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Intermediate restorative skills (Den 305) > Temporisation > Flashcards

Temporisation Flashcards

1
Q

Luting agent and procedure for metal and metal-ceramic restorations

A

Procedure: conventional cementation
Zinc phosphate cement
Zinc polycarboxylate cement

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2
Q

Luting agent and procedure for metal and ceramic endodontic posts

A 
Procedure: conventional cementation
Luting agent:
-glass ionomer cement
-RMGIC
-compomers
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3
Q

Luting agent for all-ceramic reinforced core ceramics

A

Procedure: conventional cementation

Luting cement: GIC, RMGICs, compomers

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4
Q

Luting agent and procedure for resin bonded bridges

A

Procedure: etching and gritblasting

Luting agent: dark cure resins, adhesive resins

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5
Q

Luting agent and procedure for precious metal bonding e.g. intra-oral repair

A

Procedure: tin plating, silica coating, metal primers

Luting agent: dark cure resins, adhesive resins

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6
Q

Luting agent and procedure for resin-bonded ceramics

A

Procedure: HF etch and silane

Luting agent: aesthetic dual resins

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7
Q

Luting agent and procedure for composite restorations, fibre reinforced resin bridges, fibre reinforced endodontic, post

A

Procedure: resin-to-resin bond

Luting agent: aesthetic dual cure resins, adhesive resins

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8
Q

Provisional restorations definition

A

Prosthesis designed to enhance aesthetics, stabilisation and/ or function for limited period of time, after which it is to be replaced by definitive prosthesis

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9
Q

Temporary vs transitional

A

Temp has limited and predetermined life-span
Transitional could be considered as something not planned for long-term but should serve, with modifications, for more extensive period of time compared to a temporary solution

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10
Q

Functions of provisional restorations

A

Protection
Maintain tooth position
Aesthetics
Diagnosis
Mastication
Facilitate plaque control - cleansable
Assess tooth reduction?
Informed consent
Provide coronal seal between RCT apts
Assess prognosis
Control/ customise emergence profile

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11
Q

Uses of temporary restorations

A 
Routine indirect resotrations
Replacing indirect restorations
Immediate tooth replacement
Replace tooth after impant placement
Planning aesthetic, occlusal or perio changes prior to definitive restoration placement
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12
Q

Materials: PMMA

A

Good for indirect provisionals
Self/ chemical cure - P/L
Good aesthetics, strength , and wear resistance, easy to repair/ augment
Significant exotherm and polymerisation shrinkage, strong smell, free monomer can cause pulpal/ gingival reactions

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13
Q

Materials

A 
PMMA
PEM (Snap)
Bis-Acryl composite
Direct composite
Pre-formed crowns
CAD-CAM milled composites
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14
Q

Materials: PEM

A

Self/ chemical cure: P/L
Lesser exotherm and shrinkage
Poorer aesthetics, strength, wear resistance

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15
Q

Materials: Bis-Acryl

A

ProTemp - we use this most of the time
Most commonly self/ chemical cure but can get dual cure
Contains Bis-GMA, TEGDMA (essentially composite)
Good aesthetics, better colour stability, good wear resistance in adequate thickness
Difficult to repair, weak in thin section

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16
Q

Materials: direct composite

A

Used mainly for adhesive preparations (veneers, minimal preps) to maintain occlusal contacts/ improve aesthetics where necessary
Placed without bonding agent (spot etch technique)

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17
Q

Materials: preformed crowns

A

Aluminium, stainless steel, polycarbonate
Useful is you don’t have a pre-op imp
Difficult to control marginal adaptation
Often require a lot of chairside modification

18
Q

Materials: CAD-CAM milled composites

A

Digital dentistry
Intra-oral scans of preparations sent to milling unit (in clinic or technician’s lab)
Composite/PEEK/PMMA milled and fitted
Very accurate provisionals

19
Q

Temporary luting cements

A

ZOE (Temp Bond)
Eugenol free ZO cement (Temp Bond NE)
-useful if using resin-based luting cement as eugenol can inhibit polymerisation of uncured resins
Temporary resin cements: translucent for cementing veneers, aesthetic trial
In very rare cases we may use Zinc Polycarboxylate cement to help to retain unretentive provisionals

20
Q

Techniques

A 
Direct
-preformed crowns
-wth use of matrices
-direct composite placement
-direct syringe
Indirect techniques
21
Q

Preformed crowns

A

Come in range of different sizes
Polycarbonate (White) for anterior teeth
Aluminium/ stainless steel mainly used for posterior teeth
Require trimming or crimping around the margins to provide adequate marginal coverage
All can be relined with resin (PMMA/PEM traditionally, but can use Bis-Acryl) to improve fit to prep

22
Q

Provisionals made from matrices

A

Pre-op imp in silicone or alginate taken of teeth before prep
-alginate: cheap, dissipates exotherm better
-silicone: more expensive, reusable - can give it to pt
Can also take an imp of wax-up of tooth or
use an Essix retainer/suck-down matrix
If seated carefully, normally require minimal adjustments
Coat tooth with vaseline - allow you to remove it easily particularly if composites on core!
Bis-Acryl (such as ProTemp) placed into impression and
then seated onto prep, remove at rubbery stage, before it
can lock into undercuts.
Adjust margins and finish/polish

23
Q

Direct composite placement

A

Spot-etch technique
Melleable composites
These often used in adhesive preps where there is minimal tooth reduction (veneer preps, gold onlay preps, resin-bonded bridge preps that require temporatisation

24
Q

Direct syringe

A

Last resort if matrix does not fit or you don’t have access to preformed crown
Material placed around tooth, starting at margins
PMMA/ PEM easier than Bis-Acryl as they tend to slump
less

25
Q

Indirect provisionals

A

Can be made before crown prep apt by taking imps for study models
Some initial reduction can be done on model and provisionals made, relined chairside to fir your preps
May start with direct provisionals until indirect are made (long-term, complex cases)

26
Q

When don’t I need a provisional?

A

Preps in enamel on non-occluding surfaces
Quick lab turnover time
Use of CAD-CAM in-office milled restorations

27
Q

Problem solving: always breaking?

A

Very minimal preps (such as FGC), relieve inside of pre-op imp to increase bulk of provisional material, then trim back chair-side

28
Q

Problem solving: marginal gaps?

A

Reline/ repair provisional, ensure adequate adaption of pre-op imp, place silicone arounds necks of teeth and in tray
Can also use light-bodied silicone on tooth and putty in tray to improve accuracy

29
Q

Problem solving: occlusion wrong?

A

Ensure imp fully seated when making provisionals

30
Q

Problem solving: can’t remove your provisional?

A

Ensure you have enough
vaseline on tooth and remove the provisional in timely fashion (rubbery stage) to prevent hardened material
locking in undercuts

31
Q

Problem solving: can I join adjacent provisionals?

A

Yes but the embrasure

area MUST be cleared and OHI demonstrated (interdental brush fit)

32
Q

Problem solving: Having difficulty removing previisonal at fit apt?

A

You can add vaseline to your temporary cement to facilitate removal

33
Q

So, what’s the point?

A

Provisionals important, they have variety of functions, rangingin from protecting tooth to testing new occlusal schemes and aesthetics
Should take similar time to temporise tooth as it does to prepare it
Bis-Acryl (ProTemp and similar) is usual ‘go-to’ temp material and is used for the majority of cases,
however in specific situations, some of the other
techniques are invaluable

34
Q

Diagnostic uses of temporary restorations

A

Aesthetic trials
Occlusal trial
Periodontal changes
–>diagnostic wax ups invaluable in these cases

35
Q

Aesthetic trials

A

Confirm tooth shape/ dimensions before
definitive crown fabrication
Easier to reshape and trim
provisional restorations

36
Q

Occlusal trials

A

Confirm patient’s ability to tolerate new occlusion prior to lab making definitive restorations

37
Q

Periodontal changes

A

Used to replace overhanging
restorations causing inflammation/recession or after crown lengthening surgery. Kept in place until periodontal tissues have stabilised

38
Q

Disadvantage of preformed crowns

A

Difficult to assess margin adaptation interproximally, may need considerable adjustments

39
Q

Preformed crowns - stainless steel/ aluminium

A

Choose suitable size.
Trim and crimp margins to improve seating.
Option to reline with PMMA/PEM/Bis-Acryl to improve fit.
Check occlusion.
Cement into place.
Remove excess

40
Q

Preformed crowns - polycarbonate (Directa)

A 
Choose suitable size
Trim margins to improve seating
Shape to improve appearance
Reline with PMMA/PEM/Bis-Acryl to improve fit. Trim excess
Check occlusion
Cement into place
Remove excess
41
Q

Direct composite placement: spot-etch technique

A

Use of phosphoric acid etch at one spot in the centre of the tooth (rinse/dry) and then directly applying
a bulk of composite without the use of a bonding agent
-means it is fairly easy to remove the composite with a probe when required

42
Q

Direct composite placement: malleable composites

A

easier handling allows them to be moulded over the tooth and then light cured

Intermediate restorative skills (Den 305) (16 decks)

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