1
Q
What are Class V restorations?
A
- Restorations involving the cervical 1/3 of the facial or lingual aspect of ANY tooth.
- Usually involves FACIAL aspect of ANTERIOR & bicuspid
2
Q
What are some reasons for preforming Class V restorations?
A
1) Caries
2) Abrasion
3) Abfraction
4) Erosion
5) Combination of all the above
3
Q
What are the causes of Cervical Caries?
A
1) Poor hygiene
2) Exposed roots from gingival recession
3) Defective margins on restorations
4) poor salivary flow
- Medications
- Xerostomia
- Immuno-compromised
5) Cariogenic diet
6) Irradiation
4
Q
Cervical Caries:
- Commonly found below the ______.
- Can be _________ shaped.
- If CHRONIC, caries tend to be _________.
A
- CEJ
- irregularly
- Darker
5
Q
What is Abrasion caused by?
A
- mechanical wear
- commonly toothbrush
- other habits
6
Q
What is the appearance of Abrasion like?
A
- Tends to have a dished out appearance
- Can affect teeth in groups
- Shallow and smooth on both occlusal and gingival walls
- Cavo-surface edge tends to be rounded
7
Q
How does abreaction affect tooth structure?
A
- Working & balancing interferences create LATERAL loading which breaks down the tooth structure.
- Lower pH increases rate
8
Q
What is the appearance of Abfraction like?
A
- Tends to have sharp V-cut notching especially on incisal or occlusal wall
- Sharp leading edge is NOT ALWAYS evident in combination cases
- Doesn’t take AWAY gingiva. AKA STRESS corrosion
9
Q
What is Abfraction?
A
- Combination of abrasion and micro fractions = STRESS CORROSION
- Occlusally related and/or habitual
- Tooth is undergoing flexural strain
- Affects single teeth (often UPPER premolars first)
- TX: light cured GIC
10
Q
In Abfraction, “Stress Corrosion” is _______________
A
Multi-factoral
11
Q
How does abreaction affect tooth structure?
A
- Working & balancing interferences create LATERAL loading which breaks down the tooth structure.
- Lower pH increases rate
12
Q
What are examples of working and lateral imbalances?
A
1) lateral loading
2) teeth out of interference
13
Q
Abfraction:
pH is modulated by what?
A
- Protective factors (saliva buffering capacity)
- Plaque control
- Diet
14
Q
What are examples of working and lateral imbalances?
A
1) lateral loading
2) teeth out of interference
15
Q
Abfraction occurs on _________ teeth (“Interferences”)
or __________ of teeth in para-functional occlusion (“Group function”)
A
- INDIVIDUAL
- GROUPS
16
Q
After restoration is completed may consider ________ or a _________
A
- Occlusal equilibrium (SINGLE tooth involved)
- “SOFT” Night guard (if A LOT of teeth involved )
17
Q
Gold leaf, lasts forever and can be placed under what conditions?
A
-Abfraction involving a single tooth
18
Q
What is Erosion (Biocorrosion)
A
-Acid attack on teeth
- Affects teeth in groups
- -Lingual upper anteriors
- -Buccal of lowers
- Enamel appears translucent or thin
- Enamel appears “polished”
19
Q
Early Erosion (Biocorrosion) starts out \_\_\_\_\_\_\_\_. Abfraction will be \_\_\_\_\_\_\_\_.
A
- SHALLOW
- DEEP
20
Q
What are some medical problems linked with Erosion (Biocorrosion)?
A
1) Gastric regurgitation
2) Anorexia/bulemia
- Pt that vomits has defects on upper teeth on lingual
3) Dietary-lemons
21
Q
Causes of Stress (abfraction) ?
A
1) Endogenous:
a. Parafunctional
b. Occlusion
c. Deglutition
2) Exogenous:
a. Mastication
b. Habits
c. Occupations
d. Dental appliances
3) Types of stress
a. static
b. fatigue (cyclic)
22
Q
Causes of Biocorrosion (chemical, biochemical and electrochemical degradation) ?
A
- Endogenous (acid)
a. Plaque (caries)
b. Gingival cervicular fluid
c. Gastric HCL - Exogenous (acid) ;
a. Diet
b. Occupations
c. Miscellaneous - Proteolysis:
a. Enzymatic lysis (caries)
b. Proteases (pepsin & trypsin)
c. Cercicular fluid - Electrochemical (piezoelectric effect on dentin)
23
Q
Causes of Friction (wear)?
A
- Endogenous (attrition)
a. parafunction
b. deglutition - Endogenous (Abrasion)
a. Mastication
b. Action of the tongue - Exogenous (Abrasion)
a. Dental hygiene
b. Habits
c. Occupations
d. Dental appliances - Erosion (flow of liquids)
24
Q
How do we treat these lesions?
A
- Do nothing
- GLUMA
- Fluoride TX and or varnishes
- ACP (Amorphous Calcium Phosphate)
- Periodontal grafting (split thickness)
- Amalgams
- GI
- Composites
- Occlusal adjustment or mouth guards
- Combination of above
25
Do __________ interventions first and then _________ interventions
- Chemical
| - Mechanical
26
When should GLUMA be used?
- If pt has sensitivity.
- Need good isolation because it is caustic
- Precipitates preteens in the dentin tubules & resin penetrates dentin & creates seal (NOT PERMANENT)
Note: it is permanent under restoration
27
With Amalgam preps the outline tens to be more ______. The cave-surface have no ________
- Angular
| - Bevels
28
The PA (Polyacrylic Acid) AKA Dentin conditioner does what ?
- Microscopically DEMINERALIZES enamel & dentin = INCREASES surface area
- INCREASES bond strength
- Removes smear layer
- 0.5 micron non-rinse-able gel phase remains on dentin (Ca-collagen salt) has STRONGER bond strength to dentin than GI itself
29
Pre-mixed compules are the _________ type of GI
-Best
30
What bur can be used to remove excess GI?
-12 fluted finishing burs (135 EF diamond)
NOTE: ALWAYS use WATER SPRAY!!!
31
What does the Resin coat do?
- Protects (light cure for 20 SEC)
- Ensures moisture free set
- help wear resistance
32
- Place composite in _______ increments.
| - Adding single bulk of composite will result in ___________ and eventually ________ & ________.
- less than 2 mm
- contraction gap
- Microleakage & failure
33
What is alternative method of placing composite?
- Filling form gingival vs filling from incisal
| - Flowable composite layer
34
Which composite (paste or flowable) causes less shrinkage?
-Paste
35
When is flowable composite useful?
- When placed on first layer w/ abfraction bc it has more elasticity.
- If worried about LATERAL loading and you want it to go to retention grooves
36
What is the traditional method of placing composite ?
- Placed in 3 layers
- First layer in incisal layer --Cured
- Second filling on top of 1st layer not all the way to surface (follows DEJ dentin color)
- Third layer sits on top of 2 layers (follows enamel shade color)
37
Why would you ever extend bevels to proximal line angles?
For color blending
38
Prep should look __________ after curing, means its coating with _________ (oxygen inhibited layer)
- Shiny
| - Resin
39
What are the basic rules of composite finishing techniques?
1) Maintain the contour of the tooth
2) Avoid the "voids"
3) Don't damage the cementum
4) Don't leave composite over the margins
5) Maintain a high luster/polish
6) When using diamonds (135 EF) ALWAYS go from tooth to composite w/ feathering technique
40
How do we apply the final glaze?
- Reapply etchant over composite for 20 SEC
- Apply Opti-guard w/ applicator and blow thin
- Light cure for 20 SEC
- Floss
41
What causes leaky restorations (looks like staining on teeth) ?
1) Shrinkage (putting all the composite on at once)
2) Not condensing well
3) Excess material (flash can pick up stain)
42
What can cause brown stain close to the gingiva ?
- Flash got chipped off
- Lateral loading on the tooth
- More elastic composite (flowable)
43
- Looks like gray stain at the gum line from composite?
| - Facial surface stains from composite?
- Contraction gap (too much composite much at once)
| - Facial surface stains? Uneven polishing (picks up coffee and food stains)
44
Whats the brown spots next to the amalgam/GI?
- Cavity and defect (maybe extend and include that )
| - GI will provide protection
45
When composite or GI is bonded to re-mineralized enamel what occurs?
-Leakage occurs
46
27 year old, very sensitive to cold, sudden sharp last seconds. No "occlusal interferences" (when you fxn & specific teeth are hitting prematurely).
What if pt not sensitive?
- pt may be GRINDING give her a Night guard.
- Root exposed below CEJ.
- Early signs of abfraction
- Do a gum graft before GLUMA and restoration
-If pt not sensitive don't do anything!!!
47
40 yr old has old GI it is failing & recession and notching has gotten worse, pt claims he does not grind his teeth.
To treat this tooth what critical info did I forget to tell you?
-Pt's often don't notice if they grind during their sleep!
-Sandwich technique :)
(Protect outer layer w/ composite)
- Adjust retention, or give patient mouthguard.
- We are concerned about retention make Incisal bevels LARGER for more retention.
48
56 yr old complains of appearance. Asymptomatic, grinds only on this tooth in lateral function.
- What is a lateral interference again?
- What story does this picture tell?
- What would you do first? Perio or composite?
- Abfraction is severe on that one tooth laterally.
- Lateral interference: Tooth wearing away above composite
- Do a light test to see if crack is symptomatic its deep .. IF Crack is on surface, no crown just restore.
- Sandwich technique
- COMBO CASE of Abfraction and Abrasion
- Do Perio first! A gum graft first than a sandwich technique
**Using articulating paper; Adjust occlusion on that one tooth
49
What if she was 95 yrs and had a toothache?
- Endo & crown or extract w/ partial
| - Extract w/ Kevlar
50
65 yr old complains of acute. spontaneous and reversible discomfort. Food gets stuck and wants it corrected. She is overly thin & grinds a lot.
- First diagnosis? "Erosion" b/c enamel is SUPER SHINY
- Pt probably has gastric problem (give MEDICAL REFERRAL)
- Composite (close up tubules to reduce discomfort)
- GI, comp-flowable
51
23 yr old complains of extreme sensitivity, short duration. Gum recession seems to be accelerating..
What is the etiology ?
Etiology: Ortho. teeth tilted outward. Bone is reabsorbed
- Pre-molar acts as cuspid, lateral loading
- Limited attached gingiva Post-Ortho Fenestration
- Occlusally exacerbated
- Do gum graft and restoration after!
- Remove comp # 29, citric acid root # 29 & peril graft 29 thru 27.
- # 29 & 28 comp w/ retention
- Mouthguard
52
65 yr old complains of acute. spontaneous and reversible discomfort. Food gets stuck and wants it corrected. She is overly thin & grinds a lot.
- First diagnosis? "Erosion" b/c enamel is SUPER SHINY
- Pt probably has gastric problem (give MEDICAL REFERRAL)
- Composite (close up tubules to reduce discomfort)
- GI, comp-flowable
53
What if she was 95 yrs and had a toothache?
- Endo & crown or Extract w/ partial
| - Extract w/ Kevlar
54
Preparations and filling materials will _________ depending upon the problem of the patient.
-Vary
55
What is Cervical Abrasion?
-Abrasion is the pathologic wearing away of tooth structure through an abnormal mechanical process.
--A common form is toothbrush abrasion. Which produces a V-shaped notch in the cervical portion of the tooth and may cause sensitivity.
56
What is Attrition?
- Occlusal wear resulting from functional contacts w/ opposing teeth.
- Attrition refers to the wearing away of tooth structure b/c of tooth-to-tooth contact.
- Considered a physiologic rather than a pathologic process, appears that most excessive wear patterns are produced by abnormal situations.
- Accelerated thru bruxism or if teeth are missing.
- Restoration of these worn away teeth may result in occlusal interferences or fracture of restoration if the original anatomy is recreated rather than the acquired anatomy.
57
What is Abfraction?
- Wedge-shaped lesions occurring in the cervical enamel. The lesion may be a result of occlusal loading & flexure.
- Happens when non-axial tooth loading leads to cusp flexure & stress concentration int he vulnerable cervical region.
- Such stress is directly or indirectly contributed to the loss of cervical tooth substance.
58
What is Cervical Abrasion?
-Abrasion is the pathologic wearing away of tooth structure through an abnormal mechanical process.
- -A common form is "toothbrush abrasion".
- --Which produces a V-shaped notch in the cervical portion of the tooth and may cause sensitivity.
59
What is Attrition?
- Occlusal wear resulting from functional contacts w/ opposing teeth.
- Attrition refers to the wearing away of tooth structure b/c of tooth-to-tooth contact.
- Considered a physiologic rather than a pathologic process, appears that most excessive wear patterns are produced by abnormal situations.
- Accelerated thru bruxism or if teeth are missing.
- Restoration of these worn away teeth may result in occlusal interferences or fracture of restoration if the original anatomy is recreated rather than the acquired anatomy.
60
What is Cervical Abrasion?
-Abrasion is the pathologic wearing away of tooth structure through an abnormal mechanical process.
- -A common form is "toothbrush abrasion".
- --Which produces a V-shaped notch in cervical portion of the tooth and may cause sensitivity.
61
What is Attrition?
- "Occlusal wear" resulting from functional contacts w/ opposing teeth.
- Attrition refers to the wearing away of tooth structure b/c of tooth-to-tooth contact.
- Considered a physiologic rather than a pathologic process, appears that most excessive wear patterns are produced by abnormal situations.
- Accelerated thru bruxism or if teeth are missing.
- Restoration of these worn away teeth may result in occlusal interferences or fracture of restoration if the original anatomy is recreated rather than the acquired anatomy.
62
What is Abfraction?
- Wedge-shaped lesions occurring in the cervical enamel. The lesion may be a result of "occlusal loading & flexure".
- Happens when non-axial tooth loading leads to cusp flexure & stress concentration int he vulnerable cervical region.
- Such stress is directly or indirectly contributed to the loss of cervical tooth substance.
63
What is Abfraction?
- Wedge-shaped lesions, NOT CAUSED by TOOTH DECAY occurring in the cervical enamel (along gum line). The lesion may be a result of "occlusal loading & flexure".
- Happens when non-axial tooth loading leads to cusp flexure & stress concentration in the vulnerable cervical region.
-Such stress is directly or indirectly contributed to the loss of cervical tooth substance or weakened & worn away
leaving a non-carious lesion on tooth surface.
Operative Week 5
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