Restorative dentistry Flashcards
What is the sequence of treatment?
Relief of pain
control of active disease and achievement of stability
reassessment of success of initial treatment
definitive treatment
monitoring
What are symptoms, signs and treatment options of reversible pulpitis?
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
What are symptoms, signs and treatment options of irreversible pulpitis?
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
How do you distinguish between dentine hypersensitivity and cracked tooth syndrome?
DH = response to thermal, tactile or osmotic stimuli
CTS = pain on release of biting. can be visualised with a torch
What are the possible occlusion restoration techniques?
Conformative approach - maintaining the patients current occlusal position
reorganised approach - establishing a new occlusion
what are the benefits of using a rubber dam?
airway protection, field isolation, improved moisture control, reduced contamination risk, patient cant talk
What are the principles of cavity preparation?
gain access, remove carious tissue from the outside in, remove unsupported enamel, modify cavity based on restoration materials used.
What are the preparation techniques for an inlay?
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
what are causes of restoration failure?
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
What is non carious tooth surface loss?
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
how do you treat NCTSL?
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
What are vital bleaching techniques?
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
What is a non-vital bleaching technique?
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
What are the indications for veneers?
teeth are sound but discoloured fractured teeth hypoplasia toothwear closing space/modifying shape
What are the contraindications for veneers?
large restorations, severe discolouration, insufficient surface for bonding, parafunctions
what are types of veneers?
resin composite and porcelain
what are options for crowns?
Metal ceramic, porcelain jacket, dentine bonded, all ceramic
What is the preparation for a crown?
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
What are the different types of post and core system
prefabricated or custom made
parallel sided or tapered
threaded, smooth or serrated
metal - StSt or Ti
non metal - carbon fibre, glass fibre
how do you remove an old post/core/crown?
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
What are some concerns patients may have about amalgam?
environmental impact toxicity aesthetics cancer tooth wear
What reassurance would you give someone about mercury toxicity?
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
what are the principles of cavity design?
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
how is resin composite bonded to dentine?
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
How can you check if a resin bonded bridge has debonded?
is there any flex over the tooth?
can you see bubbles in saliva?
can you get probe underneath?
can you get floss through it?
if a patient comes in with #MOD od 36 which broke 6 months ago, how would you proceed?
Hx, exam, Rx, investigations, sensibility testing, check for caries,
when would you re-root treat a tooth where the GP has been exposed?
<6 months
20yr old male attends with increasing discolouration of 21 over 2 years. good PDH
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
what are the differences between reversible and irreversible pulpitis?
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
What is dentine hypersensitivity?
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
What are the benefits of provisionalising a tooth during restorative work?
protects tooth vitality maintains occlusion and positional stability patient gets used to it aesthetics diagnosis function
How do you improve the function and longevity of a posterior composite restoration?
linings good setting technique - in steps occlusal condsideration dry field correct composite - macrofilled
What are different reastons for post failure?
perforation bacteria introduced in post prep accessory canals not cleaned poor post design or placement occlusion not taking into account not cemented properly
What are treatment options for dentine hypersensitivity?
toothpastes with desensitising agents (strontium Chloride) duraphat varnish GI dentine bonding agents RCT if severe
What is ludwigs angina?
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
Who is susceptible to osteomyelitis?
alcoholics
drug users
diabetic patients
immuno suppressed
How do you treat osteomyelitis?
remove sequestra and necrotic bone
treat with amox 500mg TID plus flucloxacillin 250mg QID
