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111 - PAST EXAM QS > Restorative/endo/perio > Flashcards

Restorative/endo/perio Flashcards

1
Q

What are the 2 criteria for valid consent?

A

it must be voluntary
it must be informed

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2
Q

Two periapical radiographs show lower anteriors 42, 41, 31, 32 that have all been
treated endodontically with posts and cores. There is radiolucencies in all of the
teeth affected. The patient is referred to you for periradicular surgery.
- Name 3 treatment options other than periradicular surgery

A

Attempt ortho grade retreatment
extraction
monitor

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3
Q

Name 6 things you should tell the patient for valid consent, before carrying out treatment

A

alternative options for treatment, their risks and potential benefits
your recommended option
the consequences, risks and benefits of the treatment you propose
the likely prognosis
the cost of proposed treatment
whether the treatment is guaranteed and how long it is guaranteed for

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4
Q

give 4 faults that can occur when instrumenting a canal with stainless steel hand files. explain briefly how they can occur

A

ledges
- internal transportation of canal when working short of working length
blockage
- dentine debris packed into apical portion of the root
apical zipping
- occurs as a result of instrument to straighten inside a curved canal
perforation
- too much pressure put when using the instruments

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5
Q

Describe the endodontic process including calculating working length until the
obturation stage

A

Pre-op PA radiographs
Rubber dam and LA
Coronal access to the root canal system
Remove all caries and defective restorations from the crown
- Allows assessment of restorability and creates an environment suitable
for obtaining adequate isolation
Root canal system instrumentation and preparation and irrigation with Sodium
hypochlorite using the ProTaper technique
Obturation of the root canal system with GP size matched cones
Coronal seal
Final restoration

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6
Q

What are the benefits of copper enriched amalgam?

A

copper increases strength and hardness of amalgam material
higher earlier stress before 24 hour mark
less creep
better corrosion resistance
increased durability at the margins

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7
Q

what is the function of zinc in amalgam

A

scavenger molecule during production
preferentially oxidises and forms slag

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8
Q

why is zinc no longer added to amalgam?

A

interacts with water in saliva or/and blood
- H2 bubbles formed within amalgam
- pressure build up causing expansion
- downward pressure = pulpal pain
- upward pressure = respration sits proud of surface

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9
Q

What is creep?

A

When an object experiences repeated low level stresses
causes the material to flow, resulting in plastic deformation

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10
Q

signs/symptoms of creep in an amalgam restoration

A

ditching of restoration margins which can result in fractured margins
- leads to micro leakage and secondary caries

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11
Q

Name the Kennedy Classifications

A

Class I = bilateral free end saddle
Class II = unilateral free ed saddle
Class III = unilateral bounded saddle
Class IV = anterior bounded saddle crossing the midline

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12
Q

What anatomical features provide support on an upper denture?

A

hard palate and residual ridge

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13
Q

What anatomical features provide support for a lower denture

A

residual ridge
buccal shelf
retromolar pad

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14
Q

What is the function of rest seats in partial dentures?

A

provides bracing and indirect retention

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15
Q

What are the benefits of not extending a partial denture framework to the anterior teeth and allowing some clearance of the gingival margin?

A

less mucosal coverage
easier to clean gingival tissue
less irritation
better compliance

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16
Q

What impression materials can be used for primary impressions in complete denture cases?

A

impression compound - non elastic impression material
alginate - elastic impression material

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17
Q

A patient attends with a fractured 26 MOD amalgam which has also been root treated. What are the treatment options for this tooth?

A

Onlay
Crown
extraction

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18
Q

A tooth requires re root treatment if the root has been exposed to the oral environment for…

A

more than 3 months
- as it puts the tooth at risk of bacterial invasion

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19
Q

Name 2 restorative materials that can bond amalgam to tooth?

A

GIC
RMGIC

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20
Q
A
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21
Q

erosion - define

A

loss of tooth surface by chemical process that does not involve bacterial action
- most common cause of pathological tooth wear

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22
Q

abfraction - define

A

loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum of the tooth

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23
Q

attrition - define

A

the physiological wearing away of tooth structure as a result of tooth to tooth contact

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24
Q

abfraction - features

A

v shaped tooth loss where tooth is under tension
classically sharp rim at ACJ

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25
Basic erosive wear examination (BEWE) grades
0 - no erosive wear 1 - initial loss of surface texture 2 - distinct defect; <50% hard tissue loss 3 >50% hard tissue surface area lost
26
BEWE risk levels
none - cumulative score of all sextants no risk = less than or equal to 2 low - 3-8 medium - 9-13 high >14
27
Give 3 ways that teeth can be desensitised
fluoride varnish prime and bond to protect surfaces desensitising toothpaste e.g. sensodyne
28
What is the Dahl technique?
a technique used to gain inter-occlusal space in cases of localised tooth wear composite or CoCr bite plane placed anterior to increase OVD
29
Dahl technique: How is spaced gained?
over a period of 3-6 months space gained between incisors anteriors intrude posteriors erupt results in space between upper and lower anteriors allowing restoration without need for occlusal reduction
30
Give at least 4 contraindications for Dahl technique
active periodontal disease post orthodontic treatment existing dental implants patients on bisphosphonates TMJ problems
31
a Silane coupling agent is used in composite resin. Name the other 4 constituents and give an example for each
Resin - Bis-GMA - urethane dimethacrylates filler particles - microfine silica - quartz - borosilicate glass photoinitiator - camphorquinone low weight dimethacrylates - TEGMA
32
Why is RMGI preferred to composite to fill a cervical abrasion cavity?
poor moisture control at the cervical region RMGIC also has less polymerisation shrinkage
33
What is the RPI system
a stress relieving claps system used in free end saddle designs to prevent stress on the last abutment tooth - can also provide reciprocation
34
constituents of the RPI system
mesial rest proximal guide plate gingival approaching I-bar clasp
35
RPI system mechanism of action
mesial rest acts as an axis of rotation during occlusal load the proximal plate and bar rotate downwards and mesially around the axis of rotation, disengaging from the tooth, thus avoiding potentially traumatic torque
36
how would you identify an infra bony defect?
PA radiograph 6PPC
37
how do infra bony defects occur?
radius of destruction of plaque determine pattern
38
How are vertical bone defects classified?
Goldman HM and Cohen: 1 wall 2 wall 3 walled defect
39
How to determine success from hygiene phase therapy?
pocket depths <4mm plaque scores <15% bleeding score <10% may not be achievable for all patients so patients with significantly improved OH, reduced bleeding and reduced probing depths from baseline could be considered to have responded successfully to treatment
40
What cases are suitable for regenerative periodontal surgery?
2 and 3 walled defects grade 2 furcation in mandibular teeth grade 2 buccal furcation in maxillary molars
41
furcation surgery options
regenerative surgery root resection root separation tunneling
42
Downsides of RMGI luting cement
contains HEMA - cytotoxic - swells in wet environment
43
ideal properties of a luting cement
viscosity thickness below 25 microns high compressive strength radiopaque ease of use cariostatic biocompatible low solubility
44
What luting cement is used for fibre posts?
dual cure composite resin cement
45
what luting cement is used for porcelain veneers?
light cured composite with dentine bonding agent
46
what are the components of temporary cement?
base - zinc oxide, starch and mineral oil accelerator - EBA, eugenol and carnauba wax
47
what information does the lab need prior to making a bridge?
bridge design master impression bite registration shade of teeth
48
What methods can be used to improve fit of loose dentures?
reline - soft or hard lining material rebase remake dentures
49
What things need to be checked at the denture try in stage?
extensions retention and stability occlusal plane occlusion - RVD, OVD, FWS speech - phonetic tests, fricatives appearance - tooth position - shade - shape
50
What is the shortened dental arch?
a dentition where most posterior teeth are missing but there is still satisfactory oral function without the use of an RD
51
What is required for the shortened dental arch to work?
3-5 occlusal units remaining - pair of occluding premolars = 1 unit - pair of occluding molars = 2 units
52
what skeletal classes are contraindicated with shortened dental arch? why?
severe class II or III - reduced chewing efficiency - TMJ problems
53
why is periodontal disease contraindicated in the shortened dental arch?
poor long term prognosis exacerbates occlusal instability challenging to treat condition
54
What cement is used for adhesive bridgework?
Panavia 21 - anaerobic cure resin cement
55
what is the 5 and 10 year survival rate for a RBB
5 year = 80.8% 10 year = 80.4%
56
Shortened dental arch indications
missing posterior teeth but 3-5 occlusal units remaining sufficient occlusal contacts to provide large enough occlusal table favourable prognosis for remaining teeth patient not motivated to pursue complex treatment plan for prosthesis financial resources for dental treatment are an issue
57
SDA contraindications
poor prognosis of remaining dentition untreated or advanced periodontal disease pre existing TMD any signs of pathological tooth wear patient has severe class II or III malocclusion
58
how might an SDA be extended
resin retained or conventional bridges implants RPD with RPI design
59
what factors can cause a bridge to debond?
poor moisture during cementation unfavourable occlusion parafunctional habits trauma to face/oral cavity poor oral hygiene
60
what materials can be used in a metal wing bridge?
cobalt chrome or nickel chrome
61
how to check a bridge debonding clinically
use probe to check around bridge abutments, Pontic and wings check visually if you can see any areas that have debonded check mobility of the bridge floss around bridge push and check for any air bubbles that may appear
62
define retention - in relation to partial dentures
resistance to displacement in a vertical direction
63
define indirect retention
resistance to rotational displacement of the denture
64
how is porcelain treated to improve its retention when placing an indirect restoration?
initially etched with HF silane coupling agent added to produce a strong covalent bond
65
26. A patient is referred to have a large MOD amalgam in their 46 replaced as it was causing a LTR. You replace it with composite and take radiograph to ensure there is no secondary caries or pathology, the patient then attends 5 days later complaining on pain when biting and to transient thermal stimuli. - Give 5 potential causes of these symptoms
pulpal exposure uncured resins entering the pulp causing irritation fluids from tubules occupying space under restoration poor moisture control when placing restoration deep cavity with no liner placed insufficient coolant when preparing the tooth - damaging pulp dental erosion bruxism gingival recession, periodontal disease
66
give 4 risk factors for necrotising gingivitis
smoking stress poor oral hygiene immunosuppression
67
Necrotising gingivitis treatment - outline
careful supra gingival instrumentation with ultrasonic scaler provide oral hygiene advice smoking cessation 0.2% CHX mouthwash until acute symptoms subside review within 10 days - Carry out further instrumentation
68
TIPPS - stands for
talking instruct practice plan support
69
Why might mechanical root surface debridement be unsuccessful in eliminating pocket bacteria?
poor technique/lack of operator experience failure to disrupt biofilm patient not compliant with OHI specific pocket sites may be inaccessible to instrumentation
70
What 3 criteria must be fulfilled before carrying out obturation?
tooth must be asymptomatic canal must be fully dried there must be full biomechanical cleaning on all canals
71
Name 4 components of Gutta Percha
gutta percha radiopacifiers zinc oxide plasticisers
72
What is the function of root canal sealer when used with GP cones?
to seal the space between the dentinal walls and core fills voids in canals and between GP ones provides a fluid tight seal
73
give 3 generic types of sealer used for obtuaration
calcium hydroxide (dycal) epoxy resin sealer (AH plus) bio ceramic sealer ZOE RMGI
74
reasons for obturating
to seal remaining bacteria provide apical and coronal seal prevent reinfection
75
give 4 methods of obturation
cold lateral compaction warm vertical compaction continuous wave compaction carried based obturation
76
What materials can be used for a core?
composite amalgam glass ionomer
77
37. Patient has a discoloured tooth anteriorly but it isn’t sensitive or symptomatic; patient sustained a blow to it a couple of years prior and discolouration is getting worse - How would you find out the aetiology of the discolouration?
thorough history regarding trauma sensibility testing including adjacent teeth type of discolouration compare with clinical photographs PA radiograph
78
treatment options for discoloured tooth
accept and monitor localised composite resin composite or porcelain veneers enamel microabrasion bleaching
79
How to take impressions in a flabby ridge - options
mucosatic impression so tissues are recorded at rest 2 stage impression with medium bodied silicone - cut out impression material and make a hole in tray over flabby ridge - take 2nd impression with light bodied windwo technique - relief holes cut in special tray to allow flow of impression material and leave tissues undisplaced
80
how does a healthy periodontium respond to occlusal trauma?
PDL widens until the forces can be adequately dissipated
81
What concerns do patients commonly have about the use of amalgam?
aesthetics mercury toxicity metal allergies environmental impact prgenancy discolouration of teeth and surrounding tissues
82
what are the characteristics of an ideal post
parallel sided - avoids wedding and more retentive than tapered non threaded/passive - smooth surface incorporates less stress to remaining tooth cement retained - cement acts as a buffer between masticatory forces and tooth
83
what percentage of maxillary 1st molars have an MB2 canal?
93%
84
what are the 3 design objectives of Endodontics
create a smooth continuously tapering funnel maintain apical foramen in original position straight line access
85
Give 4 reasons for irrigation during endodontic treatment
disinfect the root canal dissolve organic debris lubrucate root canal instruments remove endodontic smear layer
86
why is sodium hypochlorite the ideal endodontic irrigant?
potent antimicrobial activity dissolves pulp remnants and collagen dissolves necrotic and vital tissue
87
Why is EDTA used in endodonics?
removes smear layer opens dentinal tubules allowing for irrigant and sealer penetration
88
what are the indications for adhesive bridges?
young teeth good enamel quality large abutment tooth surface area minimal occlusal load good for single tooth replacement
89
RBB contraindications
insufficient or poor quality enamel long spans gingival recession heavy occlusal forces bruxism poorly aligned, tilted or spaced teeth
90
What are the sigs of occlusal trauma?
fractured restorations or teeth tooth mobility dental pain not attributed to infections tooth wear contributing factors to TMD pronounced lines alba radiographic widening of PDL
91
give 4 intrinsic causes of tooth discolouration
fluorosis tetracycline non-vitality cystic fibrosis (grey) dental materials porphyria (red)
92
give 4 extrinsic causes of tooth discolouration
smoking tannins chromogenic bacteria chlorhexidine iron supplements
93
Name 4 types of articulators
simple hinge average value semi-adjustable fully-adjustable
94
What are the ideal properties of a denture base material?
dimensional stability high softening temperature high hardness high thermal conductivity biocompatible inexpensive high fatigue and impact strength
95
Give 4 possible production faults of PMMA and how they occur
contraction porosity - too much monomer, insufficient pressure, insufficient excess material gaseous porosity - monomer boiling in bulkier parts of denture granularity - not enough monomer crazing - internal stresses due to fast cooling rate
96
what are the principles of crown preparation?
preservation of tooth substance retention and resistance structural durability marginal integrity preservation of the periodontium aesthetic considerations
97
How to avoid overhangs when placing amalgam
correct matrix band adaptation using wedges between teeth adequate condensing of amalgam
98
amalgam overhangs - potential consequences
plaque trap and food packing - secondary caries - gingivitis - periodontal disease can lead to fracture in amalgam if section is thin
99
how to manage an amalgam restoration overhang?
replace restoration ensuring better contour and clear contacts repair if possible to adjust overhand without damaging rest of restoration
100
define retention and stability, in relation to dentures
retention = resistance to vertical displacement stability = resistance to lateral displacement
101
Immediate denture advantages
- guide for aesthetics - speech - function - self esteem - avoid drifting/tilting or over eruption of remaining teeth - promotes health - better adaption to dentures - prevents collapse of facial musculature
102
immediate denture disadvantages
- temporary prosthesis due to resorption - poor adaptation to ridge very quickly - guesstimate as to how healing will proceed

111 - PAST EXAM QS (1 decks)

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