Op Techs

 What determines cavity design?

o Caries – follow the caries and remove as per sequence of removal – Examine
& diagnose, access, extend, remove, restore
o Restorative material – modify the cavity if required by choice of restorative
material (retention and resistant factors for amalgam)
 Define erosion, abrasion, attrition, abfraction, hyper + hypoplasia
o Erosion – the non-bacterial loss of tooth tissue due to chemical agents
 When do you intervene with caries removal treatment?
o If the lesion is cavitated
o If the patient can not access the lesion to clean for prevention
 True or False – unsupported enamel should be removed before restoration
o True
 What is the difference between primary, secondary and tertiary dentine?
o Primary dentine makes up the largest portion of the tooth between the
enamel in the pulp chamber. It fills this space and is present before the tooth
erupts.
o Secondary dentine is laid down by odontoblasts after root formation is
complete, typically after the tooth has erupted and is functional.
o Tertiary dentine – two types: sclerotic and reparative - is laid down in
response to carious lesions and can often be found apically from occlusal /
incisal lesions.
 What is the definition of marginal integrity and what are the complications if this is
not achieved?
o Marginal integrity is the successful adaptation of the restorative material
with the cavo-surface margins of the prepared cavity.
o If this is not achieved the complication is micro-leakage occurring between
the compromised margins.
 What is a pulp cap, what material is it made of and why it it used?
o A pulp cap is a small amount of material (usually a form of CaOH, Dycal)
placed onto the pulpal floor of a cavity when there is a danger of exposing, or
being close to exposing, pulp. It is bactericidal, prevents pulpal necrosis and
also helps to generate secondary dentine.
 What is (pulp) lining, what is it made of and why is it used?
o Pulp lining is a small amount of material placed on top of a pulp cap. It is
made of RMGI and is used to protect the pulp cap from masticatory forces as
cap has a weak compressive strength. It also protects the cap and pulp from
bacteria from intra-oral fluids and from chemical irritation from restorative
materials.
 What are dead tracts and where would you find them?
o Dead tracts are empty dentinal tubules beneath a carious lesion where
odontoblasts have died and not laid down sclerotic dentine
 What is tissue sclerosis?
 o Tissue hardening usually after a lesion of some kind. Dentinal sclerosis is
dentinal tracts of increased density occurring beneath a carious lesion
 List advantages of composite
o Tooth coloured
o Conservation of tooth tissue – do not need to remove more than what is
carious
o Bonds to tooth tissue
o Command cure possible
o Can manipulate into accurate morphology
o Low thermal conductivity
o Galvanism eliminated
 List disadvantages of composite
o Polymerisation shrinkage
o Costs more than amalgam
o More technique sensitive
 List advantages of amalgam
o Less technique sensitive
o Cheaper than composite
 List disadvantages of amalgam
o Not tooth coloured
o Contains mercury
o Requires removal of extra tooth tissue for retention + resistance
o Does not bond to tooth tissue
o Command cure not possible
o Does not support tooth
o Requires at least 2mm of cavity depth to work
 Define retention and resistance in relation to amalgam
o Retention – cavity design features which prevent the restorative material
from being dislodged in an occlusal direction (required for non-adhesive
material, amalgam)
o Resistance – Cavity design features which prevent the restorative material
from being dislodged in a direction perpendicular to the axis of the tooth
 Define polymerisation shrinkage
o This is the term given to describe the shrinking effect when monomers in a
material join up to make polymers upon curing
 Define configuration factor + configuration stress
o Configuration factor - This is a ratio between bonded and un-bonded surfaces
of restorative material. For example: in a class 1 occlusal cavity prep (total of
5 walls), if composite bonds to the lingual wall of a cavity it has a
configuration factor of 1:4
o Configuration stress – This is the effect of the monomers pulling on cavity
walls as they as cured and become polymers. “The effect of polymerisation
shrinkage on cavity walls as the restorative material cures”
 How would you clean a cavity after preparation before you restore it?
o Use water, some chlorhexidine and leave the surface moist.
 Define ‘ditching’
 o When a restorative material fails in an area of low volume due to occlusal
forces. Usually occurs at restoration margins

Composite 1+ 2

 Define ‘Marginal integrity’

o This is the success of the restoration at the material/ cavity barrier
 True or False - You should avoid a cavo-surface margin at points of occlusal
contact?
o True
 Cavity Nomenclature – know the following:
o Pulpal wall
o (M/D) Gingival wall
o Lingual wall
o Buccal wall
o Mesial wall
o Distal wall
o (M/D) Axial wall
o Interproximal box
o Cavo – Surface margin
o Isthmus
o Occlusal key / Dovetail
o Line/ point/ cavo-surface margin angle
 Define ‘Micro-leakage’
o The leaking of micro-organisms and saliva bourn constituents into the
interstices of an improperly sealed restoration margin

Amalgam

 What are the indications for amalgam?

o Large cavity (must be at least 2mm deep)
o Posterior cavity
o Aesthetics are not important to the patient
o Core build up for indirect restoration such as a crown
 What are the contra-indications for amalgam?
o Anterior cavity
o Aesthetics are important to the patient
o Insufficient cavity width/ depth (must be at least 2 mm deep)
o Too much tooth tissue would have to be removed to create retentive and
resistant factors
o Not enough tooth tissue remains to create retentive and resistant factors
 Cavity design
 o Inter-proximal boxes: self-retentive + resistive – can make these design
features with minimal removal of occlusal surface tissue
o Proximo-occlusal preparations – will be very retentive and resistive however
you will need to remove more sound tooth tissue to create these features
 What are the 4 dangers of moisture contamination in amalgam restorations?
o Reduces strength
o Increases creep – deformation of material over time. Amalgam creep can
cause cuspal fractures
o Increases corrosion – chemical or electro-chemical deterioration over time
o Increases Porosity – presence of small pores or holes. In amalgam due to
incomplete condensing. Can also be found in dental casting
 True or False
o Dentine is sealed before an amalgam restoration is placed with RMGIC (Resin
modified glass ionomer cements) – True
 What are the effects of micro-leakage?
o Pulpal irritation and infection
o Secondary carries
o Discolouration
 What causes secondary caries?
o Micro-leakage due to improper sealing of the restoration at the
cavity/restoration margins + inadequate adaptation of the restoration to the
walls of the cavity.
 Describe optimal condensing of amalgam
o Large plugger into cavity
o Small condenser for axial and lateral condensing
o Overlapping axial condensing
o Spherical form requires less condensing
 What are the effects of Inadequate condensing of amalgam?
o Pores
o Lack of marginal integrity leading to ditching, micro-leakage, ditching, pulpal
infections and discolouration of dentine
 True or false?
o For amalgam restorations you always overfill the cavity, remove excess
mercury with carving and high intensity aspiration.
 What is burnishing?
o To smooth or polish a material to obtain a high gloss finish. Done after
amalgam has set

Pros

 Define ‘Support’ + state how it is achieved

o “The resistance of a partial denture to occlusally directed loads”
o Support is achieved in 2 ways: by the use of rests for tooth bourn dentures
and the use of soft tissue for mucosa bourn dentures (mucosa bourn must
have large surface area of soft tissue in order to be able to resist occlusally
directed loads)
 o Rests also transmit the occlusal forces down the long axis of the tooth
 If we are using rests in our denture design – which material will be the automatic
choice and why? What are the exceptions?
o The automatic choice is CoCr – this is because working metal rests / clasps
into an acrylic base causes weaknesses at connection points. The exception is
using metal rests with an acrylic denture base in the ‘Every’ denture design
and generally using metal rests with acrylic denture designs in the exception
 What is the default position for rests in bounded and free-end saddles? Why would
this position change if at all?
o Bounded saddle – on the abutment teeth and immediately adjacent to the
saddle area. Position would only change due to occlusion!
o Free-end saddle – on the abutment tooth. Never adjacent to the saddle area
due to drift. Position only changes due to occlusion!
 Where can you use cingulum rests?
o Upper anteriors and lower canines- Think! Only these teeth have a cingulum
to rest on!
 Define the following denture components – Saddle, flange + base
o Saddle – edentulous area
o Flange – replacement tissue extending to vestibular sulcus
o Denture base – connector
 What is the sequence of design?
o You have prescribed a removable partial denture
o Support
o Retention (direct + indirect)
o Connectors
 List and describe the 4 Kennedy Classifications
o Class 1 – Bilateral free-end saddle
o Class 2 – Unilateral free-end saddle
o Class 3 – Unilateral bounded saddle
o Class 4 – Anterior saddle (crosses the midline)

o Please note: 8’s are ignored and you always classify the saddle using the most
posterior saddle. You can add a mod per extra saddle.
o A trick to learn is: Bi, uni, uni, anterior + free free bounded
 List and describe the 3 Cradock’s classifications
o Class 1 – Tooth bourn denture (supported by rests on teeth)
o Class 2 – Mucosa bourn denture (supported by mucosa, at least 3 teeth
saddle ideally)
o Class 3 – Tooth and mucosa bourn (used when there is a free-end saddle)
 What is the defacto choice for support?
 o Rests
 How do you describe a rest?
o By the area of the tooth that is comes in contact with…
o E.g. occlusal (or just say mesial/ distal), cingulum, incisal, ledge, ring or onlay

o
 True or False
o Cingulum rests require preparation

o
 What are rests best used and what are they made of?
o Rests are best used as part of a a cast metal alloy base and are also made of
alloy metal.
o Rests also oppose the movement of the base toward the tissue (the portion
covering the palate or floor of mouth)
 Discuss rests used in acrylic dentures
o This is not the preferred choice as the metal rests weakens the acrylic
structure at the connection points.
o The rests here will be made of wrought metal and not cast metal
 Discuss metal vs acrylic bases
 o
 How do you take the load from missing teeth and support it?
o Use the root area of each tooth to be replaced and add this up. This will give
you a value (x).
o Add up the root area of the teeth used for support and x by 1.5
o This should equate to more than x
o If not – the denture base will also provide support via the hard palate
 True or False
o Avoid putting occlusal rests where there is a centric stop as this will interfere
with occlusion and be uncomfortable for the patient
o Rest seats can be prepared but remember the possible consequences:
 Loss of occlusal stop when denture is not worn
 Removal of healthy tooth tissue
 Exposure of dentine
 Describe the “Every’ denture design
o This is a design for the maxillary arch which restores the full dental arch with
prosthetic teeth connected via an acrylic base. It incorporates 2 wire stops
posteriorly to the last teeth to ensure the most posterior teeth do not drift
distally due to forces from the contact points between the prosthetic and
abutment teeth.

o
 Discuss the function of an RPI and what are its components?
o The function of an RPI system is to relieve stress on the last standing
abutment tooth in Kennedy class 1+2 arches (free end saddles).
o The components of an RPI are: Mesial rest, Proximal plate, I-Bar clasp system.
 o This is because of the difference in compressibility between the teeth down
the long axis into the periodontum and the muco-periostium

o
 Guidelines for Support of a denture

o
 What is the definition of direct an indirect Retention?
o Direct retention - “The resistance of a RPD to vertical movement away from
the soft tissues”
o Indirect retention – “The resistance of an RPD to rotational movement away
from soft tissues about an axis”
 How is retention achieved?
o Direct retention is achieved with the use of clasps. These engage undercuts
to resist the vertical movement away from soft tissues
o Indirect retention is achieved by placing rests on the teeth/ tooth furthest
from the fulcrum point which is calculated by joining the most posterior
points of retention
BAMS –
 Gastro

 Name two H2 Blockers

o Cimetidine
o Ranitidine
 Which is the most effective group of drugs to stop excess stomach acid production
o PPI’s
 What is barretss oesophagus?
o A conditioned marked by the metaplastic change of the oesophageal mucosa
into gastric mucosa. Caused by acid entering the oesophagus
 What is GORD and What are the 3 main cuases of it?
DMS
Exam questions based on metals and alloys 1

 Define Slip
 Define cold working + give an example of it
 What are the benefits of cold work
 What are the influence of dislocations on a metal’s properties?
 How do you work out YM (rigidity) in MPa
 List the properties of interest of a metal / alloy
 Label this graph:

 Define
o Fracture strength
o Elastic Limit
o UTS
o Ductility
 Which material properties would you achieve with large coarse grains vs small fine
grains
 What is the problem arisen by cold working? How do you relieve this?