Restorative Dentistry Flashcards
1
Q
Treatment options for missing teeth - general (3)
A
- No treatment - Leave space
- Replace missing teeth
- Close space
2
Q
Reasons for treating tooth loss (4)
A
Aesthetics
Function
Speech
Maintenance of dental health (over eruption etc.)
3
Q
Treatment options for replacing teeth - specific (3)
A
Denture
Bridgework
Implants
4
Q
What is a bridge
A
Prosthesis which replaces a missing tooth or teeth and is attached to one or more natural teeth (or implants)
5
Q
Main Types of Bridgework (2)
A
Adhesive
Conventional
6
Q
Abutment Definition
A
A tooth which serves as an attachment for a bridge
7
Q
Pontic Definition
A
The artificial tooth which is suspended from the abutment tooth/teeth
8
Q
Bridge Retainer Definition
A
The extracoronal or intracoronal restorations that are connected to the Pontic and cemented to the prepared abutment teeth
9
Q
Edentulous Span
A
Space between natural teeth that is to be filled by a bridge or partial denture
10
Q
Pier Definition
A
An abutment tooth which stands between and is supporting two pontics, each Pontic being attached to a further abutment tooth
11
Q
Unit Definition
A
Either a retainer or a pontic
A bridge with 2 retainers is a 3 unit bridge
12
Q
Bridge Designs (5)
A
- Fixed-fixed
- Cantilever
- Fixed-moveable
- Hybrid
- Spring cantilever
13
Q
How can a pontic be manufactured (4)
A
- Patients own tooth
- Acrylic denture tooth
- Polycarbonate crown
- Cellulose matrix filled with composite
14
Q
General Indications for Bridgework (6)
A
- Function and stability
- Appearance
- Speech
- Psychological Reasons (denture difficulty)
- Systemic Disease (epilepsy)
- Co-operative patient
15
Q
Local Indications for Adhesive Bridgework (4)
A
Big teeth
Favourable abutment angulations
Favourable occlusion
Heavily restored teeth (conventional)
16
Q
General Contraindications for Bridgework (6)
A
- Uncooperative patient
- Medical history contraindications
- Poor OH
- High caries rate
- Periodontal disease
- Large pulps (conventional bridge)
17
Q
Local Contraindications for Bridgework (6)
A
High possibility of further tooth loss within arch
Prognosis of abutment poor
Length of span too great
Ridge form and tissue loss
Tilting and rotation of teeth
Periapical/Periodontal status
18
Q
Other names for adhesive bridgework (5)
A
Resin retained bridgework
Resin bonded bridgework
Minimal preparation bridgework
Maryland bridge
Resin bonded fixed partial denture
19
Q
RBB
A
Resin Bonded Bridgework
20
Q
RRB
A
Resin Retained Bridgework
21
Q
RBFPD
A
Resin Bonded Fixed Partial Denture
22
Q
Metal used in adhesive bridgework (2)
A
Cobalt chrome or Nickel Chrome
23
Q
Longevity of adhesive bridgework
A
Around 80%
24
Q
How do you ensure a common path of insertion for fixed-fixed conventional
A
Ensure preparation of abutment teeth are parallel
25
Issues with hybrid bridges
The adhesive side tends to debond first and accelerates decay underneath the wing
26
What should you of when you see a fixed-fixed adhesive bridge clinically
Lightly press on both wings to ensure they are still bonded.
If one side is not bonded you will see bubbles and the wing will depress slightly
27
Optimum crown to root ratio for abutment teeth
2:3
28
Minimum crown to root ratio for abutment teeth
1:1
29
Spring Cantilever Bridge
One Pontic attached to the end of a metal arm that runs across the palate to a rigid connector on the palatal side of a retainer
30
Indications for adhesive bridgework (6)
1. Young teeth
2. Good enamel quality
3. Large abutment tooth surface area
4. Minimal occlusal load
5. Good for single tooth replacement
6. Simplify partial denture design
31
Contraindications for adhesive bridgework (6)
1. Insufficient or poor quality enamel
2. Long spans
3. Excess soft tissue or hard tissue loss
4. Heavy occlusal forces
5. Poorly aligned or tilted teeth
6. Contact sports - Debate, ensure mouth guard
32
Amalgam in potential abutment teeth
Replace with composite
Amalgam does not bond well
33
Why should you aim to stay in enamel for preparation of adhesive bridges
Enamel creates a stronger bond than dentine
34
Where should preparation be for an adhesive bridge in relation to the gingival margin
0.5mm supra-gingival
35
What should happen to the metal wing of a bridge before it arrives at your chair?
The surface should be sandblasted
Aluminium oxide
50 microns
36
Temporary solutions to tooth loss (5)
1. Consider RPD
2. Essix retainer with tooth inside
3. If prep remains in enamel is there any need for temp?
4. If prep into dentine - cover with layer of dentine bonding agent
5. Fit bridge asap to minimise over eruption and tooth movement
37
Abutment evaluation (6)
1. Remaining tooth structure
2. Root configuration
3. Periodontal health
4. Surface area for bonding
5. Risk of plural damage
6. Quality of current restorations/endo
38
Types of Pontic (4)
1. Wash through/Sanitary
2. Dome/Bullet/Torpedo
3. Modified ridge lap
4. Ovate pontic
39
Pontic Function (3)
1. Restore appearance of missing tooth
2. Stabilise the occlusion
3. Improve masticatory function
40
Wash through Pontic (3)
Makes no contact with soft tissue
Functional rather than for appearance
Consider in lower molar area
41
Dome shaped/Torpedo/Bullet Pontic (3)
Useful in lower incisor, premolar or upper molar areas
Acceptable if occlusal 2/3 of buccal surface visible
Poor aesthetics if gingival 1/3 of tooth visible
42
Modified Ridge Lap Pontic (4)
Buccal surface very tooth like
Lingual surface cut away
Line contact with buccal of ridge
Problems with food packing on lingual surface of ridge
43
Ridge Lap Saddle Pontic (4)
Greatest contact with soft tissue
If designed carefully: can be cleansed
Less food packing than ridge lap
Care taken not to displace soft tissue or cause blanching
44
Types of all ceramic crown (2)
Zirconia
Lithium disilicate
45
Metals used in conventional bridges (3)
1. Gold
2. Nickel/Cobalt chromium
3. Stainless steel
46
Longevity of conventional RBB
Around 80%
47
Longevity of conventional fixed-fixed metal ceramic
5 year - 93%
10 year - 89%
48
Longevity of conventional fixed- fixed ceramic
88%
49
Longevity of conventional cantilever bridge
5 year - 91%
10 year - 80%
50
Longevity of implant retained bridge
5 year - 95%
10 year - 87%
51
Direct vs Indirect Restorations
Direct - Can be placed in a single visit
Indirect - Fabricated outside the mouth
52
Indirect restoration stages (4)
Preparation
Temporisation
Impression and occlusal records
Cementation
53
Types of Inlays/Onlays (4)
Composite
Gold
Porcelain
Ceromeric
54
Advantages of indirect restorations over direct (3)
Superior materials
Superior margins
Won't deteriorate over time
55
Disadvantages of indirect restorations over direct (2)
Time
Cost
56
Most important factor for long term success of a crown
Coronal seal
57
Which crown material is better if a retentive cavity can be cut
Ceromeric
58
Which crown material gives a better bond
Porcelain
59
How can you make a veneer more adhesive
Lab with 10% acid
60
What etch is used in dentistry
37% phosphoric etch
61
Tooth Surface Loss (4)
Caries
Trauma
Developmental Problems
Toothwear
62
Non-Carious Tooth Surface Loss (3)
Trauma
Developmental Problems
Toothwear
63
Physiological Toothwear
Normal wear associated with function
64
Pathological Toothwear
Remaining tooth structure or plural health is compromised
OR
Rate of toothwear is excessive for age
OR
Patient experiences masticatory or aesthetic defecit
65
Causes of Toothwear (4)
Attrition
Abrasion
Erosion
Abfraction
66
Attrition Definition
Physiological wearing away of tooth structure as a result of tooth to tooth contact
67
Where are attritive lesions found
Occlusal and incisal contacting surfaces
68
Early attritive lesions
Polished facet or flattening of cusp/incisal edge
69
Abrasion Definition
The physical wear of tooth substance through and abnormal mechanical process independent of occlusion. It involves a foreign object or substance repeatedly contacting the tooth
70
Common Features of Abrasive Lesions (3)
Labial/Buccal
V shaped or rounded lesions
Sharp margin at enamel edge
71
Erosion Definition
The loss of tooth surface by a chemical process that does not involve bacteria action
72
Features of Erosive Lesions (5)
Loss of surface detail of enamel
'Cupping' of occlusal surfaces as dentine becomes exposed
Fillings stay high as the tooth erodes around them
Increased translucency of incisal edges
No tooth staining
73
Abfraction Definition
The loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the crevical fulcrum areas of the tooth
74
Abfraction Theories
1. Abfraction is the basic cause of all non-carious cervical lesions
2. Multifactorial aetiology. A combination of occlusal stress, abrasion and erosion
75
Where does abfraction occur
Cervical margin
76
Wear Indices
Smith and Knight
BEWE
77
BEWE 0
No erosive wear
78
BEWE 1
Initial loss of surface texture
79
BEWE 2 (3)
Distinct defect
Hard tissue loss
<50% of surface
80
BEWE 3
Hard tissue loss >50% surface area
81
BEWE No risk
82
BEWE Low risk
3-8
83
BEWE Medium risk
9-13
84
BEWE High risk
14+
85
Dento-alveolar compensation
Bone growing to compensate for tooth surface loss
86
SOI
Severe Odontogenic Infection
87
Pericoronitis Treatment if no systemic signs present (2)
Operculectomy
Irrigation
88
Pericoronitis treatment if systemic signs present
Systemic treatment
89
Salivary gland infection treatment (3)
1. Drainage
2. Flucoxacillin
3. Metronidazole
90
What condition might result in grey teeth?
Cystic fibrosis
91
What might result in green teeth (3)
Hyperbilirubinaemia
Thalassemia
Sickle cell anaemia
92
Types of tooth bleaching
External
Internal non-vital
93
Factors affecting bleaching (4)
1. Time
2. Cleanliness of tooth
3. Concentration of solution
4. Temperature
94
What should be done before bleaching? (3)
1. Pt dentally fit
2. Shade recording
3. Ideally clinical images
95
Warnings for the patient before bleaching (5)
1. Sensitivity
2. Relapse
3. Restoration colour
4. Compliance
5. May not work
96
Should chlorine dioxide be used in bleaching
No. Never use it
97
Contraindications to non-vital internal bleaching (2)
1. Heavily restored tooth
2. Staining due to amalgam
98
Combination bleaching
Inside-outside bleaching
99
Medical contraindications to tooth bleaching (2)
Glucose-6-Phosphate dehydrogenase deficiency
Actalasemia
100
Why should you never use GI or a material that bonds to tooth surface as a temp for indirect restorations?
The shape of the preparation will change when the temp is cut away
101
What type of caries is seen in between teeth
Aproximal
102
Cavity base liners (4)
1. Zinc phosphate
2. Zinc oxide eugenol
3. CaOH
4. RMGI
103
Effects of CaOH (4)
1. High pH - stimulates fibroblasts
2. Simulates recalcification of demineralised dentine
3. Cytotoxic - can kill pulp cells
4. Very soluble if not protected
104
How much enamel does acid etching remove
10 microns
105
How much enamel does prophy with pumice remove
5-50 microns
106
Types of vital bleaching (2)
1. Chairside
2. At home
107
Types of non vital bleaching (2)
1. Inside outside technique
2. Walking bleach technique
108
Are the effects of bleaching permanent
No
109
What is used for home bleaching
10% carbamide peroxide
110
Why should chair side bleaching be avoided
Unpredictable and greater risk to soft tissues and eyes
111
What is used for chair side bleaching
Rapidly reaction hydrogen peroxide equivalent to 75% carbamide peroxide
112
What does carbamide peroxide break down into
Water, ammonia and carbon dioxide
113
Non vital bleaching methods (2)
1. Walking bleach
2. Inside-outside
114
After how long does bleach stop working
2 weeks
115
After how many renewals of bleach should you stop if there's been no change
3-4
116
Walking bleach
Bleach placed inside tooth and covered with GI
117
Inside-Outside bleach (4)
1. Mouth guard worn all the time
2. Windows cut in teeth that don't need whitened
3. Gel replaced every 2 hours
4. Don't need GI lining
118
Non-vital bleaching complications (5)
1. External cervical resorption
2. Spillage of bleach
3. Failure to bleach
4. Over bleach
5. Brittleness
119
What makes external cervical resorption more likely in non vital bleaching
Trauma
120
Prevention of external cervical resorption after non vital bleaching (2)
1. Layer of cement over GP
2. Non setting calcium hydroxide in tooth for 2 weeks pre final restoration
121
Tooth mousse
CPP-ACP
122
How long to use tooth mousse for post microabrasion
4 weeks
123
How long to use tooth mousse for post bleaching
2 weeks
124
Resin infiltration - what is used
Low viscosity light cured resin
ICON
125
Passive Management of toothwear (4)
1. Prevention/Monitoring
2. First part of tx of toothwear
3. 6 months +
4. For many, this is the only tx
126
Width of composite for incisal edges
2mm
1mm unstable
127
Active Management Toothwear (3)
1. Preservation of remaining tooth
2. Simple restorations
3. Pragmatic aesthetic approach
128
Pattern of maxillary incisal wear (3)
1. Palatal only
2. Palatal and incisal
3. Labial only
129
Factors that influence maxillary incisal toothwear restoration decision (5)
1. Pattern
2. Inter-occlusal space
3. Space required
4. Quality and quantity of remaining tooth
5. Aesthetic demands
130
Increasing inter occlusal space options (5)
1. Increase OVD
2. Crown lengthening
3. Elective RCT and post crown
4. Ortho
5. Reorganise occlusion
