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BCHD V: Basic Restorative Dentistry & Dental Materials Semester Test 2

MEMORANDUM

SECTION A
Question 1
1.1 Restoring the root caries: difficult to get access and subgingival with bleeding (1)
1.2 No proper seal is achieved, bacteria will leak past the restoration causing coronal re-
infection. (1)
1.3 Preventive part: good oral hygiene, with floss and high fluoride treatment
Restoration of root and interproximal caries, root canal treatment, crowns
Treatment/referral of periodontal bone loss and crown lengthening (3)
1.4 Root caries: Glass-ionomer/Resin modified Glassionomer: Chemical bond, release
fluoride, less moisture sensitive, less technique sensitive
Class II lesions: Conventional resin composite: good wear resistance and polishability
Sandwich technique: Glass-ionomer/resin modified glass-ionomer capped with resin
Amalgam: moisture tolerant, problem with aesthetics
Giomer (2)
(7)

Question 2
It is a single-component, light-curing universal adhesive which can be used in a self-etching,
selective enamel and total etching procedure. (3)

SECTION B

Question 1
1.1
1. Excessive gingival display in both the first and second quadrant.
2. Gingival line does not follow a straight line from the tooth gingival interface of the left
mx canine to the tooth gingival interface of the right mx canine.
3. Tooth 12 is missing.
4. No contact point present between teeth 13 and 11.
5. Contact point between teeth 21 and 22 is to far gingival.
6. Buccal corridor of the 2nd quadrant (patients left my right) is to large.
7. Step up appearance of mx incisors in 1st quadrant.
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8. Incisal embrasures does not gradually increase in size toward distal. Embrasure
between teeth 21 and 22 is larger than embrasure between teeth 22 and 23. And
embrasure between teeth 11 and 13 is larger than embrasure between teeth 13 and
14.
9. Attrition present on mandibular incisors
10. Golden proportion is not followed. (23 not proportionally smaller than 22, 13 not
proportionally smaller than 11)
11. Mx Incisal plane does not follow the curve of the lower lip. (7)

1.2 The tooth gingival interface of the mx centrals should fall just below the gingival line.
The lateral incisors may fall either on the gingival line on 1.5mm below the gingival
line.
The tooth gingival interface of the mx right canine should from a straight line to the
tooth-gingival interface of the mx left canine.
>2mm of gingival display above the gingival line will compromise the aesthetics of
the smile. (3)
(10)

Question 2
RESIN COMPOSITION VARIABLES
Concentration of photo-initiator
The higher the amount of photo-initiator the higher the rate of polymerisation. High amounts
may reduce the working time under operatory lights.
Type of filler
Composite resins with inorganic fillers in form of glass particles will cure to a greater depth
because of the higher level of light transmission.
Particle size
Light transmission and therefore the depth of cure and rate of polymerisation is influenced by
the size of the filler particles. The smaller the size the higher is the scattering of the light. The
higher the scattering of light the lower the depth of cure and rate of polymerisation. Maximum
scattering occurs when the particle size is one-half the wavelength of the light source
approximately 0,25 µm.
Filler load
Generally, the more heavily loaded a composite (larger particles) is, the more easily and
deeper it cures. However, extremely high loading can make a composite become opaque and
obstruct light penetration.
Refractive index
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The depth of cure is also affected by the differences in refractive index of the resin and filler.
The smaller the difference between the refractive indices the greater the depth of cure that
can be achieved.
Shade of resin
The transmission of light and therefore the penetration is affected by the shade of the resin.
The darker shades restrict the penetration because of a higher absorption. It was determined
that the light intensity at 1 mm depth of an A4-composite resin was half of that measured for
an A1-composite resin at the same depth.
Thickness of resin layer
The rate of conversion, as reflected in the surface hardness, is affected by the thickness of
the resin layer. For the lighter shades the surface hardness at 1 and 2 mm depth was 84%
and 60% of the hardness at the surface respectively. In comparison the hardness of the darker
shades at 1 mm was only 63% and at 2 mm the composite was too soft to measure. (6)

Question 3
Traumatic occlusion. Teeth 16 and 24 are the only two posterior teeth left to bear the occlusal
forces made worse by a history of excessive grinding (attrition and chipped teeth, TMJ clicks
and muscle pain.). Further evidence of this is an increased density of the alveolar bone
and thickened PDL around the remaining posterior teeth 16, 14, and 24. (4)

SECTION C
Question 1
1.1 The reproduction of a good anatomical contact point will prevent food impaction; this will
in turn prevent interproximal gingivitis/periodontitis. The correct anatomical contact point
will result in a stable marginal ridge (that will not fracture due to a point contact); it creates
the correct embrasure spaces (Gingival, buccal, lingual, and occlusal) that aids in the
hygiene of interproximal spaces. It will also provide stability during masticatory forces
(5)
1.2 It prevents overhangs by securing the band against the tooth; it separates the teeth slightly
aiding in better interproximal contact; compensates for the thickness of the band); it
protects the gingiva during cavity preparation; it aids in moisture control (isolation) –
providing pressure that stops bleeding, and crevicular fluid from seeping into the cavity
preparation. (5)
1.3 A gingival overhang can be removed using an interproximal polishing strip, using a flame
shaped finishing bur, or a no 12 Scalpel blade. (2)
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1.4 You will prepare the cavity from the buccal side, drilling a tunnel preparation, and keeping
the marginal ridge intact. You must drill a hole in the matrix band, in order for the material
to be delivered through the hole in the matrix band directly into the cavity preparation. By
doing this, you have access to the cavity through the hole in the matrix band, without
removing the marginal ridge. (3)
(15)
SECTION D
Question 1

1.1 * With the incorporation of more efficient photo-initiation systems in some resins. (1)
* Greater translucency - which allows deeper light penetration by reducing light
absorption by pigments. (1)
*To achieve high translucency, fillers and monomers with similar refractive index's
(refractive index matching) are used. (1)
*Also a decreased matrix/filler surface interface, which reduces light refraction. (1)
1.2 * Flowable bulk-fill composites all required the placement of a universal composite as a
capping - 1.5 – 2 mm thick, for improved strength and better aesthetics. (1)
* Due to capping, the operative time is once again increased. (1)
* With flowable bulk fill composites especially, the proper use of matrix bands and wedges
are essential for tight proximal contact points and avoidance of overhangs because they are
prone to open proximal contacts and overhang formation. (2)
(8)

Question 2
Vitrebond co-polymer (1) - Bonding to wet or dry dentine (1)
MDP monomer (1)
- Good bond to Enamel
- Facilitate chemical bonding to zirconia, alumina and metals without a separate primer ie
silane /metal primer
-Shelf-life up to two years – greater hydrolytic stability (ANY 1)
Silane (1) - Adhesion to glass-ceramic surfaces without the need for a separate primer. (6)

Question 3
3.1 Nano-fillers allow for a maximum filler load of up to 87% (1) by weight of inorganic phase,
by filling spaces between larger particles with smaller ones. (1) The increased filler levels
result in lower amount of resin monomer matrix (1) in nanocomposite and will significantly
reduce polymerization shrinkage and shrinkage stress. Less monomers will link up to form
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polymer chains during polymerization which usually results in shrinkage within the composite
because polymers occupy less space than monomers. (1)
Besides the size that allows a higher amount of inorganic phase into the composite, the shape,
i.e. spherical fillers, nano-clusters, has a significant and positive influence on composite
properties.

3.2
A higher filler fraction helps in increasing the fracture toughness because fillers decrease the
volume of the weak polymer matrix and act as toughening sources, besides increasing the
elastic modulus. Filler packing is also influenced by the size, arrangement, distribution and
shape of the filler particles. (2)
Nanocomposite have a high degree of conversion of monomers to polymers, which also result
in increased hardness. Higher hardness values are attributed to higher filler content, large and
densely packed filler particles, and the resin content of the nanocomposite. (2)
As the inter-particle dimensions decrease, the load-bearing stress on the resin is reduced, in
so protecting the organic resin matrix and inhibiting crack formation and propagation.
Furthermore, nano-fillers can act as points that may slow the initiation of or even stop crack
propagation. The spheroidal shape of nano-filler particles provides smooth and rounded
edges, distributing stress more uniformly throughout the composite resin. (2)
(10)

Question 4
Good aesthetics, better than GI and RMGI.
Good fluoride release with caries protection, better than Compomers.
Anti-plaque and anti-biofilm effect by forming a material film layer with the saliva which
minimize plaque adhesion and inhibit bacterial colonization, better than GI and RMGI.
Less surface roughness and better colour stability than GI and RMGI.
Stronger than zirconia-reinforced GI, nano-particle RMGI, and highly viscosity GI. (5)

Question 5
5.1 Before and after pictures with a shade guide next to the tooth (2)
5.2 (4)
In Office At Home
Dentist administered Dentist supervised
High concentration Lower concentration
Shorter time Longer time

Total: 80