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CARIES - FINALS PREP > Restorative > Flashcards

Restorative Flashcards

1
Q

What are the different classes of cavity design

A

Class 1-5

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2
Q

Describe the class 1 cavity design classification

A

this form of cavity forms in the occlusal surfaces of premolars and molars as well as on the lingual pits of anterior teeth. class 1 cavities are typically shallow and may extend into enamel or dentine dependant on severity

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3
Q

describe a class 2 cavity

A

these occur on the proximal (mesial/distal) surfaces of premolars and molars where the two adjacent teeth contact eachother. These cavities develop between the teeth, often as a result of poor oh and inadequate id cleaning

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4
Q

describe the class 3 cavity design

A

these occur on the proximal (mesial/distal) surfaces of anterior teeth (incisor and canines), excluding the incisal edge

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5
Q

describe a class 4 cavity design

A

these cavities involve the proximal surfaces (mesial/distal) of anterior teeth involving the incisal edge. they are typically more extensive and may result in significant loss of tooth structure

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6
Q

describe a class 5 cavity

A

these occur on the smooth surfaces of the teeth, including the buccal or lingual surfaces of all teeth and the cervical margins of all teeth

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7
Q

list some disadvantages of black’s classification(4)

A
  • was used before adhesive materials were available
  • removes more tooth substance than necessary
  • black’s classification dies not include root caries and secondary caries
  • sometimes cavity preps nowadays are modified versions of blacks classification
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8
Q

What is the purpose of outline form when restoring a tooth

A

to gain access to caries - this is dependent upon the location of caries: either by direct access or by gaining access through another part of tooth (more destructive)

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9
Q

what is the purpose of resistance form when restoring a tooth

A

to resist occlusal forces - this will enable the restoration and remaining tooth structure to withstand masticatory forces.
for amalgam especially - enamel margins must be finished so that no unsupported/overhanging enamel remains

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10
Q

what is the purpose of retention form when restoring a tooth

A

to retain the material in the cavity

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11
Q

what are the different ways we can design a cavity to provide retention (4)

A

‘grooves’ in the cavity wall
use of undercuts and occlusal keys
use of acid etch and bonding agents
dentine pins (Not used anymore)

RETENTION ONLY MODIFIED FOR NON-ADHESIVE MATERIALS EG AMALGAM

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12
Q

What does etch do/how does restorative material bond to the tooth

A

etch removes the enamel changing the structure of the prisms/different etch patterns

  1. removes the prism core exposing the periphery
  2. removes the periphery and exposes core
  3. haphazard - does this randomly
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13
Q

why is it a good thing we disturb structure of enamel

A

‘micromechanical tags’ - retention lock and key effect

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14
Q

why do we etch dentine

A

to expose dentine tubules and removes the smear layer - ground substance enamel/dentine to powder - etch removes this so resin can flow into dentinal tubules

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15
Q

what does primer do?

A

acts as a ‘go-between’ because bond has a solvent in. need to make surface of dentine hydrophobic to hydrophillic (for the bond)

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16
Q

what does bond do?

A

acts like a glue - flow into dentinal tubules and sticks (with the aid of primer IT CAN STICK)

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17
Q

what are the constituents of amalgam

A

mercury, copper, silver, zinc, tin

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18
Q

what are the different TYPES of amalgam

A
  • high copper amalgam (improves strength/more durable and wear resistant)
  • low copper amalgam
  • lathe cut (small condensers, high force)
  • spherical cut (provides better adaptation and packing into cavity walls)
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19
Q

What are the advantages of using AMALGAM (5)

A
  • durable material
  • moisture control is not as important as it would be with composite, however, still aim to keep tooth as dry as possible
  • cheaper material
  • long lasting
  • has good compressive wear/strength for masticatory forces etc
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20
Q

What are the disadvantages of AMALGAM

A
  • not as aesthetically pleasing
  • environmentally not friendly (due to the mercury)
  • MINIMATA convention
  • more tooth tissue taken away for cavity design/retention
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21
Q

what different types of composite do we have

A

PARTICLE SIZE - micro, macro, nanofilled or hybrid:universal - used anterior and posterior!, High resin:filler ratio, high filler:resin ratio

WAY IT IS CURED - heat/light/chemical

TYPE OF COMPOSITE - floable, bulk composite, conventional

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22
Q

what are the constituents of composite

A
  • filler (silica powder/glass)
  • resin matrix
  • camphorquinone (activator)
  • Silane coupling agent
  • pigments
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23
Q

what are the advantages of using composite(4)

A

-aesthetic/aesthetically pleasing
- dont need to remove unsupported tooth tissue/enamel as bonded to tooth
- wear resistant/strong - compressive strength matches tooth substance
- command set

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24
Q

what are the disadvantages of composite(7)

A
  • need to have really good moisture control
  • polymerization shrinkage when light curing
  • can be expensive
  • can be brittle in thin sections
  • depth of cure only 2mm - increments needed
  • prone to staining due to whiter material
  • technique of placement can be difficult to master
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25
Q

what can we do to minimize polymerization shrinkage?

A

OBLIQUE LAYERING
composite is hydrophobic - will shrink away from water - keep operator field as dry as possible
C- factor (for bonding, no of surfaces the restoration is bonded to) - LOWER C FACTOR FAVOURS A RESTORATION

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26
Q

what is in GI (in the capsule)

A
  • glass powder (silica)
  • malaic acid (dicarboxylic acid that can participate in the acid-base reaction with the powdered glass component to form the hardened cement)
  • acid based reaction when mixed together
  • FLUOROALUMINOSILICATE GLASS (fluoride containing)

ONLY light cure resin modified GI and compomer !

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27
Q

What is the setting reaction of GI

A

Calcium rich region - few mins which is the initial setting reaction
Aluminium rich region - 24 hrs for the final set!
* sensitive to moisture until FINAL set, hence why we put vaseline*

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28
Q

What different types of pulp caps do we have?

A

INDIRECT - suitable for primary and permanent teeth
DIRECT - UNSUITABLE FOR PRIMARY TEETH

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29
Q

What are the 4 different liners used in pulp capping?

A
  • zinc oxide euginol
  • zinc phosphate
  • hard setting calcium hydroxide
  • Resin GI - vitrebond
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30
Q

When do we carry out a DIRECT pulp cap

A

When an exposed pulp (caries, trauma, prep) is covered by a capping material
usually hard setting caoh or mta (more recent)
only a successful outcome under certain conditions - 50% success rate

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31
Q

When do we carry out an indirect pulp cap

A

when cavity extended to within 0.5mm of pulp
capping material is applied to the deepest part of the cavity
restored as normal

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32
Q

Describe how we carry out the stepwise procedure

A
  • technique used in the management of deep carious lesions to avoid pulp exposure an thus reduce risk of pulp pathoses
  • partial caries removal employed - clearing the ADJ/margins of tooth
  • soft leathery wet caries overlying the pulp is LEFT IN SITU
  • cavity dressed with a material that gives it a good coronal seal and revisited later
  • caries can arrest if substrate is removed
  • pulp exposure is avoided by allowing time for new dentine to be laid down for lesion to arrest
  • REMOVE ALL OF THE DRESSING A YEAR LATER AND REVIEW THE CAVITY
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33
Q

List some reasons why we would carry out a HT chart(10)

A
  • caries risk/if any
  • missing teeth
  • restorations present
  • sinuses
  • deficient restorations/retained roots
  • PE teeth
  • way of indetifying patient
  • forms part of official dental record of a patient
  • forms a benchmark for the following examination
  • good way of using it as a motivational tool
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34
Q

What do we protect the pulp from

A
  • bacterial insult
  • chemical attack
  • thermal discomfort
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35
Q

What causes thermal discomfort

A

polymerisation exotherm of some restorative materials
light curing units themselves
hot/cold food/drinks
cavity preparation produces heat (must use coolant)

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36
Q

What is the IDEAL pulp protection?(10)

A
  • non-toxic
  • non irritant
  • bacteriostatic
  • gives a good coronal seal
  • thermal/electrical insulator
  • strength to withstand restoration placement eg condensing amalgam
  • radioopaque
  • compatible with wide range of restorative materials
  • OBTUNDANT (soothing) effect on dental pulp
  • IDEAL PULP PROTECTION IS DENTINE
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37
Q

Describe some GOOD properties of calcium hydroxide (dcal, unocal)(5)

A
  • High pH - initially irritates the pulp - reactionary dentine is laid down
  • High pH makes it bacteriocidal
  • thermal/electrical insulator
  • radiopaque
  • good restorative compatibility
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38
Q

Describe some BAD properties of calcium hydroxide

A
  • insufficient strength for condensation
  • non-adhesive - NO CORONAL SEAL
39
Q

describe some GOOD properties of glass polyalkenoate (vb)- (7)

A
  • low pH but only mildly irritant to the pulp
  • contains fluoride - bacteriostatic
  • thermal/electrical insulator
    -sufficient strength to withstand condensation
  • directly adhesive - good coronal seal
  • good compatibility with other materials
  • may be chemical cured or reinforced with ‘resin modification’ and made to LC (vitrebond)
40
Q

What do we use as a pulp liner - where and when?

A
  • cavities of 2mm or less - NO LINING REQUIRED
  • cavities of significantly deep - within 0.5mm of pulp - hard setting caOH (dycal) - do not need to cover with RMGIC unless restoring with amalgam (condensing forces) - DIRECT PULP CAP
41
Q

Where do we use our lining materials on a tooth surface

A
  • pulpo-axial wall and/or
  • occlusal floor
  • linings are not indicated in the base of preparations , as the pulp is not affected in these areas. the lining may slightly weaken the overlying restoration if placed along gingival floor! - SANDWHICH EFFECT
  • if it is direct - we always make sure WE COVER THE EXPOSURE! again this would be occlusal/pulpoaxially placed!
42
Q

What is the criteria for direct pulp capping(4)

A
  • tooth is vital
  • no history of pain in the tooth
  • no evidence of periradicular pathology
  • pulp is pink and healthy, no excessive bleeding
43
Q

Describe the technique for direct pulp capping

A
  • MICRO-EXPOSURE - dried with cotton wool - NO AIR DRYING due to risk of EMPHYSEMA
  • pulp capping material applied to exposure, and other areas if close to pulp (occlusal floor and also pulpoaxial wall area!)
  • tooth restored as normal, patient advised to return if problems with the tooth.
44
Q

what should the favoured results be from stepwise excavation(4)

A
  • cavity floor should now be stained by no longer soft - not firm
  • lesion arrested and pulp vitality maintained
  • the tooth can now be restored with a permanent material
  • if soft dentine still present - consider repeating stepwise procedure again.
45
Q

What is the clinical handling technique of composite in posterior teeth

A
  • do not try to condense like amalgam - pat into place
  • where possible use composite instruments
46
Q

What are occult caries?

A

when the occlusal surface appears intact, but carious underneath
- due to bacteria entering via deepest part of fissure and rapidly spreading along the ACJ

47
Q

What can we use to aid the diagnosis for OCCLUSAL caries(5)

A
  • radiographs are the MOST RELIABLE SOURCE
  • radiolucent areas show infected dentine
  • lesions not visible radiographically harbour few bacteria and can be fissure sealed
  • bitewings at regular intervals very important
  • CARIES ALWAYS UNDERESTIMATED RADIOGRAPHICALLY
48
Q

When do we/what is the criteria to restore occlusal caries

A
  • obvious cavity
  • when dentine is INFECTED - wet/carious dentine
49
Q

What are the 4 forms of tooth wear

A
  • attrition
  • abrasion
  • abfraction
  • erosion
50
Q

Describe attrition

A

the loss of tooth substance as a result of mastication, or of occusal/proximal contact between the teeth (in other words, wear due to tooth to tooth contact)

51
Q

what 2 categories can attrition be classed as

A

PHYSIOLOGICAL attrition
PATHOLOGICAL attrition

52
Q

What is physiological attrition

A
  • happens in every individual with age, therefore more noticeable in older patients
  • most common sites affected are occlusal surfaces or incisal edges
  • rate is reported to be higher in men than in women
53
Q

what is non carious tooth substance loss

A

the physiological or pathological loss of dental hard tissues by any means other than the carious process or traumatic injury

54
Q

what are the clinical signs of physiological attrition

A
  • disappearance of incisor mamelons
  • flattening of occlusal cusps
  • exposed dentine may be dark brown in colour and lesions may be “cup-shaped”
55
Q

what is pathological attrition?

A
  • can be localised or generalised
  • caused by the development of an abnormal habit eg bruxism -
    or a malocclusion!
56
Q

What is dentine attrition

A

-dentine rate of attrition is higher than enamel because it is less mineralised
-dentine attrition usually results in the faster formation of tertiary dentine - reparative?, which prevents sensitivity

57
Q

describe the definition of abrasion

A

pathological wearing away of tooth structure due to contact of a foreign object/body eg toothbrush abrasion

58
Q

what are some signs of abrasion

A

most commonly seen on exposed root surfaces/cervical margins

59
Q

what is the diagnosis and treatment guidance w a patient that has abrasion

A

by assessing the clinical picture and by thorough history taking
treatment is given mostly in the form of PREVENTITIVE ADVICE in order to limit further damage - find cause and remove

60
Q

what is erosion

A

tooth loss due to chemical (usually acid) attack and not bacterial activity ! - NOT CARIES RELATED

61
Q

what are some of the clinical signs of erosion (5)

A
  • can be seen on any tooth surface
  • appears smooth and glossy
  • ‘proud’ restorations
  • fractures of the incisal edges
  • ‘cupping’ of lower molar cusps
62
Q

what are the clinical signs of bulimia (4)

A
  • normal body weight
  • erosion of palatal surfaces on upper teeth
  • lesions on palate, fingers, oral mucosa, lips
  • signs of malnutrition
63
Q

what may the dental management of bulimia be (6)

A

find and eliminate cause
if bulimia disclosed or suspected, encourage pt to speak to gp
fluoride therapy
maintain oh
spit dont rinse
dont brush immediately after acid has been in contact with the teeth - wait 30 mins
restorations may be indicated

64
Q

what are the treatment options for tooth wear(4)

A

prevention, monitor
fluoride therapy
acrylic hard/soft splints
restorations - limitation on how effective these can be due to worn away enamel

65
Q

rather than removing and replacing a restoration - what should we do?

A

REPAIR AND REFURBISHMENT where clinically indicated and appropriate - we want the least clinically invasive procedure

66
Q

what is repairing/refurbishing a restoration dependent on?- 4 things

A

the:
- patients wishes (aesthetics)
- dental/medical/social history
- caries risk
- marginal defects/secondary caries

67
Q

what factors can be considered regarding the survivability of a restoration- 4 things

A
  • caries risk of the patient - if high, secondary caries is likely to occur
  • depth and extent of the cavity, no of surfaces involved - higher the c factor the less favourable
  • operator skill and techniques employed during cavity prep and restoration placement
  • other LOCAL factors
68
Q

what can cause a restoration to fail? (10)

A
  • secondary caries
  • NCTSL
  • pulp pathology
  • trauma
  • bond failure
  • ditching
  • lack of retention
  • defective contacts
  • defective margins
  • aesthetics
69
Q

what is the take home message for a poor/failed restoration?

A

failed restorations can be the result of poor technical placement by the operator
invest time to place restorations minimally and with good technique, rather than having to correct mistakes which are costly to the patient later on down the line!

70
Q

What is the function of the ACUTE inflammatory response?(4)

A
  • A DEFENCE MECHANISM
  • provides an exudate which brings proteins, fluids and cells to an area OF DAMAGE
  • destroys and/or eliminates the injurious agent
  • breaks down the damaged tissue and removes the debris
71
Q

what is an abscess

A

this is a LOCALISED collection of pus
can appear in an acute or chronic infection
is associated with tissue destruction and swelling

72
Q

how do we get the progression of chronic inflammation?(3)

A
  • if the agent causing ACUTE inflammation is not removed, it may progress onto chronic stages
  • “characterised by continuing inflammation at the same time as attempts at healing”
  • attempts at reconstruction of damage tissue happen simultaeneously with inflammation
73
Q

List the different types of pulpal diagnosis we can get (5)

A
  • NORMAL PULP
  • DENTINE SENSITIVITY
  • REVERSIBLE PULPITIS
  • IRREVERSIBLE PULPITIS
  • NECROTIC PULP/PULP NECROSIS
74
Q

Signs/symptoms of normal pulp(4)

A
  • symptom free
  • normally responds to sensibility testing
  • mild response that subsides immediately when stimulus is removed
  • histologically - no inflammatory change
75
Q

signs/symptoms of dentine sensitivity(3)

A
  • pain occurs with thermal, chemical, tactile or osmotic stimuli and is associated with exposed dentine
  • an exaggerated response of normal pulpo-dentinal complex
  • severe and sharp but does not linger on removal of stimulus
76
Q

signs and symptoms of reversible pulpitis(4)

A
  • pain short and sharp, not spontaeneous
  • stimuli - thermal, sweet - short sharp pain
  • lasts no longer than 5-10 seconds
  • no radiographic changes other than caries (into dentine)
77
Q

signs and symptoms of irreversible pulpitis(3)

A
  • spontaeneous pain
  • exaggerated response to hot/cold that lingers after stimulus is removed
  • sensibility tests responsive
78
Q

what is the treatment for irreversible pulpitis

A

RCT or XLA

79
Q

what can ledermix be used for(3)

A
  • an antibiotic to treat infection
  • anti-inflammatory to reduce swelling and inflammation
  • relieves pain until def rct therapy can be carried out
80
Q

what are the signs and symptoms of an acute periapical abscess(6)

A
  • rapid onset
  • pain - TENDER TOOTH
  • pus formation
  • increased mobility of tooth and tooth may be in hyper-occlusion
  • systemic involvement eg fever and malaise
  • swelling io and eo
81
Q

why is dental dam the best method of moisture control?(3)

A
  • airway protection
  • best way of isolating the tooth
  • protects st’s in the mouth
82
Q

what are we testing when we test the VITALITY of the pulp?

A

BLOOD SUPPLY OF THE PULP

83
Q

What tests would we do to test vitality of pulp

A

ttp or ethyl chloride (sensitivity tests)

84
Q

list 9 propertied that would make the IDEAL RESTORATIVE MATERIAL

A
  • strength
  • good marginal seal
  • bond to tooth substance
  • wear resistant
  • cariostatic
  • good aesthetics
  • easy to manipulate
  • non-toxic
  • non irritant to dental tissues
85
Q

What is the definition of a fissure sealant? (4 points)

A
  • hard insoluble or unfilled resin material
  • used in a LIQUID form
  • fills pits and fissures WITHOUT cutting the enamel surface
  • clear, opaque, sometimes coloured!
86
Q

Where do we seal most commonly when doing a fissure sealant - 4 sites

A
  • occlusal fissures of molars
  • buccal pits of lower molars
  • palatal pits of upper molars
  • cingulum pits of upper incisors
87
Q

What are we looking (good or bad) when we have placed the fissure sealant (7)

A
  • occlusal harmony
  • are there any bubbles present
  • any under/over extension
  • softness in material from under curing
  • is it SMOOTH like glass
  • is it BONDED to the tooth
87
Q

What are some clinical indications of fissure sealants (why may we place them for patients)

A
  • high caries risk patients
  • deep pits and fissures
  • limited manual dexterity
  • medically compromised
  • tooth MUST BE ABLE TO BE KEPT DRY/ISOLATED
88
Q

how often do we check fissure sealants?

A

every 6 months

89
Q

what techniques are there for sealing in a carious lesion?

A
  • hall technique
  • fissure sealants
  • selective caries removal and restorative material
90
Q

what non-restorative cavity control method do we have

A

Discing and then fluoride varnish

91
Q

How do we halt the caries process?

A

By placing a crown over the tooth, we isolate the carious lesion from the oral environment and change the ECOLOGY of the biofilm so drastically that the carious lesion simply cannot thrive and will arrest!

92
Q

Use the Hall Technique if….

A
  • full history and clinical exam including bitewings
  • the tooth is ASYMPTOMATIC (or reversible pulpitis)
  • there must be a band of ‘normal’ looking dentine visibile between the pulp and cavity on rads
93
Q

What are the ADVANTAGES of non restorative cavity control?

A
  • can allow the child to develop INTELLECTUALLY and cope with something a bit more invasive
  • very little technical skill required
  • dont need injections
  • very low patient tolerance/coop reqd
  • may slow caries enough to allow tooth to exfoliate without causing pain/abscess!

CARIES - FINALS PREP (4 decks)

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