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DMD2 > TOOTH CONS > Flashcards

TOOTH CONS Flashcards

1
Q

What are the principles of cavity design?

A

Access form - simples direct route to caries

Outline form - dictated by anatomy and peripheral caries

Resistance form - preventing fracture of the tooth and restoration

Retention form - preventing displacement of restoration in all possible directions

Convenience form - adeqaute shape and size of cavity for instruments and materials

Removing remaining carious dentine

Completing cavosurface angle

Cavity debridement

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2
Q

What are the indications for placing a fissure seal

A

Non-carious posterior teeth with deep retentive fissures

Early permenent dentition at high risk of caries (within 2-4 years of eruption)

Posterior teeth with minimal evidence of staining or a non-cavitated lesion

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3
Q

A young patient attends your surgery with recently erupted lower 6’s, this patient is a high caries risk, which of the following is the optimal tx?

A. Do nothing, reinforce OH
B. GIC restoration
C. Flowable composite resin fissure seal
D. GIC fissure seal

A

D - the patient is a high caries risk; FS is indicated
The newly erupted tooth will create limitations in the FS due to moisture control issues and because of this GIC is the recomendation over a resin-based material

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4
Q

Define each of the black’s classifications

A

Class I - occlusal surfaces, occlusal 2/3 of buccal or lingual surfaces on posterior teeth, palatal surfaces of upper anterior teeth

Class II - proximal surfaces of posterior teeth

Class III - proximal surfaces on anterior teeth

Class IV - proximal surfaces on anterior teeth, involving and incisal corner

Class V - gingival 1/3 of buccal and lingual surfaces of anterior and posterior teeth

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5
Q

What are 6 benefits of using rubber dam

A

Medicolegal - preventing ingestion/inhalation of materials and/or instruments

Patient safety - prevention of aspiration of fluids/instruments, protection of soft tissues

Aseptic - preventing salivary contamination

Access - visual field is improved

Patient comfort

Reduced aerosols - less cross-contamination

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6
Q

Which clamp would you use on a 26

A. 00
B. 9
C. 7A
D. 2A

A

C - This is a molar clamp
other molar clamps –> 8A, 14A, 26N, 27N & 56

A & B are anterior clamps
D is a premolar clamp

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7
Q

Why does the progression of a carious lesion reaching dentine result in unsupported enamel?

A

Caries begins in the enamel and travels down towards the DEJ, once at the DEJ the carious lesion spreads laterally –> the undermining of DEJ and lateral spread then results in cavitation as the enamel becomes weakened/unsupported

  • taken from a DMD1 quiz
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8
Q

What is the difference between a simple, compound and complex cavity prep?

A

Simple - involves 1 surface
Compound - involves 2-3 surfaces
Complex - involves 4+ surfaces

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9
Q

Define cavosurface angle

A

The angle between a prepared wall and the external tooth surface

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10
Q

What are the cavity dimensions of a conventional class III cavity for CR?

A

Height - 3-3.5mm height (labial wall)
- 0.5-1mm into proximal region
Width - half-way across palatal ridge
Depth - atleast 1/2 way across the proximal surface

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11
Q

In which cavity design for CR would you add a labial bevel, a chamfer and a gingival bevel?

A

Class IV

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12
Q

Which of the following is most true about amalgam?

A. A high copper amalgam has a gamma 2 and eta-phase
B. A low copper amalgam contains = 15% Cu
C. A high copper amalgam is more succeptible to erosion
D. The gamma 1 phase of both high and low copper amalgams is Ag2Hg3 (silver mercury)

A

D

A - high copper amalgam does not have a gamma 2 phase
B. low copper amalgam contains = 5% Cu
C. low copper amalgam is more succeptible to corrosion because of the gamma 2 phase (tin/mercury)

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13
Q

What does ‘creep’ refer to in amalgam restorations

A

creep is the plastic deformation of the material under a constant low-level load

High-copper amalgam has less creep

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14
Q

How does amalgam self-seal?

A

microleakage –> causes corrosion –> corrosive product accumulation att the surface/interface of restoration and cavity –> reduced microleakage

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15
Q

Which of the following is most correct regarding pulpal protection

A. Moderate cavities where 1-1.5mm of dentine remains do not require a GI liner/base
B. MTA and Biodentine are examples of calcium silicate cements which can be used as pulpal protection
C. Deep cavities where <0.5mm dentine remains require a Ca-hydroxide liner only
D. Ca-hydroxide OR calcium silicate cement can be used as a base in deep cavities

A

B

A - these cavities DO require a liner/base
C - these cavities require a liner (pulpal protection such as Ca-hydroxide) and a base
D. these are materials for pulpal protection and are used as liners, not as a base

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16
Q

You triturate (mix) your amalgam and once you open the capsule and dispense it into a dappen dish it looks dull, grainy and crumbly. Did you;

A. over-triturate
B. mix correctly
C. under-triturate

A

C. under-triturate

If its mixed properly it will appear shiny and plastic

If its over-triturated it will have a high shine, be hot and sticky

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17
Q

What is the difference between ‘finishing’ and ‘polishing’ an amalgam restoration?

A

Finishing - removing macroscopic irregularities

Polishing - removing microscopic irregularities

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18
Q

Discuss the setting reaction of GIC’s

A

MIXING: acid-base reaction –> acid attacks the glass network resulting in aluminium, calcium and fluoride
20-40 seconds

INITIAL SET: decomposition and gelation –> cations form salt bridges (calcium-polyacrylate) which forms a silica hydrogel
3-6 minutes

MATURATION: aluminium-polyacrylate linkage
24hrs+

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19
Q

Match the type of GIC with its function

A. Luting/Bonding cement: crown cementation and root canal sealing
B. FS, liner/base
C. Restorative

Type I, Type II, Type III

A

Type I - Luting/Bonding
Type II - Restorative
Type III - FS, liner/base

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20
Q

Give the specific name to the following instruments;

A. probe with 1mm incremental markings
B. probe with incremental markings of 3, 2, 3, 3 (no ball tip)
C. explorer probe
D. cylindrical double sided instuments used to condense amalgam
E. triangular/cone shaped double ended instument used to place/push composite resin into tight proximal boxes

A 
A. CP-15
B. CP-11
C. #6 Explorer
D. #153 amalgam packer
E. Westco Mortenson packer
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21
Q

Describe phase 1 and 2 of resin bonding to the tooth surface (ie. what is happening at the tooth surface in etching and bonding)?

A

Phase 1 –> creation of microporosity in enamel and dentine by removing superficial hydroxyapatite
Phase 2 –> resin infiltration and in situ polymerisation within the created microporosities (hybridisation)

22
Q

What is the primary mechanism of adhesion?

A

Micromechanical interlocking in the hybrid layer

23
Q

Which is the correct protocol for bonding

A. phosphoric acid treatment of enamel margins only, wash/dry, application of prime&bond, air thin, light cure
B. phosphoric acid treatment of enamel margins only, wash/dry, application of self-etch prime&bond, air thin, light cure
C. phosphoric acid treatment of enamel and dentine, wash/dry, application of self-etch prime&bond, air thin, light cure

A

B

A - treating the enamel margins only is a self-etch technique, the dentine still requires an etchant and for this you would need to use a self-etching primer

C - this is a total etch techique of enamel and dentine, you would not need to use a self-etch primer here

24
Q

What are the main components of dental composites

A

Organic matrix - BisGMA, UDMA, TEGDMA
Inorganic filler - modified silica glass particles
Silane (coupling agent)

25
Q

Describe the curing reaction of CR

A

Initiation –> initiator becomes excited/activated by the light energy –> interaction and activation of monomers

Propogation –> activated monomers bind to other monomers forming polymer chains

Termination –> growing chains bind to other polymer chains –> complete polymerisation

26
Q

Which of the following has the best aesthetic properties?

A. Macrofill CR
B. Amalgam
C. GIC
D. Microfill CR

A

D

27
Q

Which of the following is most correct

A. degree of conversion is the percentage of C=C double bonds converted to C-C single bonds in polymerisation, this should always reach 100%
B. Universal composites shrink around 10%
C. Shrinkage stress is the tension at the composite-tooth interface
D. The greater the C factor the less stress development

A

C

A. this is mostly correct but it never reaches 100%
B. universal composites normally shrink 2-4%
D. the greater the C-factor the greater the stress

28
Q

Which of the following is incorrect about CR

A. Elastic modulus is the stiffness of a material and this correlates with inorganic filler content
B. In an abfraction lesion a material with a low elastic modulus is ideal
C. The more filler content in CR the more translucent
D. The more filler content the better the mechanical properties

A

C - the more filler content the more opaque the material

29
Q

What is the wavelength range of dental curing lights?

A

400-500nm

30
Q

At what thickness can CR be cured adequately

At what thickness can bulk-fill CR be cured adequately

A

2mm

4-5mm

31
Q

You have a large cavity (>4mm) and you are planning to use a bulk-fill composite, what process will achieve the best outcome

A. Using a fibre reinforced bulk fill for the entire cavity
B. Using a flowable bulk-fill for the entire cavity
C. Using a sculptable bulk fill in two increments, the lower layer <4mm
D. Using a sculptable bulk fill in two increments the lower layer being 4mm and the upper layer being <4mm

A

C. - this is ideal as the lower layer is harder to reach with the light so a thinner increment will have increased potential for complete cure at that depth

A. fibre-reinforced has excellent mechanical properties but the glass fibres cannot be polished so this would require a capping layer
B. Flowable bulk fill MUST be covered with a sculptable bulk fill
D. as above, a 4mm layer at the base increases the risk of inadequate curing

32
Q

Differentiate between a liner and a base

A

Liner - a fluid paste-type material used on pulpal/axial walls in 0.5-1mm increments to create a protective barrier between the dentine and restorative material

Base - as above except >1mm increment beneath a final restoration

33
Q

What are 5 objectives of a liner/base

A 
pulpal protection
remineralise caries-affected dentine
provide adequate cavity geometry for AR
block undercuts
chemical bond to dentine --> reduce microleakage
restore lost dentine --> base
stress relief during CR shrinkage
resistance during AR condensation
34
Q

You need to etch the dentine with phosphoric acid prior to placing a therapeutic agent

True/False

A

False

35
Q

In an open sandwich technique it is ideal to place the GIC below the contact point

True/False

A

True - GIC is prone to proximal defect if its in contact with the adjacent tooth

36
Q

Select the most correct answer regarding liners/bases

A. GIC liner is recomended below all ARs
B. eugenol-based materials can be used as a liner/base under resin based materials
C. flowable composites are superior to GIC as a liner
D. You only need a therapuetic agent if you expose the pulp

A

A

B - eugenol-based materials adversely affect resin polymeristation
C. no evidence to show flowable is better than other liners
D. You want a therapeutic agent in any deep cavities where you may be near the pulp - a pulp exposure will require a directy pulp cap with calcium-silicate cements (MTA/Biodentine)

37
Q

What is the common name for zinc-oxide sulphate cement

A

Cavit

38
Q

What level of reduction would you need to do in order to cusp cap

A

2mm

39
Q

Select the most correct answer regarding complex composite restorations

A. Composite is the material of choice in a complex restoration
B. A cusp is defined as weak when the occlusal outline extends more than 2/3 from primary groove to cusp tip
C. Complex CR restorations are long-term solutions
D. Flowable and sculptable bulk-fill are recomended for cusp replacement/protection

A

B

A. Indirect restorations are more ideal and amalgam is the material of choice in direct, but CR is often selected due to aesthetics, efficiency and conservative properties
C. complex CR’s are a medium-term solution
D. Highly-filled (>/=74%) universal CRs in 2mm increments are the composite resins that are recomended

40
Q

Explain why the endodontically treated tooth is weaker?

A

Altered dentine –> from irrigant and dressing tx
Reduced tooth structure –> significant removal in tx
Reduced proprioception –> sensation removed = higher loads applied without the patient awareness

Decreased moisture –> there is a small degree of dehydration 5-12% but this is not a key issue

41
Q

Which of the following is correct regarding restorations of endodontically treated teeth?

A. anterior and premolar teeth should have a post if there is 30% or more tooth structure lost
B. A ferrule can be a mix of restoration and tooth structure
C. A ferrule increases the resistance form of an indirect restoration
D. GIC can be used as a core material

A

C

A - >50%
B - must be all tooth structure
D - core material should be amalgam or CR

42
Q

Discuss the steps in restoring a tooth, from access –> finishing restoration

A
  1. Establish outline at optimal depth
    - direct simplest access to caries, removing peripheral caries in enamel, the DEJ and 0.5mm of dentine
    - freedom from contact
    - outline beyond fissure system
  2. Satisfy retention, resistance and convenience form
  3. Remove deeper caries
    - from periphery to deepest region
    - using large slow speed bur and tactile sensation
  4. Complete the cavity
    - adjustments to cavity margins, removing weakened enamel, debridement
  5. Place a liner or therapeutic IF needed
  6. Matrix selection and placement
  7. Bonding procedure
    - total etch (three step, two step)
    - self-etch (two step, one step)
    - selective etch (three step, two step)
  8. Place restoration
  9. Finish restoration
43
Q

Name 3 indications and 3 contraindications for a veneer?

A

Probs the only q they will have for simple composite veneer.

• Indications:
o Inadequate tooth colour that does not respond to any whitening method
o Unsatisfactory tooth shape and/or position
o Inadequate tooth size
o Diastemas
o Partial tooth crown fracture
o Gummy smile

•	Contraindications:
o	Bruxism
o	Bad habits (e.g. nail biting)
o	Weak support
	Teeth with big fillings
	ETT without intraradiculat posts
o	Unrealistic expectations
o	Bad OH
44
Q

What are the four exceptions to palatal access for a class III?

A
  1. Irregular alignment of teeth
  2. Caries positioned towards labially (tooth tissue preservation)
  3. Extensive caries involving labial surface
  4. Old restoration placed labially
  5. If you’re the too-big-for-her-boots OHT at ashleigh’s workplace
45
Q

When to place a palatal bevel vs palatal chamfer?

A

Palatal bevel indicated when outside of occlusal contact area and palatal chamfer indicated when in occlusal contact area.

46
Q

Which of the following is true?
A) Lathe cut amalgam alloy requires less force on condensation
B) Low copper amalgam < 12% copper
C) High copper amalgam increases gamma 1 phase
D) Spherical cut amalgam alloy requires less force on condensation

A

D)

47
Q

What are the two types of resin-based fissure sealants and which one is recommended?

A

 Filled: Filler particles only have a small impact on the outcome of the fissure sealant and reduces ability of the penetration into the fissure sealant. Filled fissure sealant generally require more occlusal adjustment.
 Unfilled: Low viscosity allows better penetration into the fissure and lower microleakage rate. Occlusal adjustments generally not required.

48
Q

Briefly explain how resin penetration occurs in the enamel and dentine in etch and rinse strategy.

A

A) Enamel

  • Macro tags = Resin penetrates adjacent enamel prisms
  • Micro tags = Resin penetrates individual HA crystals

B) Dentine

  • Adhesive layer = Complete zone of demineralisation with only resin
  • Hybrid layer = Complete demineralisation of inorganic material but collagen remains - penetration of resin around these collagen fibrils
  • Resin tags = Penetration of resin into the dentine tubules
49
Q

Distinguish CaOH and CaSilicate as therapeutic agents, which is indicated for direct and indirect pulp exposure?

A

CaOH = Indirect pulp capping

  • Less expensive
  • More soluble
  • Stimulate tertiary dentine (dentine bridge) irregular, porous, cellular inclusions
  • Inferior marginal adaption

CaSilicate = Direct pulp capping

  • More expensive
  • Less soluble
  • Stimulate tertiary dentine (dentine bridge) homogeneous, tubular, less cellular inclusions
  • Better marginal adaption
  • May discolour tooth (bismouth oxide)
50
Q

What are 4 objectives of a therapeutic agent

A

Pulpal protection (isolation)
Tertiary dentine formation
Remineralisation of caries affected dentine
Reduction of bacterial count

DMD2 (13 decks)

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