Week 6- Restoring badly broken down tooth Flashcards
How do you assess a badly broken down tooth
- Sensibility testing
- Quality of root filling
- Radiograph
- Frac finder/tooth sleuth
- Any current pain or symptoms
- History of frequently failing restorations
- BPE/6PPC (basic perio exam)
- Study models
What do you need to know before restoring a tooth?
- Is tooth vital?
- Crack?
- Furcation?
- Perio involvement?
- RCT and condition of RCT?
How to improve prognosis of direct restorations in vital teeth?
- No pins
- Slots/grooves (1mm)
- Isolation
- 6 or 12 monthly reviews for vitality and fractures.
What is issue with open sandwich technique?
- GIC will wash out (will appear like caries on radiograph)
- Causes food/plaque trap
- Only indicated for very deep subgingival/inaccessible restos
What can be used for direct resto on non vital teeth?
- Fibre post
- Naayer core
- Composite vs amalgam
- Single canal/anterior
- Posterior/multirooted need cuspal coverage
- Crown lengthening
What happens if core is bulky and thin post?
- Stress can build up between post and core leading to fracture
- Need to make interface wider in root surface.
- Fill space with CR after placing thicker fiber post
What are issues with pin?
- Can cause internal resorption if close to pulp
- Can cause vertical root fracture
- Propagate cracks in the tooth around the hole where they’re screwed in
- Can fracture off chunk of CR
- Can show through CR (grey)
When is a badly broken down tooth non restorable?
- Ferrule effect
- Occlusion
- Subgingival caries
- Perio compromised
- Failing root tx
- Root fracture
- Poor access
- Poor OH
What are the take home messages for restoring badly broken down teeth?
- Only restore what is restorable
- Assess any tooth appropriately before restoring
- Carefully decide what procedure/materials are most appropriate for long term success
- Don’t go against your own better judgement
What is necessary for a ferrule effect?
A minimal height of 1.5-2 mm of intact tooth structure above the crown margin for 360 degrees around the circumference of the tooth preparation
How do we assess for a fracture in a tooth?
Frac finder (pain on release indicates crack, pain on biting indicated periapical pathology (TTP))
Why do posterior teeth need cuspal coverage?
- Further you prepare apically, the higher the chance of fracture.
- Needs support
- They will fracture otherwise
What can improperly placed pins lead to?
Internal resorption- if placed close to pulp
What should we do to endo treated teeth to allow inside to settle?
Take out of occlusion (up to 2mm of cusp)
Why do we use fibre posts?
- To provide retention of the core
- Fiber posts are more MI than metal posts
- Aesthetic
- Easier to remove for endo retreatment
- More fatigue resistant
- Fiber posts have similar physical properties to dentin, reducing risk of root fracture.
