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BDS3 Endodontics > Restoration of the endodontically restored tooth > Flashcards

Restoration of the endodontically restored tooth Flashcards

1
Q

What should you be looking for in your clinical assessment?

A
  • Is the coronal seal adequate, restorations/crowns/leakage/caries
  • How much remaining tooth structure is there
  • Is tooth restorable and can you isolate with rubber dam
  • Swelling
  • Sinus
  • TTP
  • Buccal sulcus tender to palpation
  • Mobility
  • Increased pocketing (periodontal disease and root fracture)
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2
Q

What is included on radiographic assessment?

A
  • Root filling (length, quality of obturation e.g. any voids)
  • Unfilled or missed root canals
  • Shape of canal
  • Patency (fractured instruments, posts, sclerosis)
  • Bone support (mild, moderate, severe)
  • Crown to root ratio
  • Any pathology (perforations, radiolucency)
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3
Q

What are some problems after RCT/re-RCT?

A
  • Amount of remaining tooth structure can be little so determines what restoration type can do
  • Lack or no ferrule
  • Wide post holes with re-RCT
  • Endodontic complications like fractured instruments, perforation, short/long root fillings
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4
Q

Are teeth brittle after RCT?

A
  • No
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5
Q

Are root treated teeth more prone to fracture?

A
  • A RCT with minimal loss of dentine no more likely to fracture than vital tooth
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6
Q

After RCT are teeth as hard as non-root treated teeth?

A
  • Dentine hardness not altered
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7
Q

Does dehydration affect the hardness of RCT tooth?

A
  • Dehydration does not appear to weaken dentine structure in terms of strength or toughness
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8
Q

What is coronal microleakage?

A
  • Ingress of oral micro-organisms into root canal system
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9
Q

What can coronal microleakage cause?

A
  • Important cause of RCT failure
  • Root filled teeth unrestored for 3 months or longer they should be generally be re-root canal treated
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10
Q

What should you do to reduce coronal microleakage?

A
  • Trim GP to AC
  • Place RMGI over pulp floor and root canal openings
  • Don’t have lining too thick, allows remainder of pulp chamber for retention and restoration
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11
Q

What can you do if anterior tooth has intact marginal ridges?

A
  • Composite restoration
  • Veneer
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12
Q

What can you do if anterior teeth with intact marginal ridges and discoloured crown?

A
  • Bleaching
  • Veneer
  • Crown
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13
Q

What to do with anterior teeth with marginal ridges destroyed or post core crowns?

A
  • Core build up with crown
  • Post crown
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14
Q

What is a post/core?

A
  • Gains intraradicular support for definitive restoration
  • Post placed in root canal
  • Core what prosthesis is cemented to e.g. crown or bridge abutment
  • Core provides retention for crown
  • Post retains the core
  • Post don’t strengthen or reinforce teeth
  • Preparation of root canal for post weakens the tooth
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15
Q

What is the root filling length of post placement?

A
  • 4-5mm root filling apically
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16
Q

What teeth can be used for post placement?

A
  • Incisors and canines but it is not needed if sufficient coronal dentine present
  • Premolars (place in widest root canal)
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17
Q

Why should you not place post in mandibular incisors?

A
  • They have thin/tapering/narrow mesiodistal roots
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18
Q

What should you be careful of if placing post in premolars?

A
  • Have small pulp chambers and tapering roots
  • Thin in mesiodistal cross-section and proximal invaginations
  • Place in widest root canal
  • Avoid curved canals to avoid perforations
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19
Q

What is the post width?

A
  • No more than 1/3 root width at narrowest point
  • 1mm remaining circumferential coronal dentine
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20
Q

What is the minimum post length/ crown length ration?

A

1:1

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21
Q

Is sufficient alveolar bone support needed for post placement?

A
  • Yes
  • Need at least half of post length into root
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22
Q

What is the ferrule measurements needed for post placement?

A
  • At least 1.5mm height and width of remaining coronal dentine
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23
Q

What is a ferrule?

A
  • Dentine collar
  • Encirclement of 1-2mm of vertical axial tooth structure within walls of a crown
  • Prevents tooth fracture
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24
Q

What can happen if a crown margin not placed onto solid tooth?

A
  • Root fracture significantly increased
  • Ferrule helps prevent this
  • Orthodontic extrusion or crown lengthening might be needed to be done
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25
Q

What are the components of an ideal post?

A
  • Parallel sided
  • Non-threaded (passive)
  • Cement retained
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26
Q

Why is a parallel sided post good?

A
  • Avoids wedging
  • More retentive than tapered
27
Q

Why is a non-threaded (passive) post good?

A
  • Smooth surface incorporates less stress to remaining tooth than threaded (Active)
28
Q

Why is cement retained a good post?

A
  • Less retentive than threaded posts
  • But cement acts as buffer between masticatory forces and post/tooth
29
Q

How can posts be classified?

A

Manufacture
- Pre-formed/prefabricated
- Custom made

Material
- Cast metal
- Steel
- Zirconia
- Carbon/glass fibre

Shape
- Parallel
- Tapered

30
Q

What are the different types of prefabricated posts?

A

A: Tapered Smooth
B: Tapered Serrated
C: Tapered Threaded
D: Parallel Smooth
E: Parallel Serrated
F: Parallel Threaded

31
Q

Benefit of prefabricated posts?

A
  • Only 1 visit required
  • No impressions and lab visit required
  • Chairside core build up so immediate prep of core
  • Large selection of designs and materials
32
Q

What are custom posts?

A
  • Cast from direct pattern fabricated in patients mouth e.g. Duralay
  • Indirect pattern fabricated in lab
  • Post and core unified and one material
  • Type IV heat hardened gold
33
Q

Disadvantage of custom posts?

A
  • 2 visits required for impressions and fit
  • Temporisation between visits and lab stage needed
  • Risk of contamination of root canal between visits
34
Q

What are some metal post materials?

A
  • Cast gold
  • Stainless steel
  • Titanium
35
Q

What are some advantages and disadvantages of metal post materials?

A
  • Poor aesthetics
  • Root fracture
  • Corrosion
  • Nickel sensitivity
  • Radiopaque on radiographs
36
Q

What are some ceramic post materials?

A
  • Alumina
  • Zirconia
37
Q

What are the advantages and disadvantages of ceramic post materials?

A
  • High flexural strength
  • High fracture toughness
  • Favourable aesthetics
  • Difficult retrievability and root fracture common
38
Q

What are some fibre post materials?

A
  • Glass
  • Quartz
  • Carbon
39
Q

What are some advantages and disadvantages of fibre post materials?

A
  • Flexible
  • Similar properties to dentine
  • Aesthetic
  • Retrievable
  • Bond to dentine with DBA
  • Radiolucent on radiographs
40
Q

Advantages and disadvantages of tapered prefab post ?

A
  • Conservative
  • High strength
  • High stiffness
  • Less retentive than parallel or threaded
41
Q

What is the recommended use and precaution of tapered prefab?

A
  • Use in small circular canals
  • Avoid excessively flared canals
42
Q

Advantages and disadvantages of Parallel prefab?

A
  • High strength
  • Good retention
  • Comprehensive system
  • Precious metal post expesnive
  • Corrosion of SS
  • Less conservative
43
Q

What is the recommended use and and precaution of Parallel prefab?

A
  • Use in small circular canals
  • Have care during prep
44
Q

Advantages and disadvantages of Threaded post?

A
  • High retention
  • Stresses generated in canal may cause fracture
45
Q

What is the recommended use and precaution of Threaded post?

A
  • Use Only when max retention essential
  • Care to avoid fracture during seating
46
Q

Advantages and disadvantages of Custom cast post and core?

A
  • High strength
  • Better than prefab
  • Less stiff than wrought
  • Mulitple apts
  • Complex
47
Q

What is the recommended use and precautions of Custom cast post and core?

A
  • Use in eliptical or flared canals (non circular or extreme taper)
48
Q

What is the recommended use and precautions of Custom cast post and core?

A
  • Use in elliptical or flared canals (non circular or extreme taper)
  • Care to remove nodules before insertion
49
Q

What is a core build up?

A
  • Internal part of tooth built up with restorative material to replace lost tooth tissue
  • Core is prepared
  • Provides retention and resistance for permanent restorations
50
Q

What are some different core materials?

A
  • Composite
  • Amalgam
  • Glass ionomer
51
Q

Why is composite the most used core material?

A
  • Tooth coloured so good aesthetics
  • Bonds to tooth structure
  • Used with fibre posts
  • But is technique sensitive so moisture control required
52
Q

Why is amalgam not tend to be used for core material?

A
  • Retention is required so healthy tooth tissue drilled away
  • Poor aesthetics
  • Core can’t be prepared straightaway as need 24hrs to set
53
Q

Why is glass ionomer not really used for core materials?

A
  • Absorbs water and core expands in size
54
Q

What is Nayyar Core?

A
  • Root treatment removed from root canals
  • Amalgam packed into root canals and tooth built up which provides retention for amalgam
  • Can’t be prepared for 24hrs until amalgam sets
55
Q

What is anti rotation notch/groove?

A
  • If sufficient coronal structure present rotation is prevented by vertical coronal wall
  • If coronal dentin absent then small vertical groove in canal serves as anti rotational element
  • Located in bulkiest area of root , usually lingual
56
Q

What is the lab prescription?

A
  • Please construct cast post and core
  • Para post (colour)
  • Core 6 degree taper
  • Please leave 2mm space in occlusion for crown
  • Enclosed registration/ opposing impression/ shade
57
Q

What to do at Try in?

A
  • Check post space for temp bond
  • Irrigate chlorhexidine 0.2%
  • Dry paper points
  • Ensure fits around prep
  • Do you have enough occlusal clearance?
58
Q

What to do to get correct fit?

A
  • Careful not to fill post pace with cement as may prevent it seating
  • Firm apical pressure
  • Get rid of excess
  • Can ask lab for provisional acrylic crown
  • Make sure non excess around when taking crown imp/ fitting MCC
  • Practice fit sequence
59
Q

What are some problems with Posts?

A
  • Perforation
  • Core fracture
  • Root fracture or crack
  • Post fracture
60
Q

How to manage post perforation?

A
  • Repair internal or external (periradicular surgery)
  • Extraction
61
Q

What to do if post fracture?

A
  • Post removal using
  • Ultra-sonics
  • Masseran Kit
  • Eggler
  • Moskito forceps (screw retained)
62
Q

What are the stastitics of Post failure?

A
  • 60% due to restorative reasons
  • 32% due to periodontal problems
  • 8% due to endodontic reasons
63
Q

How much GP should you leave when placing a post?

A
  • 3-5mm GP in apical third
  • Solid GP plug

BDS3 Endodontics (5 decks)

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