30 Questions
What happens when the organic plug fails in the fissure?
Bacteria have full access to the depths of the fissure
Which part of the fissure may not be decalcified and thus undetectable by a probe?
The enamel defects in the fissure wall
What is the purpose of intraoral examination in the context of fixed prosthodontics considerations?
To examine the arch curvature and crown root ratio
Which traditional technique for examining proximal smooth surface caries involves using a curved explorer?
Tactile examination
Which of the following abnormalities may be detected during intraoral examination for fixed prosthodontics?
Hypocalcification and erosion
What is the purpose of using transillumination to examine proximal caries?
To direct light through the teeth
What type of radiographic examination is NOT typically used in fixed prosthodontics diagnosis?
Intraoral digital radiography
Which traditional technique for examining proximal smooth surface caries involves the use of a bitewing x-ray?
Radiograph
During the clinical examination of teeth, which type of caries may tend to occur bilaterally and on adjacent proximal surfaces?
Pit and fissure caries
Which traditional technique for examining proximal smooth surface caries can detect a shadow under the marginal ridge?
Visual method
What adjunctive diagnostic aid is used to assess the vitality of the pulp in fixed prosthodontics?
Percussion
Which type of defect is NOT included in the category of non-carious defects detectable during intraoral examination?
Caries on smooth surfaces
What is the purpose of the Cariogram?
To serve as an analytical tool for assessing caries risk
Which sector of the Cariogram represents the patient's diet?
The dark blue sector 'Diet'
What does a larger green sector in the Cariogram indicate?
A higher chance of avoiding new cavities
Which of the following factors is NOT considered in the 'Susceptibility' sector of the Cariogram?
Presence of mutans streptococci
What is the relationship between the 'Chance to avoid caries' and caries risk?
They are inversely related
Which sector of the Cariogram is based on a combination of past caries experience and related diseases?
The yellow sector 'Circumstances'
Which of the following statements about radiographic examination of caries is correct?
A 4mm deep cavity or a cavity that is widened to 1/3 occlusal width may appear on X-ray.
According to the digitally created Caries Classification, what does the letter 'M' represent?
Moderate (Stage II)
Which of the following statements about incipient interproximal caries is correct?
It extends up to half the thickness of enamel.
What does the term 'moderate' refer to in the context of interproximal caries?
Caries extending more than halfway through the enamel, up to the dentino-enamel junction (DEJ).
Which of the following statements about bitewing radiographs is correct?
They are used for detection of proximal decay.
Which of the following statements is correct regarding the radiographic detection of caries?
A 3mm deep cavity cannot be detected by radiograph.
What is the recommended treatment for mild cases of tooth misalignment?
Enameloplasty
Which of the following is a common problem associated with the second molar abutment?
Malalignment
What is a potential solution for a tilted or malaligned abutment tooth?
Telescopic crown on the tilted molar
What is a potential issue with short abutment teeth?
Decreased surface area for bonding
What is a potential solution for an overerupted abutment tooth?
Orthodontic intrusion
What is a potential issue with an overerupted abutment tooth?
Protrusive interference in occlusion
Study Notes
Fissure Caries
- Decalcification occurs when the organic plug fails, allowing bacteria to access the depths of the fissure.
- The fissure walls are in close proximity, making it difficult for a probe to detect caries.
Modern Fissure Caries Model (Coke Bottle Shape Fissure)
- The model consists of:
- Organic plug
- Area that may not be decalcified, making it difficult for a probe to detect
- Enamel defects in the fissure wall
- Decalcified enamel (caries in this zone is undetectable by probe)
- De-mineralized dentin
Traditional Techniques of Examination of Proximal Smooth Surface Caries
- Visual Method:
- A white chalky appearance or a shadow under the marginal ridge
- Visual with temporary tooth separation
- Tactile examination:
- Probing with a curved explorer may detect cavitation occlusal or cervical to the contact area
- Radiograph:
- Bitewing x-ray is usually used to diagnose proximal caries
- Transillumination:
- Placing a light source on the lingual side of the anterior teeth and directing the light through the teeth
Intra Oral Examination
- Includes any abnormality in the mucosa, tongue, cheeks, palate, and teeth
- Should be performed under good operatory light
Clinical Examination of Teeth
- May reveal:
- Caries:
- Pit & fissure
- Smooth surface (proximal or facial and lingual)
- Defective Restorations:
- Amalgam
- Cast restoration
- Tooth-colored restoration
- Non-carious defects:
- Hypo calcification
- Abrasion
- Abfraction
- Erosion
- Attrition
- Fracture lines
- Hypersensitivity
- Caries:
Radiographic Examination
- Includes:
- Periapical radiographic
- Bitewing
- Panoramic
- Digital radiography
Adjunctive Diagnostic Aids
- Percussion
- Palpation
- Pulp vitality
Fixed Prosthodontics Department
- Intraoral Examination
- Lecturer: Dr. Sherif Samir
- Lecturer of Fixed Prosthodontics
- MSA University
Lecture Outline
- Cause of discoloration
- Abnormal Coronal form and size
- Occlusion
- Spam length
- Arch curvature
- Crown root ratio
- Root configuration
- Diagnostic Wax-up
Case Analysis
- Mild cases may be adjusted by enameloplasty
- Severe cases may require elective root canal treatment or full coverage high-strength material
Diagnostic Wax-up
- Identify the relative information required for proper diagnosis
- Analyze the collected data and recognize the relative information to determine patients' diagnosis
Problems Encountered in the Abutment Teeth
- Malaligned teeth
- Solutions:
- Orthodontic up-righting
- Restoring or recontouring mesial surface of third molar
- Proximal half crown as a retainer on tilted abutment
- Telescopic crown on the tilted molar to modify the path of insertion
- Non-rigid connector used on the anterior abutment
- Crowning of abutments to compensate for the narrow space without constructing a pontic
- Short teeth
- Overerupted teeth
- Solutions:
- Orthodontic intrusion
- Simple contouring of plunger cusp and topical application of fluoride
- Onlay preparation
- Crowning of over-erupted tooth
- Endodontic treatment and crowning of over-erupted tooth
Caries Risk Assessment
- Cariogram:
- A unique PC software that draws a pie circle-diagram
- Shows if the patient is at high, intermediate, or low risk for caries
- Used for clinical purposes, educational, and preventive
- The Cariogram is divided into five sectors:
- Diet (dark blue)
- Bacteria (red)
- Susceptibility (light blue)
- Circumstances (yellow)
- Actual chance to avoid new cavities (green)
Traditional Method of Examination of Caries
- Radiographic Examination:
- Caries is regularly found beneath a seemingly intact enamel surface
- Frequently, the diagnosis of occlusal caries cannot be done by radiograph unless it reaches a considerable size
- Radiograph is not reliable for detecting early stages of caries
Caries Classification
- Digitally created Caries Classification:
- I: Incipient (Stage I)
- M: Moderate (Stage II)
- A: Advanced (Stage III)
- S: Severe (Stage IV)
Interproximal Caries
- Incipient (Stage I):
- Up to half the thickness of enamel
- Usually not restored unless the patient has a high level of caries activity (high risk)
- Treated with fluoride and oral hygiene measures
- Moderate (Stage II):
- More than halfway through the enamel (up to DEJ)
- The bottom arrow points to a moderate lesion on the distal of #20
Explore the concepts related to the Modern Fissure Caries Model, including the failure of organic plug, decalcified enamel, and enamel defects in fissure walls. Learn about how caries in this zone is undetectable by a probe.
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