Dental Dentin Quiz
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Questions and Answers

What characterizes arrested caries involving dentin?

  • Absence of secondary dentin formation
  • Complete obliteration of all dentinal tubules
  • Marked brown pigmentation of dentin (correct)
  • Presence of large cavities with retained food

What is sclerotic dentin primarily known for?

  • Decreased hardness and density
  • Formation of large cavities due to food retention
  • Increased sensitivity of the pulp
  • Enhanced protection of the pulp against irritation (correct)

What occurs when further irritation affects the dentin?

  • Reversal of the sclerotic process
  • Formation of a Calcific Barrier (correct)
  • Dissolution of peritubular dentin
  • Increased permeability of tubules

What is a notable consequence of sclerosis in dentin?

<p>Obliteration of peripheral dentinal tubules (C)</p> Signup and view all the answers

How does the dentin respond to irritation with regard to Tome's fibers?

<p>They undergo mineralization and deposit peritubular dentin (A)</p> Signup and view all the answers

What is the required condition of the tooth before performing direct pulp capping?

<p>It must be asymptomatic and vital. (C)</p> Signup and view all the answers

Which of the following is NOT a favorable condition for direct pulp capping?

<p>Spontaneous pain before the procedure. (C)</p> Signup and view all the answers

What is the purpose of provisional restoration after pulp capping?

<p>To allow healing and monitor the tooth for 6-12 weeks. (B)</p> Signup and view all the answers

Which step of the procedure involves managing the site of pulp exposure?

<p>Direct pulp capping. (C)</p> Signup and view all the answers

What type of restoration is recommended for teeth with pulp exposure that shows signs of vitality?

<p>Direct pulp capping. (A)</p> Signup and view all the answers

Which condition is critical for the prognosis of pulp capping when an exposure occurs?

<p>A completely dry operative field. (A)</p> Signup and view all the answers

What approach is taken when the pulp exposure is extensive and cannot ideally be capped?

<p>Step-wise excavation is preferred. (C)</p> Signup and view all the answers

What is the first action in the management of deep dentin caries with a potential pulp exposure?

<p>Assessment of symptomatic response. (C)</p> Signup and view all the answers

What is one of the criteria for success in dental treatment as mentioned?

<p>Radiographic evidences of reparative dentine formation (D)</p> Signup and view all the answers

Which statement accurately describes the management of extensive active caries in multiple teeth?

<p>Infected dentin is removed and temporary restorations are placed. (B)</p> Signup and view all the answers

Which of the following is NOT a part of the criteria for dental treatment success?

<p>Patient exhibits ongoing discomfort (A)</p> Signup and view all the answers

What is the role of calcium hydroxide in dental treatments as mentioned?

<p>Stimulates tertiary dentin formation (D)</p> Signup and view all the answers

What does the procedure of treating multiple teeth with caries aim to achieve?

<p>Stop the progress of caries in multiple teeth (C)</p> Signup and view all the answers

Why is annual recall significant in dental treatment success criteria?

<p>It ensures ongoing assessment of tooth health. (A)</p> Signup and view all the answers

What is one benefit of treating multiple teeth with extensive caries at once?

<p>It enables more teeth to remain serviceable. (D)</p> Signup and view all the answers

What is a sign of treatment success according to the criteria provided?

<p>Formulation of reparative dentine (D)</p> Signup and view all the answers

Which zone is characterized by being soft, lighter in color, non-sensitive, and infected?

<p>Zone 1: Infected (D)</p> Signup and view all the answers

What is the characteristic of Zone 3?

<p>Dead and un-re-mineralizable (D)</p> Signup and view all the answers

What describes Zone 4?

<p>Affected and sub-transparent (C)</p> Signup and view all the answers

In the context of cavity preparation, selective removal to firm dentin is recommended for which type of lesions?

<p>Shallow or moderately deep lesions (B)</p> Signup and view all the answers

What is indicated by dentin that deforms when an instrument is pressed into it?

<p>It is soft dentin (D)</p> Signup and view all the answers

What characteristic indicates that Zone 5 is normal?

<p>It has intact collagen matrix (C)</p> Signup and view all the answers

Which statement is true about Zone 2?

<p>It is turbid and collagen is irreversibly denatured (A)</p> Signup and view all the answers

When excavating for a restoration, what is the purpose of reaching hard dentin?

<p>To seal the margin and increase the longevity of the restoration (B)</p> Signup and view all the answers

What is always recommended to be used with amalgam restorations?

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

What type of material is required as a base for metallic final restorations in moderately deep cavities?

<p>Reinforced or resin modified GI material (A)</p> Signup and view all the answers

What technique might be used in moderately deep cavities for direct composite restorations?

<p>Sandwich technique (A)</p> Signup and view all the answers

Which of the following is NOT a reason for using a layer of flowable composite under packable composites?

<p>To provide additional color matching (A)</p> Signup and view all the answers

What dimension is particularly relevant when considering the location of cavity margins in relation to the central fissure?

<p>Distance to cusp tip (C)</p> Signup and view all the answers

In cases of deep cavities, what kind of material might be used for the base under direct composites?

<p>Resin-based base (D)</p> Signup and view all the answers

What depth range is specifically noted for moderate cavities requiring additional restorative measures?

<p>2-4 mm (D)</p> Signup and view all the answers

For effective function, which one of the following stresses must be considered when placing cavity margins?

<p>Functional and non-functional stresses (B)</p> Signup and view all the answers

What is a major drawback of using Biodentin?

<p>It relies mainly on micromechanical bonding. (D)</p> Signup and view all the answers

What does TheraCal LC not require for its setting process?

<p>The presence of water. (A)</p> Signup and view all the answers

What is one of the advantages of TheraCal LC?

<p>It shows lower solubility than other materials. (C)</p> Signup and view all the answers

How can the need for a specific liner or base be determined?

<p>By the thickness of remaining dentin. (D)</p> Signup and view all the answers

What is one of the drawbacks of TheraCal LC?

<p>It has lower bioactive potential due to resin components. (B)</p> Signup and view all the answers

Which of the following factors influences the selection of a liner or base?

<p>Adhesive properties of restorative material. (A)</p> Signup and view all the answers

What characteristic makes TheraCal LC facilitate the placement of final restoration?

<p>Its fast setting time. (B)</p> Signup and view all the answers

What is a necessary condition for applying adhesive materials?

<p>They should always be applied directly. (C)</p> Signup and view all the answers

Flashcards

Arrested Caries

Caries (tooth decay) that stops progressing and does not get worse.

Sclerotic Dentin

Dentin becomes harder, denser, and less sensitive due to added mineral deposits, protecting the pulp from irritation.

Calcific Barrier

A layer of completely mineralized dentin that blocks the ends of the tubules, preventing irritation from reaching the pulp.

Secondary Dentin

New dentin formed on the inner surface of the existing dentin, further protecting the pulp.

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Tome's fibers

Tiny fibers that run through the dentinal tubules, connecting the pulp to the outer dentin.

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Zone 1 (Infected)

The outermost zone of a carious lesion, characterized by soft, discolored dentin that is no longer sensitive to stimuli.

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Zone 2 (Turbid)

The zone beneath the infected layer, where collagen has been irreversibly denatured, making it un-re-mineralizable.

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Zone 3 (Transparent)

The zone below the turbid zone, composed of dead dentin that is transparent and un-re-mineralizable.

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Zone 4 (Sub-transparent)

The zone adjacent to the normal dentin, characterized by affected dentin that is still hard but discolored.

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Zone 5 (Normal)

The innermost zone of a carious lesion, composed of healthy, hard, and discolored dentin with an intact collagen matrix. This zone is re-mineralizable.

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Excavation Endpoint: Hard Dentin

The goal of cavity preparation is to remove all infected and affected dentin while leaving a smooth surface of hard, sound dentin at the margin of the cavity.

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Selective Removal for Deep Lesions

For deep carious lesions, the dentist may only remove softened dentin to preserve as much healthy tooth structure as possible, particularly when the pulp is vital and painless

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Leathery or Soft Dentin Removal

For deep carious lesions, the dentist may need to carefully remove leathery or soft dentin to ensure a clean and well-defined cavity preparation.

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Dentin Caries Removal

The process of removing decayed dentin, stopping 0.5mm away from the pulp (the soft inner part of the tooth).

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Complete Excavation

Removing all decayed dentin, exposing the pulp, followed by direct pulp capping or indirect pulp capping.

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Partial Excavation

Removing some decayed dentin, leaving a layer over the pulp, followed by indirect pulp capping.

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Direct Pulp Capping

Placing a protective material directly on top of an exposed pulp, followed by a final restoration.

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Indirect Pulp Capping

Placing a protective material over the remaining decayed dentin, leaving a layer to protect the pulp, followed by a final restoration.

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Favorable Pulp Prognosis

A positive outlook for the pulp's health and survival after a direct pulp capping procedure.

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Asymptomatic Tooth

A tooth that doesn't cause pain, has a normal response to temperature changes, and is alive.

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Controlled Hemorrhage

Bleeding from the pulp exposure is minimal and easy to stop.

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Pulp Vitality

The ability of the pulp (the living tissue inside a tooth) to remain healthy and functioning.

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Reparative Dentin

New dentin formed by the pulp in response to injury or irritation, helping to protect the pulp from further damage.

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Periapical Changes

Changes in the bone surrounding the tooth's root tip, often indicating infection or inflammation.

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What is the goal of step-wise caries management?

To stop the progression of caries (tooth decay) and preserve as many teeth as possible by treating multiple teeth with extensive decay in stages.

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What is the benefit of step-wise caries management?

This approach allows for the treatment of many teeth with extensive caries, increasing the chances of keeping more teeth functional.

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What is the first step in step-wise caries management?

Removing infected dentin from multiple teeth with extensive caries and placing temporary restorations.

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What is the second step in step-wise caries management?

After treating all teeth with extensive caries, individual teeth are restored with permanent restorations.

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What is the advantage of step-wise caries management?

It allows for more teeth to remain serviceable compared to treating one severely decayed tooth at a time.

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Restorative Material Types

Restorative materials used to repair teeth can be classified as either metallic (like amalgam) or non-metallic (like composites).

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Pulp Floor and Axial Wall

These are specific areas within a tooth cavity that are closest to the pulp, the living tissue inside the tooth.

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Sealers with Amalgam

Sealers are always recommended when using amalgam restorations, regardless of how deep the cavity is. They prevent corrosive products from the amalgam from damaging the tooth.

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Moderate Cavity Base

For moderate cavities with metallic restorations, a reinforced or resin-modified glass ionomer material is used as a base, compatible with the cement chosen for the restoration.

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Flowable Composite in Deep Cavities

For deep cavities with composite restorations, a thin layer of flowable composite is applied under the main composite to improve adaptation and sealing. It also acts as a shock absorber.

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Sandwich Technique and Bulk-Fill

For moderately deep cavities filled with composite, the 'sandwich' technique or bulk-fill composite can be used. These methods help to create a strong and durable restoration.

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Cavity Margin Location: Cusp Tip and Central Fissure

The placement of the cavity margins in relation to the central fissure and cusp tip determines the restoration's size and shape and influences the strength of the tooth.

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Cavity Margin Location: Factors

Choosing the location of the cavity margin depends on the depth of the cavity, the amount of tooth structure left, and the stress the cusp will experience.

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Biodentine Drawback

Biodentine's main drawback is its water-based chemistry, leading to poor bonding with overlying resin restorations. The bond is primarily micromechanical, meaning it relies on the physical interlocking of surfaces rather than a strong chemical bond.

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TheraCal LC Setting

TheraCal LC, a light-curable hydraulic resin-modified tricalcium silicate, sets by hydration. However, it doesn't require added water. Instead, the manufacturer recommends placing it on moist dentin, allowing the material to absorb moisture and set.

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TheraCal LC Advantages

TheraCal LC offers advantages like lower solubility and better sealing compared to other pulp capping materials. It also sets quickly and is resin-based, facilitating the placement of the final restoration.

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TheraCal LC Drawback

TheraCal LC's drawback is its potential toxicity to pulp fibroblasts. It can cause more inflammation and has lower bioactive potential than Biodentine due to its resin components.

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Liner/Base Decision Factors

The need for a specific liner or base depends on factors like remaining dentin thickness, restorative material type (metallic or non-metallic), and adhesive properties of the restorative material.

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Dentin Thickness & Liner

The thinner the remaining dentin, the greater the need for an intermediary material like a liner or base. This provides extra protection for the pulp.

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Restorative Material & Liner

Adhesive restorative materials can be applied directly, except when pulpal medication is needed. Non-adhesive materials often require a liner or base for proper bonding.

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Liner Use for Pulp Medication

When pulpal medication is used, a liner is necessary to separate the medication from the restorative material. This prevents the medication from interfering with the bonding of the restorative material.

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Study Notes

Conservative Management of Residual Caries

  • Complete caries removal is necessary to eliminate all bacterial traces of carious dentin.
  • If pulp exposure occurs, endodontic treatment is required.
  • Partial caries removal differentiates between affected and infected dentin (using a caries detector dye).
  • Chemo-mechanical caries removal (e.g., Carisolv, ozone, enzymes, laser cutting) is employed.
  • Indirect pulp capping is used if pulp is exposed.
  • Direct pulp capping can be used as well and depends on indication.

Caries Removal Techniques

  • Avoid burs with sharp edges for pulpal and axial walls.
  • Employ low-speed round burs for caries removal.
  • Do not leave undermined enamel occlusally.
  • Do not flatten pulpal or axial walls of a tooth during caries removal.
  • Remove only the infected carious material, preserving the rounded or concave shape of the remaining wall that surrounds the caries removal depression.
  • Remove residual caries from the DEJ (dentinoenamel junction) or enamel wall.

Differentiation Between Acute and Chronic Caries

  • Acute caries involves multiple teeth and shows a lighter color.
  • Chronic caries is slow-developing and displays a dark brown or leathery appearance.
  • Caseous consistency is a feature of acute caries, making excavation challenging.
  • Sensitivity is often higher in acute caries.

Arresting Caries

  • Arrested caries presents stationary or static conditions without progression.
  • Sclerotic dentin, a hard, dark discoloration of the tooth, is a sign of arrested caries.
  • Sclerosis of the dentinal tubules and secondary dentin formations are commonly associated with arrested caries.

Sclerotic Dentin

  • The dentin hardens, becomes denser, less sensitive and more protective toward the pulp.
  • Mineralization occurs around the peritubular dentin.
  • The ends of Tomes fibers transform into a calcified barrier or calcific barrier.

Direct Pulp Capping

  • Successful direct pulp capping is more likely when the tooth is asymptomatic before the procedure, the exposure is 0.5 mm or less, there is reduced hemorrhage, the procedure is atraumatic and the tooth is not desiccated.

Caries Control Techniques

  • Extensive active caries in many teeth can be addressed in one visit through removal of infected dentin and temporary restorations for each tooth.

Removing Undermined Enamel and Caries

  • Demineralized enamel appears opaque and chalky, whereas carious dentin appears soft, mushy, gummy, leathery, or sticky.
  • Removing undermined enamel and carious dentin at the Dentin-Enamel Junction (DEJ) is crucial.

Pulp Capping Materials

  • Calcium hydroxide is capable of stimulating tertiary dentin formation, but it's susceptible to moisture and resorbs over time.
  • Mineral trioxide aggregate (MTA) material has biocompatibility and induces calcium phosphate formation at the interface of the pulp and periodontium.
  • Biodentine, a calcium silicate-based material, creates homogeneous dentin and is bioactive, with an easy handling profile and short setting time.

Pulp Capping Criteria

  • Vital pulp preservation and absence of symptoms are ideal criteria for successful pulp capping.
  • Absence of periapical changes on radiographic examination, with radiographic evidence of reparative dentin formation.
  • Periodic follow-ups are necessary to monitor the patient's condition.

Liners and Bases

  • Liners and bases depend on dentin thickness, restorative type (metallic or non-metallic) and adhesive properties.
  • They're applied at the pulpal floor close to the pulp for maximum effectiveness.

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Management of Deep and Extensive Lesions PDF

Description

This quiz explores key concepts related to dentin and how it responds to caries and irritation. It covers the characteristics of arrested caries, sclerotic dentin, and the responses of dentin to further irritation. Test your knowledge on this vital aspect of dental health.

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