restorative Flashcards
indications for replacing/restoring teeth
- pain
- sensitivity
- poor aesthetics
- fracture
- functional problems (mastication, speech)
- structure problems
- occlusal instability
- perio splinting
- restoring OVD
reasons to not restore/replace teeth
- Damage to tooth and pulp
- effect on periodontium
- cost
- unrestorable teeth
principles of cavity prep
Access - identify and remove carious enamel.
Remove enamel to identify maximal extent of lesion at ADJ and smooth enamel margins.
Ensure ADJ margins are caries-free
Caries management - progressively remove peripheral dentinal caries.
Remove deep caries over pulp.
Cavity modification - outline form modification and internal design modification (for chosen material)
D1
clinically detectable enamel lesions with intact surfaces
preventative care
D2
clinical detectable cavities limited to enamel
preventative
D3
clinically detecetable lesions into dentine
preventative care and restorative care
affected dentine
softened demineralised
D4
into pulp
infected dentine
softened demineralised dentine that has been invaded/contaminated by bacteria
partial caries removal
access
caries removal
removal of infected dentine where possible
definitive restoration
stepwise caries removal
access
caries removal
leave caries over pulp
temporary restoration
allow tertiary denine formation
remove temporary and remove remaining soft dentine
defintive restoration
methods of managing caries
partial caries removal
stepwise caries removal
self cleansing
direct pulp cap
pulpotomy
functional/stable occlusion
free of interferences to smooth gliding movements of the mandible with the absence of pathology
mutually protected occlusion
gold standard - canine guidance, posterior disculsion in lateral excursions, no protosive interference, no non-working side/working side contacts
working side is the side you move to
supporting cusps
cusps that occlude with opposing centric stops
palatal uppers, buccal lowers
non-supporting cusps
cusps that don’t occlude with opposing centric stops
buccal upper, lingual lower
BULL
non-supporting cusps
cusps that don’t occlude with opposing centric stops
buccal upper, lingual lower
BULL
centric stops
points on occlusal surface which meet with opposing teeth
occlusal interefernce
undesirable tooth contacts that may produce mandibular deviation during closure to ICP or may hinder smooth passage to and from ICP
Contacts that hinder smooth excursive movements of the mandible.
* Lateral obtrusive - undesirable working side contact
* Protrusive - posterior contact during protrusion
benetts angle
angle described by the orbiting condyle during lateral protrusive movements
average is 10-15 degrees
sagittal condylar angle
angle at which teh condyle descends down the glenoid fossa of the TMJ in the saggittal plane
rest position
normal position when not eating/talking
teeth slightly appart (interocclusal clearance)
TMJs in fossa
neutral, relaxed position
free way space
difference between rest position and ICP
difference between OVD and RVD
av 2-4mm
conformist
maintain existing/original occlusion
reorganised
altering existing/original occlusion (new occlusal scheme)
need pt in RCP
guidance
factors which control protrusive and excursive movements of mandible
- anterior teeth contact (incisors and canines) on working side during excurisve movement
- group function - multiple posterior teeth contacts on working side during excursive movements
- canine - disclusion of teeth on working side - except canines; and absence of non working side contacts during excursive movements
reproducible and protects posterior teeth - preferred
ideal features of occlusal contacts
3
- lower incisal edges occlude afainst upper cingulum (BSI class I)
- lower buccal cusps and upper palatal cusps occlude against fossa and marginal ridges of opposing teeth
- tripid/cusp tip to base of fossa contacts - forces directed down long axis of tooth
features of unfavourable occlusal contacts
- on cuspal inclines
- no contacts
features of normal occlusal forces
- contact only in ICP
- short duration
- light forces compared to maximum biting forces
- forces directed down long axis of tooth
- protective neuromuscular reflexes prevent injury
features of abnormal occlusal forces
and what may occur
- greater forces exerted
- longer duration
- contacts in many mandibular positions
- horizontally directed
- protective neuromuscular reflexes do not operate
may cause damage to teeth, PDL, muscles and joints
what is posselts envelope of motion
3D concept of mandible movement - a combination of border movements in a ll 3 planes (sagittal, transverse, frontal)
ICP
intercuspation
position of maximum interdigitation/intercupation
postiion of best fit between maxillary and mandibular teeth
RCP
guided tooth position in which condyle in most anterior superior position within the condylar fossa
edge to edge
incisal edge to incisal edge.
Upper and lower incisors at same coronal/frontal leve
protrusive position
occlusion when mandible maximally protruded
retruded axis position
position adopted by condyle during terminal hinge movement opening and closing
(condyles in most anterior superior position - rotation not translation)
maximum opening
when mandible maximally despressed
centric relation
mandible position when condyles are in most anterior superior position in their fossa, resting against the posterior slopes of the articular eminences with articular discs interposed
repeatable, reproducible position that can occur anywhere between retruded axis position and RCP
protrusion
jaw position when mandible maxillary protruded
SDA
dentition where most posterior teeth are missing but satisfactor function without RPD
long term occlusal stability
3-5 occlusal units left
(usually 5-5)
pair of occluding molars in occlusal unit
2
pair of occluding premolars in occlusal units
1
indications for SDA
- missing posterior teeth with 3-5occlusl units remaining
- sufficient occlusal contacts to provide large enough occlusal table
- favourable prognosis of remaining teeth
- pt not motivated to pursure more complex tx plan
- limited finances
contraindications for SDA
- poor prognosis of remaining teeth
- untreated/advanced perio disease
- pre-existing TMD
- signs of pathological wear
- significant malocclusion (class II or III)
occlusal stabilitiy definition
- stablity of tooth position relative to its spacial realtionship in occluding arches
- absence of tendency for tooth migration other than normal physiologic compensatory over time
features that can determine occlusal stablity
- absence of pathology (tooth wear, caries)
- perio support
- number of teeth in each arch
- interdental spacing
- occlusal contacts
- mandibular stability
requirements for occlusal stability
- stable contacts on all teeth of equal intensity in centric relation (balanced occlusion)
- anterior guidance in harmony with Posselt’s envelope of motion
- disclusion of all posterior teeth during mandibular protrusive movement
- disclusion of all posterior teeth on non-working side due to madnibular lateral movement
- disculsion of all posterior teeth on working side during mandibular lateral movement
purpose of facebow
used to orientate maxillary case in same relationship on articulator as maxilla is related to condyles
is a horizontal record of the hinge axis of mandible
function of articulators
- obsever occlusal relations
- provide dx wx ups and locate undercuts
mechanical devices which represent TMJ and jaw members to which casts can be attached to simtulate jaw movement
* non adjustable (hinge, av valu)
* semi-adjustable (arcon/non arcon)
* fully adjustable
adv of indirect gold restorations
- excellent strength
- good support
- good cuspal protection
- durable
- corrision resistant
- wear resistant
disadv of indirect gold restorations
- expensive
- poor aesthetics
- difficult to make
- demanding and non conservative prep
adv of indirect Vs direct composites
no polymerisation contraction stress
no cuspal flexure
adv of milled porcelain restoration
best aesthetics
good wear resistance
good retention
5 advantages veneers
improve aesthetics
change tooth shape/colour
correct peg shaped laterals incisors
reduce/close spaces
align labial surfaces of instanding teeth
minimal tooth prep
disadvantages of veneers
often fail and require replacement with crowns
destructive prep
irrevsible
expensive
indications for veneers
sound tooth - perio
mild discolouration
hypoplasia
fracture tooth
tooth wear
shape modification/space closure wanted
contraindication veneers
poor OH
heavily restored/extensive tooth surface loss - insufficient bonding area
high caries rate - interpoximal caries
gingival recession/ root exposure
heavy occlusal anterior tooth contacts
severe discolouration
2 types of veneer materials
composite and porcelain
adv composite veneer
less destructive
can be direct or indirect
adv of porcelain veneers
better aesthetics and stronger
but indirect only, cost more
standard tooth prep for veneers
0.5mm incisal depth cuts - for labial reduction
chamfer finish line extending to gingival margin and into embrasures (short of contact point)
incisal edge reduction (0.5mm)
indications for crowns
protect weakened tooth structure - cuspal coverage
restore function
fixed bridge retainer
after veneer failure
contraindications for crowns
active caries/perio disease
lack of tooth tissue available - ferrule
unfavourable occlusion
healthy tooth
poor OH
advantages of crowns
restore function
strong
good aesthetics
abutment possible - restore tooth shape
disadv of crown
destructive to tooth
£££
irreversible
indirect - multiple visits
likely to fail and need post/core
principles of crown prep
preserve tooth structure
retention and resistance form
structural durability
marginal integrity
preserve periodontium
aesthetic considerations
materials for crowns
precious metal - gold shell crown
Porcelain jacket crown
metal ceramic crowns
all ceramic crowns - zironia, lithium disilicate
non precious metal - stainless steel
metal crown margins
0.5mm axial, non-working cusp;
1.5mm functional cusp;
0.5mm chamfer
PJC prep
1.0mm axial, non-functional cusp;
1.5mm functional cusp;
1.0mm shoulder
MCC prep
- 1.5mm axial, non-working cusp;
- 1mm functional cusp;
- 0.5mm lingual chamfer, 1.5mm buccal shoulder (0.4mm metal and 0.9mm porcelain)
ceramic crown prep
1.5mm axial, non-functional cusp;
2.0mm functional cusp;
1.5mm chamfer circumferentially