Restoring Large and in charge (Annie) restorations

Question 1

An extremely sensitive part of the tooth, where enamel and dentin meet:

Answer 1

DEJ

Question 2

Dentinal tubules are filled with ____ and wrapped in ____

Answer 2

odontoblastic processes; afferent nerves & dentinal fluid

Question 3

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

Answer 3

external seal of dentin

Question 4

Refer to a mike the situation when one tooth or multiple teeth at the same appointment are treated quickly by:

1. removing the infected dentin
2. medicating the pulp, if necessary
3. restoring the defects with a temporary material

Answer 4

caries control restorations

Question 5

T/F: according to caries control restorations, undermined enamel can be left to better retain the temporary material:

Answer 5

true

Question 6

What are the steps to caries control restorations?

Answer 6

1. removing the infected dentin
2. medicating the pulp (if necessary)
3. restoring the defects with a temporary material

Question 7

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)

Answer 7

indirect pulp cap

Question 8

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

Answer 8

asymptomatic; reversible pulpitis

Question 9

T/F: Caries is typically less extensive than the radiograph shows

Answer 9

false- usually deeper than appears on radiograph

Question 10

The objective of an indirect pulp cap is to:

Answer 10

AVOID A PULP EXPSOURE

Question 11

A liner may be added to the:

Answer 11

deepest parts of a prep, closest to the pulp

Question 12

When using a liner, the liner material should be kept away from:

Answer 12

away from the margin

Question 13

Liner materials include:

Answer 13

1. calcium hydroxide
2. resin modified glass ionomer

Question 14

Brand names for calcium hydroxide liners:

Answer 14

Life & Dycal

Question 15

Indications for calcium hydroxide liners (Life & Dycal)

Answer 15

use on deepest preps- pulp capping material

Question 16

Brand name for resin modified glass ionomer:

Answer 16

Vitrebond

Question 17

Vitrebond must be ____ and releases ____ over time

Answer 17

light cured; fluoride

Question 18

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:

Answer 18

a pulp exposure

Question 19

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:

1. Remove:
2. Leave:

Answer 19

1. Remove- all caries, both affected and infected dentin from all areas EXCEPT the deepest, close to the pulp
2. Leave- the last little bit of infected dentin, cover it with calcium hydroxide (dycal or life) and glass ionomer (vitrebond)

Question 20

T/F: With the two appointment approach for indirect pulp capping, some infected dentin (closest to pulp) can be left

Answer 20

True

Question 21

T/F: With the two appointment approach for indirect pulp capping, affected dentin is left while infected dentin is removed

Answer 21

False- both are removed except for the last little bit of infected dentin closest to pulp

Question 22

T/F: with the two appointment approach for indirect pulp capping, either dycal/life or vitrebond is used:

Answer 22

False- both are used (Liner and RMGI)

Question 23

After placing liner and RMGI with the two appointment approach to indirect pulp capping, place:

Answer 23

a temporary restoration such as IRM or ketac silver

Question 24

According to the two appointment approach to indirect pulp capping, it is okay to:

Answer 24

leave some underlined enamel TEMPORARILY to help col dn the temporary restoration

Question 25

How long should you wait between the first and second appointment with the two appoint approach to indirect pulp capping:

Answer 25

several weeks (perhaps 12)

Question 26

With two appoint approach to indirect pulp capping, why should you wait several to twelve weeks between the first and second appointment?

Answer 26

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

Question 27

What is the desired result for waiting the several weeks between appointments with the two appoint approach to indirect pulp capping:

Answer 27

dentin bridge formation (fingies crossed)

Question 28

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

Answer 28

asymptomatic; vitality test

Question 29

With the two appointment approach to indirect pulp capping, the tradition approach following the 12 weeks and confirming asymptomatic patient is:

Answer 29

1. remove the temp restoration, glass ionomer, and CaOH 2. carefully remove remaining infected dentin 3. leave affected dentin 4. place new liner of dycal and if desired, place vitrebond 5. remove all undermined enamel & modify prep 6. restore with permanent material

Question 30

Soft, leathery caries=

Answer 30

infected dentin

Question 31

dry, powdery caries

Answer 31

affected dentin

Question 32

Is affected dentin invaded by microorganisms?

Answer 32

no

Question 33

What is the more common approach for indirect pulp capping?

Answer 33

single appointment approach

Question 34

Used when a small pulpal exposure occurs during cavity preparation:

Answer 34

direct pulp cap

Question 35

For a direct pulp cap, a thin layer of ____ is floated over the exposed pulp. A layer of ____ is placed over that.

Answer 35

calcium hydroxide; glass ionomer

Question 36

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.

Answer 36

secondary odontoblasts; dentin bridge

Question 37

With a direct pulp cap, it is most successful when the exposure is _____ rather than ____

Answer 37

mechanical; carious

Question 38

Direct pulp caps work better at the ____ than they do on an exposure on the ___

Answer 38

tips of pulp horns; side of a pulp chamber

Question 39

If the tooth will require a crown to adequately restore it, DO NOT RELY ON:

Answer 39

direct pulp cap

Question 40

Whether you are doing an indirect of direct pulp cap, temporary, or "permanent" restoration:

Answer 40

SEAL THE CAVITY

Question 41

When is a smear layer created?

Answer 41

whenever the dentin has been cut

Question 42

The smear layer is a few micrometers thick and is composed of:

Answer 42

denatured collagen, hydroxyapatite, and other cutting debris

Question 43

The smear layer acts like a natural bandage over the cut surface since it occludes many dentinal tubules with debris called:

Answer 43

smear plugs

Question 44

When using "total etch" systems, we do not want to:

Answer 44

bond t the smear layer

Question 45

Acid conditioners =

Answer 45

35% phosphoric acid pH=0

Question 46

Most dentin bonding systems have ____ that remove the smear layer and partially demineralize the intertubular dentin

Answer 46

acid conditioners

Question 47

Dentin without a smear layer provides a good area for:

Answer 47

micro mechanical retention

Question 48

What is the the pH or acid primers? Give an example:

Answer 48

pH= 2.5 (HEMA)

Question 49

Acid primers do not remove the:

Answer 49

smear layer

Question 50

What removes the smear layer? Acid primers or acid conditioners?

Answer 50

acid conditioners

Question 51

Resin bonding to ____ can last for many years, however the strength of resin bonding to ____ haas a limited life span

Answer 51

enamel; dentin

Question 52

How does resin bonding to dentin have a limited lifespan?

Answer 52

due to deteriorating of the hybrid layer

Question 53

Often the bond of restorations that rely exclusively on resin bonding to dentin will be severely weakened after about:

Answer 53

four years

Question 54

Regardless of if etching to dentin or not, the enamel:

Answer 54

MUST be etched with 35% phos[horic acid, with total-etch or self etch

Question 55

Adhesive bone strengths to ____ dentin are greater than those for ____ dentin

Answer 55

superficial; deep

Question 56

dentin with more tubules:

Answer 56

deep dentin

Question 57

Dentin with the larger diameter of tubules

Answer 57

deep dentin

Question 58

Deep dentin has a ____ amount of intertubular dentin in deep areas

Answer 58

reduced amount

Question 59

_____ dentin is more permeable than ____ dentin

Answer 59

deep; superficial

Question 60

The defensive function of the pulp is related to:

Answer 60

its response to irritation by mechanical, thermal, chemical, or bacterial stimuli

Question 61

Why might the inflammation of pulp become irreversible leading to death?

Answer 61

Because the confined rigid structure of the dentin limits the inflammatory response

Question 62

The size of the pulp cavity ____ with age

Answer 62

decreases

Question 63

What are more reparative? Younger or older pulps?

Answer 63

younger

Question 64

a primary objective during operative procedures must be the ____. All _____ except in the event of an indirect pulp cap.

Answer 64

preservation of the health of the pulp; caries must be removed

Question 65

Usually manifests as cold sensitivity, and sometimes spontaneous pain, in the maxillary posterior teeth. Often hard to isolate to a single tooth:

Answer 65

maxillary sinusitis

Question 66

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:

Answer 66

Cracked tooth

Question 67

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

Answer 67

occlusal trauma

Question 68

slight tooth movements when the teeth are clenched and then moved from side to side may be seen, but not always

Answer 68

fremitis (seen with occlusal trauma)

Question 69

Cementum is slightly softer than dentin and consists of about ____ to ___% of inorganic material by weight

Answer 69

45-50%

Question 70

What has the highest fluoride content of all the mineralized tissues:

Answer 70

cementum

Question 71

In about 10% of teeth, enamel and cementum do not meet and this can result in:

Answer 71

a sensitive area

Question 72

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:

Answer 72

overcontouring undercontouring

Question 73

Where are proximal contacts located in max and mand central incisors?

Answer 73

incisal third

Question 74

Where is the proximal contacts in teeth posteriorly to the central incisors?

Answer 74

junction of occlusal and middle third (creates larger occlusal embrasure)

Question 75

Marginal ridges should be the same height to prevent:

Answer 75

food impaction

Question 76

Proximal contacts are sightly ____ to the center of the proximal surface FL

Answer 76

slightly facial

Question 77

Regarding periodontal concerns, what is extremely important to important to preserve in the restorative process?

Answer 77

attached keratinize tissue

Question 78

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

Answer 78

true

Question 79

Liners should be added to the:

Answer 79

deepest parts of the preparation close to the pulp

Question 80

Keep liners away from:

Answer 80

margins of the restoration

Question 81

Liner materials are ____ Brand names are ____

Answer 81

calcium hydroxide (dycal & life) resin modified glass ionomer (vitrebond)

Question 82

What type of liner is used on the deepest preps (and is a pulp capping material)

Answer 82

CaOH (life or dycal)

Question 83

What type of liner is light cured?

Answer 83

RMGI (vitrebond)

Question 84

What type of liner releases fluoride over time?

Answer 84

RMGI (vitrebond)

Question 85

Restorations should be supported by atleast:

Answer 85

a tripod of natural structure

Question 86

DO NOT have the entire floor the restoration covered by ____. Why?

Answer 86

calcium hydroxide (CaOH is too soft to support the restoration)