Session 5: Restorative DTP

oral path/med/radiology consult is what axium code?

D99992

student will complete the oral dx 2024 form, book a 20min appt with front disk in pilot clinic on tues or wed morning

for radiology consult send directly to radiology faculty

common dx of failing restorations

• cracks/fractures

• open margins

• voids in material

• loose restorations

• poor contour

• overhang

most common tooth structure problems

• attritions (wear facets)

• abrasion

• abfraction

• erosion

(last three are non-carious cervical lesions)

abfraction vs abrasion

Abfraction is tooth wear caused by internal flexural stress from biting forces that creates V-shaped lesions at the gum line, whereas abrasion is physical wear from external friction that creates flat, scooped-out damage on exposed tooth surfaces

In cases of asymptomatic teeth, where tooth vitality and function are not compromised, abfraction/erosion lesions should be monitored for at least (?) months before any invasive procedure is planned

6

abfraction is associated w (?) meaning there are restorative and perio considerations

gingival recession

most common functional problems with tooth position

• hyper-erupted tooth

• crossbite

most common esthetic complaints

discolored teeth:

• extrinsic staining

• intrinsic staining: physical trauma, congenital and developmental conditions

• diastema

most common pulpal and periapical dx:

(cold test + PA w/in 6 mo for endo consult)

• Reversible pulpitis

• Irreversible pulpitis

• Pulpal necrosis

• Acute apical periodontitis

• Chronic apical periodontitis

• Calcified canals

• Internal/external resorption

• Root fractures

• Secondary to trauma

what are four reasons a crown is indicated?

(either to improve appearance or fix structurally damaged dentition)

1. tooth fracture

2. esthetic reason

3. tooth w craze lines

4. large existing restoration (MOD, deep, leaving thin axial walls)

fillings can create (?) effect that leads to tooth fracture

wedging effect

fillings that take up 1/3rd of intercuspal distance of tooth (increases/reduces) tooth resistance to fracture by one half

reduces

a tooth’s risk for fracture increased substantially as its filling approached 50% of its intercuspal distance. so fillings, composites, or amalgam should not exceed (?-?) of this distance

1/3rd to 1/4th this distance

what are some examples of structurally damaged dentition?

• Pre-existing defective crown

• Large pre-existing defective restoration

• Large pre-existing restoration as preventative measure

or damage due to:

• Caries

• Large Enamel-Dentin fractures

• Cracked tooth Syndrome

what is the difference between a crown and a direct restoration?

The width of the prep or the defective restoration exceeds one-half of the facial- lingual cusp tip to cusp-tip distance = Crown

A direct restoration is a filling placed directly into a prepared cavity in a single visit, while a crown is a custom-made cap that covers the entire visible portion of a tooth and typically requires two visits and laboratory fabrication.

The width of the prep or the defective restoration exceeds one-half of the facial- lingual cusp tip to cusp-tip distance = Crown

crown

advantages

full cast metal crown

advantages

plus superior esthetics

PFM

advantages

all ceramic crown

disadvantages

cast metal

disadvantages

PFM

disadvantages

all ceramic

indications

cast metal

indications

PFM

indications

all ceramic

contraindicationsx

cast metal

contraindications

PFM

contraindications

all ceramic

which crown?

esthetics: superior translucency and color matching as well as thin tissue biotype

E- max and zirconia

which crown?

surveyed crowns: modification difficulty, precision in design

PFM (zirconia would be a challenge)

which crown?

metal allergy/sensitivity: metal-free, highly biocompatible

zirconia (E-max would be a challenge for molars and bruxism)

which crown?

heavy bruxism: high risk of fracture in heavy occlusion situations

zirconia and cast metal (PFM would be a challenge and avoid e-max)

axial reduction: 1.2-1.5mm facial

occlusal/incisal reduction: 1.5-2.0mm

minimum thickness: about 1.5mm

best use case: esthetics + strength but not ideal for limited space

PFM

axial reduction: 1-1.5mm

occlusal/incisal reduction: 1-1.5mm

minimum thickness: 1mm

best use case: best for short crowns or reduced interocclusal space

zirconia (monolithic)

axial reduction: 1-1.5mm

occlusal/incisal reduction: 1.5-2mm

minimum thickness: about 1.5mm

best use case: high esthetics but needs more space than zirconia

all-ceramic (e.max)

my summary of porcelain classification and composition

They can be predominantly glassy (Feldspathic), particle-filled glasses (Lithium-Disilicate) , or polycrystalline ceramics (Zirconia)

Glassy ceramics are more aesthetic, while crystalline ceramics offer higher strength

*zirconia can be layered like PFM to make it more esthetics

*PFZ porcelain fused to zirconia - layer e.max on top, for anterior only bc will fracture w function

materials used at tufts