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CDT management of caries > When prevention fails > Flashcards

When prevention fails Flashcards

1
Q

what is needed when presentation fails?

A

restoration or extraction required

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2
Q

You can only restore a tooth if?

A

if there is sufficient viable tooth surface (hold restorative material in place)

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3
Q

what is class I of caries?

A

Occlusal surfaces of molars and premolars, buccal pits of molars

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4
Q

what is class II of caries?

A

approximal surfaces of molars and premolars

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5
Q

what is class III of caries?

A

approximal surfaces of incisors and canines

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6
Q

what is class IV of caries?

A

incised edges of incisors and canines

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7
Q

what is Class V of caries?

A

cervical margins

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8
Q

what are the principles of cavity preparation?

A
  • convenience form
  • outline form
  • resistance
  • retention form
  • treatment of residual caries
  • correction of enamel margins
  • cavity debridement
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9
Q

what is convenience form?

A

when you prepare a cavity - we enlarge it so we can get instruments in but before we can establish outline form

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10
Q

what is resistance form?

A

support the restoration (if there is a curved bottom, apply cement to level out because if not it can rotate)

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11
Q

what is needed in retention form?

A

-with parallel sided cavity , restorations can slide out so undercuts are needed - it will be locked in place (non adhesive material to stay in place)

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12
Q

In retention forms, what is needed to prevent restoration moving along occlusal floor?

A 
cross brace to prevent movement (occlusal key/lock) 
-when it comes to class II, any force is resisted
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13
Q

Describe the correction of enamel margins.

A
  • remove weakened tooth substance
  • facilitates placement of matrix retainers
  • bevel to increase surface area for bonding
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14
Q

what is used for cavity debridement.

A
  • triple syringe

- aspiration

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15
Q

what are further considerations on treatment of residual caries?

A
  • classically excavator and round bur- judicious use of large bur as opposed to small
  • consider use of caries detector dyes (some say risk excessive tooth tissue removal )
  • may facilitate when used with chemical agent in chemomechanical method
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16
Q

what is the reason for using larger bur drill over a small drill?

A
  • the large bur can rotate slowly so it will remove caries slowly so it is more controlled and more efficient
  • with a small diameter round burr, large amounts of pressure into soft dentine so could end up in dental pulp
17
Q

Describe the chemomechanical method.

A
  • chemicals make soft dentine to remove with hand instruments
  • Carisolv, amino acids(leucine, lysine,glutaminc acid) and sodium hypochlorite when combined there is proteolytic action
  • this acts on denatured proteins of carious dentine and enables separation of sound and carious dentine
  • use specific hand instruments with rubbing action
  • reduces need for local anaesthesia and less/no time with rotary instruments
  • of value in children and anxious
18
Q

Describe stepwise excavation.

A
  • wise to adopt when conventional caries removal is likely to expose pulp
  • clear periphery
  • free cavity floor of superficial necrotic and demineralised dentine avoiding areas close to pulp
  • line CaOH and temporary GIC resin
  • 8-12 weeks reopen and excavate to yellow/greyish hard dentine
  • line decal , vitrebond and restore
19
Q

Do we need to augment the retention afforded by the cavity design?

A
  • use of acid arch technique

- use of dentine bonding agents

20
Q

what do these techniques reduce?

A

reduce the need for the mechanical creation of undercuts for retentive purposes and conserve tooth substance

21
Q

Describe the acid etch technique.

A

-Buonocore
-application of acid gel
-selective decalcification of enamel prisms
(allows restorative material to penetrate and hold in place)
-micromehcnical tags into Inyo which bonding resin may flow
-20-30MPa

22
Q

when are dentine pins or adhesive bonding agent considered?

A

-if restoring cavity with amalgam need mechanical retention , where little tooth substance remains and there are no cavity walls problem

23
Q

how are dentine pins inserted?

A
  • placed at corners of tooth
  • cut pin channel first
  • insert pin
24
Q

when are dentine pins used?

A

used for amalgam where one or more cusp is missing

25
Q

where are pins inserted?

A
  • one pin per missing cusp except in premolars where two pins should be used
  • placed 1mm within ADJ at corners of tooth so as to avoid the pulp
26
Q

what is the risk of dentine pins?

A
  • risk pulpal exposure, pal and so rarely used

- helpful when modern bonding fails

27
Q

what happens when caries spreads along the ameldodentinal junction?

A
  • unsupported enamel is weak
  • trim back for non adhesive materials
  • consider leaving for adhesive materials as weakened enamel may be splinted by the use of such materials
28
Q

what restorative materials are to be used?

A
  • amalgam and resin composite non adhesive

- glass polyalkenoate is adhesive

29
Q

what is conservation of tooth substance?

A
  • restorations don’t last forever
  • small is beautiful
  • preserve oblique ridge in maximally molars
30
Q

what injures the tooth?

A

caries and cavity preparation

31
Q

what do you do when preparing cavity?

A
  • minimise further plural injury
  • water coolant
  • aim to : maintain pulp cell function and viability , reduce probability of post operative complications
32
Q

what are significant factors associated with potential for damage?

A
  • remaining dentine thickness
  • cavity morphology -depth , area, volume
  • pulpal inflammation due to restorative dental technique e.g. acid etch , lining - all can release TGFb
  • type of restorative material
33
Q

Describe the restorative escalator.

A
  • complexity has gone up because cavity is getting bigger each time
  • so small as possible with mimunum intervention
  • more likely to surface the whole life of patient
34
Q

when do you restore caries?

A
  • where it is active or aesthetic concerns

- only remove soft caries

35
Q

how do you avoid exposure for deep penetrating lesions?

A

stepwise techniques

36
Q

what procedures/materials are selected?

A

least likely to damage pulp

CDT management of caries (3 decks)

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