Restorative Flashcards
Anterior tooth with ferrule
Fibre Post
Anterior tooth without ferrule
Cast post and core
Restorative options for anterior teeth
Whitening (discoloration)
Post core and crown (broken down marginal ridges)
Veneer (intact marginal ridges)
Composite restoration
+
Crown
Bridge
Implant
Single tooth denture
What canals do you avoid posts in
Curved and thin canals
Post placement guidelines
No greater than 1/3 root width at narrowest point
Leave 4-5mm GP apically
1mm of circumferential coronal dentine
At least 50% post length bone support into root
Minimum 1:1 crown to root ratio
Ferrule: at least 1.5mm height and width of coronal dentine
Ferrule purpose
Prevent tooth fracture
Ideal post
Parallel sided
Non threaded
Cement retained
Prefabricated posts a.k.a
Direct posts
I.e. Fibre Posts
Chairside core build up (composite)
Cast post and core advantage over fibre
Higher strength
Better in flared canals (wide orifice)
The core build up is
Replacement of lost internal tooth structure
Risks of removing a post
Root fracture (immediate or delayed)
You can’t remove it successfully
Tooth deemed unrestorable
Post space too wide to re-tx
Post breaks on removal
Post risks in-situ
Post fracture
Root fracture
Core fracture
Perforation
Lab prescription for cast post and core
Please construct a cast post and core
State para post color
Core 6 degree taper
Please leave 2mm space in occlusion for crown
Included: bite registration and opposing arch impression
Lab prescription for crown
Please construct..
What tooth (44)
What type (zirconia)
What shade (A2)
Bite registration and opposing impression enclosed
Try in and cementing cast metal post-core
Probe for any remaining material in post space
Irrigate with chx 0.2%
Dry with paper points
Ensure the post fits well
Adjust the post with a burr if it doesn’t seat correctly
Cement with aquacem (on post and in post space)
If there are deficiencies in the ferrule, can use Chemfil afterwards
Smoking and implants
> 10/day high risk of failure
<10/day med risk of failure
Implants and age
Implants must only be placed after cessation of growth.
Otherwise you risk:
Relative infra-occlusion
Suboptimal aesthetics
Occlusal disharmony
Implant fenestration
Smile line
High - >2mm ST
Normal - <2mm ST
Low - Lip covers >25% of tooth
Gingival phenotype
Determined through probe visibility
-thin
-thick
Does an infected tooth reduce the odds of survival for a future implant
If the infection is acute, yes
Little evidence to suggest so if it’s chronic
Implant placement protocol
Immediate
Early (4-6w) soft tissue healing
Early (12-16w) partial bone healing
Late (6m+) full healing
Patients most likely to have implants
Oral cancer
Congenitally missing teeth
Trauma
Full denture patients unable to tolerate them
Tooth loss from caries in a stable dentition
Risk factors for peri-implant disease
Poor oral hygiene
Poor access for oral hygiene (poor manual dexterity)
Smoking
History of periodontal disease
Poorly controlled diabetes
High Occlusal forces
Peri implant mucositis and peri implantitis differences
Peri implant mucositis has no evidence of crestal bone loss
Both can express; bop, supparation, pocket depths up to 4mm
OHI for an implant
Patients should be made aware an implant is a high maintainance dental restoration
Superfloss
Implant floss (implant floss technique)
360⁰ flossing technique
Interdental brushes
Implant care brush
Single tufted brush
CHX mouthwash after surgery
Clean area with soft toothbrush until area has healed
Smoking cessation advice if relevant
Checking an implants health
Probe gently at 4 points around the implant
Assess;
BOP
Supporation (suggests tissue necrosis and collagen breakdown)
Pocket depth (3mm is normal)
Mobility
Radiographic evidence
Gingival condition: texture, color
Should be checked and recorded in the notes at every appointment. *an implant is expensive. So you don’t want to assume its okay. If its not and you miss it, your patient will be pissed
BOP is normal because its not a normal tissue interface but if there’s a lot of bleeding, judge it in respect to the rest of the dentition.
Looking after the implant as the dentist
Provide advice and OHI regarding its keeping clean
If avaliable, use carbon fibre, titanium (hand instruments) or plastic ultrasonic inserts to protect the implant superstructure and clean iatrogenic damage free
What information provides you with your provisional diagnosis
CO
HPC
Mx
Dx
Sx
Fx
E/O
I/O
Special Investigations
Radiographs
MPBS
6PPC
Sensibility testing; ECL, EPT
Mobility
Trans-illumination
Diet diary
Clinical photographs
Biopsy
Diagnostic wax up
Treatment planning
Immediate:
relief of acute symptoms
*considering xla, rct, immediate denture/bridge
Initial: (Disease control)
xla of hopeless teeth
Diet diary
OHI
NSHPT (perio)
Management of carious lesions with direct or temporary restorations
Re-evaluation: (evaluate OH compliance)
Re-assess perio status
Reconstructive:
Indirect restorations
Dentures
Maintenance:
Supportive periodontal care
Root treated posterior tooth. What coronal restoration are you thinking?
Onlay or crown for cuspal coverage. Reduce fracture risk
Bridge types
Conventional
Resin-retained
Cantilever
Fixed-fixed
Spring cantilever
Informed consent for indirect restorations
Talk about the irreversiblity of the restoration
Talk about the likely prognosis in terms of how long it will last
Talk about the risks and benefits
Talk about the time involved
Talk about what the procedure involves (impressions, drilling, anaesthetic ect)
Talk about the cost
Talk about alternative options
Common complaints against indirect restorative treatment
The patient wasn’t aware of the; cost implication
time involved (time off work) procedure itself (gooey impression material or needles)
Alternative options
The risks of this treatment failing
The likely success rate/chance this restoration has to keep the tooth
Ideal ICP contacts
Posterior Lower Buccal cusps occlude fossae and marginal ridges of uppers
Posterior Upper palatal cusps occlude the fossae and marginal ridges of the lowers
Normal occlusal function vs parafunctiom
The teeth are only in ICP for a matter of minutes every day (to chew). At relatively low biting forces.
With parafunction, the teeth are in contact outside of these times exclusively for chewing.
So, that includes greater and more frequent purposeless forces being exerted, in different directions on the teeth and the periodontium.
Which can lead to tooth damage, damage to the periodontium, damage to the soft tissues and damage to the joints
Guidance refers to
The factors that lead to the movement of teeth in: protrusion and lateral excursions
Ie. The anterior teeth and the tmj
Basically, your anterior teeth and your tmj guide how your lower teeth move in those 3 movements
Different size/shape/missing anteriors/tmj dysfunction would equal a different pattern of movement
Tooth guidance is usually most important factor in determining mandibular movement
Conforming or reorganised
Conforming to existing ICP
Or
Reorganising to somewhere on the retruded axis (because the restorative objectives cannot be met in existing ICP)
So the new ICP=RCP
Reorganised always requires a bite registration: there must be no muscle interference, the operator manipulates the mandible and the patient curls their tongue to the back of their mouth
Mounting articulators with the bite registration
They put that on the lower cast and then put the upper cast on top. So basically, you don’t want any increase in OVD using the bite registration. Otherwise the models will have a propped bite.
All the technician wants is to mount the casts successfully. Help a brother out.
Is the ICP stable and reproducible? Then the technician will be able to find it too when hand articulating the casts
Problems related to occlusion
Tooth wear
Mobility
Fractured teeth
Fractured or de-bonded restorations
Difficulty chewing
TMD
Restoring a posterior tooth and checking it’s occlusion
A posterior tooth should not be involved in excursive movements, so make sure it doesn’t disrupt the original anterior guidance scheme
What medical condition is cautioned with bridgework
Epilepsy. It may dislodge during a seizure/fall. Inform patient of the risk
Role of GPD in cancer screening
Soft tissue check
Clinical photograph
Refer
Cancer screening checks
For all, refer if present for >3 weeks
Is there pain on swallowing
Unexplained head or neck lumps
Red or white patches in mouth
Throat pain
Ulceration or unexplained swelling
Factor in when it started
Ie. If they’ve had pain for months. Refer immediately instead of waiting 2 weeks
What will happen at OMFS with odd pain, lumps, bumps, swellings or ulceration patients?
New assessment
Maybe a biopsy
Maybe a CT scan
Fast track time frames for suspected H&N cancers
14 days to appointment
28 days to diagnosis
~8 weeks to treatment
Head and neck cancer referral?
Start to think about getting them dentally fit
(no infection or sources of potential infection before beginning cancer therapy)
You don’t want the patient to interrupt or delay their cancer tx because of outstanding dental tx
Cancer patient
Stop any ortho immedietly
Remove any teeth of dubious prognosis no less than 10 days before cancer treatment
Do not do any dental treatment during cancer therapy
If emergency, liase with cancer team
Can use CHX mouthwash as short term alternative to toothbrushing if gums are sensitive
At high risk for fungal/viral infections: can be prescribed CHX, miconazole (topical) or fluconazole (systemic) to prevent candidal infections
*nystatin ineffective
What can head and neck cancer therapy have an adverse effect on?
Swallowing, speech, mastication, salivary function, outward appearance, taste, mouth opening, mucosa (traumatic/herpes simplex reactivation), mouth opening, radiation-induced caries, erosion
Xerostomia: 50%-60% reduced salivary flow in first week with further 20% loss in subsequent 5-6 weeks
Salivary function may return over years or not at all
After cancer treatment, the saliva becomes thicker and more acidic.
Patients are more prone to caries and perio disease
Saliva adjuncts; frequent sips of water, biotene oral balance gel, bioxtra gel
Therabite and active/passive physiotherapy movements for trismus treatment
Cancer and oral mucositis
Oral mucositis begins 1-2 weeks after treatment starts and typically ends ~6 weeks after treatment is complete
During this time, typical OHI may not be able to be performed (ie. CHX mouthwash)
Prevention and management:
Caphosol
Gelclair
Mugard
Difflam
Zinc supplements *may prevent
Aloe Vera
Cryotherapy
Manuka honey
2% lignocaine mouthwash prior to eating
Ice chips
Remove sharp edges of teeth/ poorly fitting dentures
Tea tree oil mouthwash
