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Existing Restoration - Clinical Status: Secondary Caries Marginal Integrity Biomechanical Form
Existing Restoration - Clinical Status: Secondary Caries Marginal Integrity Biomechanical Form
Existing Restoration - Clinical Status: Secondary Caries Marginal Integrity Biomechanical Form
Biomechanical Form
restoration fracture tooth fracture
Esthetic
patients esthetic concern
Contour
proximal contact axial contour occlusion
Reasons for replacing an existing restoration with defective margin- Survey of 124 dentists
It is a plaque trap, thus increasing the chance of developing secondary caries (37%)
More likely to find secondary caries on the cavity wall below the defect (25%)
Tooth Amalgam
NO
Indirect/Empirical Evidence
We are seeing the majority of the disease in a small population of our patients; therefore not everybody is equally susceptible to the disease. If physical barrier for oral hygiene is a problem, why do some pits and fissures never develop into lesions.
Assuming these defects on the margin of an aging restoration has been there for years; why no lesion has been developed in all these years.
Reasons for replacing an existing restoration with defective margin- Survey of 124 dentists
More likely to find secondary caries on the cavity wall below the defect
Tooth Amalgam
There is scientific evidence showing that there is NO relationship between marginal defect and the presence of secondary caries on the cavity wall below the defect
30 extracted teeth with occlusal amalgam restorations were sectioned. Caries were identified by imbibing the section in with quinoline and examined in polarized light
Replacement Decisions
Risk Factors
Risk factors related to dental caries and periodontal diseases. Presence of pulpal pathology (e.g. sensitivity to temperature change, sweet). Patients complaint (esthetic concern).
Biomechanical Form
restoration fracture tooth fracture
Esthetic
patients esthetic concern
Contour
proximal contact axial contour occlusion
Contour
Status
Proximal contact - open, rough, location Axial contour - over/undercontour, location Occlusion
Posteriors
Direct restoration - know the clinical and mechanical limitations of the restorative materials; direct composite restorative may be contra-indicated; deep gingival seat clinical limitation. Indirect restoration - may be the only viable option.
Contour
Replacement Decision
Rough Proximal Contact Smooth or replace only if patient complain about not being able to floss
Proximal Contact at Non-physiologic Location Use the same criteria as no proximal contact (no treatment indicated in the absence of pathology, patients complain and esthetic concern)
Contour
Replacement Decision and Options
Axial contour Undercontour - e.g. porcelain fracture from PFM crown Overcontour - e.g. buccal or lingual axial surfaces overcontour
Recontour or replace if patient has esthetic or functional concern; presence of periodontal pathology
Contour
Replacement Decision and Options Occlusion
Dx: usually based on patients complain Hyper-occlusion/interference - adjust Hypo-occlusion - replace
Biomechanical Form
restoration fracture tooth fracture
Esthetic
patients esthetic concern
Contour
proximal contact axial contour occlusion
Biomechanical Form
Status
with bulk fracture or fracture line Restoration with bulk fracture or fracture line
Tooth
Diagnosis
Visual,
Why a full crown may not be an option for restoring a large anterior fracture?
Inadequate retention and resistance
Fractured Area
Mn first molar with an existing Class I amalgam restoration (pulpal depth of 2 mm). Fractured ML cusp from mid MMR to Li groove area at the level of the pulpal floor.
Treatment Options
Direct bonded restoration Indirect bonded restoration Full veneer crown
2002 cc the sensitivity is getting worst Dx - incomplete fracture on #30 Tx - #30 full gold crown
Replacement Decisions
Start out with the least invasive option; always ask yourself the question: will the proposed option improve the health of the tissue/oral health?
Will the new restoration improve function/esthetics? Will the new restoration addresses the chief complaint of the patient? Will the new restoration prevent further destruction of the surrounding hard/soft tissue
Decision to repair/replace a cast gold restoration with a perforation on the occlusal surface
What rationale can you give to repair/replace a cast gold restoration with a perforation on the occlusal surface? (Assuming there is no complaint from patient and you cannot find a cement line)
Biomechanical Form
restoration fracture tooth fracture
Esthetic
patients esthetic concern
Contour
proximal contact axial contour occlusion
Esthetic
Status
Diagnosis
Esthetic
Replacement Decision
Listen to patients REAL concern, try to understand EXACTLY what they want and expect Choose a procedure(s) that has the potential of matching patients expectation (end result vs patients ability to pay), and satisfy our criteria of conservation and optimal oral health following the procedure Important to understand the limitations of each of the esthetic procedure; match patients concern with the limitations of the procedure in mind
Esthetic
Treatment Options
Recontour - least invasive, limited to minor alternation Bleaching - non-invasive; unpredictable result; relatively inexpensive Composite Veneer - limited ability to mask dark stain; longevity; technically more challenging Porcelain Veneer - more invasive, limited ability to mast dark stain; more expensive; better esthetic Porcelain fused to metal crown - invasive, metal collar All Porcelain crown - most invasive; most expensive; best color