite = best option!
  2. Amalgam
  3. Glass ionomer
37
Q

What is involved in placement of a Nayyar core?

A
  • root treatment is removed from the root canals
  • amalgam is packed into the root canals and tooth build up (provides retention for the amalgam)
  • cannot be prepared for 24hrs until amalgam sets (PROBLEM)
  • difficult process
38
Q

What are the problems associated with posts?

A
  • perforation
  • core fracture
  • root fracture or crack
  • post fracture
39
Q

How is a tooth managed that has had post perforation?

A
  • repair = internal or external periradicular surgery
  • extraction
40
Q

What can be used to remove a post from a tooth?

A
  • ultrasonics
  • Masseran kit
  • eggless
  • miskito forceps
41
Q

What are the reasons for post failure?

A
  • 60% due to restorative reasons
  • 32% due to periodontal problems
  • 8% due to endodontic reasons
42
Q

Do all cores need a post?

A

NO

43
Q

What are the benefits and cons of using composite as a core material?

A

Benefits =
- tooth coloured (good aesthetics)
- bonds to tooth structure

Cons =
- technique sensitive
- moisture control required

44
Q

What are the cons of using amalgam as a core material?

A
  • poor aesthetics
  • core cannot be prepped straight away as amalgam needs 24 hrs to set
45
Q

What are the cons of using glas ionomer as a core material?

A

absorbs water so core expands in size

46
Q

What should apply to the design of a core?

A
  • 6º taper
  • 10mm length
47
Q

What would be included on the lab prescription for a post and core?

A
  • please contrast cast post and core
  • para post (colour)
  • core 6º taper
  • please leave 2mm space in occlusion for crown enclosed registration/opposing impression
48
Q

What are the steps of a post try-in?

A
  • check post space for temp bond
  • irrigate chlorhexidine (0.2%)
  • dry with paper points
  • ensure fits around prep
  • do you have enough occlusal clearance
49
Q

What are the essential techniques of fitting a post-crown?

A
  • be careful not to fill post space with cement
  • use firm apical pressure
  • get rid of excess
  • make sure no excess around when taking crown impression/fitting MCC
50
Q

What may be the signs of vertical root fracture?

A
  • Long single pocket
  • Repeated debonding of post/core

BDS3 ENDODONTICS (1 decks)

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