Dental Restorative Procedures Quiz

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Questions and Answers

What is indicated by circular patterns with a clean center in a single restoration?

Need for a remount procedure

Desirable occlusal contact

Proper alignment of teeth

Hyper-occlusal contacts (correct)

Which condition is acceptable when evaluating occlusion for a complete arch of crowns?

Distribution of contacts equally and bilaterally (correct)

Concentrated contacts in the anterior region

Localized contacts in the posterior region

No contacts with the bull's-eye effect

What is a primary purpose of the remount procedure in extensive restorative dentistry?

To convey relationships of restorations and teeth to the dental laboratory (correct)

To enhance aesthetic outcomes

To minimize the use of materials

To reduce patient discomfort

Which of the following is NOT part of the armamentarium for a remount procedure?

Air abrasive unit Signup and view all the answers

What happens if there is excessive pressure of the pontic against the alveolar ridge?

Induces blanching of the mucosa Signup and view all the answers

Which technique provides a matte finish on the occlusal surfaces during adjustment?

Using air abrasive unit with aluminum oxide Signup and view all the answers

What is a potential disadvantage of using the air abrasive unit for occlusal adjustment?

It cannot differentiate centric and excursive contacts Signup and view all the answers

What is emphasized when evaluating the pontic's contour in relation to the mucosa of the alveolar ridge?

It should enable a self-cleansing effect Signup and view all the answers

Which method is used to finish supragingival margins?

Finishing occurs with the casting seated on the tooth. Signup and view all the answers

What indicates the stability of a dental bridge during placement?

The absence of any rocking motion when pressure is applied. Signup and view all the answers

What is a common cause of distortion in dental restorations?

Incorrect handling of the wax pattern before investing. Signup and view all the answers

How should occlusion be evaluated during the procedure?

Using articulating paper to check occlusal contacts. Signup and view all the answers

What does a true inter-occlusal contact mark look like?

A point that resembles a ball point pen's point. Signup and view all the answers

What tool is recommended for identifying occlusal contacts?

Mylar shim stock. Signup and view all the answers

What adjustment stage is optimal for working with dental porcelain?

At the bisque stage. Signup and view all the answers

Which statement correctly describes burnishing in relation to cementation?

It can be done during the cementation process before initial setting. Signup and view all the answers

What is the primary purpose of rigid connectors in fixed prostheses?

To ensure adequate strength and maintain correct interproximal relationships Signup and view all the answers

Which factor is NOT evaluated when assessing the contour of a ceramic restoration?

Patient's tooth sensitivity Signup and view all the answers

How should the incisal edges of maxillary lateral incisors compare to those of central incisors?

They should be 1-2 mm shorter Signup and view all the answers

What is the problem if a restoration has excessive bulk in the gingival third area?

It may contribute to periodontal disease Signup and view all the answers

What is indicated by the absence of 'negative space' and incisal embrasures in anterior teeth restorations?

An artificial appearance Signup and view all the answers

When checking surface characterization of a ceramic restoration, what should be avoided?

Over-characterizing the surface Signup and view all the answers

What aspect does radiographic checking primarily verify in fixed prostheses?

Gingival adaptation and detection of open margins Signup and view all the answers

To observe light reflection in a restoration, what should be done to the teeth?

Moisten them with saliva Signup and view all the answers

Study Notes

Checking and Verification of Fixed Prostheses

The completed restoration is cleaned and disinfected.
The temporary restoration is removed.
Remaining cement is removed from the prepared tooth surface using an explorer.
The preparation is rinsed with water and air spray, then inspected after drying.

Evaluation of Fixed Prostheses

Seating (proximal contact): The restoration should seat with minimal friction and a gentle occluding force.
Marginal integrity: The restoration should fit without binding against the occlusal or axial walls.
Retention and stability: The restoration should have adequate properties to stay in place by friction during initial seating. A bridge's stability can be checked by applying gentle pressure to one retainer verifying the other retainer does not noticeably rock or rotate.
Occlusion: Evaluate the presence and absence of occlusal contacts using a mylar shim stock and articulating paper to identify high spots. Examine both centric and eccentric contacts (lateral and protrusive). Any issues should be adjusted.
Contour alignment and occlusal anatomy: The contour of the restoration needs to be compared with adjacent and opposite teeth. This will ensure harmony in appearance and function.
Contour of the pontic and its relation to the alveolar ridge mucosa: The pontic shape prevents the mucosa from becoming irritated or inflamed by excessive pressure. The contact area should allow for easy self-cleansing.
Connectors: Rigid connectors should meet the correct interproximal relationship for strength. Non rigid connectors must have the proper retentive qualities.
Aesthetics: The restoration must match the form, size, surface character, and color of adjacent natural teeth.
Radiographic checking: X-rays are used to verify the adaptation of the gingival tissue or if there are any undetected open margins.

Seating (Proximal Contacts)

The restoration should seat with minimal frictional resistance.
A gentle occluding force should be sufficient to complete seating.

Causes of Incomplete Seating

Excessive proximal contact
Nodules on the restoration's fitting surface
Overextension of the gingival margin
Tight cast
Faulty assembling and soldering
Lack of parallelism of abutment teeth

Excessive Tightness

All-metal restorations: If tight, adjustment is possible using a rubber wheel. Identify binding points from a satin finish where a shiny spot will show where adjustment is necessary. Quick drying marking liquid or pressure indicating paste can be used to detect areas of excessive contact.
Ceramic restorations: The contact area can be identified with a red pencil or thin marking tape. A tight proximal contact in unglazed ceramic can be adjusted with a cylindrical stone.

Deficient Proximal Contact

All-metal restorations: Deficient contacts are usually corrected by soldering.
Porcelain restorations: Minor corrections can be made with low-fusing "add-on" or correction porcelain.

Presence of Nodules

Detection: Use a magnifying lens to examine the restoration's surface, particularly the inner angles.
Causes: Air trapped during investing, inadequate vacuum during investing, improper brush technique, lack of surfactant, and excessive vibration.
Correction: Small nodules not in critical areas can be removed. Large nodules or those near the margins require remaking the restoration.

Overextension of the Gingival Margin

Errors in die making or wax pattern carving can lead to overextension of the gingival margins, causing resistance to complete seating.
Correction: New impressions, dies, and working casts are required.

Tight Cast

Causes: Improper investment expansion, improper spatulation, improper mold heating, lacking a ring liner, incorrect liquid addition.
Detection: Paint the restoration's fitting surface with pressure-indicating paste, seat the restoration. Any tight areas will be scratched due to friction.
Correction: Small interferences can be corrected by spot grinding. Large interfering areas require electro-stripping.

Lack of Parallelism of Abutment Teeth/ Faulty Assembling and Soldering

Causes: Failure to maintain proper relationship of assembled bridge parts, improper heating of the assembly, incorrect heat application during soldering, improper proximal gap.
Correction: Disassemble and resolder. Alternatively, use a diamond disk to fracture the joint or melt the solder joint.

Margin Integrity

The completed restoration should seat passively into place without binding against the occlusal or axial walls of the tooth preparation. Methods used to check for binding include disclosing wax, water-soluble marking agents, and powdered spray.

Elastomeric Detection Pastes

Similar to silicone impression material.
Two-paste system.
Similar viscosity to final luting agents.

Assessment

Use a sharp explorer that is perpendicular to the marginal area.
Move the explorer occluso-cervically across the margin. Evaluate for overhanging margins. A slight overhang might be corrected by adjusting the casting, A very small ledge might be acceptable, however it may lead to recurrent decay. An open margin requires a new casting.

Finishing of the Margins

Subgingival margins: Inability to access in the mouth. Finished on the die, require pre-cementation X-rays.
Supragingival margins: Finish with the casting seated on the tooth. Use a white stone rotating from the restoration to tooth structure for a proper finish. Burnishing can be done during cementation prior to the cement setting.

Marginal Discrepancy

Caused by overextended lingual margins: Reduce the overextension from the axial surface preventing it from being underneath the tooth. Reach seating with the axial bulk removed. Adjustment errors lead to a deficient margin.

Retention and Stability

The restoration should have sufficient retentive properties to stay in place with tenso-frictional grip during initial seating.
Bridge stability is ensured by placing a finger on one retainer and verifying no rocking or rotation occurs in the other.

Causes of Distortion

Incorrect wax pattern handling prior to investing
Underestimating wax relaxation due to induced stress, setting, and hygroscopic expansion.
Incorrect wax pattern positioning in the casting ring.
Applying excessive force while removing restoration from casting ring.

Occlusion

The presence and absence of occlusal contacts are evaluated using mylar shim stock and articulating paper. Check centric and eccentric contacts (lateral, protrusive).
Occlusal adjustments involving dental porcelain are better done before the finalization of the bisque stage.

Occlusal Assessment

Select a pair of index teeth as a base for holding shim stock.
Mark with black articulating foils.
Mark with red to adjust excursive interferences and deflections.

Alternative Technique for Occlusal Adjustment

Use an air abrasive unit with aluminum oxide.
Obtain a matte finish, and check for shiny marks, which suggests areas needing adjustment.
Disadvantage: Cannot distinguish between centric and excursive contacts, time-consuming, and only applicable to cast metal occlusal surfaces.

Contour, Alignment, and Occlusal Anatomy

Compare contour and alignment with neighboring and opposing teeth.
Evaluate cervical contour of the retainers.
Assess cervical embrasure and interproximal contour.

Contour of Pontic and Alveolar Ridge Mucosa

(a) The pontic should seat passively in the ridge with a self-cleansing relationship. Pressure should not cause blanching. Pass floss between the pontic and the ridge.
(b) The pontic should have a correct contour that allows food to sweep over the mucosa (self-cleansing). Stimulating action is needed but avoiding impingement leading to irritation and inflammation.

Connectors

Rigid connectors ensure proper strength and interproximal relationship.
Non-rigid connectors are checked for retentive qualities maintaining the corrected interproximal relationship.

Aesthetics

Fixed restorations should harmonize with adjacent natural teeth in terms of form, size, surface character, and color.
Evaluate ceramic restorations for contour, surface characterization, and color.

Contour of the Restoration

Check proximal contact relationships and marginal fit.
Verify the contour of the gingival third to avoid excessive bulk (P.D. disease).
Use a thin flexible disc to reduce any overcontoured interproximal areas.

Anterior Teeth Evaluation

In anterior teeth, 1–2 mm of clinical crown should be visible with the upper lip relaxed.
Incisal edge of maxillary lateral incisors are 1-2 mm shorter than central incisors.
Evaluate "negative space", and incisal embrasure presence to ensure a natural appearance.
Have the patient pronounce the letter "F", with the incisal edges of the maxillary central incisors touching the "wet/dry line" of the lower lip.

Line Angles and Overall Contour

Mark line angles of porcelain in the bisque stage using a red pencil and comparing with adjacent and contralateral teeth.
Evaluate overall contour – should match adjacent teeth.
Saliva moistening reflects light in the same way as glazed restoration.

Surface Characterization

Thoroughly dry the teeth and examine their surfaces.
Simulate surface defects with diamond stones.
Flat/concave surfaces should reflect light producing highlights.
Avoid over-characterization to prevent unnatural appearance.

Radiographic Checking

Verify gingival adaptation and ensure no open margins interproximally using radiographic imaging.

Remount Procedure

Necessary if significant occlusal adjustments are required on multiple restorations.
A remount procedure helps convey restoration relationships to the lab for further adjustments.
Advantages include organized occlusion adjustment, and decreased chair time.

Armamentarium

List of equipment for a remount procedure, including impression trays, irreversible hydrocolloid, rubber bowl and spatula, interim luting agent, petrolatum, photopolymerizing resin, stiff wire, zinc oxide-eugenol occlusal registration paste, inlay wax, reversible hydrocolloid, facebow transfer equipment, and centric relation recording.

Materials for Remount

The materials used for the remount should be 5mm or less in thickness, fit the cast passively, and have a lubricated casting, occlusal index, and impression material.

Alternative Techniques for Occlusal Adjustment

Using an air abrasive unit with aluminum oxide: Obtain matte finishes Identify and adjust areas with shiny marks Negative: Not able to differentiate between centric and excursive adjustments, time consuming, limited to cast metal restorations

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Description

Test your knowledge on various aspects of restorative dentistry, including occlusion evaluation, pontic contour, and remount procedures. This quiz covers important principles and techniques essential for successful dental restorations. Prepare to challenge your understanding of dental restoration practices.