GENDT830: Operative II Final ( Info Post-midterm)

What was often used to whiten teeth in the olden days?

limestone

eggshells

T/F: the teeth whitening market as increased drastically over the years in North America

TRUE

Extrinsic stains are located on the ___ of teeth

surface

How do you remove extrinsic stains?

mechanical means

Extrinsic stains can become ___ into the teeth over time if not removed

incorporated

Sources of Extrinsic Stains

wine

coffee

iron

fruits

smoking

Extrinsic Stain

Tobacco Stain

Iron Supplement Stain

Causes of Intrinsic Stains

aging

enamel microfractures

medications

excessive fluoride ingestion

medical

restorations

What is the most common cause of dark teeth?

aging

Tetracycline Stain

NEVER ADMINISTER TO PREGNANT WOMEN AND CHILDREN < 8 YO

Fluorosis

too much F during amelogenesis--> porous enamel that is HYPOmineralized

Teeth Whitening Mechanism

H2O2 --> ROS --> high molecular weight molecules break down into smaller molecular weight molecules (lighter in color)

Chromophore

large stain molecule

Hydrogen Peroxide

Fast Action

Carbamide Peroxide

slow release

T/F: Carbamide Peroxide is very slow release up to 5 hours

TRUE

Which Peroxide is more likely to cause sensitivity?

Hydrogen Peroxide

In-Office Whitening

quick

high concentration

quick rebound

burns tissue

technique sensitive

need touch-ups

At-Home Trays

impression/scan

lower carbamide peroxide concentrations

last longer

less rebound

"touch-up" later

What whitening product does MUSC clinics use?

Opalescence

Non-Custom Whitening Kits

one size

inexpensive

good for teens

no dental supervision

misuse increases

Which brand is known to treat TETRACYCLINE STAINING?

Kor

Contraindications for Whitening

children with large pulps

cracks

exposed root

loss of enamel

pregnant/breastfeeding

hypersensitive teeth

decay

composite/porcelain restorations

T/F: You don't need radiographs when treatment planning whitening case

FALSE

2 Weeks 2 Treat

whitening should be done PRIOR to any esthetic restorative procedures and at least 2 weeks between whitening and restorative work as bonding is affected after whitening

Microabrasion / Macroabrasion

Icon Resin Infiltration

acid/etch on white spots to light refract

What is the difference between extrinsic and intrinsic staining and causes of each?

Extrinsic stains are on the surface and caused by external substances

Intrinsic stains are within the tooth and caused by aging, medications, and systemic substances

What is the mechanism of action of whitening products?

the oxygenation of chromophores breaks down into smaller particles, resulting in lighter appearance

How does whitening affect bonding?

the free oxygen released by whitening hinders the polymerization of resin. Wait two weeks!

What are the types of whitening most commonly used and pros/cons of each?

In-Office: fast results/ quick rebound, expensive, increased chance of sensitivity

Take-Home Trays: slower results, less rebound, can touch up later/ takes longer, patient must be educated on tray placement and application of whitening gel

OTC: inexpensive, no dental visit requires, misuse

What is the difference between carbamide and hydrogen peroxide?

carbamide breaks down into hydrogen peroxide and urea , works slowly

There is a __:___ ratio of carbamide peroxide to hydrogen peroxide

3: 1

What is the most common side effect of whitening? How can you prevent/treat it?

sensitivity

use desensitizing toothpaste prior, decrease exposure time

What are alternatives to whitening?

microabrasion, macroabrasion, composite, porcelain restorations

What are the two components of glass ionomer?

Calcium Fluoroaluminosilicate glass

Polyacrylic Acid

Which type of reaction defines GI and RMGI? How log does it take to complete?

GIC: weak acid (poly acrylic acid) + base reaction 48 hours

RMGIC: polyacrylic acid + base glass + resin + camphorquinone. Light cure

What are the strengths of GI?

long term fluoride release

little to no net polymerization

shrinkage, moisture tolerant, self adhering w/ durable chemical bond

CTE the same as dentin

biocompatible

What are the weaknesses of GI?

vulnerable to fracture and can be difficult to handle (if you don't know how)

Know the steps of placing a GI

GIC: pumice, rinse, lightly dry. Activate capsule,. triturate, apply material, set, easy glaze, trim, easy glaze or Fuji coat

RMGIC: same, one less easy glaze or Coat & LC

What is the sandwich technique?

Open: glass ionomer exposed to the oral cavity

Closed: glass ionomer buried under other restorative material

GIC

conventional

self-cured

RMGIC

resin modified

light dual cured

Self Cure GIC brands

Triage

Fuji IX

RIVA

IonoStar Plus/Molar

Dual Cure RMGIC brands

Vitrebond

Fuji II LC

Riva LC

Ionolux

Polyacrylic Acid is a ___ acid

weak

Calcium Fluoroaluminosilicate Glass is a ___

base

The Glass Ionomer should include ___ too!

strontium

How GICs bond to tooth?

fuses to the tooth structure

bonds chemically

T/F: GIC and RMGIC create a hybrid layer

FALSE

***Create a interdiffusion zone

Composites methods of adhesion to the tooth

require a bonding agent

more esthetic

better physical properties

GIC methods of adhesion to the tooth

bonds to MOIST tooth

ultimately forma a union with the tooth

How long does GI take to "mature" ?

24-48 hours

initial acid pH --> demineralization

remineralization occurs with fluorapatite formation and fluoride release

T/F: GI can be bulk filled

TRUE

T/F: GI is bioactive

TRUE

GIC Strengths

release of fluoride

no polymerization shrinkage

moisture tolerant

durable chemical bond

CTE same as dentin

biocompatible

Ionic Bond of GI

-COOH from GI : Ca++ from Tooth

What is the shear bond strength of GI ionic bond?

8-10 MPa

What is the weakness of GI?

poor flexural strength

fracture toughness

wear resistance

What happens if there is too LITTLE water with GI? (application to a desiccated tooth)

inhibits GI maturation

failure

What happens if there is too MUCH water with GI?

GI absorbs excess water and SWELLS!!!

dilutes metal ions

T/F: GI require you to "coat" them with a resin based sealer both PRIOR to trimming and then AFTER all adjustments have been made to protect them from the impacts of moisture

TRUE

(does not apply when used as a liner)

Uses of GI

sealants

sedative restorations

high caries risk

liners/bases

pedo restorations

class V

NCCL

ART

Sealant GI Material

Fuji Triage

ART

Atraumatic Restorative Treatment

*only hand instruments*

RMGI is ___ ___

dual cured

1. acid/base reaction

2. LC via camphorquinone

Which teeth are best for RMGIC?

anterior teeth through 1st bicuspid with good isolation and esthetic demands

Which teeth are best for GIC?

second bicuspid to molars (poor isolation)

RMGI use an ___ resin on instrument

unfilled

GIC use __ on instrument

water

What is a bioactive material?

one that elicits a specific biological response at the interface of the material, which results in the formation of a bond between the tissues and the material

Bioactive Materials are __

dynamic

Examples of Materials with Potential for beneficial ion release

PulpDent

Septodont

Doxa

NovaMin

PulpDent

Bisco

Shofu

Biomineralization

how living organisms secrete inorganic minerals in an organized manner

Types of Bio-interactive Material

Biodentine

lime-lite enhanced

Activa Presto

NCCL

Non-Carious Cervical Lesions (Cervical Loss of Tooth Structure)

What contributes to NCCLs?

Cervical erosion

toothbrush abrasion

abfraction

**Star** Friction leads to wear via ___ (exogenous) and ___ (endogenous)

Abrasion

Attrition

**Star** Corrosion / Erosion leads to the manifestation of ____ or ____ degradation

chemical/ electrochemical

**Star** Stress (resulting in compression, flexure, and tension) leads to ___ and ___

microfracture

abfraction

Etiology of NCCL

multifactorial

Considerations for the etiology of NCCL

diet

habits

occlusion

Friction causes

dentrifice

toothbursh

oral habits

occlusion

Corrosion/ Erosion causes

medicinal

regurgitation

citrate content of saliva

idiopathic

*Star* Areas affected by NCCL

Facial/Lingual Surfaces

*Star* What is the most common tooth affected by NCCL?

maxillary premolars

Location of Erosion (Corrosion)

lingual, buccal, occlusal, incisal

Shape of Erosion

U shaped

Enamel surface of Erosion

smooth, polished

Margin of Erosion

smooth

Location of Abrasion

Buccal

Shape of Abrasion

wedge

groove

Enamel surface of Abrasion

smooth/ scratched

Margin of Abrasion

Sharp (but smooth)

Location of Abfraction

buccal

Shape of Abfraction

V shaped

Occlusal

Overlapping

multiple lesions

Enamel surface of Abfraction

Rough

Margin of Abfraction

Sharp

subgingival