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dentistry bds4 > Restorative dentistry > Flashcards

Restorative dentistry Flashcards

1
Q

What is the sequence of treatment?

A

Relief of pain
control of active disease and achievement of stability
reassessment of success of initial treatment
definitive treatment
monitoring

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2
Q

What are symptoms, signs and treatment options of reversible pulpitis?

A

fleeting sensitivity to hot/cold/sweet - immediate onset. sharp pain, difficult to locate. quickly subsides.

Exaggerated response to pulp testing. not TTP

remove any caries present and restore. place a sedative dressing

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3
Q

What are symptoms, signs and treatment options of irreversible pulpitis?

A

spontaneous, dull throbbing. lasts for several minutes or longer. worse at night, can be pulsatile. Sensitivity to hot/cold. pain continues after removal of stimulus.
tooth is sensitive to pressure

exaggerated or reduced/no response to EPT

treatment is extirpation of pulp and RCT. place intercanal medicament

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4
Q

How do you distinguish between dentine hypersensitivity and cracked tooth syndrome?

A

DH = response to thermal, tactile or osmotic stimuli

CTS = pain on release of biting. can be visualised with a torch

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5
Q

What are the possible occlusion restoration techniques?

A

Conformative approach - maintaining the patients current occlusal position

reorganised approach - establishing a new occlusion

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6
Q

what are the benefits of using a rubber dam?

A

airway protection, field isolation, improved moisture control, reduced contamination risk, patient cant talk

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7
Q

What are the principles of cavity preparation?

A

gain access, remove carious tissue from the outside in, remove unsupported enamel, modify cavity based on restoration materials used.

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8
Q

What are the preparation techniques for an inlay?

A

take impression of tooth before preparation with silicone
Preparation has slightly divergent walls, rounded line angles, slight bevel to enamel margins which arent occlusal.
block out undercuts with RMGI
take impression of occluding arch
choose shade
make temp with the silicone impression

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9
Q

what are causes of restoration failure?

A

poor occlusion, incorrect preparation (caries left, incorrect margin), incorrect choice of restorative material, incorrect management of material (poor moisture control)

can be failed margins, bulk fracture or failed aesthetics. Failed margins allows secondary caries

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10
Q

What is non carious tooth surface loss?

A

NCTSL is loss of dental tissue for reasons other than bacterial.
attrition - tooth on tooth contact
abrasion - tooth on non - tooth surface
erosion - intrinsic and extrinsic
abfraction - abnormal cyclical loading on the tooth causes fracture at the cervical margin

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11
Q

how do you treat NCTSL?

A

identify aetiological factor and treat that - might be refer to GP, soft splint, diet advice, refer to psychiatrist

monitor by taking study models and photographs

restore if required - comp or GI can be useful

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12
Q

What are vital bleaching techniques?

A

Home bleaching - 10-15% carbamide peroxide in splint
worn up to 8 hours per day for 2 weeks
give patient advice and instructions - small drop of gel into the tray. review weekly

“in office” bleaching - higher concentration of bleach or light activated.
need orobase to protect gingiva before dam. use dam - must be sealed. polish teeth with pumice, apply bleach, wash teeth, remove dam and polish.
pt needs to avoid dietary stains

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13
Q

What is a non-vital bleaching technique?

A

inside/outside bleaching
construct a bleaching tray. open access cavity, remove root filling to 2mm below gingival margin and seal with GI.
remove stained dentine in the cavity, wash with etchant and then alcohol. dry. place pledget with carbamine peroxide (10%) and get the patient to replace this every regularly (active for 2 hours) and also place bleaching material in the tray

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14
Q

What are the indications for veneers?

A 
teeth are sound but discoloured
fractured teeth
hypoplasia
toothwear
closing space/modifying shape
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15
Q

What are the contraindications for veneers?

A

large restorations, severe discolouration, insufficient surface for bonding, parafunctions

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16
Q

what are types of veneers?

A

resin composite and porcelain

17
Q

what are options for crowns?

A

Metal ceramic, porcelain jacket, dentine bonded, all ceramic

18
Q

What is the preparation for a crown?

A

interproximally - walls should have 5 degrees taper
labial
lingual
occlusal - 0.5mm reduction for gold up to 1.5mm reduction for all ceramic (zirconia) crown.

chamfer for metal, shoulder for porcelain

19
Q

What are the different types of post and core system

A

prefabricated or custom made
parallel sided or tapered
threaded, smooth or serrated

metal - StSt or Ti
non metal - carbon fibre, glass fibre

20
Q

how do you remove an old post/core/crown?

A

remove the crown with a tornado bur, protecting the patients air way. use ultrasonic scaler to remove left over cement.
use Spence - Wells forcepts and twist

can use eggler post remover or masseran

21
Q

What are some concerns patients may have about amalgam?

A 
environmental impact
toxicity
aesthetics
cancer
tooth wear
22
Q

What reassurance would you give someone about mercury toxicity?

A 
small amount, well controlled
doesnt leak out 
compressing it into the cavity pushes mercury to the top - then removed
good logenvity
no link to cancer
metal scavengers and recycling
23
Q

what are the principles of cavity design?

A

access the cavity to the ACJ - extend to the edge of caries
remove affected enamel and dentine from outside in, cleaning ACJ
leave no unsupported enamel
clear the contact areas
dont finish restoration on contact area
cavo surface margin angles/internal line angles/undercuts for the restorative material to be used

24
Q

how is resin composite bonded to dentine?

A

remove smear layer and etch with phosphoric acid (37%) to demineralise and open tubules to expose collagen

prime - primer monomer which is bifunctional molecule - hydrophobic and hydrophillic and allows bonding

bond - unfilled resin monomer - creates hybrid layer with resin tag for micromechanical retention

25
Q

How can you check if a resin bonded bridge has debonded?

A

is there any flex over the tooth?
can you see bubbles in saliva?
can you get probe underneath?
can you get floss through it?

26
Q

if a patient comes in with #MOD od 36 which broke 6 months ago, how would you proceed?

A

Hx, exam, Rx, investigations, sensibility testing, check for caries,

27
Q

when would you re-root treat a tooth where the GP has been exposed?

A

<6 months

28
Q

20yr old male attends with increasing discolouration of 21 over 2 years. good PDH

A

could be intrinsic colour change - pulp obliteration, root resorption (int+ext), caries, plaque/calculus

extrinsic: diet, bacteria, smoking, tanins, CHX

check trauma history, diet, SH

29
Q

what are the differences between reversible and irreversible pulpitis?

A

reversible: sharp, shooting pain to stimulus but stops when stimulus removed. +ve EPT and EtCl. poorly localised. Tx - restoration, indirect pulp cap

Irreversible: spontaneous, dull ache, persists after removal of stimulus, keeps pt awake, worse when lying down. ++ or -ve response to EPT and EtCl. Tx - XLA or RCT

30
Q

What is dentine hypersensitivity?

A

osmotic theory
movement of dentinal fluids within the dentine tubules pulls on nerve fibres and elicts a painful response
thermal, osmotic or tactile response
Dx by elimination

31
Q

What are the benefits of provisionalising a tooth during restorative work?

A 
protects tooth vitality
maintains occlusion and positional stability
patient gets used to it
aesthetics
diagnosis
function
32
Q

How do you improve the function and longevity of a posterior composite restoration?

A 
linings
good setting technique - in steps
occlusal condsideration
dry field
correct composite - macrofilled
33
Q

What are different reastons for post failure?

A 
perforation
bacteria introduced in post prep
accessory canals not cleaned
poor post design or placement
occlusion not taking into account
not cemented properly
34
Q

What are treatment options for dentine hypersensitivity?

A 
toothpastes with desensitising agents (strontium Chloride)
duraphat varnish
GI
dentine bonding agents
RCT if severe
35
Q

What is ludwigs angina?

A

potentially life threatening cellulitis involving the sub mental, sun lingual and sub mandibular spaces
usually caused by periapical abscess of mandibular molars
urgent referral to hospital, need IV ABs

36
Q

Who is susceptible to osteomyelitis?

A

alcoholics
drug users
diabetic patients
immuno suppressed

37
Q

How do you treat osteomyelitis?

A

remove sequestra and necrotic bone

treat with amox 500mg TID plus flucloxacillin 250mg QID

dentistry bds4 (20 decks)

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