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revision Flashcards

1
Q

Dental adhesives:

Components:

A 
resin monomers
initiator system
solvent 
fillers
inhibitors
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2
Q

Dental adhesives:

Classified by:
Types of adhesive systems:

A

Classified by:

  • generation
  • adhesion
  • combination

Types of adhesive systems:
Etch-and-rinse
Self-etch

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3
Q

Dental adhesives:
resin monomers:
forms and categories:

A
  • hydrophilic in nature
  • main component in adhesive systems and resin based composites

liquid form when placed in adhesive mixture
hard form after photopolymerization

2 categories:

  • > functional (hydrophilic)
  • contain a functional group that enhances wetting/demineralization of dentin
  • > cross linker
  • resists hydrolytic degradation
  • interlocking with this
  • better mechanical properties
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4
Q

Dental adhesives:
solvent:
ex:
functions:

A

Needs appropriate storage and handling otherwise restorations will fail
-> close the DBA bottle cause the solvent evaporates fast

ex: ethanol, water, acetone

Functions:

  • > eliminates water molecules prior to curing of resin adhesive, without collapse of collagen fibrils
  • > facilitate penetration of hydrophilic, small molecule resin monomers into the collagen meshwork of demineralized dentin
  • > dissolves and reduces viscosity of monomers which results in simplifying transportation of monomers into demineralized collagen fibrils
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5
Q

Dental adhesives:
Fillers:
Functions:

A

-not always in dental adhesives

Functions:

  • in low amounts they are used to increase mechanical properties
  • prevent over-thinning of adhesive layer
  • reduce shrinkage stress (produced during curing)
  • provide radio-opacity
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6
Q

Dental adhesives:

initiator types:

A

photo-initiator (ex: camphorquinone (cq))

chemical-initiator

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7
Q

Dental adhesives:

ADV:
DISADV:

A

ADV:

  • more conservative tooth preps
  • antibacterial properties -> may prevent recurrent caries
  • can treat root sensitivity
  • increased R to recurrent caries
  • increased R to caries in sealed fissure systems of posteriors
  • reliable micromechanical retention to etch enamel w/o macro-retention features
  • reinforcement of residual tooth structure
  • stronger retention and increased R of glass matrix ceramic restorations fracture
  • stable chemical adhesion to hydroxyapatite
  • retain wide range of restorative materials
  • expanded across different dental disciplines, not only operative dentistry

DISADV:

  • marginal bacterial leakage
  • post-operative sensitivity
  • pulp inflammation or pulp necrosis
  • enamel cracks
  • moisture contamination
  • contact dermatitis
  • open contacts in posterior resin restorations
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8
Q

Dental adhesives:

generations:

A 
1st generation -> 2 steps -> 2 components -> enamel etch
2nd -> 2 -> 2 -> enamel etch
3rd -> 3 -> 2-3 -> dentin
4th -> 3 -> 3 -> total etch
5th -> 2 -> 2 -> total etch
6th -> 1 -> 2 -> self-adhesive
7th -> 1 -> 1 -> self-adhesive
8th -> 1 -> 1 -> self-adhesive

4th generation uses 3 step E+R (so we use a separate step for etch and then rinse it off before applying primer and adhesive)
5th generation 2 step E+R (primer and adhesive are combined together)
6th generation 2 step SE (etch and primer are combined together)
7th generation 1 step SE (all in one bottle)

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9
Q

Resin based restorative materials:

ADV:
DISADV:

A

ADV:

  • aesthetic appearance (main ADV over AMG)
  • more conservative prep
  • non-toxic -> no Hg release
DISADV:
higher chance of:
-fracture and failure of large restorations
-secondary caries
-marginal deficiencies
-wear
-post-operative sensitivity
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10
Q

Composite resins components:

A

3 organic components: resin matrix, silane coupling agent, initiator
Inorganic component: filler
-contain also inhibitors and pigments

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11
Q

Why we need to light-polymerize the bonding agent before the application of dental adhesives?

A

1) To obtain proper mechanical properties of adhesive

2) To ensure production of a thin layer of adhesive prior to composite application

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12
Q

How does polymerization occur?

A

CQ absorbs light and causes activation of amine co-initiators that produce free radicals

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13
Q

Hydrolytic degradation of hybrid layer components includes:

A

adhesives, collagen

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14
Q

Main goal of adhesive material is to achieve:

A

Tight and durable adaptation of restorative material to tooth structure

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15
Q

Enamel:

A
  • densely mineralized
  • brittle but hard
  • not resilient
  • dried
  • the ideal substrate to form a tight adhesive joint
  • micromechanical bonding (seals the restorative margins against leakage)
  • more inorganic than dentin
  • hydroxyapatite crystals: LARGER, more regular and arranged parallelly in enamel rods (92%)
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16
Q

Dentin:

A
  • less brittle
  • resilient
  • similar at the nanostructural level to the bone (bone-like nanocomposite built of carbonated hydroxyapatite mineral particles, protein and water)
  • COMPLEX BIOCOMPOSITE STRUCTURE
  • humid (more water) and more organic than enamel (less inorganic than enamel)
  • hydroxyapatite crystals: smaller and arranged in crisscross pattern in organic matrix
  • no micromechanical interlocking (unlike enamel)
  • dentin aging/carious lesion/aggressive stimuli cause physiological changes (ex: increase mineralization, dentin thickness and reduce permeability)
  • reduction of permeability with age has a direct effect on dentin bond strengths, as dentin permeability affects the adhesion process
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17
Q

ETCH AND RINSE ADHESIVES:

ADV:
DISADV:

A

ADV:

  • long track record (3-step ER)
  • high immediate bond strength to enamel and dentin
  • excellent bonding to enamel
  • minor contamination with saliva doesn’t always decrease bond strength
  • excellent results of clinical studies for 3 step ER
  • ability to bond composite, porcelain, fiber posts, amalgam and etched or sandblasted metals

DISADV:

  • acetone based adhesives need more applications than those recommended by manufacturers
  • over-etching decreases bond strength
  • more technique sensitive (than SE)
  • 2 step ER undergoes degradation faster than 3 step ER
  • bond strengths can VARY depending ON MOISTURE DEGREE
  • more incidences of post-operative sensitivity with posterior composite restorations
  • insufficient solvent air-drying recommended by manufacturers
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18
Q

SELF-ETCH ADHESIVES:

ADV:
DISADV:

A

ADV:

  • long track record (2 step SE)
  • EASY to apply (no etch or rinse)
  • can be used with selective enamel etching
  • contain hydrophobic bonding resin which PREVENTS DEGRADATION of resin-dentin interface
  • less technique sensitive

DISADV:

  • acidic primer not as acidic as phosphoric acid
  • 1 step SE need more applications than those recommended by manufacturers
  • 1 step SE can cause enamel leakage
  • residual water may become entrapped if not properly evaporated which results in nanoleakage
  • 1 step SE (HEMA-free) may compromise DURABILITY of enamel bonding
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19
Q

Bonding agents:

Components:

A

Etch -> to remove minerals, inorganic components (ex: hydroxyapatite in both enamel and dentin, leaving in dentin collagen fibers)

Primer -> contains solvent and monomer and attaches adhesive to tooth

Adhesive

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20
Q

components of resins:

Fillers:

Silane coupling agent:

Initiator:

A

Fillers:
enhance the strength and modulus of organic resin matrix

Silane coupling agent:
enhances tensile strength and bond strength of resin composite

Initiator:
polymerizes and crosslinks the composite into a hard form
->polymerization rxn can be triggered by light, chemicals or both

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21
Q

widely used monomer to construct composites:

A

Bis-GMA

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22
Q

Macrofilled self-cured composites DISADV:

A
  • not used for posteriors bc of low wear R properties

- hand mixing

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23
Q

Composite modifications:

A

(a) curing modification
(b) filler modification
(c) resin modification

  • macro
  • micro
  • hybrid
  • universal
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24
Q

Microfilled composites – ADV:

A

higher polish ability and better color stability

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25
Q

Hybrid composites

ADV:
DISADV:

A

= combination of macro- and microfilled composites
ADV:
-improved wear R
-favorable mechanical and optical properties
DISADV:
esthetic

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26
Q

Universal composites:
ADV:
uses:

A

ADV:

  • improved wear R
  • improved mechanical properties
  • maintain good polishability
  • esthetic properties of microfilled composites

-used for both anteriors and posteriors

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27
Q

Classes of composites depending on consistency:

A

a) flowable

b) packable

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28
Q

flowable composites

ADV:
DISADV:
uses:

A

ADV:
-better adaptation in deep or undercut areas of cavity

DISADV:
-lower mechanical properties

uses:
cavity lining
small restorations
load free areas (class V)
restoration repairs
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29
Q

Failures due to improper light curing:

A
  • time of light polymerization
  • amount of energy delivered
  • > improper position of light tip
  • > thickness of resin
  • > movement of light tip amid curing
  • > separation of light tip from resin
  • > shade and type of resin
  • > state of light curing unit
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30
Q

Consequences of polymerization shrinkage stress:

A
  • > is critical as a result of its impact on cavosurface edges
  • > marginal gap
  • > incremental filling techniques have been recommended due to this polymerization shrinkage
  • post-operative sensitivity
  • marginal staining
  • recurrent caries
  • eventual loss of restoration
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31
Q

Reducing the volume of composite that is polymerized at each stage of the restorative procedure:

A
  • minimizes shrinkage

- maximizes the conversion conversion of monomers to polymer

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32
Q

Pre-warming of composites:

A
  • increases composite flow
  • marginal adaptation
  • monomer conversion
  • decreases system viscosity
  • enhances radical mobility
  • additional polymerization
  • higher conversion
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33
Q

Factors influencing secondary caries:

A

1) caries risk factors
- saliva
- diet
- fluorides

2) restorative material
- placement technique
- surface properties and plaque accumulation
- bonding to tooth
- biodegradation
- antibacterial and buffering effect

3) restoration
- gaps and overhangs
- location
- size
- class

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34
Q

Posterior composite restoration – class ii success depends on which factors?

A
  • patient selection/characteristics
  • > high caries risk pts have 2x more failure rate than low caries risk pts
  • > take in consideration the caries status of pt and adjust recommendations for restorative materials accordingly
  • tooth prep
  • > composite prep is more conservative
  • > as the no of restored surfaces increases, the risk of restoration failure increases
  • > tooth position influences the clinical performance and longevity of restoration (P lower failures than M)
  • matrix use
  • > reproduces good proximal contact, which minimizes food impaction and maintains healthy periodontal tissues
  • > poorly done: open margin -> penetration of liquids

-composite composition-dentin bonding

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35
Q

C-factor:

A

= cavity - configuration factor

  • ratio of bonded SA to non-bonded SA (needs to decrease)
  • the higher it is the less chance for relaxation of polymerization shrinkage
  • decreases bond strength
  • we want it low
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36
Q

Why do premolars show less failures than molars?

A

bc the masticatory forces and stresses placed on Molar restorations are higher than those placed in Premolars

The position of tooth influences the clinical performance and longevity of restoration

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37
Q

Correct Matrix use/type:

A
  • you create a good proximal contact which helps:
  • minimize food impaction
  • maintain healthy perio tissues
  • avoid open margin (oral fluids go through)
  • avoid marginal leakage -> most common reason for composite restoration failure
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38
Q

Improper isolation causes:

A
  • decreased bond strength

- decreased physical and mechanical properties of composite restoration

39
Q

self etch
Vs
etch and rinse

difference in etching:

A

self etch:

selective etching on enamel only for 15’’

40
Q

bioactive restorative materials:

=

A

= elicit a response from living tissues/organisms/cells

  • > ex: induce formation of hydroxyapatite
  • macrofilled composites
  • exhibit capacity to release bioactive agents
41
Q

Inlay prep steps:

A
  • 1,5 mm depth
  • 2,5 mm depth
  • Stop 1 mm from the nearest occlusal contacts
  • Dovetail in the facial groove to enhance R+R
  • Flat pulpal floor; perpendicular to path of insertion
  • Proximal box: 1-2 mm supragingival
  • Enamel hatchet to break undermined tooth structure
  • Extend the box B and L where it will break contact with adjacent tooth
  • Widen the isthmus where it joins the proximal box
  • Proximal flare: cut equally B and L wall of the box and the outer surface of the tooth (gingiva: narrow, occlusal end: wider)
  • Gingival beveling of 30-45 degrees to provide strength and marginal fit (flame bur for bevel)
  • Occlusal beveling of 10-20 degrees at the junction of occlusal 1/3 and pulpal 2/3 of isthmus wall
42
Q

Onlay prep steps:

A
  • Functional cusp: 1,5 mm
  • Non-functional cusp: 1 mm
  • Facio-occlusal line angle: 0,5 mm
  • Functional cusp beveling of 1.5 mm
  • Occlusal shoulder finish line: 1 mm
  • Lingual occlusal chamfer/shoulder finish line
  • Isthmus: 1 mm shallower than inlay
  • Proximal box should break contact with the adjacent tooth mesially
  • Gingival floor: 1 mm
  • Facial walls: diverge occlusally, Axial walls: converge occlusally
  • Once proximal boxes are finished, flares are added
  • Gingival bevel 0,5-0,7 mm
  • Facial occlusal bevel 0,5 mm
  • Lingual occlusal bevel of 0,5 mm on the occlusal shoulder
43
Q

cariogram:

A 
green: chance to avoid new cavities
dark blue: diet
red: bacteria
light blue: susceptibility
yellow: circumstances
44
Q

PHTEN:

A 
P: purpose
H: health
T: treatment
E: evaluation
N: next
45
Q

radiographic examination - notes:

A
  • type of x-ray
  • quality of x-ray
  • bone levels
  • findings
  • justification
46
Q

main reason for bonded partial ceramic crown failure:

A

fracture

47
Q

when does the susceptibility of ceramic inlay fractures increases?

A

when the cavity angle is increased by 5 -> 10 -> 20 degrees

48
Q

a large internal cement space can cause:

A
  • a higher polymerization shrinkage of luting cement

- less optimal support to ceramic restoration

49
Q

non retentive Vs retentive preparation design for partial ceramic crowns:

A

a non retentive design increases the internal adaptation and marginal fit

  • > the easier the restoration to be positioned on prepared tooth surface
  • > the easier the cement will flow during seating and cementation
  • > the more precise the occlusion
50
Q

Conventional cements:
indications:

Vs

Adhesive cements:
types:
properties:
indications:

A

Conventional cements:
– Retentive conventional castings such as pfm and bridges or metal inlays/onlays
– Retentive tooth colored restorations that is indicated to be conventionally cemented (e.g. Zirconium oxide)
– METAL prefabricated or cast posts

Adhesive cements:
types:
1. self etching resin cements
2. resin cements:
-10-MDP
-higher strength
-types: dual, dual, light cure
-bonding agent is required
– More technique sensitive
– More difficult to use
– More difficult to clean up
– More expensive
– More time consuming

– All ceramic restorations that require adhesive bonding (e.g. feldspathic porcelain veneers, inlays/onlays)
– Non retentive conventional castings (e.g. PFM crowns)
– Resin bonded bridges
– Non retentive natural tooth colored restorations (e.g. Zirconium oxide or lithium disilicate crowns)
– Posts of any type

51
Q

conventional cements and their properties:

A 
Zinc phosphate cement:
• Very long successful track record
• Low film thickness
• Easy cleanup of excess cement
• Good working time

Zinc polycarboxylate cement:
• Considered more biocompatible
• Not very strong
• More difficult to use than Zinc Phosphate
• Thicker consistency during mixing
• Low working time
• More difficult to clean up than zinc phosphate

Glass ionomer cement:
• Biocompatible
• Chemical bonding to dentin
• Fluoride release
• Stronger than zinc phosphate and zinc
polycarboxylate
• Should be protected from water for at least 10 min

Resin modified glass ionomer cement:
• May be less soluble and stronger than GIC
• Can be light cured

52
Q

Self-Etch Approach

A
  • No etching and no rinsing
  • Smear layer is not removed
  • More superficial interaction with dentin
  • Etching of enamel is not adequate
53
Q

Porcelain/Composite:

Metal:

A

microetching, HF-, Silane primer, Resin cement

microetching, metal primer, resin cement

54
Q

caries categories:

A

sound surface:

  • no visible caries
  • icdas 0

initial stage caries:

  • white spot lesion or brown discoloration
  • icdas 1 and 2

moderate stage caries:

  • brown spot lesion
  • localized enamel breakdown w/o dentin exposure
  • > icdas iii
  • underlying dentin shadow
  • > icdas iv

extensive stage caries:

  • distinct cavity in opaque or discolored enamel with visible dentin
  • icdas v and vi
  • a WHO probe can confirm cavity extending into dentin
55
Q

radiographic scoring system - ICDAS:

R0
R1
R2
R3
R4
R5
R6
A

R0 - no radiolucency

initial:
R1 - radiolucency in outer 1/2 of enamel
R2 - radiolucency in inner 1/2 of enamel
R3 - radiolucency in outer 1/3 of dentin

moderate:
R4 - radiolucency in middle 1/3 of dentin

extensive:
-clinically cavitated
-dentin is soft or leathery on gentle probing
R5 - radiolucency in inner 1/3 of dentin
R6 - radiolucency in pulp
56
Q

signs:

active:
initial/moderate:
severe:

Vs
inactive:
initial/moderate:
severe:

A

active:
initial/moderate:
-enamel is whitish/yellowish, opaque, rough and matted on probing
-lesion covered by thick plaque prior to cleaning
severe:
-dentin is soft/leathery on gentle probing

inactive (arrested):
initial/moderate:
-enamel is whitish/brownish, shiny and smooth on probe
severe:
-dentin the same

-> you need to air-dry the tooth to check the lesion

57
Q

ICDAS codes:

0
1
2
3
4
5
6
A

0

  • sound tooth
  • no tx

1

  • first visual change in enamel
  • F, OHI, debridement, icon, sealants

2

  • distinct visual change in enamel
  • F, OHI, debridement, icon, sealants

3

  • localized enamel breakdown
  • PRR and F, OHI, debridement, icon
  • depends on caries risk assessment

4

  • dentin shadow
  • conservative tooth prep

5

  • distinct cavity less than half of the tooth, with visible dentin
  • restoration with filling

6

  • extensive distinct cavity more than half of the tooth with visible dentin
  • restoration with filling or crown
  • > caries risk assessment
  • > x-rays
58
Q

single tooth isolation:

multiple tooth isolation:

isolation for class v restorations - subgingival lesion:

general rule:

A 
single tooth isolation:
class i
class v
sealants
RCT

multiple tooth isolation:
class ii
multiple restoration and quadrant
bonding indirect restorations

isolation for class v restorations - subgingival lesion:
retraction cord

general rule:
1 posterior and 2 anteriors

59
Q

part of the old restorative material can be left in the tooth if:

A
  • recurrent caries
  • asymptomatic tooth
  • base and liner periphery are intact
60
Q

enamel beveling is required when:

A
  • aesthetics
  • increase SA
  • better bonding
61
Q 
class iii
access if always lingual unless:
A
  • facial caries extension
  • teeth are not straight and access is not possible
  • too much removal of sound tooth structure will be needed
  • old restoration extends facially
62
Q

class ii - most difficult task to achieve:

A

tight proximal contact

63
Q

selective caries removal:

A

small to moderate:
-removal until firm dentin (affected dentin)

moderate to large:

  • removal until soft dentin (infected dentin)
  • soft caries left over the pulp to avoid pulp exposure
64
Q

pulp protection - bases and liners:

ex:
functions:

A

ex: MTA, Ca(OH)2, Biodentine

functions:

  • protective physical and thermal barrier to the pulp
  • allow healing and repair
  • reduction of configuration factor (C-factor)
  • reduction of shrinkage stress
65
Q

indirect pulp capping:

tx for remaining dentin thickness:
2 mm
1-2 mm
0.5 mm

A

2 mm
-no tx, proceed with composite only

1-2 mm
-GIC or RMGIC

  1. 5 mm
    - Ca(OH)2 and then GIC or RMGIC
66
Q

direct pulp capping:

A
  • wash cavity with sterile saline
  • control the hemorrhage
  • once bleeding stops
  • place MTA/Ca(OH)2
  • then place GIC/RMGIC
  • proceed with restoration

->if bleeding doesn’t stop: RCT

67
Q

post-operative instructions after amg restoration:

A
  • wait until anesthesia wears off
  • pt may experience post-operative sensitivity to hot or cold for a few days
  • pt should not chew on the side of the new restoration for at least 12hrs
  • pt should not chew anything for at least 2hrs
68
Q

best to worst dentin bonding agents:

A
  1. 2 step SE
    - > etch enamel only, primer bottle, dry, bond bottle, dry, lc
  2. 3 step E+R
    - > etch, primer a and b mix, dry, bond, lc
  3. 1 step SE
  4. 2 step E+R
    - > clinics
69
Q

ideal properties of bonding agent:

A
  • low technique sensitivity
  • strong enamel acid etching w/ H3PO4
  • mild dentin self-etching, for self-etching bonding agents
  • to have final hydrophobic layer
  • not to be acidic after light curing to avoid hydrophilicity
  • to be dual cure
  • to contain the powerful monomer 10-MDP
70
Q

2 step self-etch steps:

A

-etch ONLY enamel for 30’’
-rinse for 10’’
-dry (not totally)
-PRIMER BOTTLE: primer added to the entire cavity with a microbrush - as well as dentin
-dry (gently and not totally)
BOND BOTTLE: bond added to the entire cavity with a microbrush
-dry (not totally)
-light cure for 20’’
-restoration

71
Q

3 step etch and rinse steps:

A
  • etch enamel for 30’’ and dentin for 15’’ w/ H3PO4
  • rinse
  • dry (not totally)
  • mix primers A and B and apply them
  • dry
  • bond applied on enamel and dentin
  • light cure for 20’’
  • restoration
72
Q

2 step etch and rinse steps:

A
  • etch enamel for 30’’ and dentin for 15’’ w/ H3PO4
  • rinse
  • dry (not totally)
  • apply bond in 2 layers
  • dry
  • light cure for 20’’
  • restoration
73
Q

sealant placement steps:

A
  • isolation with rubber dam
  • clean occlusal surface
  • wash and dry surface
  • etch w/ H3PO4 for 30’’
  • rinse for 10’’
  • dry
  • optional for bonding
  • flowable composite
  • explorer
  • light cure for 40’’
  • check occlusion with articulating paper

-> for PRR use bonding agent, dry (leave moist) and then LC for 20’’

74
Q

enameloplasty for aesthetics:

A
  • always w/o anesthesia

- at the 1st sign of pain you stop to avoid sensitivity and need restoration later

75
Q

air abrasion:

indications:

A

indications:

  • stain removal
  • debriding pits and fissures before sealing
  • micromechanical roughening of surfaces to be bonded
  • repair to more aggressive procedures like tooth prep
  • > to excavate caries
  • > pain free
  • > no drill
  • > no contact preparation method
76
Q

gold onlay rules:

A
  • no undercuts
  • sharp angles to be avoided to prevent stress and crack propagation through the restoration
  • accessibility of subgingival margins
  • absence of contact b/w cavity and adjacent teeth
  • adequate interocclusal space in centric and during lateral movements
  • tooth prep to remain in enamel where possible
  • sufficient thickness for technical construction
  • smooth transition b/w tooth prep and restoration
  • restoration margins not to be under occlusal load
  • detailed sharp margins
77
Q

ceramic onlay rules:

A
  • no sharp edges or corners
  • adequate sharp margins
  • adequate uniform thickness of restoration
  • simple cavity design w/ basic geometry
  • avoid high tensile stress
  • avoid stress peaks and sudden changes in cross-section
  • minimize notch stresses
  • make as large as possible contact surface with ceramic restoration
  • enamel bordered restoration margins facilitate a stable and adhesive bond of ceramic restoration
78
Q

gold onlay Vs ceramic onlay:

A 
gold onlay:
ADV:
-biocompatible
-rare allergies
-soft material so kind to opposing teeth
-long term longevity (more survival time than ceramic)
-easy to work with
-wide range of indications
DISADV:
-expensive
-poor aesthetics
Ceramic onlay:
ADV:
-biocompatible
-wear R
-cheaper than gold
-aesthetics
DISADV:
-more likely to have allergies than gold
-less survival time than gold
79
Q

Indications for onlays and inlays:

A
  • post endo restoration -> RCTed teeth
  • to correct occlusal plane of a tilted tooth
  • broken down teeth with intact B and L cusps
  • MOD restorations with wide isthmus
  • teeth with risk of fracture
80
Q

partial crowns Vs crowns:

A

partial crowns:

  • better perio health
  • preserves of tooth structure
  • less endo complications
  • better bonding
81
Q

Biomechanical reasons that a heavily restored M1 can break:

A
  • unsupported cusps
  • insufficient or excessive beveling
  • heavy occlusal forces
  • bad prep design
82
Q

Carious dentin zones:

A

soft (infected)

  • cannot self repair
  • easily excavated with hand and rotary instruments
  • irreversibly denatured collagen
  • severe bacterial contamination

leathery:
-transition from soft to firm

firm (affected)

  • demineralization
  • collagen intact
  • R to hand excavation

hard

  • includes: 3ry, sclerotic, normal dentin
  • removed only with burs or sharp cutting instruments
83
Q

Composite:
indications:
contraindications:

A

indications:

  • class I, II, III, IV, V restorations
  • core build ups
  • sealants or PRR
  • esthetic restorations
  • temporary restorations
  • veneers

contraindications:

  • no moisture control
  • high caries risk
  • poor OH
  • uncompliant patient
  • heavy occlusal contacts restorations
84
Q

Amalgam:
indications:
contraindications:

A

indications:

  • patient with mental disabilities
  • core build up
  • posterior restorations
  • no moisture control
  • class II and V
  • pin retained restorations
  • heavy occlusal contacts restorations
  • large amount of tooth structure missing

contraindications:

  • anterior restorations
  • class I, III, IV anterior
  • small restorations
85
Q

Proximal contacts – importance:

A
  • prevent food impaction
  • protect soft tissue from perio disease
  • premature restoration failure
  • prevent caries
  • accessible to clean
86
Q

High caries risk patient:

A
  • too many carious lesions
  • drinks many soft drinks/juices
  • frequently eats sweets
  • bad OH
  • lost teeth due to caries
  • inadequate salivary flow (xerostomia)
87
Q

wingless clamps:

A
  • provide more space for matrix bands and wedges

- bear a W before their number

88
Q

safe removal of amalgam:

A
  • The use of Rubber Dam isolation
  • High volume air evacuation
  • Use of special burs and equipment to minimize aerosols
89
Q

ideal properties of bases and liners:

A
  • friendly to the pulp
  • radiopaque (visible on x-ray)
  • easy to mix
  • easy to clean
  • rapid setting
  • high tensile strength
  • bonding to dentin
90
Q

IRM:

A
  • to check if the patient has any symptoms
  • stays for 3m
  • patient comes back, use the cold test and check if patient is symptomatic or not and then remove it
    a) -patient is asymptomatic
  • remove half of it and then place amalgam

b) -patient is symptomatic
- remove all of it
- and then bond and use composite

91
Q

flowable composites:

A

polymerization shrinkage risk so don’t fill the whole cavity with it

92
Q

Common Causes of Teeth Sensitivity:

A
  • Brushing too aggressively and with hard bristles
  • Consuming too much highly acidic food and drink
  • Poor OH (leading to gum disease and tooth decay)
  • Gum recession (leaves your root surfaces exposed)
  • Grinding teeth
93
Q

Ideal Post Properties:

A
  • Minimal preparation required for post space
  • Not technique-sensitive
  • Biocompatible
  • Resistant to fracture
  • Retrievable
  • Similar mechanical properties to dentine
  • Aesthetic
  • Radiopaque
  • Inexpensive

operative (1 decks)

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