rubber dam, pulp protection, class II Flashcards
1
Q
advantages of rubber dam
A
- isolation (moisture control)
- retraction
- access
- visibility
- patient/staff protection
- safety, quality, efficiency
2
Q
rubber dam for anterior teeth
A
1st pm to 1st pm
3
Q
rubber dam for posterior teeth
A
8 (or one tooth distal) to opposite lateral incisor
4
Q
clamp for upper left molars and lower 8
A
12A
5
Q
clamp for upper right molars and lower 8
A
13A
6
Q
clamp for lower molars
A
3
7
Q
clamp for premolars
A
2
8
Q
butterfly clamp
A
- single tooth (eg endo)
- class V
- anterior premolars
9
Q
exceptions to rubber dam
A
- ortho
- fixed/partial dentures
10
Q
pulp
A
loose connective tissue with many cell types, vascular network, and sensory innervation
11
Q
functions of pulp
A
- dentinogenesis
- defense
- sensation
- nutrition
12
Q
main factor responsible for pulpal inflammation and necrosis
A
bacteria
13
Q
responses of pulp to noxious stimuli
A
- inflammation (pulpitis)
- deposition of tertiary dentin
- degeneration and necrosis
14
Q
vital tissues
A
respond to stimuli
15
Q
functions of pulpal protection materials
A
- protect pulp from thermal, chemical and bacterial stimuli
- seal dentinal tubules and resto margins
- reduce sensitivity
- induce tertiary dentin
- promote pulpal healing
16
Q
best protection for pulp
A
healthy dentin
17
Q
varnish is used with
A
amalgam
18
Q
varnish function
A
- seal dentin and reduce microleakage
- prevent dentin discolouration by amalgam
19
Q
can you use varnish with composite resin, adhesive systems, or GI
A
NO (only amalgam!)
20
Q
another name for calcium hydroxide
A
dycal
21
Q
function of calcium hydroxide
A
- inhibits bacterial growth
- promotes formation of tertiary dentin
22
Q
pH of dycal
A
> 9 (HIGH!)
23
Q
disadvantage of dycal
A
low resistance to compressive forces
24
Q
when can you use ca oh2
A
amalgam, CR, GI
25
where do you apply ca oh2
only in select areas (deep areas)
| *not to be used as a base
26
varnish is used as a
base (applied all over)
27
ca oh2 can be used with
RMGI (because CaOH2 isnt strong against compressive forces)
28
varnish should go ____ RMGI and ca(OH)2 if its amalgam resto
ontop
29
product name of RMGI
vitrebond
30
properties of RMGI
- cariostatic (releases f-)
- weak chemical adhesion to enamel and dentin
- good compressive strength
- minimal shrinkage
- low pH
- cytotoxic
31
how does RMGI polymerize
light cure (30 sec)
32
function of adhesive system
- retention
- seal
- reduce microleakage
33
property of adhesive system
cytotoxic
34
can you use adhesive systems for both Ag and CR
yes
35
what makes up the adhesive system
- acid etch
- primer
- adhesive
36
bonded amalgam
adhesive used instead of varnish
37
when should you use bonded amalgams
larger amalgam restos
38
bonded MOD amalgam restos on max PM have ____ cuspal deflection
decreased
39
IRM ingredients
```
powder = zinc oxide and PMMA
liquid = eugenol and acetic acid
```
40
function of irm
temporary filling
41
how long does irm last
up to 10 months
42
why is irm bad near pulp
eugenol is cytoxic
| *use ca oh2 first
43
can you use irm under CR
no
44
what should you do if you expose the pulp
- place caoh2
- rmgi
- permanent or temp filling
45
what is indirect pulp capping
leaving some demineralized or infected dentin near pulp to avoid pulpal exposure
46
shallow, Ag
| liner?
varnish
47
shallow, resin
| liner?
adhesive
48
medium, Ag
| liner?
GI then varnish
49
medium, resin
| liner?
Gi then adhesive
50
deep, Ag
| liner?
caoh2 then Gi then varnish
51
deep, resin
| liner?
caoh2, then GI then adhesive
52
shallow or medium, rmgi
| liner?
no liner
53
deep rmgi
| liner?
ca oh2 only
54
most common global health condition
untreated tooth decay
55
stagnant sites
- proximal spaces below contact
- cervical below HOC
- developmental grooves and pits
- surface irregularities/malocclusions
- pre existing restos
56
factors of pre-existing restos to consider
- finishing/polishing
- overhangs
- fractures
- crowns and bridges
57
when does protective pulpo-dentinal reaction to enamel lesion start
before bacteria invades dentin
- pulp receives signals through enamel water and odontoblasts that lesion is forming
- pulp makes inflammatory cytokins and odontoblasts trigger 3rd dentin
58
what happens first: demin or bacteria invasion?
demin happens 1st, then bacteria invades after acid diffuses
59
pulp starts inflammatory response when lesion is ___
0.5-1mm away from pulp
60
lesion moves faster in which? enamel or dentin
dentin (5 times faster)
61
zones of infected dentin
- zone of destruction
| - zone of bacterial penetration
62
zone of affected dentin
zone of demineralization
63
zone of destruction
outermost superficial dentin that is decomposed, due to acid and proteolytic enzymes
64
outer carious dentin
- infected
- destroyed
- unremineralizable (bc collagen destroyed)
- dead
- senseless
65
inner carious dentin
- affected (uninfected)
- demineralized (not destroyed, collagen is intact)
- remineralizable
- alive
- sensitive
66
matrix metalloproteinases
proteolytic enzymes that degrade ECM
67
cystein cathepsin
lysosomal protease that degrade ECM
68
CT-K
triple helical collagenase activity
69
local pH causes mineral dissolution, which leads to
enzymatic degradation of dentin organic matrix
70
why is cysteine cathepsin K the most potent mammalian collagenolytic enzyme
has multiple triple-helical cleavage sites
71
what facilitates activation of MMPs
cleavage of MMP prodomain
72
are MMPs stable in acidic pH
yes, but their optimal functional pH is neutral
73
steps to dentin lesion progression (wrt MMPs)
1. mineral dissolution
2. collagen exposure
3. low pH followed by neutralization
4. MMP activation and function
5. collagen degradation
6. irreversible stage
74
are cystein cathepsins stable in acidic pH
yes, and it is not stable in neutral PH
75
what is the optimal pH for cathepsin
5.5
76
steps to dentin lesion progression (wrt cystein cathepsins)
1. mineral dissolution
2. collagen exposure
3. low pH
4. cathepsin activation and function
5. collagen degradation
6. irreversible stage
77
explain distribution of cathepsin and MMP
cathepsin is sparse and MMP is moderate and evenly distributed
78
synergistic digestive effect
cathepsins and MMPs work at low pH, then when neutralized, MMPs work
79
inhibitor of MMP and cathepsin k
sodium fluoride
80
what can be used to preserve collagen in dentin
chlorhexidine
81
how far into the tooth is op intervention required
0.5 mm into dentin (past DEJ)
82
setting reaction for low copper amalgams
produces gamma 1 and 2 phase
83
what is the gamma 2 phase
Sn8Hg
84
whats the disadvantage of the gamma 2 phase
- low strength
- high marginal breakdown
- high creep
- high tarnish and corrosion
85
setting reaction of high copper amalgams
produces gamma 1 phase and the eta phase
86
what happens if you have moisture contamination in amalgam
- delayed expansion
- voids
- greater corrosion
- weaker resto
87
lathe-cut amalgam alloy particles
- high positive pack
- requires high packing forces
- minimal sensitivity
- poor packing of particles
88
spherical amalgam alloy particles
- lower packing pressure
- shorter working time
- no positive pack (poor contact and overhangs)
- more sensitivity
89
requirements for spherical amalgam alloy
- varnish
- broader packing instrument
- more pre-carve and post-carve burnishing
90
function of wedge
- separation
- prevent overhangs
- prevent movement of matrix band
- protect gingiva and RD
