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BDS3 - Endodontics > restoration of the endodontically treated anterior tooth > Flashcards

restoration of the endodontically treated anterior tooth Flashcards

1
Q

what needs to be considered when doing the clinical assessment

A
  • coronal seal = restorations/crowns, leakage, caries?
  • amount of remaining tooth structure = ferrule
  • is tooth restorable?
  • can tooth be isolated with rubber dam?
  • need to look for signs of infection = swelling, sinus, TTP, buccal sulcus, mobility
  • increased pocketing = perio disease and root fracture
  • look at reflected and attached mucosa
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2
Q

what type of restorations are radiographs important for pre-treatment

A
  • indirect

- but need for both

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3
Q

what is assessed from the radiograph

A
  • root filling = length, quality, obturation
  • unfilled/missed canals
  • shape of canal
  • patency = fracture instruments, posts
  • bone support
  • crown to root ratio
  • pathology
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4
Q

why are voids and missed canals a problem

A
  • voids allow transport of bacteria and substrate
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5
Q

what should the crown to root ratio be

A
  • 1:1.5

- if teeth are 1:1 can cause problems with crown lengthening as root not long enough to support

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6
Q

what needs done before prosthodontics can begin

A
  • inadequate root fillings should be re-treated
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7
Q

why is it important to know when RCT was done

A
  • can determine if tooth is still healing or if treatment has failed
  • if there is infection after 4 years it has failed
  • but if it doesnt look right after only 6 months, then could still be healing
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8
Q

why should rubber dam and hypochlorite be used

A
  • more likely to fail without
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9
Q

what are some other important considerations when assessing rCT

A
  • fractured instruments
  • cracks or fractures
  • perforations
  • periapical pathology
  • repeated RCT’s, implants, alternativeS?
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10
Q

what is coronal micro leakage

A
  • ingress of road micro-organisms into the root canal system
  • significant in multi-rooted teeth
  • important cause of RCT failure
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11
Q

what should be done to root treated teeth that have no been restored in 3 months

A
  • should be re-root treated

- if GP has been exposed to the mouth for longer than 3 months, then it will be contaminated so need to redo it

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12
Q

how should RCT be sealed in

A
  • trim GP to the ACJ and place RMGI over the pulp floor and root canal openings
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13
Q

why should lining not be too thick

A
  • allowing remained of pulp chamber for retention and restoration
  • liner should be over GP and over the base of pulp floor as often have a number of lateral canals in multi-rooted teeth
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14
Q

what is the importance of a coronal seal

A
  • technical quality of coronal restoration is significantly more important for apical periodontal health than the technical quality of the RCT
  • coronal restoration is more important than good RCT
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15
Q

how far should RCT go

A
  • 1-2mm from radiographic apex of tooth
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16
Q

what can commonly give rise to infection of tooth

A
  • leaking restorations
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17
Q

what can often cause leaking restorations

A
  • salivary contamination
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18
Q

what are some problems to consider after RCT/re-RCT

A
  • amount of tooth structure remaining
  • restoration type
  • lack of or no ferrule
  • wide post holes
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19
Q

why is amount fo tooth structure left important

A
  • need to have enough tooth to build a restoration on

- should consider this before starting

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20
Q

what are some endodontic complications

A
  • fractured instruments, perforations, short/long root fillings
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21
Q

are teeth brittle after RCT

A
  • teeth do not become more brittle after endodontic treatment
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22
Q

are root treated teeth more prone to fracture

A
  • a root filled tooth with minima loss of dentine is no more likely to fracture than vital tooth
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23
Q

after RCT are teeth as hard as non-root treated teeth

A
  • dentine hardness is not altered after endodontic treatment
  • irrigants can sometimes make teeth softer = EDTA and citric acid can remove minerals
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24
Q

does dehydration affect the hardness of a RCT tooth

A
  • does not appear to weaken dentine structure in terms of strength or toughness
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25
Q

what are the clinical choices for direct restoration

A
  • composite = class III and IV restoration

- glass ionomer is rarely used now, more for cervical restorations (class V)

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26
Q

what are the clinical choice for indirect restoration

A
  • crown or post crown
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27
Q

what is important about marginal ridges

A
  • if these are intact, then don’t do crowns or post crowns

- once start to lose marginal ridges, need to replace with crowns

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28
Q

what are the restoration options for anterior teeth with intact marginal ridges

A
  • direct composite restoration
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29
Q

what are the restoration options for anterior teeth with intact marginal ridges +/- discoloured crown

A
  • direct restoration with composite
  • bleaching tooth internally and externally and if it bleaches down enough could restore with composite
  • if not then could veneer labially to mask discolouration
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30
Q

what are the restoration options for an anterior teeth with marginal ridges destroyed

A
  • core build-up with crown

- post crown = last resort

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31
Q

how can age influence restorative option

A
  • crowns only last 8-10 years so wouldn’t want to give to young patient as they will need to keep coming back for a new crown which means drilling more tooth structure away each time
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32
Q

what is a post/core

A
  • used to gain intraradicular support for a definitive restoration
  • core provides retention for crown
  • post retains the core
  • posts do not reinforce or strengthen teeth
  • preparation for post weakens tooth as need to create space in root canal
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33
Q

are posts placed in incisors and canines

A
  • post unnecessary if sufficient coronal dentine is present
  • but excessive loss of coronal tooth tissue will need a post as pulp chamber and single root canal are not adequate enough to retain core
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34
Q

are posts placed in mandibular incisors

A
  • avoid
  • they have thin/tapering mesiodistal roots
  • if you put posts in these, tooth will breakdown
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35
Q

are posts placed premolars

A
  • small pulp chamber and tampering roots
  • thin in mesiodistal cross-section and proximal invaginations
  • place post in widest root canal if you have to place one
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36
Q

what should post width be

A
  • no more than 1/3 of root width at narrowest point and 1mm of remaining circumferential coronal dentine
37
Q

why do we need sufficient alveolar bone support for a post

A
  • we can’t put a post in a mobile tooth as will just get a fracture as the root is not supported in the bone
38
Q

what size does a ferrule need to be to do a post and core

A
  • at least 1.5mm height and width of remaining coronal dentine
39
Q

what is a ferrule

A
  • dentine collar
  • encirclement of 1-2mm of vertical axial tooth structure within walls of a crown
  • heigh and width should eb 1.5mm
  • collar should go all the way around the tooth
40
Q

what happens if a crown margin is not placed into solid tooth

A
  • root fracture is much more likely to occur
41
Q

what happens if there is no ferrule

A
  • root fracture
42
Q

what can you do to get a ferrule

A
  • orthodontic extrusion or crown lengthening may be necessary
  • can put a wire in the post hole and add chain in it to try and extrude structure supragingivally = very few cases amenable to this however
43
Q

what is the ideal post

A
  • parallel sided = avoid wedging, more retentive
  • non-threaded = passive
  • cement retained = less retentive but cement acts as a buffer between masticatory forces and post/tooth
44
Q

what are the different manufactured ways of a post

A
  • pre-formed
  • prefabricated
  • custom made
45
Q

what are the different materials for a post

A
  • cast metal
  • zirconia
  • carbon/glass fibre
46
Q

what are the different shapes of posts

A
  • parallel sided or tapered
47
Q

what are the different kinds of prefabricated posts

A
  • tapered smooth
  • tapered serated
  • tapered threaded
  • parallel smooth
  • parallel serated
  • parallel threaded
48
Q

what is good about prefabricated posts

A
  • only 1 visit needed
  • no impressions and no fit visit required
  • chair-side build-up of core
  • large selection of designs and materials = some have notches and grooves (notches)
49
Q

what is bad about prefabricated posts

A
  • post and core are different materials = causes problems such as leakage and corrosion
50
Q

what are the ways in which custom made posts are made

A
  • cast from direct pattern fabricated in patient mouth = Duralay - old technique, not used as much now as monomer is carcinogenic
  • indirect pattern can be fabricated in the lab = most common method
  • impression of post hole taken and wax-up of pot and core in lab, sculpt the material into a post and core which is then invested in requested material
51
Q

what is good about indirect method of making custom made posts

A
  • post and core are made from same material
52
Q

what are some problems about indirect methods of making custom made posts

A
  • 2 visits required
  • impressions and fit
  • temporisation between visits and lab stage required
  • risk of contamination of the root canal between visits
53
Q

what is the common material for custom posts to be cast in

A
  • type IV heat hardened gold
54
Q

what are some metal post material

A
  • cast gold
  • stainless steel
  • brass
  • titanium
55
Q

what are some problems with metal post material

A
  • poor aesthetics = this isn’t as much a problem anymore as new things have been made to block out metal shine
  • root fracture
  • corrosion
  • nickel sensitivity
56
Q

what is good about metal post materials

A
  • radiopaque on radiographs
57
Q

what are some ceramic post materials

A
  • alumina

- zirconia

58
Q

what is good about ceramic post materials

A
  • high flexural strength and fracture toughness

- favourable aesthetics

59
Q

what is a problem about ceramic post materials

A
  • difficult to remove and root fracture common

- the tooth around them often fractures

60
Q

what are some fibre post materials

A
  • glass
  • quartz
  • carbon
61
Q

what is good about fibre post materials

A
  • flexible = similar properties to dentine

- aesthetics, removable, bone to dentine with DBA’s

62
Q

what is a problem about fibre post materials

A
  • radiolucent

- can’t really see difference between this and overlying composite

63
Q

why are grooves placed on posts

A
  • there to give extra retention and help block the cement into them
64
Q

what are the advantages and disadvantages of tapered prefabricated post

A
  • +ve
  • conservative
  • high strength
  • high stiffness
  • -ve
  • less retentive than parallel or threaded
65
Q

what are the uses and precautions for tapered prefabricated posts

A
  • use = small circular canals

- cautions = avoid excessively flared canals

66
Q

what are the advantages and disadvantages of parallel prefabricated posts

A
  • +ve
  • high strength
  • good retention
  • comprehensive system
  • -ve
  • precious metal
  • expensive
  • corrosion of stainless steel
  • less conservative
67
Q

what are the uses and cautions of parallel prefabricated posts

A
  • use = small circular canals

- cautions = care duding prep

68
Q

what are the advantages and disadvantages of threaded posts

A
  • +ve
  • high retention
  • -ve
  • stresses generated can cause fracture
69
Q

what are the uses and cautions fo threaded posts

A
  • use = only when max retention essential

- caution = care to avoid fracture during seating

70
Q

what are the advantages and disadvantages of custom cast post and core

A
  • +ve
  • high strength
  • better than prefab
  • -ve
  • less stuff than wrought
  • “multiple appointments
  • complex
71
Q

what are the uses and cautions of custom made posts and core

A
  • use = elliptical or flared canals

- caution = care to remove nodules before insertion

72
Q

what is a core build-up

A
  • internal part of tooth is built-up with restorative material to replace the lost tooth tissue
  • core is prepared
  • provides retention and resistance for permanent restorations
73
Q

what are some core materials

A
  • composite = most common
  • amalgam
  • glass ionomer
  • biodentine
74
Q

what is god about composite as a core material

A
  • tooth coloured

- bond to tooth structure

75
Q

what is a problem about composite as a core material

A
  • moisture sensitive
76
Q

what posts are composite cores often used wit

A
  • fibre posts
77
Q

what are problems with amalgam as core material

A
  • tend to avoid as retention required as can’t bond to tooth
  • poor aesthetics = shine through
  • needs 24 hours to set
  • need to avoid pinned amalgams as often fail
78
Q

why are glass ionomer cores not really used

A
  • absorbs water

- core will increase in size so then can’t get crown on

79
Q

why is biodentine quite difficult to use

A
  • takes about 10-12 minutes to set and if it is touched in that time the setting time begins from the start again
80
Q

what is a Nayyar core

A
  • amalgam is packed into the root canals and tooth is built-up
  • use all the little spaces under the pulp horns to retain amalgam
81
Q

how can you manage a perforation

A
  • repair = internal or external
  • peri-radicular surgery
  • extraction
82
Q

how can a core fracture

A
  • if don’t have enough of a ferrule then core can break off from root
  • get fractures without a ferrules
83
Q

what can be indicative of a root fracture

A
  • if you find a single deep pocket

- common with ceramics

84
Q

how can a post fracture occur

A
  • post could be tooth short or narrow

- if there are lots of lateral forces applied, it can fracture

85
Q

how can posts be removed

A
  • ultrasonics
  • masseran kit
  • eggler
  • moskito forceps
86
Q

how does a masseran kit work

A
  • like an apple corer
  • work way down root canal and break cement down and get post out
  • don’t away with mostly as it is difficult to sterilise
87
Q

how does a moskito forceps work

A
  • screw retained
  • applied to post and pushed against root surface
  • can only be used if there is something sticking up to grasp onto
88
Q

what are the reasons for post crown failure

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

BDS3 - Endodontics (10 decks)

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