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ABPD 2021 > Restorative > Flashcards

Restorative Flashcards

1
Q

Amalgam composition

A 
Mercury
Tin
Silver
Copper
Zinc
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2
Q

What does tin do in amalgam?

A

Critical to setting reaction

Controls dimensional change

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3
Q

What does copper do in amalgam?

A

Prevents corrosion
Reduces fracture
Eliminates Gamma 2

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4
Q

What does zinc do in amalgam

A

Scavenger for oxygen

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5
Q

What does mercury do in amalgam?

A

Wets alloy and initiates setting reaction

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6
Q

What is the gamma 1 phase of amalgam?

A

Silver and mercury

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7
Q

What is the gamma 2 phase of amalgam?

A

Tin and mercury

Responsible for early fracture and failure

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8
Q

3 Types of Amalgam

A

Spherical: amalgamates more readily, less mercury required
Lathe-cut
Admixed: better proximal contacts

Both spherical and admixed are marketed today

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9
Q

What is the amount of creep amalgam can have to be ADA certified?

A

Maximum 5% creep
Occurs under loading
Modern alloy should not have more than 1% creep

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10
Q

Does amalgam or composite have more dimensional change?

A

Composite (2%)

Amalgam has 0.2%

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11
Q

What is the only restorative material in which the marginal seal improves over time?

A

Amalgam

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12
Q

What is the eta phase of amalgam?

A

Copper and Tin

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13
Q

3 forms of mercury

A

Elemental: liquid at room temperature, used in amalgam
Organic: methyl mercury (most toxic) and ethyl mercury - formed in water/soil by bacteria, can build up in fish
Inorganic: enters air from mining or deposits, burning coal/waste

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14
Q

Main human exposures to mercury

A

Mercury vapor from dental amalgam
Methyl mercury from seafood
Inorganic mercury from food

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15
Q

Threshold for health hazards from air/mercury

A

5 g/m2 for adults
1 g/m2 for kids and pregnant women

This is well-below daily amalgam associated exposure

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16
Q

What is the primary risk to dental personnel for use of amalgam?

A

Inhalation

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17
Q

How to reduce plasma and urine mercury levels during dental restorations

A

Use rubber dam
Use high speed evacuation and water spray
Do not heat sterilize amalgam
More mercury removed when fillings are removed than when placed

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18
Q

New England Children’s Amalgam Trial

A

534 children between 6-10 years of age with no prior amalgam
Assignment to amalgam (vs composite) associated with higher mercury level
No association with IQ, urinary albumin, general memory index or visuomotor composite

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19
Q

Indications for Amalgam

A

Class II preparations that do not extend beyond the line angles
May be inappropriate for primary 1st molar in children 4 and younger

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20
Q

Amalgam Preparation Design

A

Pulp floor depth 0.5mm into dentin
Isthmus 1/3 of intercuspal width
Carved anatomy should be shallow
Convergent walls occlusally
Broader proximal box at cervical portion than occlusal
Gingival wall is flat, not beveled
Axial wall 0.5mm into dentin with 1mm wide gingival seat

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21
Q

Trituration of Amalgam

A

Under triturated (most serious error) appears dry and sandy, sets rapidly
Higher trituration speed gives less working time
Back-to-back restorations should be condensated simultaneously

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22
Q

Amalgam longevity vs composite

A

Up to 7 times more need for repairs of composite compared to amalgam
Need for additional restorative treatment 50% higher with composites versus amalgam historically

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23
Q

3 Phases in Composite

A

Resin (matrix)
Surface (interstitial or continuous) - binds to organic resin matrix to inorganic fillers
Dispersed (reinforcement, filler)

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24
Q

Composite oligomers

A

All composite have dimethacrylate oligomer such as Bis-GMA, Bis-EMA6 (larger), siolorane monomer

Larger oligomers (TEGDMA or Bis-6) have less shrinkage

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25
Q

Filler sizes of composite

A

Microfilled: 40nm
Nanofilled: 20-75nm
Hybrid: 40nm and small particle (200-300nm)
Flowable: 45-75% filler

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26
Q

Does more resin result in more or less shrinkage?

A

More

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27
Q

What does larger particle size do? What does smaller particle size do?

A 
Larger = strength
Smaller = polishability

Microfilled composites can achieve better polish more quickly; used for esthetic restorations

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28
Q

Indications for composite

A

Class I restorations
Class II restorations that don’t extend beyond line angle (except when exfoliating in 1-2 ears)
Class II restorations in permanent tooth extending 1/3-1/2 B/L intercuspal width of tooth
Indirect resins allow more complete polymerization of resin and reduced shrinkage

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29
Q

Contraindications for composite

A

Young children at high caries risk

Tooth cannot be isolated

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30
Q

What does beveling do in composite?

A

Removes the prismatic layer of enamel, which may not etch well

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31
Q

What is the increment of composite that can be placed at a time?

A

2-4mm

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32
Q

How do you achieve the best contact for back-to-back restorations?

A

Do one at a time

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33
Q

What is the typical polymerization shrinkage of most composites?

A

1-5.7%

Newer composites are lower

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34
Q

Advantages of bulk fill composite

A

Increased depth of cure (4-5mm)
Decreased time to cure (20s)
Less technique sensitive

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35
Q

Disadvantages of bulk fill composite

A

Greater translucency, poorer esthetics
Extra equipment
Shrinkage/post op sensitivity

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36
Q

Etching

A

Overcomes smear layer, obstruction of dentin tubules
Liquid and gel produce similar results
No significant difference of resin bond strength etching for 20 or 60 seconds

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37
Q

Bonding Agent

A

Solutions of resin monomers with hydrophilic and hydrophobic groups
Rely on phosphate-calcium bond for retention

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38
Q

Hybrid Layer

A

Mechanical bond created when the smear layer is removed, monomers infiltrate into demineralized dentin, polymerize and interlock with dentin matrix

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39
Q

How does composite bond to dentin?

A

Micromechanical retention

Little evidence supports chemical bond

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40
Q

Glass Ionomer Physical Properties

A 
Chemical bonding to enamel and dentin
Thermal expansion similar to tooth
Less shrinkage than resin 
Uptake and release of fluoride
Hydrophilic
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41
Q

What is the only dental material that has potential for true adhesion to tooth structure?

A

GI

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42
Q

3 Categories of GI

A

Luting
Restorative
Base/Liner

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43
Q

Composition of GI

A

Base: calcium or strontium alumino-fluoro-silicate glass powder
Acid: polyacrylic acid

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44
Q

How does GI bind to dentin?

A

Hydrogen bonds at tooth surface

Free hydrophilic carboxyl groups form the bond

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45
Q

How does GI release fluoride?

A

Hardening reaction involves neutralization of acid by powdered glass base
Fluoride is released by reaction from calcium and aluminum ions binding to polyacrylic acid
Requires presence of water

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46
Q

How does GI result in tooth sensitivity?

A

If not sufficient water is present, GI takes water from dentin tubules

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47
Q

Is GI recommended for class II restorations in primary molars?

A

No

Conventional GI is not recommended

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48
Q

RMGI

A

Conventional glass ionomer formulation with addition of resin monomers of acrylic acid and methacrylate like HEMA

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49
Q

Triple Hardening of RMGI

A

Initial curing of light-sensitive resin
Chemical resin cure
GI acid/base neutralization matures over time

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50
Q

Sandwich Technique

A

GI or RMGI is used to replace dentin, composite is overlaid as a bonded enamel replacement
Ionomer bonds adhesively to tooth, bonding agent bonds mechanically between ionomer and enamel

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51
Q

Advantages of Sandwich Technique

A

Decreased marginal leakage
Reduced sensitivity
Reduced shrinkage
Improves esthetics of GI/RMGI only

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52
Q

Indications for RMGI

A 
May be considered for class I and II restorations in primary teeth
Class V permanent teeth

Insufficient evidence for long-term restorations in permanent teeth

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53
Q

RMGI compared to composite

A

RMGI has less wear resistance
RMGI has lower fracture strength
RMGI placed without occlusal dovetail is more likely to show adhesive failure

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54
Q

Compomer

A

Polyacid modified resin composite
72% strontium fluorosilicate glass and resin matrix to allow for release of fluoride
Does NOT recharge with fluoride like GIC
Not hydrophobic
No bond to tooth structure (must be used with adhesive)

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55
Q

Compomers for restorative material?

A

Not enough data to compare compomers to other restorative materials
Resins have better mechanical properties than compomers

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56
Q

Should you acid etch with compomer?

A

Not according to manufacturer instructions, but studies found better bond strength with enamel acid etch

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57
Q

Bioactive material compositions

A

56% filler
21% bioactive glass filler
Bioactive ionic resin matrix
Rubberized resin

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58
Q

Properties of bioactive materials

A 
Some chemical bond to teeth
No Bis-GMA or BPA derivatives
Releases calcium phosphate and fluoride
Reportedly greater deflection to break than composite or RMGI
Light cure 20s, chemical cure 2 min
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59
Q

Technique for bioactive materials

A 
Etch 10s
Use bonding agent in non-retentive prep
Dispense into preparation 
Use up to 4mm 
Allow to be in contact for 20-30s
Light cure
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60
Q

Does ACTIVA, composite, or RMGI have greater microleakage?

A

ACTIVA has greater microleakage than composite or RMGI

61
Q

What type of steel is used in SSCs?

A

316 Stainless Steel

Orthopedic surgery type

62
Q

Composition of SSCs

A

65-73% iron
17-19% chromium
Some nickel

63
Q

Indications for SSCs

A 
After pulp therapy
Multisurface caries in high risk 
Proximal box extending beyond line angle
Fractured teeth
Teeth with extensive wear
As abutment for space maintainer
Multisurface lesions when restoration needed more than 2 years or if patient is younger than 6
64
Q

Contraindications for SSCs

A

Patients undergoing MRI of head and neck
Patients with nickel allergy
Teeth exfoliating in 6-12 months

65
Q

Indications for permanent tooth SSC

A

Interim restoration
When finances do not allow lab-fabricated crown
Teeth with developmental defects
Permanent tooth requiring full coverage but partially erupted

66
Q

Technique for permanent tooth SSC

A

1.5-2mm occlusal reduction
Restore original morphology with buildup before cementation
BW radiograph to verify fit

67
Q

Comparison of SSCs versus amalgam and composite

A

SSCs have highest success rates
Amalgam failure 2-7x SSC
Cost per patient is lower when teeth restored with SSCs due to fewer replaced restorations

68
Q

Reasons for failure of SSCs

A

Crown loss

Perforation

69
Q

Gingival health and SSCs

A

Crowns with poorly adapted margins show gingivitis
Extension of crown not associated with gingival health
Poor OH associated with unhealthy gingiva around SSCs

70
Q

Primary tooth SSC technique

A 
Occlusal reduction 1.5mm
Proximal reduction without ledges (feather edge)
Round line angles
Minimal buccal and lingual reduction
Crown seats 0.5-1mm subgingival
71
Q

Cementing SSC

A

Bonded resin cement has greater tensile strength and retention with least microleakage - may have isolation problems

GI or RMGI is acceptable

Do NOT use polycarboxylate cement

72
Q

Purpose of base/liner

A

Reduce marginal microleakage

Prevent sensitivity

73
Q

Calcium hydroxide formulation

A

Catalyst paste: Ca(OH)2, zinc oxide, zinc serate in ethylene toluene sulfonamide
Base paste: calcium tungstate, calcium phosphate and zinc oxide in glycol salicylate

74
Q

Calcium Hydroxide Properties

A

Alkaline pH prevents bacterial invasion
Hydrolysis and microleakage

Should use less soluble high-strength base over calcium. hydroxide

75
Q

Zinc Oxide Eugenol formulation

A

Powder: zinc oxide, rosin and zinc acetate
Liquid: eugenol

76
Q

ZOE properties

A

Sedative effect for pulp
Low compressive effect
Eugenol is inhibitor for polymerizing resins

77
Q

Hall Technique Success

A

Up to 98% successful
More successful than intracoronal restorations
No different than traditional SSC

78
Q

Alternative Restorative Technique

A

Means of restoring and preventing cares in populations with little access to traditional dental care

Developing countries

79
Q

Interim Therapeutic Restoration

A

May be used to restore, arrest or prevent progression of caries where traditional restoration is not possible or desirable

Fluoride releasing materials, no anesthetic, minimal tooth structure removal

Not great for interproximal restorations

80
Q

Failure from ART/IRT?

A

Inadequate cavity preparation

Loss of mechanical retention

81
Q

Esthetic posterior SSCs

A

Major problem is chipping and loss of preveneered facings
More reduction than SSC, cannot be crimped/adapted as much
Moisture/heme control is less of an issue compared to zirconia

82
Q

Why are class III restorations difficult in primary teeth?

A

Small clinical crowns
Large pulp chambers
Thin enamel
May need labial or lingual dovetail

83
Q

Indications for full coverage for primary incisors

A 
Multiple carious surfaces
Incisal edge involvement 
Extensive cervical decay
Pulp therapy
Hypoplastic
Poor moisture or hemorrhage control
Large single-surface lesions 
Discolored incisors that are esthetically unpleasing
84
Q

Are zirconia or SSC more resistant to fractures?

A

SSC

However all crowns exceed maximum bite force of children 6-8 years

85
Q

Main reasons for zirconia failure?

A

Loss of crown

Infection

86
Q

Is gingival health better around SSC or zirconia?

A

Zirconia

87
Q

Advantages of zirconia

A

High strength
Abrasion resistant
Biocompatible
Color-stable

88
Q

Disadvantages of zirconia

A

Greater tooth reduction
More technique sensitive
Higher cost
Can cause abrasion of opposing teeth

89
Q

Prosthetic replacement of primary incisors

A

Space maintenance typically not required for incisors
Ideal to allow 6-8 weeks following tooth loss before appliance fabrication but can be done immediate
Bands or SSCs on primary molars are abutment for anterior pontic teeth

90
Q

Diastema closure

A

Orthodontist can help have optimal arrangement of teeth for closure
Partial diastema closure may be a good option

91
Q

Microabrasion

A

Esthetic treatment of hypoplasia
Hydrochloric acid 6.6% in slurry of silicon carbide microparticles
Follow with fluoride treatment

92
Q

Full coverage restorations of permanent teeth

A

Reduction of all ceramic materials are less than metal-ceramic (1.5mm vs 2mm)
Posts and cores do not strengthen teeth (only indicated with inadequate structure)
Veneers require 0.3-1mm tooth structure removal

93
Q

Vital Bleaching

A

Hydrogen peroxide, carbamide peroxide or sodium perborate

Home bleaching: carbamide peroxide
Office: hydrogen peroxide, rubber dam, light

Carbamide peroxide is 1/3 what hydrogen peroxide is
-ex: 10% carbamide peroxide is 3.3% hydrogen peroxide

94
Q

Side effects of vital bleaching

A

Sensitivity
Tissue irritation
Marginal leakage of restorations

95
Q

Nonvital bleaching - walking bleach technique

A

Walking bleach technique

  • open RCT, ensure no pulp remains
  • clean with alcohol
  • create cervical seal below CE
  • sodium perborate mixed with water
  • change after 3-7 days
96
Q

Side effects of nonvital bleaching

A

Increased marginal leakage of existing restoration
External root resorption
Ankylosis

97
Q

Issues with dental implants in pediatrics

A

Impact of growth on position of impact

Effect of implant-supported prosthesis on growth and development

98
Q

Implants in mandible

A

May be done in patients with ectodermal dysplasia
Mandible has less change, so implants can be done earlier
Posterior mandible implant placed too early may lead to lingual positioning of implant

99
Q

Implants in maxilla

A

Can give rise to diastema

Prosthesis of midline can inhibit growth

100
Q

Pubertal growth spurts

A

Boys: 11-17 years
Girls: 9-15 years

Important to consider growth for implant placement

101
Q

Dental lasers

A

Device that generates intense beam of coherent monochromatic light by stimulated emission of photons from excited atoms or molecules

102
Q

Differences primary teeth from permanent

A 
Enamel is thinner
Greater dentin thickness over occlusal fossa
Pulp horns are higher
Pronounced cervical ridges
Enamel rods slope occlusally
Marked cervical constriction
Longer, more slender roots
Roots flare out
103
Q

Crowns of primary teeth

A 
Shorter than permanent teeth
Wider MD
Narrower occlusal table
Cervical constriction
Broad, flat contacts
Prominent MB bulge
No developmental grooves/mamelons on incisors 
Thinner enamel
Lighter in color
Dentin tubules increase in diameter with depth toward pulp
104
Q

Pulp in primary teeth

A

Larger than permannet teeth
Pulp horns closer to outer surface
Great variation in size and location
Mesial pulp horn is higher

105
Q

Roots of primary teeth

A 
Anterior roots are narrower MD than BL
Molar roots are longer and more slender
Roots more flared
Roots branch directly from crown with no root trunk
Larger apical formina
Many accessory canals
106
Q

Maxillary Central Primary Incisor Anatomy

A

MD crown width is greater than crown height

Square Tooth

107
Q

Maxillary Lateral Primary Incisor Anatomy

A

Longer than maxillary central

108
Q

Maxillary Primary Canine Anatomy

A

Wider, more symmetrical than mandibular canine

Cusp tip is offset to the distal

109
Q

Maxillary 1st Primary Molar Anatomy

A

Greatest dimension is BL

4 cusps - 2 distal cusps are diminished

110
Q

Maxillary 2nd Primary Molar Anatomy

A

Very similar to permanent counterpart

Can include cusp of Carabelli

111
Q

Mandibular Central Primary Incisor Anatomy

A

Narrowest tooth MD

Straight incisal edge, very symmetrical

112
Q

Mandibular Primary Lateral Incisor Anatomy

A

Wider and less symmetricalthan central

Rounded incisal edge

113
Q

Mandibular Primary Canine Anatomy

A

Narrower than maxillary
Cusp is to mesial
Long distal slope

114
Q

Mandibular Primary 1st Molar Anatomy

A

Wider MD than BL
2 mesial cusps are larger than distal cusps
Prominent “S-curve” of gingival tissues
Broad contact between mesial of of molar and canine

115
Q

Mandibular Primary 2nd Molar Anatomy

A

Similar to permanent counterpart

Narrower BL and less pentagonal than permanent 1st molar

116
Q

Objectives of Restorative Care

A 
Restore damage caused by caries
Preserve remaining tissue
Prevent pain and infection
Retain function
Restore esthetics
Facilitate good hygiene
Maintain arch length
117
Q

Sensitivity vs Specificity for caries diagnosis

A

Sensitivity: ability to determine caries when present
Specificity: ability to determine absence of caries when disease is not present

Visual, radiographic, laser fluorescence, fiber optic transillumination, electrical conductance, quantitative light-induced fluorescence have poor sensitivity and specificity

118
Q

What is the best current method for caries detection?

A

Visual methods continue to be the standard for clinical assessment due to financial and practical reasons

119
Q

Nonselective/Complete Caries Excavation

A

Carious dentin is completely removed at first visit

120
Q

Stepwise caries excavation

A

Carious dentin is partly removed at 1st appointment with caries left over the pulp and temporary filling
Remaining carious dentin removed at 2nd appointment
Reduces pulp exposure compared to complete excavation

121
Q

Partial/Incomplete Caries Excavation

A

Caries left over pulp with base and restoration placed in one visit
Reduces pulp exposures compared with complete excavation
More cost effective than stepwise excavation

122
Q

OSHA requirements for materials

A

MSDS sheets need to be in a binder for any material that you have in your office

123
Q

Epidemiology of pit-fissure caries

A

90% of caries in permanent teeth of children occurs in pits and fissures
2/3 occurs on occlusal surface alone
Primary teeth 44% occlusal caries

124
Q

Is fluoride more or less effective on smooth surface compared to pits and fissures?

A

More effective on smooth surfaces

125
Q

Primary, Secondary, Tertiary Prevention

A

Primary: intervention before evidence of disease (sealants)
Secondary: intervention after disease has begun, before symptoms (sealants)
Tertiary: intervention after disease is established (temporary sealant, PRR)

126
Q

ADA Noncavitated/Initial Lesion Definition

A

Initial caries lesion development before cavitation occurs

Change in color, glossiness or surface structure as a result of demineralization before macroscopic break in tooth structure

Up to D1 lesion

Sealants can be placed on these lesions

127
Q

Sealant success

A

Up to 76% reduction of incidence of occlusal caries
Risk of developing carious lesions in teeth with fully or partially lost sealants is no greater than teeth that have not been sealed
Sealed restorations superior to unsealed

128
Q

Indications for Sealants

A 
Caries-susceptible permanent molars
-history of caries in primary molars
-susceptible anatomy
-poor oral hygiene
Teeth that can be isolated
129
Q

Resin Based Sealant Composition

A

Monomer: urethane dimethacrylate or bisphenol A-glycidyl methacrylate

Bis-GMA is product of bisphenol A and glyceryl methacrylate

130
Q

Mechanism of adhesion of resin sealants

A

Mechanical

131
Q

Wavelength of light for curing sealants

A

450-470nm
Camphorquinone/diketone-amine system

Minimal light output is 350

132
Q

How do chemically cured sealants set?

A

By means of tertiary amine (activator) that is mixed with benzoil peroxide, producing free radicals that initiate polymerization

133
Q

Compomer Sealants

A

Hydrophobic
Requires bonding agent
Fluoride release is low
Less retention than resin sealant

134
Q

GI/RMGI Sealants

A

Suggested when isolation is difficult

Mechanical and chemical retention

135
Q

GI versus Resin Sealants

A

GI has 5x greater risk of loss
GI has 3x greater risk of loss compared to RMGI
No difference in caries development with GI or resin sealant, but resin based has better retention

136
Q

Indications for Sealant

A

Pit and fissure caries are questionable or in enamel only
Caries-free pits and fissures with at risk morphology
Medical history of xerostomia
Patient is receiving routine preventive dental care

137
Q

Contraindications for Sealant

A 
Caries extends into dentin
Proximal caries or restoration involving pit and fissures
Inadequate isolation
Minimal or no caries risk
Pit and fissure morphology not at risk
Sporadic dental care
138
Q

Reason for sealant failure

A

Most common from salivary contamination

139
Q

Sealing over caries?

A

Acid-etch eliminates 75% of viable bacteria
Following sealant placement, dentinal lesions have been shown to be arrested
Retention of sealants over sound and carious tooth surfaces are similar

140
Q

ADA Guidelines - Sealant Panel Recommendations

A
  • Sealants effective in preventing and arresting pit-and-fissure caries in primary and permanent molars
  • Sealants can minimize progression of non-cavitated occlusal carious lesions (initial lesions)
  • Use of hydrophilic bonding layer enhances long-term retention
  • Self-etching bonding agents provide less retention than total etch
  • Routine mechanical preparation of enamel before etch is not recommended
  • When possible, 4-handed technique should be used
  • Use of explorers is not necessary for detection of early lesions
141
Q

Is there a difference in sealant retention with air polishing versus conventional cleaning methods?

A

No

142
Q

Rubber dam versus vacuum system isolation for sealants?

A

No difference

Rubber dam better than cotton

143
Q

Does topical fluoride interfere with bonding between sealant and enamel?

A

No

144
Q

Should you use adhesive with sealant?

A

Yes

Probably should cure it

145
Q

BPA and Dental Materials

A

Dental materials contribute to very low level BPA exposure for up to 3 hours

Amount does not exceed FDA safe exposure limit

Limit by gargling with water, pumice on cotton ball, rubber prophy cup

146
Q

PRR and CAR

A

PRR: Preventive Resin Restoration
CAR: Conservative Adhesive Restorations (reflects that other bonded materials like GI may be used)
Both involve removal of caries with sealant of adjacent pits/fissures

147
Q

Resin Infiltration (ICON)

A 
Can improve appearance of WSL
May reduce lesion progression
No preparation required
No margin of restoration
Not radiopaque
148
Q

Components of resin infiltration

A

Icon dry: ethanol
Icon etch: 15% hydrochloric acid
Icon infiltrate: methacrylate based resin matrix, ignitors, adhesives

149
Q

Indications for Resin Infiltration

A

Noncavitated E1-D1 lesions
WSL
Posterior and anterior use

ABPD 2021 (14 decks)

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