Clinical Considerations

When navigating the transition from preclinic to clinic, you want to ___

successfully convert knowledge to practice

Communication is critical to know the patient's ___ and ___

goals

expectations

Subjective Findings

talk to the patient!

Objective Findings

examine the patient

A ___ treatment plan should be developed

comprehensive

What is the threshold for operative dentistry?

enamel cavitation

or

dentin involvement

(D1)

What are some restorative material options that we can use?

amalgam

composite resin

IRM

GI

RMGI

ceramic

Amalgam is a ___ option... unless ___

great

the FDA outlaws it

___ is used for caries controls and is temporary

IRM

GI and RMGI are (temporary/permanent)

can be either or!

Most restorations will be ___ (material)

composite

___ is best for areas of poor isolation

Amalgam

___ is best for high caries risk patients

Amalgam

___ restorations with ___ coverage should be employed when remaining coronal tooth structure is minimal or compromised

Indirect

cuspal

What should an appropriate preparation have?

outline form

initial depth

resistance form

retention form

refinement

decay removal

bases and liners (if deep)

secondary retention (if need)

Enamel is ___, but has a reliable bond to ___

brittle

composite

Dentin is ___, composed of ___, and contains ___

resilient

tubules

moisture

Bonding strength for dentin differs based on ___ and ___

type of dentin

distance from the pulp

Which type of dentin bonds less than normal?

carious

Amalgam is a ___ material that requires ___ cavomargins

brittle

90 degree

Ceramic is a ___ material that requires ___ cavomargins

brittle

90 degree

Composite is a ___ material that requires ___ cavomargins OR ___

quasi-brittle

90 degree OR bevel

When employing the hatchet, use the "___" method to open the proximal outline form and produce 90-degree

extend and chop

You always want to minimize ___ damage when operating

adjacent tooth

Proximal bevels can be created using ...

hatchet, one-sided flexible disks, narrow diamonds

For anterior preparations, ___ bevels should be created using ...

'long'

football or straight diamond or chamfer bevels using a round bur

___ is important for preps

Breaking contact

How much should contact be broken for inlays/onlays?

0.5 mm

(or at least visually)

Why?

to verify decay removal

to allow for easier placement of the matrix band

Don't forget to break ___ contact, as well! On top of proximal contacts

gingival

What is the minimum prep depth needed for amalgam and ceramic?

2 mm

Isthmus for ceramic prep should be at minimum ___

2 mm

An amalgam isthmus should be at minimum ___

1 mm

1 mm is the width of the ___ (measure tool)

smallest condenser

Amalgam isthmus should be less than ___ intercuspal distance

1/4

Why?

to preserve strength

Composite isthmus width needs to be enough to ___

extend into sound tooth structure

Is there a minimum dimension for composite isthmus?

no

Composite depth needs to be enough to ___... or at least ___ deep

remove decay

1 mm

Give some examples of resistance form compromises:

Deeper preps and wider isthmus weaken teeth

Removing or weakening the marginal ridge weakens teeth

Unsupported enamel will fracture

Unsupported enamel could be ...

enamel spurs

undermined enamel from decay removal

You may have to ___ cusps to aid resistance form

cap

You cap a cusp when decay extends ___ the distance from central groove to cusp tip

2/3

Retention is, for the most part, provided by ___

opposing walls

The length of the walls, as well as their ___, matters when gauging retention

taper

___ are necessary for direct restoration retention form

Undercuts

Do indirect restorations need undercuts?

no!! get rid of them!!

What do indirect restorations require?

minimal taper

Bonded restorations allow for greater ___

taper

Retention form is provided by ...

dovetail

converging occlusal walls

secondary retention features

Secondary Retention

grooves

slots

boxes

___ provide additional retention for composite

Bevels

___ and ___ are forms of retention supplication that remove sound tooth structure... only used these when necessary!! + be as conservative as you can be

Boxes

dovetails

When bonding, ___ is important... bonding is also technique sensitive (FYI)

isolation

What are some bonding agents that you can utilize?

total etch

selective etch

self etch

Self etch has a ___ bond to enamel

weak

is less technique sensitive

Boxes and grooves provide (a lot/a little) retention

a lot

How can you tell if a tooth has been prepped for metal to be applied on it?

if there is very little reduction around the circumference

if there are 2 grooves

Ceramic has the benefit of ___

bonding

Non-Ideal Prep: Defect with a bulk of sound dentin above and at least 1mm from the finish line can be filled with ___ prior to the impression or ___ on the die.

cement

blocked out

Non-Ideal Prep: For defects near the occlusal surface, consider ___ can be placed to remove the defect, especially if additional retention is needed.

box preparation

How should a refined prep look?

smooth walls

rounded line angles

rounded axiopulpal line angle

Refinement is typically done using ___

hand instruments

Decay depth should be evaluated using a ___

radiograph

Depth of decay is usually ___ IRL

deeper

than in radiograph

Decay should be evaluated using its ___ and ___ as a guide

color

texture

Decay should be removed using a ___ handpiece

slow speed

Why?

less likely to remove sound tooth structure than a high speed would

There is ___ when using a high speed

no forgiveness

All lateral walls of a prep must be ___

caries free

(stain free at cavomargin)

Decay can remain on the pulpal floor if ___

an exposure of pulp is possibly resultant

Can you operate on a tooth with irreversible pulpitis to fix it?

no

extract or endo

Can decalcified enamel at the margin stay in the tooth when creating a prep?

no! this is decayed

Bases and Liners

used to protect the pulp or aid in its recovery

-can be used as sealers, reinforcers, insulators, obtundents, pulp stimulators

___ should be used for indirect and direct pulp caps

Dycal

Dycal needs to be covered with ___

a stronger base

___ can be used for sedative effect and for its antibacterial properties

IRM

___ feature fluoride release, have antibacterial effects, and are good with bonding

GI/RMGI

Bonding agents, as a whole, can be used to seal ___ or to provide bonding mechanism for ___

tubules

composite

___ is seldom used; only under amalgam

Varnish

Secondary retention is generally necessary for the ___ and ___ preps

smallest

largest

Secondary retention should be placed into ___

dentin

Secondary retention features should be large enough to ___

feel with an explorer

___ are placed in the horizontal plane

Slots

You use ___ bur to make slots

inverted cone (34)

___ are placed in the vertical plane

Grooves

You use ___ bur (or ___ bur) to make grooves

round (1/2 - 2)

tapered fissure (169)

Centric Occlusion

closing of the jaws in a position that maximizes contact between the occluding surfaces of the maxillary and the mandibular arch

Protrusive Occlusion

occlusion when mandible undergoes protrusion

When creating a restoration, you need to avoid leaving ___

openings (at margins)

especially at the proximal box ^^

Patients MUST be ___ about their treatment and how to maintain personal hygiene

EDUCATED

by you, the dentist!!

Patients should brush teeth for ___ at a time

2 minutes

Patients should floss (before/after) brushing

before

Why?

flossing after wipes away all interdental fluoride

Fluoride concentrations within toothpaste should be at least ___

1000 ppm

Higher concentrations (around ___ ppm) should be used for high-risk patients

1500

___ is standard recall schedule for patients

6 months

may differ based on patients' caries risk

Is once per year for a dental appointment generally OK?

yes

What are two extreme red flags for high-caries-risk patients?

dry mouth — caused by radiation or medications

Outcomes of treatments and progressions should be monitored using ___

previous stats/radiographs