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Operative dentistry

Motamiz OPRD 41 Lectures

lecture 5

WED 15-4-2020

Patient Assessment, Examination,

Diagnosis and Treatment Planning

Examination of non carious lesions

1 Tooth wear

Erosion Attrition Abrasion

2 Developmental enamel hypocalcification

3 Fracture or craze line

Examination of non carious lesions

Attrition

Physical wear of one tooth against another. Affects the incisal edges and occlusal surfaces of opposing teeth. May be accelerated by erosion or may be aused entirely by bruxism or other parafunctional activities.

Examination of non carious lesions

Abrasion

Commonly affects the neck of the buccal surfaces of both anterior and posterior teeth. The etiology is not clear, but some dentists believe that it is caused by physical wear from external agents such as: - Abrasive toothpastes and powders. - Hard toothbrushes or excessive use of other cleaning aids.

Examination of non carious lesions

Erosion

a Regurgitation erosion: Affects palatal surfaces of upper anterior teeth and occlusal and buccal surfaces of lower posterior teeth.

Examination of non carious lesions

Erosion

b Dietary erosion:

Affects the labial surfaces of

upper anterior teeth. Caused by an excess of food and drink with a low pH as Citrus fruits, Pickles and carbonated drinks.

Examination of non carious lesions

c Industrial erosion:

Commonly affects the labial surfaces of the

upper anterior teeth and may cause pitting.

Caused by industrial processes which produce

acid fumes or droplets.

It is a cervical, wedge shaped defect that

is angular. Occur due to heavy force in eccentric occlusion. It has the same clinical features as abrasion but mare aggressive form.

Erosion

Abfracion

Examination of non carious lesions

2 Non hereditary developmental enamel

hypocalicification areas

It have man resulted factors

such as childhood fever, trauma or fluorosis that occurred during the developmental stages of tooth formation. It is opaque white and remain visible regardless if the tooth is wet or dry.

Examination of non carious lesions

3- Fracture or craze line

It is usually occurs in teeth with extensive restoration, weakened cusps and deep developmental fissures across marginal or cusp ridges. It is detected by dye material, light reflected from a dental mirror or transillumination.

Examination of existing restorations

I Clinical examination of Amalgam restorations

Amalgam restorations can be examined using:

a Visual observation. b Tactile sense with the explorer. c Dental floss d Radiographs (Bitewing).

Examination of existing restorations

Clinical examination of amalgam restorations may show: (1) Amalgam blues (2) Proximal overhangs

Examination of existing restorations

(3) Marginal ditching (4) Voids It occurs at the margins of amalgam restorations. It is at least 0.3 mm deep. Small voids may be corrected

by recontouring or repairing with a small restoration. It is the deterioration of the

amalgamtooth interface as a result of wear, fracture or improper tooth preparation.

Examination of existing restorations

(5) Fractures (6) Improper anatomic contours

Proper anatomy Improper anatomy

Examination of existing restorations

(7) Improper proximal contacts

Proper contact

incompatibility ridge ) Marginal8( caries ) Recurrent9(

Open contact & incompatible

marginal ridge height

Examination of existing restorations

Examination of composite restorations

Ideal restoration Recurrent caries

Fractured restoration Marginal discoloration

Examination of existing restorations

Examination of cast restorations

Proper cast restoration Improper margins

Chipped porcelain

Adjunctive aids for examination

1 Percussion:

It is done by gentle tapping of

occlusal or incisal surfaces by the use of mirror handle.

2 Palpation:

It is rubbing the index finger along the facial and lingual mucosa overlying the apical region to detect a periapical pathosis in teeth showing tenderness to

Percussion

Adjunctive aids for examination

3 Vitality test

Cold: ethylchloride or

pencil of ice

Hot: hot gutta percha or

instrument

Thermal

test

No response means pulp

death

Tingling sensation means

vital pulp.

Electric

pulp tester

Adjunctive aids for examination

4 Cavity test:

It used round bur without anesthesia, a cavity is made through the restoration into dentin.

5 Anesthetic test:

It must be used anesthesia for

the suspected tooth and if the symptoms subside, so affected tooth has been identified.

6 Study cast

Clinical examination of non caries lesions: 1- Tooth wear occurs naturally throughout life and so it is common to

find moderate degrees of wear in older people. Tooth wear happened as a result of: Attrition, Abrasion, abfracture and Erosion.

Attrition:

It loss of hard tooth structure due to physical wear of contacting teeth due to normal physiologic phenomenon as mastication. It affects incisal edges and occlusal surfaces of opposing teeth. May be accelerated by pathologic conditions as bruxism or other parafunctional activities.

Abrasion:

It is loss of hard tooth structure due to use of an external object e.g. hard tooth brush, whitening tooth paste and smokers tooth powder. Also, habits such as thread biting and pipe smoking can cause wear in the form of notches in the incisal edges. It commonly affects the neck of the buccal surfaces of both anterior and posterior teeth. The surface of the defect is smooth and varies according to the causative factor. The most common form of the lesion is the wedge shaped defect resulting from excessive tooth-brushing.

Erosion:

Erosion is loss of hard tooth structure due to chemical agents as acids. It is the most common and most damaging cause of tooth loss. There are different types of erosion as: a-Regurgitation erosion: Commonly affects the palatal surfaces of upper anterior teeth and the occlusal and buccal surfaces of lower posterior teeth. Caused by the regurgitation of hydrochloric acid from the stomach in patients with:

Various digestive disorders.

Anorexia and bulimia nervosa.

Chronic alcoholism

Morning sickness associated with pregnancy.

Voluntary regurgitation.

b- Dietary erosion: Commonly affects the labial surfaces of upper anterior teeth. Caused by using food and drink with a low pH, including:

Citrus fruit and fruit juices (citric acid).

Pickles and other food and drink containing vinegar (acetic acid)

Carbonated drinks.

c- Industrial erosion: Commonly affects the labial surfaces of the upper anterior teeth and may cause pitting. Caused by industrial processes which produce acid fumes or droplets.

Abfraction:

It is a cervical, wedge shaped defect that is angular. It is similar to abrasion but in a more aggressive form. Occurs due to heavy occlusal force associated with eccentric occlusion. It is hypothesized that bending forces produce tension stresses at the neck of the affected teeth. These stresses cause micro-fractures at the CEJ of the teeth resulted in a wedge shaped or V shaped defect.

2- Non hereditary developmental enamel hypocalicification areas:

Many factors can resulted in enamel hypocalcification such as childhood fever, trauma or fluorosis that occurred during the developmental stages of tooth formation. It is opaque white and remains visible regardless if the tooth is wet or dry.

3- Fracture or craze line:

Craze lines commonly appear in old age and considered as potential cleavage planes for possible future fractures e.g. in teeth with extensive restoration and weakened cusps and deep developmental fissures across marginal or cusp ridges. It can be diagnosed using dye material or light reflected from a dental mirror. Minor fractures can be treated by recontouring but in extensive case the tooth should be restored.

Clinical examination of existing restoration:

I- Clinical examination of Amalgam restorations:

Evaluation of all restorations must be done in a clean, dry, well lighted field using one of the following methods: a- Visual observation. b- Tactile sense with the explorer. b- Dental floss d- Interpretation of radiographs Amalgam restorations may have (10) distinct conditions, when they are evaluated:

1 - Amalgam blues.

2 - Proximal overhangs.

3 - Marginal ditching.

4 - Voids.

5 - Fracture lines.

6 - Improper anatomic contours.

7 - Marginal ridge incompatibility.

8 - Improper proximal contacts.

9 - Recurrent caries.

10- Improper occlusal contacts.

(1) Amalgam blues: It is seen through the enamel in teeth that have amalgam restorations. This bluish discoloration resulted either from leaching of corrosion products of amalgam into the dentinal tubules or from the color of underlying amalgam as seen through translucent enamel. The latter occur when no dentin support such as in undermined cusps, marginal ridges, and region adjacent to proximal margins. (2) Marginal ditching: It is the deterioration of the amalgam-tooth interface as a result of wear, fracture or improper tooth preparation.It can be diagnosed visually or tactilely using an explorer. Shallow ditching less than 0.5 deep have no need for restoration replacement. However if the ditch is too deep, the restoration should be replaced to avoid secondary caries around the restoration. (3) Proximal overhangs: It is diagnosed visually, tactilely using an explorer, radiographically or by using dental floss. Overhangs resulted in plaque accumulation and so it requires restoration replacement. (4) Voids: It is occur at the margins of amalgam restorations. It is at least 0.3 mm deep and is located in the gingival third of the tooth crown so it must be repaired or replaced. Small voids in the marginal area where the enamel is thicker may be corrected by recontouring or repairing with a small restoration.quotesdbs_dbs21.pdfusesText_27