Restorative Dentistry #3

Notes

Operative Dentistry

Pain Quality

Sharp : Aẟ-fibres

Throbbing : C-fibres

 

Tooth 'slooth' - to localize cracked cusps

Management

Prevention and Stabilization Phase Care

1. Control aetiology of problem - diet, oral hygiene, topical fluoride
2. Stabilization phase - extract unrestorable, restore by simple means all restorable teeth, simple endodontic treatment
3. Reassess response to treatment

Definitive Reconstructive Phase Care

1. Endodontics, endodontic retreatment, provision of post-retained cores, crown and bridgework, removable prosthesis, implants
2. Know your limitations, patient's limitations, refer for specialist care

Occlusion

Retruded contact position (RCP) = when condyles are in their most retruded  (antero-superior) position in the glenoid fossa and there is occlusal contact of teeth (repeat, oops)

Intercuspal position (ICP) = position of maximum intercuspation of teeth

Border (Posselt's) Movements of Mandible

Working side = side towards which the mandible deviates in lateral excursive movements

Non-working side = the side away from which the mandible deviates in lateral excursive movements

Bennett movement = condyle on working side moves laterally

Bennett shift = condyle on non-working side moves anterior and medial

Cavo-surface angle : 90 - 110° (amalgam more critical)

Class V cavity - GIC has greatest longevity

Biodentine (tricalcium silicate based cements) → pulp capping

• Antibacterial - alkaline
• Remineralization - release calcium ions and form hydroxyapatite when hydrated and in contact with pulpal tissue fluids
• Reactive dentinogenesis - induce highly organized neodentine formation and maturation
• Low porosity - homogenous, ↓ leakage

VS

Calcium Hydroxide

• Antibacterial - high pH, quickly neutralized
• Remineralization - activation of alkaline phosphatases, neutralizes lactate from osteoclastic activity
• Reparative dentine formation - formation of atubular reparative osteo-dentine, disorganized
• High porosity

Common Faults with Crowns

• Overhanging margin
• Negative margin
• Poor gingival emergence angle
• Poor contact point
• Poor aesthetics
• Persistent debonding

👉 All-ceramic crowns : acid etchable with strong acid i.e. hydrofluoric acid

👉 5° taper is ideal

👉 Cementing of crown : dual-cure resin cement

Metal-ceramic VS All-ceramic Crown Preparation

Labial Veneers

Palatal Veneers

Uses : tooth wear (in particular acid erosion), ↓ dentine sensitivity, restore aesthetics, protect pulp, 'Dahl' appliance

Tooth Whitening

Causes of staining

• Extrinsic - tobacco, tea, coffee, chlorhexidine, betel
• Intrinsic - trauma, hypocalcification, tetracycline, systemic causes e.g. renal transplant
• Age-related - secondary dentine formation, enamel wear

👉 Products containing / releasing 0.1 - 6% hydrogen peroxide can only be made available to patient via treatment by a registered dental professional

👉 10% carbamide peroxide → 3.5% hydrogen peroxide

👉 Tetracycline staining - need to bleach for up to 6 months