operativevivaquesin dentistry-170219131358.pdf

Operative dentistry

1. Dr. MuaazAmjadAwan
Dr.Almas M Arshad
UCD, UOL (PAKISTAN)

2. •Pulp capping agent
•Intracanal medicament
•Canal sealer
•Antimicrobial properties
•Ph 12.5 strongly alkaline
•Types:
•Setting
•Non -Setting (Intra-canal)

3. Composition:
1-Tricalcium Silicate
2-Tricalcium Aluminate BOSA
3-Tricalcium Oxide
4-Bismuth oxide
5-Tetracalcium Silicate (Grey MTA)
USES:
1-Pulp capping Agent
2-Root end filling after apicectomy
3-In Internal and external root resorption
4-Lateral perforation sealing
5-Root canal sealer

4. •In the crown:
oTemporary enamel restoration
oPermanent dentin restoration
oDeep or large carious lesions
oDeep cervical or radicular lesions
oPulp capping
oPulpotomy…..
•In the root:
oroot and furcation perforations
ointernal/external resorptions
oApexification
oRetrograde surgical filling.

5. ZnO 75%
Gutta percha 25%
Types:
•Standardized type: follows same ISO
classification as endodontic files
•Non-standardized: have a greater taper than
the standard ISO type

6. Use:
Root canal Irrigant
Root canal Medicament
Advantages:
broad spectrum antimicrobial properties 2% equals to 5%
NAOCL in sense of antibacterial action
synergic affect when used with NAOCL
Disadvantage:
can’t dissolve orgainc and inorganic components of pulp

7. •Chlorohexidine
•Sodium hypochloride
•EDTA (also decalcifying agent)

8. •Sodium Hypocholorite (5 –35%)
•Sodium Perborate –Walking bleach
•Carbamide peroxide

9. •Components :
•Bacteria:
•Streptococcus mutans
•Peptostreptococcus
•P gingivalus
•Fusobacterium
•P denticola
•P Forshytia

10. •Prevents Hypocholorite accident

12. •K FILE:
•triangular or square cross section
•Advantages:
•More flexible and don’t fracture
•Disadvantages:
1-Less cutting efficiency
2-Extrusion of debris periapically
•H FILE:
•has flutes that resemble successive triangles..
•Advantage: They have superior cutting efficiency
•Disadvantageis they are not flexible and fracture
easily

13. •Used to extirpate PULP
•Removal of cotton and paper points

14. •Small flame shaped
•Used in conventional hand piece
•Used for :
1-enlarging canal orifice (/coronal 3rd)
2-to remove lingual shoulderin Anteriors

15. •To remove GPduring post preparation
•Small flame-shaped cutting instrument
•used in the conventional handpiece

16. •Small flexible instrument
•Placement of material into the canal
•Fits into the conventional slow handpiece

18. •Loss of working length
•Ledging and stripping
•Perforations

19. •ZIP: Apical portion transportation of a canal
•ELBOW: Rotating the instrument in curved
canal can produce a biomechanical defect.
How to avoid these
1-never rotateinstrument in curved canal
2-Always pre curvethe small size instruments

20. Requirements:
Good adhessivness
Biocompaitability
Slow setting time
Easy manipulation
Less solubility
Types:
1-zinc oxide eugenol bases
2-Plastics: epoxy based
3-Calcium hydroxide
4-glass Inomers

21. Returning to smaller num file time to time before advancing
to a larger file.

26. •Tofflemire Universal
•Ivory Bands
•Pilodent –for composites
•Automatrix –difficuilt to contour

27. •When the tooth structure is prepared with a
bur or instruments, residual organic and
inorganic components form a smear layerthat
is composed of hydroxyapatite and denatured
collagen.
•When primer and bonding agent are applied
on the etched dentin they form resin-dentin
interdiffusion zone called hybrid layer.

28. •Etching with 35% Phosphoric acid
•EDTA

29. 1.Cold Lateral
2.Warm vertical
3.ThermoplastisizedGP inj
4.Chemically Plasticized GP
5.McSpaddenthermomechanicalGP
6.Continuous wave compaction
7.Carrier based GP
8.Custom cone

34. •Maxillary 1st Molar
•MB (MB1MB2), DB, Palatal
•Mandibular1
st
Molar
•MB(MB1 MB2), DB

36. •Should have a continuous tapering, conical shape,
with the narrowest cross-sectional diameter apically
and the widest diameter coronally.
• The walls should taper evenly towards the apex and
should be confluent with the access cavity.
• To give the prepared root canal the "quality of flow;'
i.e, a shape that permits plasticized gutta-percha to
flow against the walls without impedance.
• Should keep the apical foramen as small as
practical.
• Should clean and shape the canal without
transporting the apical foramen.

37. •Iodoform paste
–(zinc oxide and iodoform mixture)
–bactericidal and nonirritant
•ZnO Eugenol paste (without catalyst)
why catalyst not used… > to increase working
time……..
•Material should be resorbable, nonirritant and
radioopaque.
•Why GP not used? –Not degraded

38. •Abutment for space maintainer
•Bruxism
•Caries involving 3 or more surfaces
•Developmental defects like Dentinogenesis
imperfecta and enamel hypoplasia
•Extensive caries in class 2 involving cusps
•Following pulp therapy to avoid fracture of
weekend tooth
•Handicapped children

39. •Stain less steel crowns
•Nickel based crowns (ni-chromium 3M)

40. •The process of inducing the development of
root and apex closure in an immature
permanent tooth with open apex.
•Calcific Root-End closure.
•Types:
1.Multiple Step(CaOH)
2.Single Step (MTA)

41. •Physiological process
•Formation of apex in vital young permanent
toothwith appropriate vital pulp therapy
•MAINTAIN PULP VITALITY
•Includes :
1-Direct pulp capping
2-Indirect pulp capping
3-Pulpotomy/Partial Pulpotomy

42. •Since gallium amalgam expands after trituration, it
provides better marginal seal than silver amalgam….
•Setting time is less than silver mercury amalgam,
therefore can be finished and polished after one hour..
•Most of the physical and mechanical properties of
gallium alloy are similar to high copper mercury
amalgam.
So better marginal seal, less setting time and same
mechanical properties………

43. •A ferrule, is defined as a circumferential area
of axial dentin superior to preparation bevel
should have a height of 1.5mm to 2.5mm

44. •Vertical → Extraction
•Horizontal:
•Coronal 3
rd
Immobilization + Splinting
(4weeks)
•Middle 3
rd
RCT of coronal segment +/-
removal of apical segment
•Apical 3
rd
Reposition Radiograph
Splint (4-6weeks)

45. •Leave the tooth in place
•Clean with saline and chlorohexidiene
•Suture the lacerated gingiva
•Determine position of the tooth both clinically and
radiographically.
•Apply a flexible splint for 2 weeks
•Antibiotics adminstration for 7 days
•Initiate root canal in transplanted tooth after 10 days with
closed apex
•Open apex in growing children can be waited for pulp
revasculrization and in adult cases open apex closed with
MTA

46. •Apply local anesthesia
•Rinse the area with saline or chlorohexidine
•Reposition the tooth using digital pressure or
forcep.
•Reposition the displaced bone both facially
and lingually
•Suture the gingiva if lacerated
•Splint with wire or acrylic for 4 months.

47. •BV Rupture → Blood into Dentin →
Breakdown of blood (Hemin, Hematin,
Hemosiderin) → Pinkish brown discoloration

48. •Concentration: 5% NaF
•When to apply?

49. •Radiographic Apex :Apex of tooth determined
radiographically
•Anatomic Apex: apex of tooth determined
morphologically. At the CDJ.
•Difference can be 1.5 –3 mm because of
cementumdeposition with age.

50. •From a Coronal refrence point to the point
where cleaning and shaping or obturation
ends
•Refrence point:
–Anteriors → Incisal Edge
–Anteriors with broken edges → Smoothen the edge
–Posteriors → Cusp Tip

51. Pulp sensibility Test
MOA:
Ionic shift in the dentinal tubules Local depolariztionin
Delta A fibers
Tells if the tooth is Vital or Non-Vital

52. •False Positive
➢Gangrenous necrotic pulp
➢Partially necortic pulp in multi-rooted
•False Negative
➢Recent Trauma
➢Extensive pulpal calcification
➢Fibrotic pulp
➢Extensive restorations with base
➢Pt on sedatives

53. 1.Zinc phosphate
2.GIC
3.RMGIC
4.Dual cured resin cement
5.Light cured composite cement
6.Polycarboxylate
7.Conventional cement

54. Based on Shape (Parallel, Tapered, Parallel and
Tapered)
Based on surface characteristic ( Active, Passive)
Based on Method of fabrication:
•Custom
•PreFabricated(Metal, Zirconia, Fiber-post)
Which one causes most internal stresses..+ Fracture :
Metal, Active, Tapered

55. Toothhas incompletelycrackedbut no part of
thetoothhas yet broken off.
Diagnosed with:
Bite Test
Biting on Tooth Sloth
(Pain on releasing of biting force)
Pain on biting Symptomatic apical periodontitis

56. Conventional tooth prep:
•Specific walls, floor, angulation.
•Amalgum
Modified:
•Does not require specific wall forms, angulation, Walls and floor
•Composite

57. Shape and form of cavity is such that it prevents the
displacement or removal of restoration by tipping and
lifting forces
Occlusalcovergence
Adhesive systems
Beveling/flaring cavity margin for composite

58. “Shape and placement of preparation walls and cavity is
such that it enables to tooth structure AND THE
RESTORATION to withstand the forces of mastication
without getting fractured”
Box like cavity
Flat floor
Rounded line angles
Adequate thickness of material
Preservation of cusps and marginal ridges
Reduction of cusp for capping

59. •Macrofill (filler size upto 8um)
•Microfill (0.01-0.04 micrometer)
•Nanofill 0.007um
•Hybrid type (0.4-1um)
•Flowable(having lower filler content and
hight matrix)………….

60. Resin : BISGMA/UDMA
Filler: Silica
Coupling agent: Silane
Initiator : Camphorquinone

61. Powder: Flouroaluminosilicate
Liquid : Polyacrylicacid

62. •Silver
•Tin
•Mercury
•+/-Copper
•Zinc -Setting Expansion
•Pallidium etc

63. Primary
Occlusal Convergence
Secondary
Pins
Slots
Retention Grooves (0.5mm into the dentin,
axiolingual and axiobuccal walls)
Coves
Amalgum Bond

64. Hydrodyanamic Theory
Stimulus (Hot/Cold/Sweet) → Movement of fluid in dentinal
tubules → stimulation of Delta A fibers → PAIN
PRECIEVED!!

65. Sharp pain → Delta A fibers (Fast Conducting/Myelinated)
Dull, Continuous Pain → C -fibers

66. Treatment: RCT + Follow up
Sinus Tract will heal on its own

67. 1.Bisecting Angle -Used in Endo
a.Xray beam is at right angle to long axis of tooth
2.Parallex
a.For curved roots in upper anteriors
b.Not recomended for Endo though
c.Superimposition of zygomatic process

68. •Right angle to the dentin surface
•Vertical in the cuspalregion
•Deciduous Horizontal cervically
•PermenantOblique cervically