1.11 Lesley Lewis- Full case PDF

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As part of the Enquiry based learning module We have to research different topics from the case study. This research can be taken in to the oral exam to aid us when discussing these topics. These topics are also a summary of all that is covered within our lectures and plenaries and is a great aid fo...

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Case 1.11 LL Crowns Crown: A dental crown is a tooth-shaped "cap" that is placed over a tooth -- to cover the tooth to restore its shape and size, strength, and improve its appearance. The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line

Used: Anterior crowns for vital teeth, posterior root canaled teeth 3 months after root canal treatment. Posterior teeth- RCT or significantly worn down- inlays or onlays may also be considered if there is enough sound tooth. Posterior crowns may be used as abutments for bridges. 1. What are the disadvantages and advantages of a gold crown (full veneer gold crown)? Advantages: Smaller amount of tooth loss in prep needed. Less change of crown fracture- unlike that seen with porcelain crowns. Disadvantages: Although it is unlikely you would use a crown on an anterior tooth- the prep is likely to expose the pulp on anterior teeth- veneers may be a better option. Very hard to colour match. Aesthetics not as nice as a white tooth coloured crown. 2. How would you carry out crown preparation? Preliminary treatment: Check vitality, via electric pulp testing. If not vital undertake root canal before crowning. Take periapical radiograph for detection of any apical pathology+ supporting tissues, pulp. You need to get some study models take, record a shade so it can be checked at each visit. Check the occlusion. Replace many old or faulty restorations which will be used as a core before starting- old restorations can lead to crown failure ( 20% fail rate in crowns leading to RCT). Protocol: Remove enough tooth substance to allow adequate thickness of gold i.e. 1.5mm on the functional cusps, 1 mm elsewhere following original tooth contours. (wide bevel on the function cusps- buccal for the lowers and palatal for the uppers). Convergence of opposing wall by less than 10 degrees. Chamfer finishing line- margin should be supra gingival and on sound tooth (seated). 3. Why would you use a temporary crown? You need to ensure good OH and gingival health for effective longevity and placement of a crown + impressions. Protection of pulp and palliation of pulpal pain, restoration of function, stabilisation og active caries prior to permanent restoration, aesthetics, maintenance of position of prepared and adjacent teeth, to prevent over eruption of opposing teeth, to prevent gingival overgrowth. Occlusion 1. Why is occlusion important and what are the cranio-facial effects of a bad occlusion? Thyroid and parathyroid Thyroid: Thyroxine- an iodine dependent hormone regulated by the anterior pituitary gland which regulates Basal metabolic rate. Irregulaties such as too high production: graves disease or hyperthyroidism or too low production hypothyroidism ( which can be confused with cushings disease

Case 1.11 LL with chronic use of steroids) can result. Both present with different symptoms but both patients will have goitres. Parathyroid hormone: essential in the relgulation of calcium- When levels of calcium are too low the parathyroid glands in addition to vitamin D will act to increase calcium levels of the blood as calcium is needed for so many roles. It acts on osteoblasts to stop producing OPG, and increases expression of RANK ligand, which goes onto activate osteoclast bon resorbtion. Acts on the DCT, and the gut for increased resorbtion. Adrenal glands: Adrenal cortex: Zona Glomerulosa: Mineralocorticoids: Aldersterone – potent vasoconstrictor ( stimulated by angiotensin 2). Zona faciculata: Glucocorticoids Cortisol: released in response to stress + blood blood glucose levels. It increases blood glucose conc. Via gluconeogenesis. It supresses the immune system ( hence why this is used as a therapy for initial autoimmune disease treatment: side effect: Cushings disease). Aids metabolism of fat, protein and carbs. Deeases bone formation. Zona Reticulosa: Adrogens: pregnerlone -> testosterones (also produced in male testes- 7 to 8 times the amount during puberty) -> androgens, found in both male and females but highly produced in males. Steroids hormones (made from cholesterol). Dihydrotestosterone – less than 7% converted into this and less than 1% turns in to oestrogen Adrenal medulla: Adrenaline and noradrenaline....