Child has caries extending to the pulp on 6. What are the treatment options with least destructive first and briefly describe
- ) Stepwise
- Removes caries in stages over two visits
- Allows the pulp time to lay down reparative dentine - ) PCR
- Remove infected dentine and leave affected dentine - ) Indirect pulp cap
- Placing CaOH over a thin layer of soft dentine over the pulp - ) Direct pulp cap
- CaOH over the exposed pulp - stimulates reparative dentine formation - ) Partial Pulpotomy
- Inflamed pulp tissue beneath an exposure is removed to a depth of 1-3mm or deeper to reach healthy pulp tissue - ) Coronal pulpotomy:
- Remove coronal portion of pulp - ) RCT
- ) XLA
Describe what factors would influence decision
• Symptoms:
- Extent of caries/condition of pulp
• Age of patient:
- open apices
- cooperation
- Patient wishes
- Radiograph
- Development of 7
- Occlusion
Paeds and ethics - Mum is concerned about her 9 yr old still having baby teeth what would you tell her
- Normal to still have baby teeth at that age
* Only worry if asymmetrical or > 6 months later than expected
What baby teeth would she still have?
• C D E
What things would you ask he about with it being her first time
• Social hx - lives with/attended with
- MH
- DH
- Any complaints - pain/appearance
- OH methods - toothpaste kind, how many times a day, who brushes, supervised?
- Diet - favourite foods/drinks
- ) You decide to XLA and she keeps bleeding and her mum decides to sue for negligence and goes to papers and they ask you for a response. What ethical area does this concern?
- ) Describe whether you should reply to the media
- ) Describe whether you should sue for deformation
- ) What are the 2 problems with talking to the media
1.) • Confidentiality
- ) • No
- Proffessional conduct more important than ‘justice’
- Only breach if benefits patient. Personal gain not acceptable - ) • No:
- Time and money
- Get paper to print a retraction
4.) Misquoting and breaching confidentiality
Paeds ectopic canine - A child of 12 comes to you for 1st time and you notice palatally impacted canines how can you tell its palatally clinically
- Missing palatal bulge
- Angulation of lateral
- Lack of C mobility
- Spacing
- Parallax (rads)
What other imaging could you do to determine where canine is
CBCT
2 surgical options and describe them
- Expose and align
- OPEN SURGERY:
- Cut palatally around soft tissue and remove bone
- Cut palate to expose canine and suture a pack of gauze in place
- Review 10 days later
- Ensure soft tissues dont heal over and leave
• CLOSED:
- When pt. presenting with ectopic canines late in life as they have less eruption potential
- Bond chain onto canine and suture palate back over
Describe the parallax technique
- 2 views - OPT and upper standard occlusal
- Compare the OPT with the upper standard occlusal and the change of position of the canine relative to the shift of the x-ray tube
- If the tube and canine move in same direction - canine displaced lingually and if opposite then canine displaced buccally
Principles of preparation of posterior tooth for a crown?
- Minimal tooth reduction
- Marginal integrity
- Structural durability
- Resistance and retention
- Preservation of the periodontium
What crown materials can be used for RPD abutments?
- GOLD
- PFM
4 crown material options for a posterior tooth
• Gold • PFM • All ceramic: - zirconia - glass infiltrated alumina
What could you do to the crown for an RPD abutment
- Implement guideplane
- Rest seats
- Alter undercut for POI/POD
- Mill for clasps
Describe the method of producing a metal restoration by hand
• Create wax template:
shape to match adjacent tooth
• Investing:
- Make a mould of the wax pattern and channel a sprue into the mould which allows metal to be casted into the mould
- Burnout wax
- Cast metal at specific temperature
- Remove sprue
- Trim and polish
• Finishing:
- De-vesting = removal of the refractory investment material from the casting
- Precious metals cleaned with acid solution and non precious shot blasted with AlO2 particles
- Series of abrasives and final polish
Describe alternative method of producing metal restoration
• CAD/CAM:
- Design can be exported then printed in wax or milled in wax to create the pattern
- The restoration may be milled from a metal ingot or 3d printed in metal via selective laser melting
10 things to check on the crown when you get it back from the lab before pt. attends
- Pt. details
- Disinfected
- Correct shape/size
- Thickness
- Contacts with adjacent teeth
- Covers all of margin
- Occlusion on articulator
- Fit on model
- Fitting surface smooth
- Correct colour and texture
RPD - pt. lost her denture as she took it out because it was unstable. Currently wearing old denture and wants replacement. High BP controlled and wears upper RPD only. What kennedy classification is this patient
- ) What would you assess in pts mouth
- ) What special tests would you do
- ) Which material and why?
- )
- Edentulous areas
- Swelling
- Tori
- Mobility
- Occlusion
- OH
- Perio/Endo status
- Restoration quality - ) - Radiographs
- Swab
3.) ACRYLIC: - Easily modified - Cheap - Quick
CoCr:
- Better fit and stability
- Lasts longer
- Indicated if good prognosis of teeth
Veneers - pt. comes with broken veneers what are the three types of fracture and described how they’re formed
• STATIC:
- Segment of veneer fractures but remains on tooth (excessive loading and polymerisation shrinkage)
• COHESIVE:
- Within the body of ceramic (excessive load)
• ADHESIVE:
- Failure of bonding interface (weak bond and heavy load)
If luting agent still on tooth then inadequate etching of veneer
If luting still on veneer then poor placement technique and bonding materials
What other ways can veneers fail
- Discolour
- Marginal leakage
- Debond
- Staining under veneer
Methods used to make veneer
- sintering
- casting
- hot pressing
- CAD/CAM
What materials can be used as a veneer
- Composite - indirect/direct
- Ceramic:
- feldspathic
- leucite reinforced
- lithium disilicate
Perio - you see pt. for first time and dx them with generalised chronic perio. What to do for initial treatment
- Emergency tx where necessary
- XLA irrational teeth
- OHI/Diet/Smoking
- Correcting plaque retentive factors (Scale & RSD)
- Initial occlusal adjustment
- Assess and monitor
You refer to H&T what do u need to tell H&T
- pt. details, date
- Referee name
- Relevant info (MH)
- Clear instructions of what needs to be done
- Outcome - what happens on completion
