Short and Long term damages that an RPD can have on soft and hard tissues?
• SHORT TERM:
- Ulcers
- Pain
- Allergies
- Trauma
• LONG TERM:
- Alveolar resorption
- Denture stomatitis
- Angular cheilitis
- Denture granuloma
- Occlusal wear
- Drifting
- Mobility
- Tilting
- Over eruption
Name 4 measures taken to minimise damage to tissues
- Ensure good distribution of occlusal forces
- All clasps should have reciprocation to reduce tooth movement
- Connectors to finish above survey line or 3mm away from gingival margin to allow good OH
- Ensure stable ICP and acceptable OVD
- Regular review so problems can be anticipated
6 things to check on the crown before seeing the patient
- Correct pt. details
- Correct tooth
- Smooth surfaces
- Margins uniform
- Occlusion on articulator
- Shade and colour correct
- Correct material
- Contact points with adjacent teeth
- Check fit on study models
2 ways to check if you have done occlusal reduction correct on an FGC prep?
- Protemp to see if there are any perforations which may indicate under preparation
- Silicone putty index with adequate thickness and stability. Williams probe can be used to check reductions
3 ways to know you have taken good impression
- No drag
- No voids
- Impression adhered to tray
- Good surface detail (frena, palate)
- Well defined margins and border mouling
- No tray evident in the impression
- Tray isnt too small (anterior teeth tend to not seat fully in impression material)
Patient comes in with chronic perio and pain from upper PM. You diagnose perio-endo lesion.
• What are the 3 classifications and treatment?
• What special investigations and why
• Primary perio and secondary endo lesion:
- RCT and Perio therapy
• Primary endo and secondary perio lesion:
RCT and review 3 months
- ‘True’ combined lesion
- Periapical radiograph is most appropriate for perio-endo lesions:
- vertical perio defect often present
- Radiolucency around apex
- ‘J’ shaped lesion may be present
• Sensibility testing:
- EPT
- ethyl chloride
• Tooth slooth/transillumination to rule out root fracture
LL6 with caries close to pulp. Restorative options to keep vitality of tooth and order them with conservative first and what would make you decide which treatment to do.
- PCR
- Indirect pulp cap
- Direct pulp cap
- Partial pulpotomy
• Which treatment:
- pt. wishes
- pt. age
- pt. compliance
- cost
- time expense
- tooth prognosis
- extent of caries
- symptomatic/asymptomatic
- remaining tooth structure
- ability to achieve moisture control
5 principles all crowns should have
- preservation of tooth tissue
- resistance and retention
- structural durability
- marginal integrity
- preservation of periodontium
Describe conventional technique to making metal crowns
• LOST WAX PROCESS:
- ) Take impression of prep
- ) Form a cast from impression
- ) Production of a wax pattern by hand
- ) Attach wax pattern to a sprue and the sprue to a crucible
- ) Form a mould from this unit
- ) Wax substructure melted away and replaced in metal - investment and casting
- ) De-vesting - removal of refractory investment material from casting
- ) Precious metals cleaned in acid; non-precious metals shot blasted with aluminium oxide particles
- ) Metal finishing and polishing
How does conventional differ to computerised technique
- Substructure only
- Design via CAD
- Print or mill wax pattern
- Mill metal from ingot or 3D print metal via SLM
- Computerised technique has less human potential error and allows use of better materials
9 yr old with proclined incisors with 9mm overjet. What is the classification and definition
Class 2 division 1:
- lower incisors occludes behind the cingulum plateau of the upper incisor
- The upper incisors are of average inclination or proclined
What ortho appliance to treat class II div I and why
Functional appliance - twin block:
- prevents forward growth of maxilla
- Brings mandible forwards
- Stetches the muscles and soft tissues
- Retroclines upper incisors
- Proclines lower incisors
- Ensures molars erupt in class I
- Uses active growth
If this was digit sucking patient, how and why would management differ?
Digit sucking may causing or catalysing the class 2 div 1 , therefore it must be stopped prior to commencing treatment
• Mx:
- Educate pt and parents
- Habit breaking appliances
- Passive removable appliance
- Nail polish
- Positive reinforcement when they don’t suck their thumb
Mother of 12 month old baby is worried none of child’s teeth have erupted yet.
• What advice you going to give (first and last erupted teeth)
- FIRST - 6 months (4-11 months) - A
- LAST - 27 months (23-31 month) - E
- There is natural variation in eruption not a specific schedule
- May be of concern if only one side has erupted or abnormal sequence of eruption
- If old siblings/parents are late teethers - hereditary
Diet advice for the 12 month old
- Breastfeeding offers best nutrition to babies
- Avoid sugary foods when weaning
- Limit frequency and amount of sugar
- Discourage bottle feeding from 12 months
- Don’t take bottle to bed
- Free flow cup from 6 months
- Sugar free medications
Give brushing advice for when teeth do come through
- At least 1000ppm fluoride
- Smear of toothpaste
- Parental guidance or assistance
- Brush twice a day on eruption (once at night and other time)
Give an example of a condition and how it may affect dental treatment
• Autism spectrum disorder:
- Some can be meticulous about things, e.g. brushing but others will have no interest at all and difficult to motivate
• Downs syndrome:
- Increase risk of periodontal but not risk of caries due to saliva composition
• ADHD - don’t like sitting still and being told
• Cerebral palsy:
- Motor control difficulties
Give 2 non dental related problems with Down’s syndrome
- Congenital heart disease
- Gastric reflux
- Immune deficiency
- Thyroid dysfunction
- Atlanto-axial instability
Patient lost upper denture on holiday. Wearing old one and has natural dentition in lower arch. Decided to make new CoCr.
• 4 intraoral examinations before starting
- Occlusal relationship - assess where guidance will be
- Inter-occlusal space - assess arrangement of opposing teeth in function
- Centre line
- Lip smile line
- Shape and position of potential abutments
- Restorative, periodontal and vitality status of remaining teeth
- Ridge assessment
- Soft tissues (muscular attachments - frenum)
- Position of teeth present - tilting, protrusion, retroclination
2 reasons radiographs before denture
- Retained roots and foreign bodies
- Bone levels of abutment teeth
- PA status of abutment teeth
- Pathological conditions that can’t be seen clinically
- Alveolar height and width
- Position of normal anatomical features
Women in pain. UR5 recently had large MO restoration. Pain after restoration and got worse. Spontaneous, keep pt. awake at night and hurts on pressure. Patient has osteoporosis and on aldendronic acid.
- ) What is differential diagnosis?
- ) 3 special investigations you can do other than EPT?
- ) Pulp test came back -ve. What is the definite diagnosis
- ) What are the treatment options available and which is the way to manage the patient in regards to her condition and what medication is she taking
1.) • Irreversible pulpitis
• PA periodontitis
• Cracked tooth syndrome
2.) • Vitality test - ethyl chloride
• Radiographs - PA
• TTP/tooth slooth
3.) • Necrosed pulp
• Acute PAP
- ) RCT/XLA
- pt. is on bisphosphonates therefore risk of BRONJ.
- Atraumatic extraction
- CHX mouthwash 2x day
- Morning appt.
- Early in week
