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The most common situation requiring the use of a band loop space maintainer is the premature loss of a _________________
first primary molar.
can you use a band loop spacer for two adjacent lost teeth?
no, this is for single tooth loss only
is a band loop spacer unilateral or bilateral?
it can compensate for how many teeth lost?
single tooth loss
you can cement the band loop spacer onto a stainless steel crown, if there isn't a crown on that posterior tooth though, can you cement it onto the natural tooth?
what are the two ways that you can attach a band loop spacer to a posterior stainless steel crown?
what are the 3 ways that you can attach the band loop spacer to the posterior tooth?
-cement it to the natural tooth (if no crown on it)
-cement it to the SCC
-solder it to the SCC
if you have lost #L and #S what are your two options for space maintenance? why would you pick each?
-one band loop space maintainer on each side (good option if you have primary incisors)
-bilateral lower lingual holding arch (good option if you have permanent incisors)
explain how a bilateral lower lingual holding arch works
-if you are missing teeth on both sides
-this rests/cements onto the cingulums of PERMANENT incisors.
-if you do this when the kid has primary incisors and cement it to them, the permanent incisors will be forced to erupt super lingual to the bar
can you do a bilateral lower lingual holding arch if you still have #O and #P ?
no, the bar is cemented onto the cingulums of permanent incisors, so you can't have any primary incisors.... so you would be forced to do two separate band loop space maintainers instead
if you have pre-mature eruption of your second primary molar, but you have your 6 year molars already, would it be better to use a band loop space maintainer or a bilateral lower lingual holding arch?
bilateral lower lingual holding arch
-because of the eruption sequence (ABDCE)
-if the second primary molar has erupted early, this means that the first primary molar is likely going to erupt next, so you will lose the anterior tooth that you are resting the BLS against, before the second premolar is able to erupt
(think about it)
which is better for each (band loop spacer, or bilateral lingual holding arch):
early loss of primary first molar
early loss of primary second molar
-bilateral lingual holding arch
(this is solely because of the eruption sequence; ABDCE)
should you ever use removable unilateral space maintainers?
-they're a choking hazard, and they require good pt cooperation since they're removable
do we use preformed band loop spacers?
they're usually too narrow and don't provide enough room for the incoming erupting tooth; they're also pretty thin, so they get bent down easily and sometimes even get forced subgingival
what are the Denovo Band loop spacers?
do we use these?
pre-formed band loop spacers
how do you select what size band you want to use for your band loop spacer?
-pick the smallest band that will fit over the HOC of the tooth
-seat it with digital (finger) pressure
what happens if the contacts around the tooth are too tight to be able to fit the band for the BLS? (ex: you're fitting it to a primary second molar, and the 6 year molar has a tight contact with the tooth)
-you can use a separating elastic (aka "O ring")
-can place it using forceps or floss, and the "O" has to completely encircle the entire contact
how does an "O ring" or separating elastic work?
-it's placed around the tight contact to allow room for the band of the BLS to fit
-you place this, which opens up the contact, then you have to see the child soon after, because the contact will open causing the O ring to fall out, then if you don't see the kid quick enough, the space/contact will close back up
how do you get the band to fully seat onto the tooth?
-use a band seater with the lead peg on the occlusal margin of the band and press down
-it's essentially like a bite stick with a metal piece to push the band down
once the band is seated onto the tooth, you can use the band adapter
what does this do?
burnishes the band to the contours of the tooth, so you don't have to rely on gobs of cement to fill in the open areas (ex: the concavities at the buccal and lingual grooves)
where should the occlusal most portion of the band for the BLS be at on the tooth?
- apical to the marginal ridges of the tooth (obviously you don't want the kid biting on the band)
where should the gingival margin of the band of the BLS be at on the tooth?
in the gingival sulcus
true or false
the gingival portion of the band for the BLS is supragingival
it is in the gingival sulcus
once the band of the BLS is seated, should you be able to remove it using just finger pressure?
no, it should be adapted very well so that it doesn't come off with just finger pressure
is it okay if the band for the BLS is in occlusion?
no, it should be out of occlusion (hence why the occlusal portion of the band should be apical to the marginal ridges of the tooth)
the band should be contoured so well to the tooth that it can't be removed with finger pressure.... so how do you get it off?
-band removing pliers
-place the plastic covered knob on the occlusal surface of the tooth
-place the sharp edge under the gingival margin of the band
-squeeze the pliers, and the band will pop off and be retained in the pliers
when you're removing the band from the tooth for the BLS, what prevents the band from going flying ?
-the pliers catch the band as you remove it
-When you press down it will pull up and off the band, then it will also catch the band, so the pt won't be at risk for swallowing it
is there a chance that the pt could accidentally swallow the band from the BLS as you're removing it?
no, because when you press down it will pull up and off the band, the removal pliers will catch the band, so the pt won't be at risk for swallowing it
what are the 2 things that you absolutely must capture in your impression for a BLS?
-the band around the tooth
-the distal surface of the tooth that we're bending the BLS against
what are the 2 types of impression material that you could use for the impression of a BLS? which do we use, and why?
ALGINATE: for removable BLS
COMPOUND: for fixed BLS (so we use this)
what are the advantages of using compound for the BLS impressions?
• Accurate and stable
how do you take the compound impression for a BLS?
• Soften compound in hot water
• Place in the impression tray (want it warm enough to flow, but not to burn the child)
• Take impression; if the band doesn't come out with the impression, just take it off and insert into the impression
if you're taking your compound impression for the BLS and the band doesn't come off with the impression, what do you do?
just take it off and insert it into the impression
one of the most important things about the compound impression for the BLS is you must clearly be able to see the ________
how do you secure the band to the compound impression before you pour up (that way it doesn't move when you put it on the vibrator)?
-sticky wax occlusal portion of the band (inside the band) to the compound
what material should you use to pour up the compound impression of the BLS? why?
plaster (or you can use stone if you think you're going to really abrade the cast)
before you remove the plaster cast from compound impression of the BLS, what do you have to do? why?
the impression has to be warm again, so put back into the water bath, then remove (the compound is too hard and won't separate unless it's warm)
what is the purpose of compound, when taking an impression for a BLS?
to allow for the proper orientation of the bands in the alginate impression
explain an alternative way to take an impression of the bands for a BLS
by making a compound index:
--you take the compound and just place a blob over the the band, then take an alginate impression of the whole thing (so the only thing the compound touches is the tooth with the band on it)
what type of wire do we use for a BLS?
what is this made of?
.036 stainless steel wire
--made of 18% chromium and 8% nickel (aka 18-8 SS)
what does it mean that our wires are 18-8 stainless steel?
--made of 18% chromium and 8% nickel (aka 18-8 SS)
why do we use the .036 stainless steel wire for a BLS?
-resistance to surface corrosion
.036 inch round wire is 36 thousandths of an _______ in diameter
why do we use 0.036 inch wire for a BLS and not bigger or not smaller?
-smaller is too bendable and the pt will break it
-0.040 is too hard to bend for us
what is the proportional limit for wires?
what is this also called?
-the point where the stress- strain curve becomes nonlinear.... so everything before this point, if you bend it, it will return back to its normal form, however after this point, the bends will be permanent deformation
-aka elastic limit
everything before the ___________, if you bend it, it will return back to its normal form, however after this point, the bends will be permanent deformation
proportional limit (aka elastic limit)
in order for a bend made in the wire to be permanent, it must be greater than the _____________
proportional limit (aka elastic limit)
wire has a natural springiness; up to a certain amount of stress, the atoms comprising the normal arrangement return to their original position; however once you pass the ___________ this no longer holds true
proportional limit (aka elastic limit)
what is "work hardening"?
as you bend wire more, the irregularities make is so that you need more stress to produce further changes.... the wire becomes stronger and harder until finally enough small fissures are created in one area which results in breakage
as you bend wire more, the irregularities make is so that you need more stress to produce further changes.... the wire becomes stronger and harder until finally enough small fissures are created in one area which results in breakage...... what is the name of this concept?
what 3 pliers will you need to make a band loop spacer?
-bird beak pliers
-wire cutting pliers
-three pronged pliers
describe the bird beak pliers
• Two beaks
what do you use the bird beak pliers for?
what do you use the 3 pronged pliers for?
-to make gentle curves and for step bends
-to make gentle bends and for the "W"
when using pliers, __________ holds the wire, while __________ bends the wires
thumb and fingers
for a more acute bend position wire __________ of the plier beaks; for a more obtuse bend position wire _____________ of the plier beaks
closer to tip
towards the base
how do prevent putting torque on the wires?
-make sure to bend the wire in a plane perpendicular to the inner surface of the beaks.
make sure to bend the wire in a plane perpendicular to the inner surface of the beaks; this prevents ______________
how do you fix an incorrect bend in a wire?
just bend it to the position you want, using the pliers and your thumbs/fingers
if the bend doesn't look the way you wanted it, it may be because you did what wrong?
didn't have the wire in the proper plane before you placed the bend
our wire cutters can cut wire up to ______ in diameter
can you use these intraorally?
no, extraorally only
how do you hold the wire, when using the wire cutters?
hold onto both sides of the wire with your fingers when using this, so you don't let one side go flying
can you use ligature wire cutting pliers for lab work?
no (idk what this means)
where should the wire contact the mesial tooth in a BLS?
- just below the HOC
- at the point of contact with the abutment tooth
the bucco-lingual width of a maxillary premolar is _____mm so the space maintainer needs to be able to allow this eruption
The loop should be contoured to follow the edentulous ridge, but ______mm off the tissue
about how much wire will you need when making your BLS?
what is the first bend that you make in the wire?
start with a 3" piece
-make a "W" in the middle of the wire
when you make a "W" in the wire, you need to make sure the "legs" of the wire are perfectly ____________ and within the same plane
after you make your first bend in the wire, the "W", you can hold it against the mesial tooth to see if it fits.... you don't want it to extend past the ____________
distal line angles
after you've made the first "W" in the wires, then what is your next bend?
how do you do this?
now want to make it into 2 planes to match the curvature of the proximal tooth surface (the frown shape)
-so take the 3 pronged pliers again, and bend in the opposite plane, so that now it looks like the "frown" of the proximal surface
the goal is to have the wire be ____mm off from the tissue, otherwise you will get _________________ and the tissue will grow up over it
how do you adapt the band to the gingiva?
do you do both legs at the same time, or one at a time?
• Form a gradual curve to parallel the gingival crest of the alveolar ridge by 'walking' the 3 prong pliers distally over the wire
• Complete one leg before proceeding to other leg
do you want the step bend made mesial to the band, or on the band?
mesial to the band
how do you make the step bend in the wire?
Place the conical beak of the bird beak pliers on the gingival portion of the wire and bend the distal portion of the wire downward against the conical beak
what is the purpose of having a step bend in the wire?
allows transition of wire from the ridge to band without impinging on the gingival tissues
where do you want the wire to attach to the band at?
junction of the middle of the occlusal and middle thirds on the band
you have to adapt the band to the distal of the band, not just the mesial... how do you adapt the distal?
• Bend distal ends of loop to rest passively against the junction of the middle and occlusal third of the clinically exposed band
• Cut away any excess wire or plaster that interferes
contour the wire so it contacts the band near the _________ line angle and remains in contact for the full ________ of the band
should you cut excess wire before or after you solder?
where should you cut the excess at?
-at the distal line angles
how do you solder the wire and the band together?
-put the wire and band back on the cast, sticky wax together the band and the wire
-put plaster over the anterior tooth and the wire touching it
-remove sticky wax (soldering site should be clear of all debris)
where on the band should the solder be?
-encircle the wire
-extends the full contact area length
-occlusal and gingival margin of the band should be free of solder
what does it mean that the wire mesial to the solder joints should not be annealed?
-annealed wires are soft and ductile, so we don't want this
-only solder where the band touches the wire and nowhere else
how do you polish the band loop spacer?
-Cratex Rubberized Abrasives
-use on slow speed, going from abrasive to fine polish
use a ___________ to reduce the distal ends of wire to form to a smooth curve continuous with the band
the ideal solder joint is concave or convex?
what type of cement do you use for the band loop spacer?
-glass ionomer cement
-easy to mix; sets up quickly; low solubility; releases fluoride; forms attachments to both tooth and band
glass ionomer is advantageous to use for a band loop spacer because it has a ________ solubility and releases ___________
can the kid still eat whatever they want with a band loop spacer in?
they should avoid sticky taffies (this may pull it off if they're constantly eating sticky things that will make the cement come off)
true or false
kids that pre-maturely lose teeth early probably have poor hygiene already so it's super imperative that you talk to them about getting better hygiene, because these will collect plaque really quickly, which is essential to having a band loop spacer
the best space maintainer is a well maintained _______________
what are the 2 main reasons that you would do a SSC on a child?
-grossly broken down tooth
-primary molars that have had pulpal therapy
if a primary or permanent molar is hypoplastic, should you do an SSC on this?
-yes, a full cast crown isn't recommended until the growth has ceased
is a SSC a good idea for children at high caries risk, or kids with special needs?
what is a "chrome steel crown" ?
the same thing as a SSC
an SCC is made of chromium and nickel
which may elicit an allergic response? is this more common in males or females?
what is the purpose of the chromium?
what is a SSC made of?
does strength increase or decrease when you manipulate it with pliers?
an alloy, which is 18% chromium and 8% nickel
which is more common, an intraoral allergic response to nickel, or an extraoral response?
(intraoral is considered to be "scarce")
what are some contraindications for why you would not do a SSC?
-tooth is about to exfoliate
-mechanical problems (such as caries extending beneath the bone) (or space loss, so you wouldn't be able to fit a SSC)
is a Stainless Steel crown considered a permanent restoration?
so this should never be used as a permanent restoration in the permanent dentition
what is the name of the brand of Stainless Steel Crowns that we use at Creighton?
how many sizes do they come in? which do we mostly use?
-7 sizes (for primary teeth, and 7 sizes for permanent teeth)
-size 4 and 5 are the most common
do the 3M UniTek SS crowns come pre-contoured? pre-trimmed? pre-crimped?
no, no, no
-so they are much more versatile since you're able to determine these factors yourself in the mouth
when were stainless steel crowns introduced? by whom?
is the initial way that they prepped for SSC the same way that we do today?
-Dr William Humphrey
historically, for SSC, what is the Hall technique?
-involving no caries removal, no crown preparation and no use of local anesthetic before placement of the SSC
in _________, you make the crown fit the prep
in ________, you make the prep fit the crown
what are some reasons why an SSC is useful in primary molars?
-incline cusps of primary teeth aren't very steep; so the relationship in occlusion between cusps/grooves is less precise
-easy to check occlusion, can just do it visually in MI
-broad contacts are able to be reproduced
-can reproduce the prominent bulge, occlusal to the gingival margin
the prominent bulge, just occlusal to the gingival margin on primary molars, is more common on the __________ of maxillary molars, and on the __________ of mandibular molars
what is the primary factor in retention of a SCC on a primary molar?
the undercut provided by the prominent buccal/lingual bulge, just occlusal to the gingival margin
gingival tissue heals more rapidly and is more resilient in children or adults?
-it's paler in color (since it has more CT than BV); the margins in children are rounded, compared to the knife edged margins in adults
between kids and adults, who has more knifed edged gingival margins? who has more blunted/rounded margins?
do SSC poorly affect the gingival health or cause an accumulation of plaque?
not enough to be significant
what should you use to trim the margins of an SCC?
(don't use scissors, since this will create sharp shards)
what are the 2 types of pliers used for SCC ?
which looks like a ball/socket?
-countouring plier (ball/socket)
what are the 5 steps of doing a crown prep?
• Occlusal reduction
• Proximal reduction
• Buccal and lingual reduction
• Round all sharp line angles/corners
all margins for an SCC are a ______________
how do you get a feather edged margin?
how does the SCC contact the margin? is it a butt joint?
-use the side of your bur (so the tip will be placed slightly subgingival)
-not a butt joint; the SCC fits over the feather edge margin to adapt to the undercut
true or false
the margin of the stainless steel crown will be apical to the feather edge margin of the preparation
-It will not be a butt joint
true or false
in a stainless steel crown, you want undercuts, so don't remove them, since this is what will lock the crown in for retention
(so you don't want good draw)
the two main differences in a pedo crown prep for an SCC are __________ margins and don't remove the ____________
what is the "sweetspot" of a prepped tooth for a SCC?
the undercut provided by the bulge
do you want any ledges in a SCC tooth prep?
how much occlusal reduction do you need for an SCC?
how much buccal/lingual reduction do you need?
1.0 to 1.5mmn (use depth cuts)
0.5 to 1.0mm
do you still have to break all contacts when doing an SCC prep?
when finished, the proximal sides should converge or diverge towards the occlusal?
converge to the occlusal (so you will have good draw and no undercuts mesiodistally, but the buccal/linugal will have a large undercut due to the prominent bulge)
to check your proximal contacts in an SCC prep,
put the tip of the explorer on the buccal (or lingual) and put it subgingival... try to drag it all the way around the tooth..... If you can't do this successfully, then you have a _________ and need to fix it
how do you avoid removing the buccal/lingual prominent bulge, when doing a crown prep?
do a 2 plane reduction
SCC requires ________mm occlusal reduction and a _________mm reduction around the tooth
1.0 to 1.5
0.5 to 1.0
instead of a functional cusp bevel, what do you do for an SCC prep?
-bevel both the buccal and lingual cusps at about 30-45 degrees
-so it will look like a functional cusp bevel on each
-this helps restore the narrow occlusal table
most often an SCC will seat from the buccal to lingual? or lingual to buccal?
lingual to buccal
after your SCC prep, how do you adapt the crown to fit the tooth?
-place SCC on tooth (it will likely be long)
-mark gingival line with a sharp instrument
-trim 1mm beneath the line with a heatless stone (so since our margin is subgingival, we will trim until there's about 1mm left apical to the line we drew)
what shape does each contour look like?
-buccal gingival of second primary molar
-buccal gingival of first primary molar
--proximal gingival of primary molars
-stretched out S
using the __________ pliers, bend the gingival third of the crown's margins inward to restore anatomic margins and to reduce the marginal circumference ensuring a good fit
which pliers will help you to hear a "snap" when seating the SCC on the tooth?
(helps you to create that undercut and really lock on to the tooth)
should you ever adjust the occlusion on an SCC?
-these crown are too thin to be reduced
for finishing of an SCC,
-use a ________ to smooth jagged edges/margins
-use a _________ to remove small scratches and smooth
-polish to a high shine using ______________
-tripoli and rouge
what type of cement do you use on a stainless steel crown?
when cleaning, you should start to remove excess when the cement is ___________
-partially set up
an SCC may fail for lots of reasons, including poor _______ margin adaptation that allows permanent molar to erupt ectopically under a second primary molar
____________ remains one of the most prevalent preventable health problems for children worldwide
_________% of school children have had dental caries
_________% of adults have had dental caries
is it easier to get a pulp exposure in children or adults?
Primary teeth are __________ in all dimensions the permanent teeth, while pulp is relatively ___________
Enamel is thinner in primary teeth so there is less __________ for the pulp
true or false
there is considerable variation in both the size and location of the pulp, in primary teeth
primary pulps closely follow the outer crown ____________; and pulp horns are _________ extending closer to outer enamel surface
are the pulps relatively the same size and shape between first and second molars? between maxilla and mandible?
they vary highly
know the pictures on slides 6 and 7 of lecture 4
which pulp appears more triangular in shape from an occlusal view: maxillary first or maxillary second molar?
MB pulp horn of 1st primary molar is _____ mm from outer enamel surface
the ________ pulp horn of 1st primary molar is 1.8 mm from outer enamel surface
which pulp horn in primary molars is usually the one that gets an accidental exposure? why?
the MB pulp horn
-because it is only 1.8mm from the occlusal surface, and preps already go 1.5mm deep (ideally), so you're super close to it already
what's the difference between a pulpotomy and a pulpectomy?
PULPOTOMY: removing just the coronal pulp
PULPECTOMY: removiong all pulpal tissue (coronal and radicular)
a primary pulp has a narrower or wider apical foramen than a permanent tooth?
primary pulps usually communicate with surrounding tissue through numerous __________________
(not as common in permanent teeth)
the coronal pulp chamber is more shallow and more susceptible to perforation in primary or permanent teeth?
true or false
-primary roots are longer and more slender (to accommodate for the developing tooth bud)
why is it nearly impossible to do a pulpectomy on a primary tooth?
-the radicular pulpal portion of a primary tooth is tortous and ribbon like
-lots of apical branching
-lots of accessory canals
-and intertwining filaments
when did a pulpotomy first become popular?
1932 by Dr. Sweet
what is the definition of a pulpotomy?
the surgical removal of the entire coronal pulp, leaving intact the vital (healthy) radicular pulp within the canals followed by placement of a medicament and a good coronal seal
what is PT?
what is PE?
why are you allowed to leave the radicular pulp, when doing a pulpotomy?
the radicular pulp is still vital (healthy)
a pulpotomy is the surgical removal of the entire coronal pulp, leaving intact the vital (healthy) radicular pulp within the canals followed by placement of a ______________ and a good coronal seal
_____________ is a root canal procedure for pulp tissue that is irreversibly infected or necrotic due to caries or trauma.
what would be a scenario in which you would have to do a pulpectomy on a primary tooth, and a pulpotomy wouldn't be enough?
if the radicular pulp exhibits clinical signs of irreversible pulpitis
-a pulpotomy works because the radicular pulp is still vital (healthy)... however if it's not healthy it must be removed
if you start by doing a pulpotomy on a primary tooth, how would you know that the radicular pulp has irreversible pulpitis and you are now going to have to do a pulpectomy?
-excessive hemorrhage that is not controlled with a damp cotton pellet applied for several minutes
(if the radicular pulp has irreversible pulpitis, you can't leave the radicular pulp)
suppuration or purulence would be indicative of a pulpotomy needed? or a pulpectomy needed?
true or false
The roots should exhibit minimal or no resorption if you're going to do a pulpectomy
what is something that you could do that would allow you to avoid having to do a space maintainer?
explain the concept of a distal shoe space maintainer
-if you have a primary second molar with a poor prognosis (this is the distal most tooth in the mouth at the time)
-do the pulpectomy
-then once the permanent first molar has erupted, then you can extract the primary second molar and put on a space maintainer
what does IPT stand for in this class?
indirect pulp cap therapy
why would you ever do an indirect pulp cap?
-to avoid having to expose the pulp and then having to do a pulpotomy (which is only successful 70-90% of the time)
what is the success rate on a pulpotomy?
usually about 70-90%
(so it isn't 100% successful.... so if we can avoid doing one and just get away with an indirect pulp cap, then we usually try that)
can you do an indirect pulp cap if the tooth has radicular pathology?
(radicular pathology would mean it has to be a pulpectomy)
explain an indirect pulp cap
-when the tooth has deep caries (but no radicular pathology)
-you remove the caries, but leave the deepest caries that are adjacent to the pulp
-this is to avoid a pulp exposure
-you must cover the caries affected dentin with a biocompatible material to produce a biological seal
___________ is an attempt to avoid a pulp exposure.
You leave some deep caries.
But then you place material to produce a seal.
Indirect pulp cap
IPT (indirect pulp cap therapy) is indicated in a primary tooth with _________ caries that exhibits no _________ or __________
The deepest carious dentin is _______ removed to avoid a pulp exposure. The pulp is judged by clinical and radiographic criteria to be vital and able to heal from the carious insult.
with reversible pulpitis
is all carious dentin removed in an indirect pulp cap therapy?
no (the deepest dentin next to the pulp is left, then a biocompatible material to placed to produce a biological seal)
Indirect pulp capping has been shown to have a _____________ success
rate than pulpotomy in long term studies.
which is more likely to allow for a normal exfoliation time:
pulpotomy or indirect pulp capping?
indirect pulp cap therapy
Therefore, __________ is preferable to a pulpotomy when the pulp is normal or has a diagnosis of reversible pulpitis.
indirect pulp treatment
can you do an indirect pulp cap treatment if the pulp is normal?
in the history of medicaments that are placed during a pulpotomy, what 3 have been used historically?
-Ferric Sulfate (15.5%) (aka Viscostat)
what does MTA stand for?
Mineral Trioxide Aggregate
why do we no longer use Formocresol as a medicament?
because formaldehyde is a carcinogen
which is mostly used today?
-Ferric Sulfate (15.5%)
(ferric sulfate is good, but MTA is better)
what is MTA derived from?
is MTA toxic?
does MTA contain resins?
is this as good as Formocresol?
-yes (it's a suitable replacement)
is MTA expensive?
it used to be, but it's not patented anymore, so it's cheaper now
_____________ is the most widely accepted treatment for carious or accidental exposures in teeth with vital pulps
in adult teeth, you use calcium hydroxide for pulp caps to stimulate repair... is this true for primary teeth?
-CaOH is NOT recommended for direct pulp caps in primary teeth
-this will over stimulate a primary pulp, and cause pulpal inflammation & internal resorption (it's too strong of a treatment for primary pulps)
_____________ will over stimulate a primary pulp, and cause pulpal inflammation & internal resorption
(so never use on primary teeth)
why are we able to just do the coronal pulp, on a pulpotomy?
in primary teeth, the pulpal inflammation is usually limited to the site of exposure or just confined to the coronal portion of the pulp (so the radicular pulp is entirely normal)
the goal of a pulpotomy is to maintain treated tooth in the
arch until time of normal ____________
If the radicular pulp is not healthy, can you do a pulpotomy.
do we pulp test primary teeth?
-this isn't a reliable method of testing with kids
the radicular pulp must be healthy in a primary tooth to do a pulpotomy... can you determine this using an EPT?
no, this isn't an accurate test since you're doing it on kids and they can't accurately describe their symptoms
what are the seven indications for a pulpotomy?
-pulpal exposure in a vital asymptomatic tooth
-no radicular pulpitis
-at least 2/3 root length
-no abscess or fistula
-no bone loss in furcation
-no internal/external root resorption
-tooth must be restorable
if a tooth is not restorable, can you do a pulpotomy on it?
no, what's the point
indications for a pulpotomy include:
-vital and ______ tooth
-free of radicular ____________
-at least _____ root length
-tooth must be ______________
bone loss in furcation
internal/external root resorption
in permanent teeth, the first place you look on an x-ray to see if the pulp is going bad is the ____________; in primary teeth it's the _____________
(so in primary teeth look at the furcation if you're trying to see if there's pulpal problem, not look at the apex)
what are some contraindications for a pulpotomy?
-painful / tender to percussion
-profuse hemorrhage at pulpal exposure (indicates radicular involvement)
-less than 2/3 root remaining
-child is immunocompromised or has a cardiac condition
what medical conditions would be a contraindication for a child to get a pulpotomy?
if there is >2/3 root remaining can you do a pulpotomy?
what is there is <2/3 root remaining?
true or false
teeth that already have been treated pulpally and are clinically and radiographically sound should be monitored periodically for signs of internal resorption or failure due to pulpal/ periapical/furcal infections.
if a child is immunocompromised, why may the clinician be much more likely to just extract the tooth rather than to do a pulpotomy?
-there isn't 100% success with pulpotomies, so if the infection can become life threatening (since pulpotomies only have a 70-90% success rate), it may be better just to pull it, than to do a pulpotomy and risk the chance of it not working
-many clinicians choose to provide a more definitive treatment in the form of extraction because pulpal/periapical/furcal infections during immunosuppression periods can become life-threatening.
which tooth usually has a higher risk of needing a pulpotomy:
1-they've been in the mouth longer and are more likely to have deep decay
2-pulp horns are higher here
3-restorations fail more here
when you remove carious dentin in a primary molar, which walls/floors should you do first?
-using a round bur on slow speed.... first do the lateral and gingival walls, then finish last with the pulpal floor
if a pulpal exposure occurs, do you have to unroof the chamber?
yes, because now you are going to do a pulpotomy
(recall that in an indirect pulp cap therapy, you never have exposure to the pulp, because you still have a layer of affected dentin that you're leaving to avoid reaching the pulp)
when you are removing the roof of the pulp chamber, should you try controlling the hemorrhage?
not at this time
(just work on removing the pulpal roof first)
what can you use to remove the coronal pulp in a pulpotomy?
-or large round bur on slow speed
will you have any undercuts in your access opening after unroofing the pulpal chamber?
if you are too conservative in your access opening, you won't be able to remove all of the coronal pulp and you won't be able to establish ______________
If you know you have a __________ pulp, you should be able to have hemorrhage control .... If you continue to have hemorrhaging, it may be because of ________________
how do you control the hemorrhage during a pulpotomy?
-blot dry with a moist cotton pellet (light pressure)
-if hemorrhage won't stop look for remaining tissue tags (tags of coronal tissue)
-may need to consider that the radicular pulp is involved if still no control of hemorrhage
the pulp must be ___________ before you can place any MTA
(if it is still damp, wet, or hemorrhaging, you can't place the MTA)
before placing in a pulpotomy, how do you mix the MTA?
-mix NeoMTA powder and gel (should become putty like)
once you've mixed the MTA, where do you place it (during the pulpotomy?
-use a moist (with sterile water) cotton pellet to apply the MTA to the walls and floor of the pulpal chamber
-so the entire floor (including the orifices) will be covered
what is the name of the powder and gel that is mixed to make the MTA?
does this have a long set time or a short set time?
once you've placed the MTA during a pulpotomy, then what?
-secure the material in place by placing a glass ionomer or flowable composite
-prep tooth for an SCC
-cement the SCC with GI cement (the cement will fill in the remainder of the prep, so you don't have to do a buildup)
what is placed, when doing a pulpotomy?
-glass ionomer or flowable composite
-SCC with GI cement
(so no buildup, since the cement fills in whatever is remaining from the prep)
do you do a buildup before placing an SCC?
no, the cement fills remainder of prep
true or false
If we get any leakage into the pulpotomy after it's complete... it's a goner. Can't do anything.
with a successful pulpotomy, the arch length is ___________ and there is a __________ resorption of primary tooth & eruption of permanent successor
-maintained (since the tooth is maintained)
is it possible that a pulpotomy tooth may later on lead to internal or external root resorption?
is it possible that a pulpotomy tooth may lead to early exfoliation? late exfoliation? why?
-yes (since low-grade, chronic, asymptomatic, localized infection)
-yes (due to bulk of cement in the chamber and there's a protective SCC on it)
if you are unable to do an SCC at the time of the pulpotomy, _________ is placed as a temporary
(then you must do the SCC at the next appointment)
true or false
Primary molars with pulpotomy don't always require stainless steel crowns
99% they always do
(only exception is when the tooth will be in mouth less than 2 years and there is a large amount of sound tooth structure remaining allowing placement of a good restoration that will not leak)
do you do a buildup prior to placing an SCC on a pulpotomy tooth?
what is the only scenario in which you could get by with not placing an SCC after a pulpotomy?
all of the following must be met:
-tooth will exfoliate within 2 years
-lots of sound tooth structure remaining
-able to place a good restoration that won't leak
the procedure for entering the pulp chamber recommends entering over a pulp horn, why?
-to avoid any chance of perforation though the furcation
-move the bur around the roof from one pulp horn
to another, severing the roof of the chamber
do you crimp or contour first?
how much do you do with each?
-contour first (gingival third of the crown)
-crimp second (gingival 1mm of the crown)
when do you start to get mixed dentition?
when do you stop having mixed dentition?
around 6 years of age
around 12 years of age
are primary teeth (compared to permanent):
whiter or yellower?
more or less mineralized?
crown to root ratio?
thicker or thinner enamel?
more or less uniform enamel?
smaller or larger pulp chambers?
more or less mamelons?
small or large cingulum?
whiter (since less dentin)
less/pretty much the same
primaries are more like 1:1
no mamelons in primary teeth
primary teeth have a __________ cervical constriction
are the HOCs the same or different for primary teeth as they are for permanent teeth?
the only primary tooth with the mesial cusp ridge longer than the distal cusp ridge is the primary __________ (this is an exception to the rule).
In primary dentition, the ________ molar is bigger.
In permanent dentition, the ________ molar is bigger.
Primary second molars look like ___________
Primary first molars look like ___________
permanent first molars
Primary molars have a very _________ root trunk and roots spread really wide (___________ extensions of the crown).
what is the eruption of primary teeth?
max: A (10), B (11), C (19), D (16), E (29 months)
man: A (8), B (13), C (20), D (16), E (27 months)
what is the eruption time of permanent teeth?
max: 1 (7), 2 (8), 3 (11), 4 (10), 5 (10), 6 (6), 7 (12), 8 (17 years)
man: 1 (6), 2 (7), 3 (9), 4 (10), 5 (11), 6 (6), 7 (11), 8 (17)
______% of children have tooth decay before they reach kindergarten
what does it mean for a child to have a dental disability?
having dental caries, periodontal disease and other oral conditions left untreated can substantially limit a child's participation in life activities
(ex. they have decay/pain that gives them a headache, so they don't eat) (ex. they have malnutrition because it hurts to eat on bombed out teeth) (ex. they don't smile because their teeth are broken)
what is something that you consider with primary teeth, that you don't with secondary, when determining whether or not you should restore the tooth?
how much longer does this tooth have before it exfoliates?
other than radiographs and obvious visual cavitation, what is another way that primary teeth caries are detected?
shadowing of the enamel may be a strong indicator with primary teeth
what are some risks for doing restorative therapy?
-increasing susceptibility to fracture
-pulp exposure during excavation
-future pulpal complications
-iatrogenic damage to adjacent teeth
◦are _____ occlusal-gingivally
◦have a ________ occlusal table
◦B & L surfaces form a prominent bulge just _______ to gingival margin
◦have a _________ pronounced cervical constriction
◦have ________ enamel and dentin layers
explain the difference between the contact point on primary molars compared to permanent molars
primary molar contacts are broad and flat, so very wide buccal lingually, extending almost to the line angles
is there an extreme color difference between dentin and enamel in primary teeth, like there is with permanent teeth?
no, the dentin is more similar in color to the enamel, it's just less shiny
pulps are smaller or larger in primary teeth ?
more or less closely follow the surface of the crown?
larger (in relation to the crown size)
which pulp horn in primary molars is pronounced occlusally?
is there usually a pulp horn under each cusp?
mesial pulp horn
why are root canals not as frequently done on children?
canals are ribbon like and more tortuous
true or false
primary roots are longer and more slender in relation to crown size
why do we round internal line angles in primary cavity preps?
reduces the stress in the tooth by 40%
Increasing the width of the isthmus or the depth of the pulpal floor ________ the stresses in the restoration
Converging walls _______ marginal fractures
which primary tooth is likely the most carious? and why?
they have deep occlusal fissures and broad flat interproximal contacts
why are caries more active in primary teeth?
do they progress faster or slower?
-one reason is because the enamel is thinner
-faster, since the dentin is thinner too
where are you most likely to get a pulp exposure in a primary tooth?
the mesial pulp horns (since they extend higher occlusally)
Primary enamel is _____ as thick as the permanent enamel.
at what depth should you prep restorations in primary teeth?
-pulpal floor is still placed in dentin but overall prep depth is 1.5 mm
what is the isthmus width for primary restorations?
1/3 the intercuspal width, buccal lingually
do you do proximal box retention grooves or S curves in a primary tooth?
no, don't want to extend any further and risk a pulp exposure
what is unique in how the primary mandibular first molar is prepped?
what about the maxillary second molar?
the transverse ridge is rarely crossed, and usually it's either the mesial or distal pit that is prepped
what two primary teeth do you try to not cross the transverse (or oblique) ridge, and instead prep the pits?
(assuming the ridge isn't carious)
maxillary second molar
mandibular first molar
at what depth do you prep primary restorations?
pulpal floor at 1.5mm (0.5mm into dentin)
with first molars, you may be able to get away with 1.25mm
what is the shape of the pulpal floor, when prepping primary molars?
curved (to avoid hitting pulp horns)
why do we curve the pulpal floor on primary restorations?
to avoid hitting the pulp horns
Cervical enamel rods slope _______ in primary teeth
how deep is the pulpal floor on a primary posterior tooth?
all walls on a primary prep are ___________
do we do slot preps on primary teeth?
do we ever do amalgams on primary posteriors?
the shape will cause a fracture
do we ever do S curves on primary teeth?
in Pedo, is it appropriate to prep and fill two adjacent class twos at the same time?
yes, we aren't super worried about having a good contact, since these teeth likely don't contact anyways
is it okay to do one bulk fill in pedo rather than incremental fills?
the quicker the better on a kid
in pedo, do you bevel the axial pulpal line angle?
because the pulp horn it right underneath this
how tall is the axial wall on a class 2 preparation?
ideally, it should be the same height as the 1.5mm pulpal floor .... so if you lower the pulpal floor more than the 1.5mm, then you will need to correspondingly drop the gingival seat too
caries in the proximal contact initially spread ____________ then ____________
________% of lesions in primary molars are undetected without radiographs
is the occlusal portion of a class 2 the same as a class 1?
how wide should the isthmus be?
one-third the intercuspal distance
If isthmus is too narrow, the sudden opening up into the contrastingly wide area of the proximal box often results in ______________
true or false
Axial wall should be deeper than pulpal floor
it should be no deeper than the pulpal floor
(if pulpal floor is 1.5mm, the axial wall should be 1.5mm and no bigger)
how much should you break contact with your proximal box on a class 2 wiht the gingival, buccal, and lingual walls?
enough for a explorer tip to fit through
the gingival seat of a class 2 will be _______ to the long axis of the tooth
will the gingival seat by concave or convex in a primary class 2 preparation? why?
slightly concave as a result of using a pear-shaped bur in a pendulum movement
there is a large gingival bulge on the buccals of primary molars, due to this, should the buccal wall parallel this angulation?
so it will be pretty converging
do you utilize reverse S curves on primary teeth?
-because of the broad flat contact area and the considerable convergence of the B/L walls of the proximal portion
-the walls of the box would not clear the contact if a reverse curve were prepared and proximal walls would be too thin
if you can
on max _____ molars, don't cross the oblique ridge
on man _____ molars, don't cross the transverse ridge
we NEVER do ______ amalgam preps on first primary molars
are there some situations where you wouldn't do a class 2 for proximal caries on a primary molar?
yes, if the preparation is going to be so big that the box will undermine the cusps, it'd be better to do a stainless steel crown (or extract)
too narrow of an isthmus causes ___________
too wide of an isthmus causes _____________
Gingival seat on a class 2 prep should be ______ wide
this is the width of the bur, and all that is required to break the contacts
true or false
the proximal box on a class 2 is perpendicular to long axis
cavo surface margin should always be _______ degrees
regardless of what kind of prep you are doing
how do you do a spot welded matrix band?
-put band on the tooth, weld the buccal end
-should be 0.5-1mm gingival to the proximal box
-should be 0.5-1mm occlusal to the cavosurface margin
-use Howe Pliers to crease ends
what do you call the pliers that we use to make a spot welded matrix band?
how far gingivally and occlusally should the spot welded matrix band extend?
-should be 0.5-1mm gingival to the proximal box
-should be 0.5-1mm occlusal to the cavosurface margin
what is the "snowplow" technique for placing resin?
placement of composite paste in bulk over a thin layer of uncured flowable composite
what are the top 2 reasons why band loop spacers fail?
most common reason is: soldering issues (11%)
second most common: cement loss (10%)
true or false
soldering issues is the main reason why BLSpacers fail
11% of band loop spacers fail due to solder failures at _____ months
10% = cement loss at an average of ____ months from insertion
5% = soft tissue lesions at _____ months
3% = caused by interference with the eruption sequence at ____ months
mean survival time (MST) for a space maintainer is ____ months
for a BLS is _______ months
for a LLHA is _______ months
which has a better mean survival time: max bilateral space maintainer or man bilateral SM?
what is Soldering?
the joining of metals by the fusion of filler metal between them, at a temperature below the solidus temperature of the metals being joined and below 450º C
the joining of metals by the fusion of filler metal between them, at a temperature below the solidus temperature of the metals being joined and below 450º C is called ______________
soldering is the joining of metals by the fusion of filler metal between them, at a temperature below the solidus temperature of the metals being joined and below ________º C
what is the Solidus temperature?
the temperature at which metals of an alloy system become completely solidified on cooling or start to melt on heating
the temperature at which metals of an alloy system become completely solidified on cooling or start to melt on heating is called _____________
soldering process involves the substrate or parent metals to be joined, soldering _________ metal, a flux and a heat source
______________ is the enemy of the solder
what are the 2 metals used in a solder?
the parent metals
the solder metal
for soldering, a _______ temp is preferred for SS wire to prevent carbide build up and to prevent excessive softening of the wire
is the oxide that forms usually from the parent metals or from the solder metals?
silver solders have a fusing temp of __________ ºC
600-750o C (so a low fusing temp)
what type of metal do we use for our solder?
which has a better resistance to tarnish and corrosion, gold or silver solder wires?
but silver isn't bad, and the strength is comparable, so we use it
what is the composition of the silver solder wires that we use?
Cadmium, tin & phosphorous in small amounts
what does the word "flux" mean?
true or false
flux needs to be liquid enough to cover the wire that you want soldered
___________ provides protection from oxides. Oxides are generated every time you bring a head source to the project. So you have to re-flux between heatings
flux provides protection from ____________
the purpose of _________ is to remove oxides on the molar band and wire surface when the solder is fluid and ready to flow into place
the resulting solution of oxides in flux constitutes "_______"
what is the composition of flux?
and the percentages?
Potassium Bifluoride: 50-60%
Boric acid: 25-35%
flux is made of potassium bifluoride and boric acid.... what is the purpose of each?
PB: dissolves the film produces by the chromium
BA: acts as a cleaning agent
true or false
Potassium Bifluoride is corrosive & is toxic if ingested.
what is Potassium Bifluoride found in?
component of flux
is it safe to put flux in a pt's mouth? why?
potassium bifluoride is a major component of flux, and it is corrosive and toxic when ingested
what happens if you have too little flux? too much?
LITTLE: flux burns off & is ineffective
MUCH: remains trapped within the solder causing a weakened joint
during the soldering process flux combines with metal oxides and forms a _____________
what do you do with this?
-have to scrape it off, so that you can evaluate the solder joint and it has to be gone before you can add more solder
The green that you see after soldering is a ________-like substance..... You have to scrape this away before you can evaluate the solder joint.
If you have just butane gas on and no air, it will be a _______ flame at a ______ temp..... If you only have air and no gas, it will be a ________ flame at a ________ temp
what is a yellow flame indicative of?
Y: just gas, no air.... low temp flame
B: just air, no gas.... high temp flame
the butane torch is capable of reaching ________ºC
the SS wire becomes annealed at ________ºC
do you fill up the butane torch upside down?
yes, the torch and the cannister are both upside down.... then turn them right side up for at least 10 seconds before using
can you use a bunsen burner when doing a solder?
have to use a butane torch
what is the "sweet spot" of a butane torch flame?
the tip right between the inner light blue and the outer dark blue...... if you go out to far, this has a lot of carbon, and carbon produces oxides.
an improperly adjusted torch or using wrong part of flame can lead to __________ of substrate or filler metal and result in a poorly soldered joint
true or false
to prevent oxide formation the flame should not be removed once it has been applied to the joint area until the soldering process has been completed
what is an easy way to prevent oxidation of the metals during soldering?
-don't remove the flame once it's been applied
Portion of flame used for soldering should be the neutral or slightly _________ portion
when solder flows properly it spreads quickly over the metal surfaces and penetrates small openings, following points of contact by _____________ action.
The parts to be joined during soldering must be perfectly _________ and remain free of __________ during the actual heating process.
where should the wires rest in relation to the band?
Wire should rest at the junction of the occlusal and middle third of the band & be parallel to occlusal surface of band
the resultant solder joint will be a ___________ union
true or false
the more wire that is in contact with band the weaker and less durable the solder joint (appliance) will be
the exact opposite is true.... more wire contacting the band means stronger and more durable
the ideal solder joint is convex or concave?
concave (look at the picture)
should the solder completely encircle the wire?
ideally, do you want the solder joint annealed?
(annealing reduces hardness, and we want the joint to be hard)
use a ___________ stone to reduce the distal ends of wire to form to a smooth curve continuous with the band
the ideal solder joint is concave.... to do this, do you apply the max or minimum amount of solder?
-minimum of solder has been used
should the solder extend to the margins of the band?
true or false
polishing the solder joint with tripoli and rouge increases resistance to tarnish and corrosion
true or false
if you can rub your finger and feel the round outline of the wire, then you don't have enough solder
what happened if the solder balls up?
if the metal glows cherry red?
if the surface of the metal is blackened?
-the metal was underheated
-the metal is too hot and possibly annealed
-there was oxidation (have to clean and re-apply flux)
what type of cement do we use to put the BLS onto the child's tooth?
-easy to mix, sets up quickly, low solubility, releases fluoride, forms attachment to tooth and band
should the child change their diet after they get a BLS?
when do they need a check up for the BLS (make sure it still fits, tooth is erupting properly, etc)?
-need to avoid sticky, chewy foods
what should the child/parent do if the BLS is lose on the kid's tooth?
call the office immediately to get it fixed
true or false
a space maintainer is a passive appliance, so the kid shouldn't be in any discomfort... discomfort means something is wrong, so they need to come back in.
what should the child do if their BLS is causing them discomfort?
come in to the office
-the BLS is a passive appliance so it shouldn't be even noticed after a day or two... so discomfort is a sign that something is wrong
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