Restoration of the Endodontically Restored Tooth Flashcards
what do you assess for on the endodontically restored tooth
coronal seal
amount of remaining tooth structure
is tooth restorable
swelling
sinus
TTP
buccal sulcus - tender?
mobility
increased pocketing
what do you look for on a radiograph
root filling
unfilled/missed root canals
shape of canal
patency
bone support
crown to root ratio
pathology
what are the problems faced after RCT
amount of remaining tooth structure
restoration type
lack or no ferrule
wide post holes
endo complications - fractured instruments
are teeth brittle after endodontic treatment
no
are root treated teeth more prone to fracture
no
is dentine hardness affected after RCT
no
does dehydration affect the hardness of a RCT tooth
no
what is coronal microleakage
ingress of microorganisms into root canal system
what can coronal microleakage cause
failure of RCT
how do you create a good coronal seal
trim GP to the ACJ and place RMGI over pulp floor and root canal openings
what restorations could you give for an anterior tooth with intact marginal ridges
composite
veneer
what restoration could you give for anterior teeth with intact marginal ridges and discoloured crown
bleaching or veneer
crown
what restoration could you give for anterior tooth with marginal ridges destroyed
core build up for crown
post crown
what is required for a direct post
ferrule
what does a post/core do
gain intraradicular support for definitive restoration
provide retention for crown
retains the core
what are the components of a post and core
post placed in root canal
core is supragingival and is what the prosthesis is cemented to
when do you avoid placing a post/core
if sufficient coronal dentine present
mandibular incisors (thin roots)
curved canals (avoid perforations)
how long should the root filling length be
4-5mm apically
how wide should the post be
no more than 1/3 of root width at narrowest point and 1mm of remaining circumferential coronal dentine
what should the minimum post length to crown ratio be
1:1
how much ferrule do you need for a post/core
1.5mm height and width
what is a ferrule
dentine collar - encirclement of 1-2mm of vertical axial tooth structure within walls of a crown
what does a ferrule prevent
tooth fracture
when is root fracture significantly increased
if a crown margin is not placed onto solid tooth
how can you achieve a ferrule if one is not already present
orthodontic extrusion or crown lengthening
how deep should a post go
at least halfway down the root to ensure good alveolar bone support
what is the ideal post
parallel sided
non-threaded
cement retained
what does a parallel sided post avoid
wedging
what does a non-threaded post allow
less stress to remaining tooth
what categories are post crowns classified into
manufacture
material
shape
what are the different types of manufactured post crowns
pre-formed or custom made
what are the materials available for post crowns
metal - cast gold/stainless steel/titanium
ceramics - alumina/zirconia
fibre - glass/quartz/carbon
what are the shapes that a post crown can have
parallel sided or tapered
what are the advantages of prefabricated posts
only 1 visit required
no impressions or lab needed
chairside core build up
immediate preparation of core
large selection of designs and materials
how are custom posts made
cast from patients mouth
how many visits are needed for custom posts
2
what material are cast posts made in
type 4 heat hardened gold
what are the properties of metal posts
poor aesthetics, root fracture, corrosion, nickel sensitivity, radiopaque
what are the properties of ceramic posts
high flexural strength and fracture toughness. favourable aesthetics, difficult retrievability and root fracture common
what are the properties of fibre posts
flexible, similar to dentine, aesthetic, retrievable, bone to dentine with DBAs
radiolucent
what is a core build up
internal part of tooth built up with restorative material to replace lost tooth tissue
what does the core of a core build up provide
retention and resistance for definitive restorations
what materials are used for core build ups
composite
amalgam
glass ionomer
what is a nayyar core
RCT removed from canals
amalgam packed into canals and tooth built up
what considerations do you need to think of when deciding what restoration to choose
how long post is
is there a ferrule
how wide
3-5mm remaining GP
is canal straight
how much space for core
how much taper is needed for a core
6 degree
how much GP is left in apical third of canal
3-5mm
how do you remove GP
dental dam
gates gliddens size 3
working length and rubber stop
how much space is left in occlusion for a crown
2mm
what do you do when trying in a post
irrigate with chlorhexidine
dry paper points
ensure fits around prep
enough occlusal clearance?
what are the problems with posts
perforation
core fracture
root fracture or crack
post fracture
how do you manage a post perforation
repair internally or externally
extract
what is used to remove a post
ultrasonics
masseran kit
eggler
moskito forceps
what are the reasons for post failure
restorative reasons
periodontal problems
endodontic reasons
