RCC Final

A complex restoration refers to a restoration that replaces one or more ______

cusps

Provisional (temporary) with questionable prognosis

What is the most important factor when deciding between amalgam and composite?

isolation

If the weakened cusp exceeds more than _____ the distance from the primary groove to the tip of the cusp, cusp coverage is indicated.

2/3

Direct vs Semidirect vs Indirect

Direct: 1 appointment technique sensitive (Restoration)

Semidirect: 1 appointment can be done on benchtop (Cast)

Indirect: 2 appointment best but a lot more expensive (Crown)

Axial Contour should be ______

convex instead of flat

Should the wedge encroach toward the contact area?

No it would deform the matrix leaving a gap

Resistance form qualities

90 degree CSM
Adequate depth (at least 1.5 mm)
Rounded internal angles

Retention form qualities

Convergent walls
Dovetails
Retention features

Which cusp fractures most frequently in Mandibular molars and premolars

Which cusp fractures most frequently in Maxillary molars and premolars

Lingual cusps (twice as often)

Buccal cusps (twice as often)

The functional cusp in maxillary molars and premolars is the ______.
Mandibular?

lingual
facial

The (functional/nonfunctional) cusp is the most likely to fracture.

non-functional

If replacing a functional cusp the reduction should be _____ mm.

If replacing a non-functional cusp the reduction should be _____ mm.

2-2.5

1.5-2

When reducing the cusp, hold bur (parallel/perpendicular) to the cuspal incline.

parallel

When reducing the cusp, Extend reduction just beyond _____ groove, Sloping toward the ______.

F/L
central groove

Boxes are placed _______, _______ or _______ grooves. Great for resistance and retention form.

interproximal, buccal, or lingual

Active lesions appear ______ and usually have _____ present.

dull
plaque

Should tooth surface be observed wet or dry

both

ICDAS is based on _______ examination

visual

ICDAS 0

sound tooth surface, no clinically detectable lesion.

ICDAS 1

First visual change in enamel (seen only after prolonged air drying or restricted to within the confines of a pit/fissure) after air drying

ICDAS 2

lesion visually distinct on wet enamel

ICDAS 3

micro-cavitation

ICDAS 4

underlying dentin shadow

ICDAS 5

distinct cavity with visible dentin

ICDAS 6

More than 50% of dentin involved. Pulp may also be affected

T or F: Forceful use of a sharp explorer for the sole purpose of detecting carious lesions is highly discourage in today's practice of dentistry.

true

The most effective radiographic technique for caries diagnostics is the _______ technique, which is an intraoral, ______ technique.

bitewing
paralleling

Early ______ lesions are difficult to see on radiographs because of the superimposition of the dense B and L enamel cusps. Typically theses lesions can only be seen radiographically once they have passed the _____

occlusal
DEJ

Proximal lesions are most likely detected ________. You may also use an _____ to separate the teeth

radiographically
orthoband

Caries Detection Dye are used primary after _______ is removed

enamel

Mostly work on carious dentin

Appearance and Hardness of Active-Acute Lesion, Active-Chronic, Inactive

Active Acute: Soft Chalky (Think that tooth is trying to remineralize)

Active Chronic: Leather chalky

Inactive: Shiny, Smooth, Hard

How to know active or stable lesion

Active is demineralized, soft

Stable is when re-mineralization occurred, shiny, smooth, hard

Color is not solely reliable

What does it mean by cavitated

Enamel demineralized

If an unbalance occurs durign the ______ phase, the enamel defect is called hypoplasia

If it occurs durign the _______ phase, it is called hypomineralization

secretion (less enamel or hole)

maturation (color change)

What is fluorosis

Excessive amount of fluoride during tooth development

Severely fluroised enamel is very porous and prone to fracture and wear

Radiolucency is a resutl of a _______ in the absorption of x-ray photons

decrease

Caries are almost always (more/less) advanced than the radiograph indicates

more
Because the bacterial penetration of the dentinal tubules and early demineralization do not produce significant changes in density to affect the penetration pattern.

Caries appear _______ because the demineralized area of the tooth does not absorb as many x-ray _______ as the unaffected portion

radiolucent
photons

Lesions confined to enamel may not be evident radiographically until ______ demineralization occurs

Typically, it takes _______ for a white spot lesion to progress to cavitation

30-40%

12-18 months

What is the most accurate x-ray to diagnose interproximal caries in posterior and anterior teeth

Periapical for anterior

Bite wings for posterior (do not diagnose on periapical)

Distal of canine should be on what x-ray

Premolar Bitewing

Beam of bitewing x-ray should be _______ to the long axis of the tooth

perpendicular

Where is the most common location for proximal caries

Apical to contact point

Intraoral radiography

Extraoral radiograpy

Bitewings and PA

Pano

What is classified as incipient caries

Less than ½ of enamel

Degree of severity of radiographic lesion

Incipient

Moderate

Advanced

Severe

Incipient: Less ½ of enamel

Moderate: More ½ of enamel

Advanced: Less than ½ of dentin

Severe: More ½ of dentin

E1, E2 and D1 caries are ______. D2 and D3 are ______

microinvasive
invasive

In posterior teeth, teeth may be ________ demineralized before proximal caries appear radiographically.

Approximately ______ of proximally caries do not appear on a radiograph

30-40%
50%

Dentinal lesions are typically (narrower/wider) than enamel lesions

wider

Most proximal caries occur (above/below) the contact.

below

Cavitation is more likely in patients with (high/low) caries risk; however ______ of D1 lesions are not cavitated and can be treated using _____

high
40-60%
fluoride

Occlusal caries are most common in _____

children and adolescents

O1 caries

O2 caries

O3 caries

O4 caries

O5 caries

White or discolored enamel, no cavitation, no radiographic signs of caries

Small cavitation clinically, no radiographic evidence

Moderately sized cavity, radiolucency in outer third of dentin

Large cavity, radiolucency in middle third of dentin

Extensive cavity, radiolucency in inner third of dentin

Is making treatment recommendations based purely on scientific evidence practicing Evidence Based Dentistry

No

Facial/lingual or occlusal caries have more defined border radiographically? Which displays image shift relative to the crown?

facial/lingual
facial/lingual

Root caries are associated with

gingival recession

______ ______ appears as a radiolucent band or notches at the neck of the tooth in the area of the cementoenamel junction (CEJ).

cervical burnout
It is contrasted because the part of the tooth apical to it is covered by bone and hence is more radiopaque, whereas the area of the tooth occlusal to it is covered by enamel and is also radiopaque.

cervical burnout occurs most frequently in ______

mandibular incisor and molar areas

Cervical burnout appears more _____ while root caries are more ______

angular
rounded

Do radiation directly cause caries?

No, it cause loss of salivary gland function which leads to decay

Secondary caries are _____ and typically ____ to the restoration whereas radiolucent restoration materials are more ______

diffuse
gingivally
angular

Image sharpening

An effect applied to digital images to give them a sharper appearance.

Can create generalized, uniform radiolucent bands next to restorations

Increase contrast at edges

Mach bands

Exaggerates the contrast between edges of the slightly differing shades of gray, as soon as they contact one another

Optical illusion

In overlap of x-ray

What class are considered as smooth surface restoration

Class V lesions

T or F: Class V lesions may be carious or non-carious

True
may be caused by erosion, abrasion, or abfraction

Color of active carious lesions

Color of inactive carious lesions

Yellow/brown

Dark brown or black

Do inactive lesion have plauq

No only active lesion have plaque

The CEJ is ______ making it ______ retentive to bacteris

irregular, more

Cementum is (more/less) susceptible to drops in pH than Enamel.

more
caries process begins at pH below 6.2-6.7

Abfraction vs Abrasion

Abfraction is loss of tooth surface in the cervical area, caused by tooth grinding compression forces

Enamel rod fracture and dislodge

Abrasion is excessive mechanical or frictional forces

Non-carious Cervical Lesions are most likely on _______ side. Why

Facial

Stress, Toothbrushing, Erosion (from acidic food not GERD)

Loss of tooth structure due to aggressive brushing is an example of

abrasion

Chemical loss of tooth structure without bacteria

Erosion

Abrasion causes smooth, concave ______ shaped lesions along the gum line

V or U

Abfraction lesions tend to occur on the _____ surface

facial
lingual surface is compressed while the lingual surface is flexed

How can you differentiate between abfraction and abrasion

Check occlusion
abfraction is typically localized (Certain point have most stress) while abrasion will affect many/all of the teeth (brush all surface)

Wear is typically caused by the (toothpaste/toothbrush)

toothpaste

Abrasion alone do not cause damage, combining with acid cause more damage

It is unlikely, that toothbrushing alone causes abrasion. Presence of _____ greatly increases the risk of abrasion.

acid

Extrinsic causes of erosion

Intrinsic causes of erosion

soda, coffee, citrus fruit

GERD, bulimia, regurgitation

Extrinsic erosion affects the _____ surfaces

Intrinsic erosion affects the ____ surfaces of _____ teeth

Occlusal and labial

Occlusal and lingual of maxillary and facial of mandibular anterior teeth.

Cervical enamel is (more/less) brittle

more

Why NCCL at cervical

What is usually the problem of NCCL

occlusion issue

Direct thermal shock to the pulp via temperature changes transferred from the oral cavity through the _______ _______, especially when remaining dentin is thin.

restorative material

Use of insulating base is indicated in composite or amalgam

How thick should the base be

amalgam

0.50 to 0.75 mm no more than 0.75 mm

The theory of hydrodynamics of the pulp states that there is a gap between the tooth and the restoration which allows fluid to enter the space. _____ fluids can cause a sudden contraction of the tubule which causes an _____ in the flow of dentinal fluid which is perceived as pain

Cold
increase

As dentin nears the pulp, tubule density and diameter _______

increase

Explain why deeper restorations with more problem of sensitivity

Rubber Dam Clamp for Class V lesion

212 clamp

Shade selection should be with dry or wet teeth

Wet

Dry have different shade

What is the first step in managing the disease process?

Is caries risk assessment for diagnosis or prognosis

caries risk assessment

prognosis

Disease indicator (WREC)

Risk factors (BAD)

Protective factors (SAFE)

White spots, Restorations (<3 years), Enamel lesions, Caries/dentin

Bad bacteria, Absence of saliva, Dietary habits (poor)

Saliva and sealants, Antibacterials, Fluoride, Effective diet

Patients with no active disease but 2 or more high-risk factors are _____ risk.

High

If patients are between risk groups, place them in the _____ risk group

higher

CAMBRA

Caries Management by Risk Assessment

Caries risk is ultimately up to ______

the clinical judgment of the physician

The presence of active lesions and fillings (caries prevalence) show the balance between caries _______ and _______ factors have been in the past or may be at present

pathological
protective

DMFT score

caries prevalence index
Decayed, Missing, and Filled Teeth

What is the most important indicator of caries risk?

past and current caries experience

How does medical history contribute to caries risk?

-medications that cause xerostomia
-conditions that make dental hygiene difficult or require carbohydrate-enriched diets
-medications containing fermentable carbohydrates such as glucose

Reassessment of a patient's caries risk should occur every ______ months depending on _____

3-12
the caries risk of the patient

For high caries risk patients, recall should be every ___ months and BW should be taken every ____ months

For moderate risk patients, recall should be every ____ months and BW should be taken every ____ months

For low risk patients, recall should be every ____ months and BW should be taken every ____ months

3, 3-6

3-6, 12-18

12-24, 24