Restoring Large and in charge (Annie) restorations Flashcards
An extremely sensitive part of the tooth, where enamel and dentin meet:
DEJ
Dentinal tubules are filled with ____ and wrapped in ____
odontoblastic processes; afferent nerves & dentinal fluid
When enamel or cementum is removed during cavity preparation, the ___ of dentin is lost which allows small fluid movements in the tubules, causing distraction s in the afferent nerve endings hence pain
external seal of dentin
Refer to a mike the situation when one tooth or multiple teeth at the same appointment are treated quickly by:
- removing the infected dentin
- medicating the pulp, if necessary
- restoring the defects with a temporary material
caries control restorations
T/F: according to caries control restorations, undermined enamel can be left to better retain the temporary material:
true
What are the steps to caries control restorations?
- removing the infected dentin
- medicating the pulp (if necessary)
- restoring the defects with a temporary material
Used when a deep carious lesion occurs and THERE IS NO CLINICAL OR RADIOGRAPHIC EVIDENCE OF IRREVERSIBLE PULP DAMAGE (such as history of spontaneous pain, heat sensitivity relieved by cold, or a P A,. lesion)
indirect pulp cap
In order to perform an indirect pulp cap, the tooth should be ___ or at most have symptoms consistent with ____ such as moderate cold sensitivity, with pain subsiding within about 15 seconds
asymptomatic; reversible pulpitis
T/F: Caries is typically less extensive than the radiograph shows
false- usually deeper than appears on radiograph
The objective of an indirect pulp cap is to:
AVOID A PULP EXPSOURE
A liner may be added to the:
deepest parts of a prep, closest to the pulp
When using a liner, the liner material should be kept away from:
away from the margin
Liner materials include:
- calcium hydroxide
- resin modified glass ionomer
Brand names for calcium hydroxide liners:
Life & Dycal
Indications for calcium hydroxide liners (Life & Dycal)
use on deepest preps- pulp capping material
Brand name for resin modified glass ionomer:
Vitrebond
Vitrebond must be ____ and releases ____ over time
light cured; fluoride
The “two appointment approach” of indirect pulp capping is done the the removal of all the infected (soft, leathery) dentin is most likely going to result in:
a pulp exposure
The “two appointment approach” of indirect pulp capping is done the the removal of all the infected (soft, leathery) dentin is most likely going to result in a pulp exposure:
- Remove:
- Leave:
- Remove- all caries, both affected and infected dentin from all areas EXCEPT the deepest, close to the pulp
- Leave- the last little bit of infected dentin, cover it with calcium hydroxide (dycal or life) and glass ionomer (vitrebond)
T/F: With the two appointment approach for indirect pulp capping, some infected dentin (closest to pulp) can be left
True
T/F: With the two appointment approach for indirect pulp capping, affected dentin is left while infected dentin is removed
False- both are removed except for the last little bit of infected dentin closest to pulp
T/F: with the two appointment approach for indirect pulp capping, either dycal/life or vitrebond is used:
False- both are used (Liner and RMGI)
After placing liner and RMGI with the two appointment approach to indirect pulp capping, place:
a temporary restoration such as IRM or ketac silver
According to the two appointment approach to indirect pulp capping, it is okay to:
leave some underlined enamel TEMPORARILY to help col dn the temporary restoration
How long should you wait between the first and second appointment with the two appoint approach to indirect pulp capping:
several weeks (perhaps 12)
With two appoint approach to indirect pulp capping, why should you wait several to twelve weeks between the first and second appointment?
To allow the body to form reparative dentin in the site of the near exposure - if we get the desired result, a dentin bridge will have formed
What is the desired result for waiting the several weeks between appointments with the two appoint approach to indirect pulp capping:
dentin bridge formation (fingies crossed)
With the two appointment approach to indirect pulp capping, at the end of the 12 weeks, confirm that the patient is _____ and do a ____ before anesthetizing
asymptomatic; vitality test
With the two appointment approach to indirect pulp capping, the tradition approach following the 12 weeks and confirming asymptomatic patient is:
- remove the temp restoration, glass ionomer, and CaOH
- carefully remove remaining infected dentin
- leave affected dentin
- place new liner of dycal and if desired, place vitrebond
- remove all undermined enamel & modify prep
- restore with permanent material
Soft, leathery caries=
infected dentin
dry, powdery caries
affected dentin
Is affected dentin invaded by microorganisms?
no
What is the more common approach for indirect pulp capping?
single appointment approach
Used when a small pulpal exposure occurs during cavity preparation:
direct pulp cap
For a direct pulp cap, a thin layer of ____ is floated over the exposed pulp. A layer of ____ is placed over that.
calcium hydroxide; glass ionomer
For a direct pulp cap, a thin layer of CaOH is floated over the exposed pulp. A layer of RMGI is placed over that.
This may help simulate the pulp to form ____ which can produce a ____ across the exposure site.
secondary odontoblasts; dentin bridge
With a direct pulp cap, it is most successful when the exposure is _____ rather than ____
mechanical; carious
Direct pulp caps work better at the ____ than they do on an exposure on the ___
tips of pulp horns; side of a pulp chamber
If the tooth will require a crown to adequately restore it, DO NOT RELY ON:
direct pulp cap
Whether you are doing an indirect of direct pulp cap, temporary, or “permanent” restoration:
SEAL THE CAVITY
When is a smear layer created?
whenever the dentin has been cut
The smear layer is a few micrometers thick and is composed of:
denatured collagen, hydroxyapatite, and other cutting debris
The smear layer acts like a natural bandage over the cut surface since it occludes many dentinal tubules with debris called:
smear plugs
When using “total etch” systems, we do not want to:
bond t the smear layer
Acid conditioners =
35% phosphoric acid pH=0
Most dentin bonding systems have ____ that remove the smear layer and partially demineralize the intertubular dentin
acid conditioners
Dentin without a smear layer provides a good area for:
micro mechanical retention
What is the the pH or acid primers? Give an example:
pH= 2.5 (HEMA)
Acid primers do not remove the:
smear layer
What removes the smear layer? Acid primers or acid conditioners?
acid conditioners
Resin bonding to ____ can last for many years, however the strength of resin bonding to ____ haas a limited life span
enamel; dentin
How does resin bonding to dentin have a limited lifespan?
due to deteriorating of the hybrid layer
Often the bond of restorations that rely exclusively on resin bonding to dentin will be severely weakened after about:
four years
Regardless of if etching to dentin or not, the enamel:
MUST be etched with 35% phos[horic acid, with total-etch or self etch
Adhesive bone strengths to ____ dentin are greater than those for ____ dentin
superficial; deep
dentin with more tubules:
deep dentin
Dentin with the larger diameter of tubules
deep dentin
Deep dentin has a ____ amount of intertubular dentin in deep areas
reduced amount
_____ dentin is more permeable than ____ dentin
deep; superficial
The defensive function of the pulp is related to:
its response to irritation by mechanical, thermal, chemical, or bacterial stimuli
Why might the inflammation of pulp become irreversible leading to death?
Because the confined rigid structure of the dentin limits the inflammatory response
The size of the pulp cavity ____ with age
decreases
What are more reparative? Younger or older pulps?
younger
a primary objective during operative procedures must be the ____. All _____ except in the event of an indirect pulp cap.
preservation of the health of the pulp; caries must be removed
Usually manifests as cold sensitivity, and sometimes spontaneous pain, in the maxillary posterior teeth. Often hard to isolate to a single tooth:
maxillary sinusitis
Usually manifests as cold sensitivity or a sudden, usually unreproducible pain when chewing. Can be evaluated with a tooth sleuth, or fiber optic light. These teeth require crowning:
Cracked tooth
Usually manifests as cold sensitivity, or pain in chewing. slight tooth movements when the teeth are clenched and then moved from side to side may be seen, but not always. This is called fremitis. Pain can often be relieved by occlusal adjustments
occlusal trauma
slight tooth movements when the teeth are clenched and then moved from side to side may be seen, but not always
fremitis (seen with occlusal trauma)
Cementum is slightly softer than dentin and consists of about ____ to ___% of inorganic material by weight
45-50%
What has the highest fluoride content of all the mineralized tissues:
cementum
In about 10% of teeth, enamel and cementum do not meet and this can result in:
a sensitive area
Regarding tooth contours, ____ is the WORST and results in flabby red-colored, chronically inflamed gingiva and increased plaque retention.
___ results in trauma to the gingival tissues:
overcontouring
undercontouring
Where are proximal contacts located in max and mand central incisors?
incisal third
Where is the proximal contacts in teeth posteriorly to the central incisors?
junction of occlusal and middle third (creates larger occlusal embrasure)
Marginal ridges should be the same height to prevent:
food impaction
Proximal contacts are sightly ____ to the center of the proximal surface FL
slightly facial
Regarding periodontal concerns, what is extremely important to important to preserve in the restorative process?
attached keratinize tissue
t/f: If recurrent caries extends gingivially n the box area, it is acceptable and preferable to have a “box within a box” rather than deepening the entire bo gingival unless caries require it
true
Liners should be added to the:
deepest parts of the preparation close to the pulp
Keep liners away from:
margins of the restoration
Liner materials are ____
Brand names are ____
calcium hydroxide (dycal & life)
resin modified glass ionomer (vitrebond)
What type of liner is used on the deepest preps (and is a pulp capping material)
CaOH (life or dycal)
What type of liner is light cured?
RMGI (vitrebond)
What type of liner releases fluoride over time?
RMGI (vitrebond)
Restorations should be supported by atleast:
a tripod of natural structure
DO NOT have the entire floor the restoration covered by ____. Why?
calcium hydroxide (CaOH is too soft to support the restoration)
