Restorations of root filled teet

Question 1

What are the broad options we have when a tooth has pulpal disease

Answer 1

1. Extraction
2. RCT

Question 2

What different things might we conclude after carrying out pre op treatment

Answer 2

1. There may be insufficient tooth tissue for strength or to create a ferrule (XLA, Overdenture abutment)
2. There may be sufficient tissue for a direct restoration
   3, Greater tooth loss but ferrule is possible (indirect restoration needed)

Question 3

What Is the ferrule of a root treated tooth

Answer 3

The portion of the crown that encircles the remaining dentine

Question 4

Why is the ferrule important

Answer 4

As it binds to the remaining portion of the tooth and prevents the root from fracturing and the crown from dislodging

Question 5

State the ideal dimensions of the ferrule

Answer 5

Height: 2mm
Width: at least 1mm
(ideally should be encircling the tooth )

Question 6

Name the 3 assessments you carry out when checking a root filled tooth

Answer 6

1. Endodontic Assessment
2. Periodontal assessment
3. Coronal tissue assessment

Question 7

How should you cary out a coronal tissue assessment?

Answer 7

1. Remove any existing restorations to evaluate remaining tooth tissue
2. Then evaluate aesthetics
3. Evaluate occlusions

Question 8

When evaluating remaining tooth tissue what should you focus on?

Answer 8

1. Quality of the remaining healthy tissue
2. Min height of ferrule should be 0.5-2mm
3. Thickness of tooth tissue
4. Portion of remain gin healthy tooth tissue

Question 9

When evaluating aesthetics during coronal tissue assessment what do we look at?

Answer 9

1, Tooth/ root discolouration
2. Tooth shape

Question 10

When evaluating occlusion during coronal tissue assessment what do we look at

Answer 10

1. Is the tooth in occlusion
2. Does the tooth contribute to lateral or protrusive guidance
3. Will the forces on the tooth be low or high during function

Question 11

What is the rationale for restoring ga root filled tooth

Answer 11

1. To provide a biological seal to prevent re infection of the root canal system
2. To protect raining tooth tissue
3. To maintain occlusal stability and proximal contacts to prevent over eruption or drifting

Question 12

If a patient has sufficient tooth tissue on their root filled tooth what are our treatment options

Answer 12

Restore with composite of amalgam with weak cusps reduced and onlayed

Question 13

If a patient has greater tooth tissue loss but ferrule possible what are our treatment options

Answer 13

1. Direct amalgam or composite core followed by preparation for an indirect restoration (crown or onlay)
2. IF the core requires additional retention and support we need a post

Question 14

What can we cover the GP with when placing a direct plastic restoration

Answer 14

1. RMGIC
2. Flowable resin core

Question 15

Name the type of core we can put in if a post is NOT required

Answer 15

The Nayyar core

Question 16

How do we place a Nayyar core?

Answer 16

1. Remove 2-4mm of Gp
2. Place a thin layer of RM-GIC over the GP
3. Finish with amalgam or composite

Question 17

What are the requirements and indications of using a post

Answer 17

1. Post length should be at leat equal to coral length with enough apical seal
2. The presence of a 1.5-2mm ferrule is important for fracture resistance

Question 18

What are the benefits of a pre fabricated post?

Answer 18

1. Aesthetic as they are metal free
2. They bond with dullard self cure resin cements and composite core material
3. Felxural properties closer to those of dentine
4. Can be used for revision of endodontic treatment
5. Claim to reinforce root
6. The post is more likely to fracture than the root so you can save the tooth

Question 19

What are the guidelines for post lengths

Answer 19

Ideally:

1. The post should in the root(which is supported by bone) as much as possible
2. The post length in the bone should be at last as much as that above the boney crest level
3. There should 4-5mm of apical GP remaining

Question 20

What will happen if stress distribution is not equal in the post and root?

Answer 20

Root fracture

Question 21

what can happen if the post diameter is too narrow

Answer 21

post may bend or fracture

Question 22

What can happen if the post diameter is too wide?

Answer 22

Root will fracture

Question 23

Give some advantages of a cast post and core

Answer 23

Can go sub gingival
good if the canal is oval

Question 24

Give some disadvantages of a cast post and core

Answer 24

1. Extra clinical visits requires
2. Greater likelihood of discrepancies due to impressions, casting models
3. Temporisation difficult as need a coronal seal

Question 25

Give some advantages f prefabricated posts

Answer 25

1. Immediate coronal seal
2. Crown prep can be done at th same visit
3. Better aesthetics
4. Reduced number of stages therefore less discrepancies

Question 26

Give some disadvantages of a prefabricated post

Answer 26

long appt

Question 27

Are anterior or posterior teeth at greater risk fo fracturing

Answer 27

Posterior

Question 28

How do we try and reduce the likelihood of fracture in posterior teeth

Answer 28

BY using cuspal coverage

Question 29

Gives some options for cusp protection

Answer 29

1. Extra coronal restorations
2. Inlays/ onlays
3. Full coverage crown

Question 30

State the occlusal guidelines in place when carrying out restorations on root filled teeth

Answer 30

1. Post crowned canines should not provide canine guidance
2. Post crowned posterior teeth should have ICP contact only
3. Post crowned anterior teeth should have incised guidance shared across all anterior teeth

Question 31

How can root filled restoration fail?

Answer 31

1. § from the drill
2. Poor coronal seal
3. Root fracture
4. Fractured post

Question 32

What will happen if a good coronal seal is not achieved

Answer 32

Reinfection of the root canal can occur