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Restorative Dentistry (Management (B: MAINTENANCE & MONITORING …

- - - - Emergency - Pain, infection, pathology
      - Urgent - Dental fracture, deep caries
    - - Prevention - OHI, diet/smoking cessation
      - Prescriptive - Topical, rinses, medication
      - Operative Management
        
        Non-Surgical - scaling, sealing
        
        Surgical - restorative, exo
      - Review/Recall (interim evaluation)
- - - - Regular Check up?
        
        SOCRATES - Pain Record
        
        Referral?
    - - Medications
        
        Systems Review
        
        Allergies
        
        Hospitalizations
    - - Denta Tx Hx
        
        Oral Hygiene Habits
        
        Type of User
    - - Diet/Snacking
        
        Occupation
        
        Smoking Hx
        
        Rec. drug use
  - - - TMJ, Nodes, Skin, Eyes, Lips, Salivary Glands
    - - SOFT TISSUE
        = buccal, vestibule, FOM, tongue, soft palate, hard palate
      - Gingiva & Periodontium - PSR and CCCs
      - Teeth
        
        Charting
        
        Guidance
        
        Class
    - - Radiographic
        
        Biopsy
        
        Diagnodent/Fluoroscopic
        
        Vitality Testing
        
        Advanced Periodontal Charting
  - - - Factors: including -
        
        Caries Hx
        
        Current Caries Status
        
        Fluoride Exposure
        
        Caries activity
        
        Dietary Habits
        
        Family caries hx
        
        Saliva flow
        
        medical hx
        
        oral cleanliness
        
        social behaviour
        
        Low Risk
        
        No new lesions
        
        good OHCP
        
        no poor diet habits
        
        optimal F- exposure
        
        no family hx of caries
        
        Moderate Risk
        
        1 new carious lesion per year
        
        irregular OHCP
        
        occasional snacking
        
        sealants done
        
        moderate F- exposure
        
        High Risk
        
        2+ new lesions per year
        
        poor OHCP
        
        no sealants
        
        no F- exposure/use
        
        family hx caries
        
        dry mouth
    - - Factors: - Perio Ex
        
        BOP
        
        CAL
        
        Tooth Loss
        
        Bone Level
        
        Exposure to RF
        
        Systemic Conditions
        
        Calculus, plaque retentive features
        
        Low Risk - 12 month recall
        
        Moderate Risk - 6 month recall
        
        High Risk - 3 month recall
    - - INFO
        
        Information about the pt (age, gender, medical history, pt name)
        
        Clinical history of the lesion (onset, duration, pain, site, size, texture, overlying skin, fixation/mobility, one or more, pigmentation, previous surgery)
        
        Description of the lesion – similar to above, may help to accompany with photograph
        
        Results of investigations – hematological, microbiological, regional LN palpation, medical imaging
        
        Surgical history – resistance to knife cutting, presence of a capsule, amount of bleeding, exudates or fluids on incision
    - - Restorability
        
        access
        
        margins
        
        occlusion
        
        current restiorations/RDT
      - Vitality
        
        Percussion
        
        Palpation
        
        Probing
        
        mobility
        
        Cold/EPT
      - Radiographic Assessment (PA, PBWs, OPGs)
        
        crown, root(s), canal(s), lamina dura, bone
        
        root filling? max sinus? furcation?
      - "endo and restorative prognosis?"
    - - I/O: Occlusion (excursive, protrusive, XB, OB, OJ)
        
        Periodontium (ppd, BOP)
        
        Endo (mobility, ept/cold)
        
        Radx (crown, root, canal, lamina dura...)
        
        Study models (Wax ups, facebow/mounting)
        
        Photographs
- - - - Procedural Steps:
        
        Cuspal Overlay
        
        2mm minimum reduction
        
        matches cuspal incline
        
        Full Cuspal Build
        
        Secondary prep
        
        retention/resistance features
        
        slots/ coves
        
        horizontal grooves
        
        dovetails
        
        amalgam pins (correct placement)
        
        Bonding?
        
        Packing and Carving
        
        Burnishing and Polishing
    - - Procedural Steps:
        
        Dental dam and retraction cord (moisture control)
        
        all margins sound enamel
        
        CSA >90 degrees, rounded internal angles
        
        placing of RMGI linings or Ca(OH)2 form (pulpal consid)
        
        Etch, prime, bond
        
        Cuspal Build Up
        
        Free-hand
        nb: spatial awareness
        
        Circumferential matrix
        
        Incremental Build Up
        nb: C-factor
        
        Polish and finishing
  - - - Metal (GOLD)
        
        :check: strength, wear resistance, biocompatible, durability, conservative prep, CADCAM
        :forbidden: aesthetics, cost, lab handling
      - PFM
        
        :check: strength, wear resistance, biocompatible, durability, aesthetics
        :forbidden: aesthetics, aggresive prep, lab handling
      - Ceramic
        
        :check: aesthetics, CADCAM, biocompatible
        :forbidden: strength, wear resistance, aggressive prep, wears opposing teeth, lab handling
      - Principals of Crown Prep
        
        Restore:
        
        Function - occlusal support, prosthetic support, phonetics
        
        Form: aesthetics, contacts(inter/intra arch), prevention of further disease
        
        Address:
        
        patients needs, wants and expectations
        
        Protect:
        
        Support remaining tooth structure
        
        Preserve:
        
        Minimise surgical intervention
        
        Indications:
        
        Alternative to direct restoration
        
        retention of larger prosthesis
        
        where stability is required
        
        tooth morphology needs to change
        
        significant discolouration
        
        OVD needs modification
        
        Contraindications:
        
        active disease
        
        Non-functional posterior tooth
        
        lack of occlusion
        
        non-restorable tooth/limited coronal structure
        
        lack of technical support
        
        Considerations for Crown Prep:
        
        Biological considerations
        
        tooth conservation and damage prevention
        
        Aesthetic consideration
        
        gingival contour, crown morph, colour
        
        function
        
        occlusion, abutment
- - - - :check: Smooth surface + Fissure caries (>30 reading)
        :forbidden: proximal caries, calibrated routinely, can't show extent