BDS11173 Indirect Esthetic Restorations

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Questions and Answers

What does Category A in the decision-making process indicate?

Direct restorations clearly indicated. (correct)

Indirect restorations clearly indicated.

Uncertainty between direct and indirect restorations.

Indications are based on patient preference.

In what situation would an indirect approach be preferred according to the decision-making categories?

When the patient has strong preferences.

When cuspal protection is required for endodontically treated teeth. (correct)

When there is uncertainty over the appropriate approach.

When direct restorations are clearly indicated.

Which factor can complicate adhesive techniques during the restoration process?

Usage of direct restorations.

Selecting indirect restorations.

A well-controlled dry field.

Inability to maintain a dry field. (correct)

What potential issue can arise from insufficient thickness in ceramic restorations?

Fracture of the restorations. Signup and view all the answers

In which category is there uncertainty about the most appropriate restorative approach?

Category B. Signup and view all the answers

Why might indirect techniques be advantageous for large restorations?

Contours and occlusal contact can be more easily developed. Signup and view all the answers

Which situation is most likely to indicate a direct restoration?

A case with clear indications for direct restorations. Signup and view all the answers

What are the modifying factors to consider when deciding between direct and indirect restorations?

Occlusion and para-functional habits. Signup and view all the answers

What is the primary advantage of using indirect esthetic restorations over direct restorations?

Improved esthetics and durability Signup and view all the answers

Which material is commonly used in the creation of indirect esthetic restorations?

Feldspathic porcelain Signup and view all the answers

What is an important step in the preparation of a tooth for indirect esthetic restorations?

Creating minimal tooth structure removal Signup and view all the answers

Which process is utilized to bond indirect esthetic restorations to the tooth?

Resin-based cements Signup and view all the answers

What aids in the fabrication of indirect esthetic restorations using modern technology?

Computer-aided design/computer-assisted manufacturing (CAD/CAM) Signup and view all the answers

What is a common limitation of direct esthetic restorations?

Inadequate esthetic results Signup and view all the answers

Which of the following methods is NOT typically used for the fabrication of indirect esthetic restorations?

Traditional casting Signup and view all the answers

What technique precedes the cementation of indirect esthetic restorations?

Trial fitting and provisionalization Signup and view all the answers

What is the minimum width required for any isthmus in most ceramic systems?

2 mm Signup and view all the answers

Which of the following is NOT a benefit of immediate dentin sealing (IDS)?

Increased thickness of the restoration Signup and view all the answers

Why should the occlusal portion of the preparation be 2 mm deep during cusp coverage?

To reduce the chances of ceramic inlay failure Signup and view all the answers

What should be done during photopolymerization of IDS to avoid the effect of oxygen inhibited layers?

Use glycerin Signup and view all the answers

What is one purpose of deep margin elevation (DME)?

To facilitate easier isolation during cementation Signup and view all the answers

Which of the following is NOT considered a method for performing DME?

Laser treatment Signup and view all the answers

What are the aims of provisionalization in dental procedures?

To stabilize occlusal and proximal contact until final restoration delivery Signup and view all the answers

In which phase of the dental restoration process is the digitization of conventional models most relevant?

Impression Signup and view all the answers

Why should deep subgingival preparations generally be avoided?

They pose a risk of involving the periodontal structures. Signup and view all the answers

What is one of the primary benefits of anatomically driven tooth preparation?

To increase adhesion to the tooth structure. Signup and view all the answers

What should be the minimum thickness of restorative material in cavity preparations?

2 mm Signup and view all the answers

What type of angle should all margins have to ensure marginal strength of the restoration?

90-degree butt-joint cavosurface angle Signup and view all the answers

What should be the gingival-occlusal divergence of the preparation walls?

2 to 5 degrees Signup and view all the answers

What is the primary purpose of occlusal adjustment in ceramic restorations?

To correct the bite and occlusal contacts Signup and view all the answers

Which of the following statements about beveling the margins is true?

Beveling provides more surface area for bonding in some cases. Signup and view all the answers

Which material is achieved by injecting a fast-setting vinyl polysiloxane into the impression?

Silicon cast Signup and view all the answers

How can retention of the restoration be improved?

By increasing sound enamel surface area beside axial walls. Signup and view all the answers

What enhances the smoothness of ceramic restorations during polishing?

A diamond polishing paste Signup and view all the answers

What is a crucial factor for the success of indirect esthetic restorations?

Operator skill and attention to detail Signup and view all the answers

What is the purpose of using a tapered diamond for tooth preparation?

To create occlusally divergent facial and lingual walls. Signup and view all the answers

What technique is used for further smoothing of restorations after initial polishing?

Rubber abrasive points and cups Signup and view all the answers

Which of the following is NOT a step in the process of indirect esthetic restorations?

Fluoride application for strengthening Signup and view all the answers

Which method can be used to remove excess resin cement during restoration procedures?

A scalpel blade Signup and view all the answers

What type of restorations have been improved due to advances in ceramic, polymer, and adhesive technologies?

Tooth-colored indirect Class I and II restorations Signup and view all the answers

What is the main purpose of using Hydrofluoric acid in the bonding process of silica-based materials?

To increase the surface area for micromechanical bonding Signup and view all the answers

Which statement accurately describes the cementation materials used in dental restorations?

Resin cement can be either dual cure or light cure depending on restoration thickness. Signup and view all the answers

What is the recommended action to prepare the tooth surface when using resin cement?

Use selective etching technique or self-etching technique Signup and view all the answers

What is the role of a silane coupling agent in the bonding process?

To form a chemical bond with silica in the ceramic matrix Signup and view all the answers

Which of the following is NOT part of the procedures for finishing and polishing dental restorations?

Applying Hydrofluoric acid Signup and view all the answers

What should be monitored during the try-in phase of restoration?

Proximal contact and adaptation of margins Signup and view all the answers

What is a common technique for preparing the fitting surface prior to cementation?

Applying Hydrofluoric acid etching Signup and view all the answers

What is the function of light curing in cementation processes?

It helps in the setting process of certain resin cements Signup and view all the answers

Study Notes

Course Title

BDS11173 Indirect Esthetic Restorations

Course Aim

Detail different types of indirect esthetic restorations, their indications, and materials used.
Explain selecting the best restoration and preparing the tooth to receive it.
Explain bonding indirect esthetic restorations.

Course Objectives

Understanding the diverse indirect esthetic restorations and their indications.
Understanding the steps and process in indirect esthetic restorations, including tooth preparation.

Outline

Limitations of direct esthetic restorations and indications of indirect restorations.
Materials and techniques of fabrication.
Material selection.
Advantages of indirect restorations.
Indications of indirect restorations.
Cavity preparation.
IDS & DME.
Impression techniques.
Provisionalization and try-in.
Cementation.
Finishing and polishing.

Limitations of Direct Esthetic Restorations

Marginal fracture.
Inadequate bond.
Shrinkage.
Marginal adaptation.
Shrinkage stress.

Indirect Esthetic Restorations

Fabricated outside the patient's mouth.
Made on a replica of the prepared tooth.
Created in a lab or using CAD/CAM.

Indirect Esthetic Restorations: Popularity

Driven by patient demand for aesthetics, durable restorative materials.
Improvements in materials, fabrication techniques, adhesives, and resin-based cements.

Indirect Esthetic Materials and Fabrication Techniques

Ceramics (feldspathic porcelain, castable ceramics, hot-pressed ceramics, infiltrated ceramics, machined ceramics).
Hybrid Ceramic.
Resin Composite. -CAD/CAM (Laboratory, flexi models, 3D printing)

Material Selection

Modules of elasticity and surface luster and wear to the opposing and wear resistance.

Advantages of Indirect Restorations

Higher physical and mechanical properties.
Variety of materials and techniques.
Wear resistance.
Reduced polymerization shrinkage.
Support of remaining tooth structure.
More precise control of contours and contacts.
Increased auxiliary support.
Biocompatibility and good tissue response.

Indications of Indirect Restorations

Lesion size, etiology, and number of involved surfaces.
Number of teeth affected.
Patient compliance, habits, and preferences.
Dentist's competence.

Decision-Making Process: Direct vs. Indirect

Category A: Direct restorations are suitable.
Category B: Uncertainty over the best approach.
Category C: Indirect restorations are better.

Additional Indirect Restoration Indications

Replacement of large compromised existing restorations.
Contour and occlusal contact ease of development.
Endodontically treated posterior teeth where cuspal protection is needed.

Modifying Factors

Inability to maintain a dry field. This impacts long-term success.
Occlusion and para-functional habits (bruxing, clenching).
Deep subgingival preparations (not an absolute contraindication but generally avoided).

Cavity Preparation

Check occlusion.
Field isolation.
Tools.
General criteria.
Cusp reduction.
Finish line.
Recent modifications.
Patient anesthetization
Area isolation with rubber dam.
Amalgam or exposure removal.
Removal of caries.
Using different tools.

Tools for Tooth Preparation

Tapered diamond burs for occlusally divergent facial and lingual walls.
Rounded-end cutting instruments.
Finishing diamonds.

Anatomically Driven Preparation

Maintains favorable stress distribution.
Improves adhesion.
Minimizes dentin exposure which supports hard tissue preservation
Optimizes esthetic integration.
Preparation design to be adequate thickness.
Rounded internal angles.
Well-defined margins.
Facial and lingual extensions.
Smooth curves around cusps.

Margins

90-degree butt-joint cavity surface angle (for strength).
Avoid beveling.
Surface increased for bonding with glass based materials.
Gingival-occlusal divergence of >2-5 degrees per wall .

Resistance and Retention

Resistance of the tooth structure.
More surface area for bonding.
Lateral displacement prevention and undercut blocking.

Pulpal Floor and Isthmus

Smooth and relatively flat.
Isthmus needs a minimum 2mm.
Smooth transition for strength.
2mm deep for cusps.

Capping Cusps

Shoulder preparation.
Prevent accidental contact with opposite tooth.

Immediate Dentin Sealing (IDS)

Better adhesive properties of freshly cut dentin.
Less intra- and post-operative hypersensitivity.
Better bond strength to dentin.
Two-step adhesive or universal adhesive covered with flowable composite.
Glycerin coverage during photopolymerization.

Deep Margin Elevation (DME)

Placing the gingival margin of the restoration for cementation ease, better impressions, restoration seating, and excess removal.
Usable composites are flowable, bulk fill, injectable.

Impression

Conventional method.
Digitization of conventional model.
Digital method.

Fabrication

Ceramics.
Hybrid ceramics.
Resin composite.
CAD/CAM(lab, flexi, 3D printing).

Provisionalization

Stabilizes both occlusal and proximal contacts.
Protects soft tissue.
Materials include light-cured temporary filling.
Additional option is 3D printed restoration.

Try-in

Checking the fit, and proximal contact.
Assessing adaptation of margins.
Materials including Wax, PMMA, or final materials.

Cementation

Cement material selection.
Tooth surface treatment.
Fitting surface treatment.
Light curing.
Excess removal and polishing.

Resin Cement vs. Composite

Comparison between resin cement and heated flowable composites.

Resin Cement

Dual cure vs. light cure: (restoration thickness, translucency, and aesthetics.)
Conventional vs. self-adhesive.

Tooth Surface Treatment and Cementation

Material specific treatments based on structure and materials.
Use of etching, primers, and adhesives.
Acidity considerations.

Bonding of Silica Based Restorations

Hydrofluoric acid: etches the internal surfaces.
Acid-etching: enhances surface area for micromechanical bonding.
Bonding generally done in office or lab.

Bonding to Tooth Structure

Tooth surface refreshment using Alumina is key.
Selective etching technique / self-etching technique.

Finishing and Polishing

The use of 30-fluted carbide finishing burs for smoothing interproximal surfaces.
Using a scalpel blade to eliminate resin cement.
Polishing ceramic restorations using abrasive techniques.

Occlusal Adjustment and Re-polishing

Occlusal adjustment tools and techniques.

Finishing Processes

Smoothing with rubber abrasive points/cups.
Diamond polishing using paste and tools.

Flexible Model Technique

Fast-setting vinyl polysiloxane injection.
Setting time.
Dye separation.
Silicon cast creation.
Layer build up with different shades and curing.

Additional Information

Reading materials are presented for further study.

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Description

This quiz covers various types of indirect esthetic restorations, their indications, and the materials used. It also focuses on the processes involved in selecting and preparing a tooth for these restorations. Additionally, the quiz addresses bonding techniques and other essential aspects of indirect restorations.