Term
| What is a better method of restoring a large extensive preparation, direct or indirect method? |
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Definition
| Indirect is generally agreed( onlay, gold crown, porcelain) But amalgam restorations may be indicated. |
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Term
| With a large restoration what 3 things dictate restoring with the use of amalgam? |
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Definition
| Money or lack of :), Carious exposure ( this situation requires immediate placement of restoration), Long lasting restoration due to treatment such as caries control, periodontal treatment, orthodontics. |
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Term
| The preparation steps for an extensive restoration are the same as a class I and II with additional added steps. What are these five steps? |
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Definition
| 1. min preparation design before extension 2. Caries identification and removal 3.. Sedative basing procedures 4. Treatment of weakended cusps %. Methods to obtain additional retention |
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Term
| With an extensive restoration who should still start with the minimal prep design? T or F |
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Definition
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Term
| What tends to happen with one does not start with a minimal prep design? |
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Definition
| Tooth gets blown out! More excessive tooth structure may be removed in turn the restoration is larger then needed. Meaning you were not conservative |
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Term
| So you went to far/extensive prepping the tooth what are the consequences? |
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Definition
| Can result in restoration failing sooner than it should. Longevity of tooth decreases |
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Term
| You know you have an extensive preparation, should all caries be removed at once? |
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Definition
| No. Minimal prep first then open and extend the prep as needed |
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Term
| To manage caries what should you know about caries and patient? |
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Definition
| The severity of the lesion (incipient, advanced), location (surface area will tell you how it spreads and you know a little about enamel thickness), Nature of lesion (acute, chronic, arrested), Rate of lesion progression (if it extended really fast or if its has been there for a while |
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Term
| CLINICALLY WHAT ARE THE TWO TYPES OF DENTAL CARIES? |
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Definition
| 1) pit and fissure caries 2) smooth surface caries (inter proximal surfaces) |
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Term
| What caused pit and fissure caries? |
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Definition
| Bacterial plaque accumulation or incomplete coalescence of enamel in developmental stage. |
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Term
| Describe the spread of caries found in pits and fissures. |
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Definition
| 1. Plaque adheres 2. progressive disintegration of enamel along groove extending to the dentinoenamel junction 3. |
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Term
| What are some reason sedative basing procedures are done with extensive preparations? |
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Definition
- Promote secondary dentin formation
- To seal dentinal tubules
- Decrease post-op pulpal inflammation
- Provide barrier to chemical irritation
- Can provide thermal insulation (low conductivity)
- Can resist condensation forces and relieve pressure on pulp
- encourage healing of injured pulp
-acts as a sub for dentin |
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Term
| When and where would you use a base? |
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Definition
- When the depth of the prep is 0.5 mm deeper than the minimal.
- Age of patient
-Patient's history to thermal sensitivity
- It should be about 0.5 mm thick in order to make sure there is still retention and stability
- Place ASAP |
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Term
| What are GIs (glass ionomers)? |
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Definition
- Rxn between silicate glass powder and polyacrylic acid
- bonds to tooth structure
- ideal for sealing a prep and reducing microleakage
- releases fluoride
- does NOT form dentinal bridges
-most are light cured
- area needs to be completely DRY!
- placed over calcium hydroxide |
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Term
| What is calcium hydroxide ( Dycal) used for? |
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Definition
- reduces bacterial infiltration into pulp
- pH=11 (slight irritant to pulp, causes pulp to create reparative dentin)
- Covered by GI |
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Term
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Definition
No, but GIs are usually light cured.
-Need to let DyCal set for 2-3 mintues (according to manual), but Dr. Fung says 45 seconds is good enough. |
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Term
| T or F: ALL caries should ALWAYS be removed to obtain the ideal health and longevity of the tooth and its restoration. |
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Definition
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Term
| When is incomplete caries removal OK? |
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Definition
- TO avoid pulp exposure
- tooth must have a healthy pulp (indicated by pulp viability test)
- must be sealed by indirect pulp capping!!! (Dycal, then GI, then restoration...monitored!) |
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Term
| What is DIRECT pulp capping? |
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Definition
When the pulp has been exposed, bleeding must be stopped (pressure with a cotton pledget).
- Dycal placed over the exposure
-GI placed over the dycal
-Final restoration is placed and tooth is monitored |
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Term
| Is the Dycal or GI applied thicker? |
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Definition
| GI- It should be about .75 mm, but the DYCal should be paper thin! |
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Term
| When does the treatment of weakened cusps become necessary? |
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Definition
- If there is enamel left unsupported
-The left over structure is minimal
- The margin terminates at the tip of a functional cusp |
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Term
| How does one treat weakened cusps? |
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Definition
- Cusps should be uniformly reduced by 1.5-2.0 mm (this is necessary to provide for bulk of amalgam so that it wont fracture with mastication forces)
- Cusp is reduced flat and perpendicular to the long axis of the tooth or with a slight inclination toward the center of the tooth
- When possible, a portion of the cusp should be retained occlusal to the pulpal floor to provide some resistance and retention for the restoration |
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Term
| What are 4 methods to obtain additional retention? |
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Definition
1. Pins
2. Adhesives
3. Additional dovetails
4. Additional box forms |
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