Clinical Operative Dentistry Guidelines

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Questions and Answers

What is the appropriate technique for removing excess primer from the canal?

  • Blot with a microbrush repeatedly to remove excess. (correct)
  • Let the primer evaporate naturally.
  • Apply water to wash away the primer.
  • Use a cotton swab to absorb the primer.

What should be done to the adhesive before applying it to the dentin surfaces?

  • Light cure it before application.
  • Remove excess adhesive after application. (correct)
  • Store it in a cold place.
  • Dilute it with water.

Which step should NOT be performed after injecting cement into the canal?

  • Light cure the cement immediately. (correct)
  • Insert the post with moderate pressure.
  • Wait for the cement to set.
  • Remove any excess cement.

When is it indicated to repair a restoration instead of replacing it?

<p>When the restoration is still acceptable and asymptomatic. (A)</p> Signup and view all the answers

What is a potential consequence of replacing a restoration?

<p>It may lead to a larger restoration. (D)</p> Signup and view all the answers

Which of the following statements about the Nayarr core is correct?

<p>It is an excellent option for posterior teeth. (B)</p> Signup and view all the answers

What should be ensured before repairing a restoration?

<p>There must be adequate retention and resistance form. (A)</p> Signup and view all the answers

What is a characteristic of endocrowns?

<p>They are ideal for maintaining tooth structure in short teeth. (D)</p> Signup and view all the answers

What is the main indication for a preventive resin restoration (PRR)?

<p>Presence of a small, cavitated carious lesion in pits and fissures (B)</p> Signup and view all the answers

What is the recommended acid-etch time for the occlusal surface during a PRR procedure?

<p>30 seconds (D)</p> Signup and view all the answers

Which of the following methods is NOT used for tooth preparation in conservative composite restorations?

<p>Pumice polishing (D)</p> Signup and view all the answers

What is the purpose of using a rubber dam during a PRR procedure?

<p>To isolate the tooth and prevent moisture contamination (D)</p> Signup and view all the answers

What should be done immediately after acid-etching the occlusal surface?

<p>Wash thoroughly with water (A)</p> Signup and view all the answers

In the context of post and core restorations, when is it appropriate to use a post?

<p>When there is minimal coronal tooth structure remaining (C)</p> Signup and view all the answers

How long should the bonding agent be light cured during a PRR procedure?

<p>20 seconds (C)</p> Signup and view all the answers

Which step in the PRR clinical procedure involves using various means like air abrasion and lasers?

<p>Preparing the pits and fissures (B)</p> Signup and view all the answers

What is the purpose of selectively removing soft dentin in carious lesions?

<p>To reduce risk of pulp exposure and promote pulpal health (B)</p> Signup and view all the answers

What is the minimum requirement of tooth structure or liner/base materials between the pulp and restorative material?

<p>2mm (C)</p> Signup and view all the answers

Which material should be placed if 1-2mm of dentin remains after caries removal?

<p>Resin Modified Glass Ionomer Cement (RMGIC) (B)</p> Signup and view all the answers

What is the recommended action if pulp exposure occurs and bleeding starts?

<p>Apply pressure with a cotton pellet and wash with sterile saline (B)</p> Signup and view all the answers

What is the function of protective biomaterials such as MTA or Ca(OH)2 in pulp capping?

<p>To create a protective barrier and promote healing (A)</p> Signup and view all the answers

Which of the following is true regarding indirect pulp capping procedures?

<p>Resin modified glass ionomer cement is indicated when dentin thickness is 1-2mm (D)</p> Signup and view all the answers

What happens to the configuration factor (C factor) when 2mm of dentin is present without pulp protection materials?

<p>It decreases, reducing shrinkage stress (B)</p> Signup and view all the answers

What is the first step after pulp exposure and bleeding occurs?

<p>Wash cavity with sterile saline (D)</p> Signup and view all the answers

Which step is essential for preventing overhangs in an amalgam restoration?

<p>Carefully inspecting the matrix at the gingival floor level (D)</p> Signup and view all the answers

What is the purpose of placing the first increment of amalgam in the box during the procedure?

<p>To establish a foundation for additional increments (D)</p> Signup and view all the answers

Why is strong condensation of amalgam important in the restoration process?

<p>To prevent formation of voids and ensure coverage of margins (B)</p> Signup and view all the answers

What should be done immediately after burnishing the overfilled amalgam?

<p>Start carving the amalgam (D)</p> Signup and view all the answers

What is the primary reason for checking interproximal contacts with dental floss after an amalgam restoration?

<p>To verify the fit of the restoration against adjacent teeth (A)</p> Signup and view all the answers

When checking occlusion after the restoration, what action should the patient perform?

<p>Lightly occlude and move the mandible in all directions (C)</p> Signup and view all the answers

Which tool is utilized to remove excess amalgam, especially in the occlusal grooves?

<p>Carver or Hollenback (A)</p> Signup and view all the answers

What is a key design requirement for tooth preparation intended for amalgam restorations?

<p>Isthmus width should not exceed 1/3rd of the intercuspal distance. (D)</p> Signup and view all the answers

Which dental restorative material typically requires a more conservative tooth preparation design?

<p>Polymeric materials (D)</p> Signup and view all the answers

What should be done with shiny areas of amalgam before it is fully set?

<p>Remove them using a carver (A)</p> Signup and view all the answers

What is the most appropriate bur type for initiating a Class I tooth preparation for amalgam?

<p>Pear-shaped bur No. 330 (D)</p> Signup and view all the answers

Which statement about amalgam tooth preparation is true?

<p>It aims to achieve resistance and retention forms. (A)</p> Signup and view all the answers

What is the recommended cavosurface angle for amalgam preparation?

<p>As close to 90º as possible. (D)</p> Signup and view all the answers

What is the purpose of beveling enamel during the repair of direct restorations?

<p>To ensure proper bonding and retention of the repair material (B)</p> Signup and view all the answers

What must be considered when performing tooth preparation for restorative materials?

<p>The type of dental restorative material being used. (D)</p> Signup and view all the answers

Which step is crucial before applying the bonding agent in the repair of direct restorations?

<p>Micro-etching the remaining restorative material (B)</p> Signup and view all the answers

Why are slightly rounded internal line angles recommended in amalgam preparations?

<p>To minimize stress concentration and potential fractures. (C)</p> Signup and view all the answers

What material should be used to micro-etch before repairing indirect restorations?

<p>50μm aluminum oxide powder (B)</p> Signup and view all the answers

What is the primary purpose of accessing the lesion during tooth preparation for amalgam?

<p>To provide convenience form and ensure effective restoration. (A)</p> Signup and view all the answers

What is the primary reason for applying hydrofluoric acid during the repair of porcelain fused to metal restorations?

<p>To increase the surface roughness for better adhesion (C)</p> Signup and view all the answers

In the context of repairing indirect restorations, when is it unnecessary to use a primer?

<p>When the tooth structure is not involved (A)</p> Signup and view all the answers

Which step should be performed after micro-etching and before applying the bonding agent?

<p>Applying a silane primer (D)</p> Signup and view all the answers

What is the purpose of using a resinous opaquer in the repair process?

<p>To provide a suitable color match for aesthetic results (C)</p> Signup and view all the answers

What is the recommended light curing time for the composite after placement during restoration repair?

<p>40 seconds (A)</p> Signup and view all the answers

Flashcards

Amalgam Tooth Preparation

A type of tooth preparation meant to accommodate amalgam restorations. It involves accessing the lesion, applying SCR (selective caries removal) principles, and providing appropriate resistance and retention forms for the material.

Cavosurface Angle

The angle created between the tooth surface and the edge of the preparation. It helps to prevent the restoration from dislodging.

Selective Caries Removal (SCR)

A key principle in preparing a tooth for restorations. It involves removing only diseased or decayed tooth structure, leaving healthy tissue intact.

Retention and Resistance Forms

A preparation technique that aims to create a strong, stable foundation for the restoration by ensuring its proper retention and resistance to forces.

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Isthmus

The portion of the tooth preparation that connects the mesial and distal walls. It should be narrow.

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Pear-Shaped Bur No. 330

A standard dental bur used to create a smooth transition between the tooth surface and the restoration.

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Continuous Bur Rotation

A technique where the bur rotates continuously while cutting, ensuring smooth preparation and minimizing heat generation.

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Punch Cut

The primary stage of tooth preparation where the bur is introduced into the carious pit. The bur's long axis should align with the tooth's long axis.

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Indirect Pulp Capping

A type of pulp protection where a thin layer of RMGIC or GIC is placed over healthy dentin to provide a barrier between the restorative material and the pulp.

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Direct Pulp Capping

A type of pulp protection where a material like MTA or Ca(OH)2 is placed directly on an exposed pulp, aiming to promote healing and prevent further damage.

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Pulp Protection/Base Material

A material, like MTA or Ca(OH)2, used to create a protective barrier for the pulp, reducing shrinkage stress from the restorative material.

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Dentin Thickness

The amount of dentin remaining between the pulp and the restorative material.

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Configuration Factor (C Factor)

The amount of space within the restoration cavity that can be filled with restorative material.

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Resin Modified Glass Ionomer Cement (RMGIC)

A type of composite resin cement that releases fluoride and bonds to tooth structure, often used in indirect pulp capping.

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Glass Ionomer Cement (GIC)

A type of cement that releases fluoride and bonds to tooth structure, often used in indirect pulp capping.

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Amalgam Restoration Preparation

This stage involves cleaning and preparing the tooth for the amalgam filling, often using a rubber dam to isolate the area. It includes steps like preparing the cavity, placing desensitizer, and mixing the amalgam. This ensures a clean field for the restoration process.

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First Increment of Amalgam

The initial layer of amalgam is placed in the "box" or the deepest part of the cavity. This provides a stable base for building up the restoration.

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Amalgam Condenser

A tool used to compact the amalgam material tightly into the preparation. This process helps to eliminate air voids and creates a solid, cohesive structure.

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Overfilling Amalgam

The amalgam is overfilled by about 1mm to ensure that there's enough material for carving and shaping. It's like adding a little extra dough to a pizza before shaping it.

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Amalgam Burnisher

A smooth, rounded tool used to gently shape the overfilled amalgam before further carving. It helps to create a smoother surface and prepare the amalgam for the next step.

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Amalgam Carving

The final stage involves carving and shaping the amalgam to restore the tooth's natural form, using instruments to create grooves, fissures, and ridges. It's like sculpting the filling to match the tooth.

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Amalgam Burnishing (Post-carving)

After carving, the amalgam is carefully polished to smooth out sharp edges and create a comfortable surface. This step ensures a smooth transition between the filling and the tooth.

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Occlusion Check

A critical final step to ensure proper function and prevent discomfort. The dentist checks the bite thoroughly to ensure that the tooth is properly aligned and comfortable. Any high spots are adjusted to prevent interference.

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Post Placement

A dental procedure that involves removing excess cement from the canal, ensuring proper placement of the post, and allowing the cement to cure.

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Post and Core

A dental technique where a weakened tooth is strengthened by inserting a post into the root canal and building a core on top of it, providing a foundation for a crown.

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Self-curing Cement

A type of dental cement that cures by chemical reaction, usually requiring a longer setting time than light-cure cements.

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Light-cure Cement

A type of dental cement that cures when exposed to a blue light source, providing quick setting.

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Restoration Repair

A dental technique aimed at repairing existing restorations instead of replacing them, minimizing damage to the tooth.

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Peri-cervical Area

The area around the neck of a tooth, considered crucial for structural integrity and longevity.

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Endocrown

A type of dental restoration that covers the entire crown of a tooth, providing a long-lasting solution.

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Preventive Resin Restoration (PRR)

A minimally invasive procedure using flowable composite to restore small, cavitated pits and fissures on teeth. It aims to prevent further decay by sealing adjacent pits and fissures.

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Flowable Composite

A thin, transparent liquid composite that flows easily into pits and fissures, providing a strong seal.

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Alternative Tooth Preparation Techniques

An approach using different techniques like lasers or air abrasion to prepare a tooth for a restoration instead of traditional burs.

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Rubber Dam Isolation

The use of a rubber dam to isolate a tooth from saliva and moisture during a dental procedure.

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Bonding Agent

A material placed in a tooth preparation to bond the restoration to the tooth structure.

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Light-Curing

The process of hardening a composite material using a special light.

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Sealant

A material placed over a tooth to seal pits and fissures, preventing decay.

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Composite Restoration Repair

Repairing a damaged composite restoration by removing the defective part, preparing the tooth surface, and placing new composite material.

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Repair involving Enamel

When the preparation and repair material include enamel, ensuring retention via bonding, creating a strong connection between the restoration and the tooth.

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Micro-etching

A procedure used to roughen the surface of existing restorative material (amalgam or composite) before bonding a new repair.

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Indirect Restoration Repair

A type of repair involving an indirect restoration, such as porcelain fused to metal crowns, where the repair material is bonded to the restoration itself.

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PFM Preparation for Repair

The process of preparing a porcelain fused to metal restoration for repair by smoothing rough edges and creating a bevel for better bonding.

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Hydrofluoric Acid Treatment

A chemical treatment applied to porcelain surfaces in PFM repairs to improve bonding.

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Resinous Opaquer

A material used in PFM repairs to hide the underlying metal surface, improving aesthetics.

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Pink Opaquer

A special type of composite resin used in PFM repairs to provide excellent aesthetic results.

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Study Notes

Clinical Operative Dentistry Guidelines

  • These guidelines are a manual for dental students at European University Cyprus
  • They provide guidance on operative dentistry techniques
  • They use evidence-based contemporary techniques and materials
  • They are a tool for calibration between clinical supervisors
  • They complement theoretical and practical education

Introduction

  • Operative dentistry studies the hard tissues of teeth, prevention and treatment of pathological conditions caused by disease, trauma, wear and/or abnormal development
  • It aims to restore natural anatomical form and function, manage caries (by risk assessment), treat the disease, and improve oral health
  • Conservative surgical approach to minimize tooth structure invasion is advocated
  • Clinical courses are available for each year and semester

Examination of Patient and Oral Cavity

  • Comprehensive caries management and prevention plans are to be established during the screening examination
  • Examination of the patient's occlusal characteristics and any possible impact on masticatory muscles and TMJs
  • Review of patient records, treatment plans, radiographs before every appointment
  • Key factors include patient needs, tooth anatomy, operative procedure, restorative materials, home, risk status, age, cooperation aspects of anesthesia
  • An examination of the aesthetic appearance is also part of the process.

Caries Assessment

  • Questions to consider for clinical decision-making and treatment planning: does caries exist, how is it detected, where is it located, does it involve only enamel or dentin, is it cavitated, can it be treated without surgery, and what is the future caries risk for the patient.
  • Caries detection methods include visual examination, bitewing radiographs, and Diagnodent laser fluorescence.
  • Acceptable methods include proper vision, lighting, bitewing radiograph, and transillumination.
  • An explorer should not be used as a primary diagnostic tool on smooth surfaces, only for roughness assessment.
  • Caries lesions may present as non-cavitated white lesions in enamel, or involve both enamel and dentin, leading to significant destruction.

Caries Management by Risk Assessment (CAMBRA)

  • This is a management philosophy for controlling caries disease using a medical model
  • It evaluates pathological and protective factors to assess the risk of future disease development
  • It leads to an individualized evidence-based management plan involving nonsurgical and surgical interventions

Pre-Operative Procedures

  • Local anesthesia is commonly used during most operative procedures
  • Shade selection (using Vita Classic shade guide) is done before any mouth work, as dehydration can affect the shade of teeth
  • Proper isolation of the operating site using rubber dam isolation is the optimal method for direct and indirect restorations and endodontic procedures, as it minimizes airborne debris and aerosols and improves operator access and visibility.

Tooth Preparation

  • The goal is the maximum preservation of tooth structure while optimizing restorative material strength and longevity
  • Instruments are used to remove carious lesions, shape the tooth, assess the preparation and obtain retention and resistance forms.
  • Hand instruments include excavators, hatchets, chisels, and gingival margin trimmers
  • Rotary instruments include round burs, pear-shaped burs, cross-cut fissure burs, and finishing diamonds.

Restorative Procedures

  • Restore natural tooth anatomy, protect pulp-dentin complex, and aid plaque control.
  • Resin-based composite is a preferred restorative material today, followed by amalgam (in some cases) for its conservative preparation and bonding capabilities.
  • The ICDAS, and various other classifications, are used for scoring caries severity, with scores ranging from 0 (no caries) to 6 (extensive caries)
  • Clinical protocols, systems, and materials for various operative conditions are detailed for amalgam and resin-based composite restorations.

Management of Dental Caries and Pulp Protection

  • Preservation of non-demineralized and remineralizable tissue is crucial.
  • Sealing sound dentine with peripheral restoration and inactivating remaining bacteria are essential steps.
  • Pulp health is maintained by avoiding unnecessary pulpal irritation, preserving remaining dentine, and preventing pulp exposure.
  • Deeper lesions require preserving pulpal health as the first priority and removing all soft dentine for optimal restoration.

Selective Caries Removal (SCR) Protocol

  • Caries is removed to normal (hard) dentin at DEJ.
  • Moderate carious lesions do not reach the inner one-third but deeper lesions involve removal of soft dentine.

Placement of Pulp Protection/Bases and Liners

  • Materials like MTA, Ca(OH)2, and Biodentine are used as barrier and thermal materials to protect the pulp.
  • This is essential for deep or moderately deep lesions.

Indirect Pulp Capping

  • For 1-2mm dentin, using RMGIC or GIC
  • For 0.5mm or less then using MTA or Ca(OH)2 materials
  • 1-year follow-up and periapical radiographs are suggested.

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