11/7 Flashcards
prosthesis is a____
general
SUBSITUTION for the lost dentition
characteristics of fixed and removable patients
missing teeth
may have or had RPD
teeth decay, or period
OCCLUSAL DISHARMONY
insufficient teeth to eat
aestehtic issues
- risk associated with that
- reclusive
what to do if more young
hang on to teeth PRESERVE BONE – generally adapt well
if patient more old
need to keep strategic eeth
so not as important to keep nonstrategic / all teeth
less adaptive than the young
xerostomia is a problem
physiologic shock?
YES – all patients - loss of teeth
assessment considerations -general 3
anatomical
dentition
design
anatomical considerations
ridge relationship
- mandible to maxilla? excessive appropriate or deficient
inter ridge space - can it even fit
plane of occlusion violation - supraeruption often against edentuous area
tori, undercuts, ridge prominence, frenum
ridge quality and height
tissue quality
tongue position and size
in fixed / or removable you need a prognosis of the abutment teeth?
YES – a single tooth can alter treatment plan
the end therapy- goal is predictable dentistry – we do NOT want to have to treat this tooth / area again
diagnostic mounted models for what?
longer list
- determine the PLANE OF OCCLUSION
- look for supra erupted teeth / infra-erupted teeth
- intra arch space
- strategic teeth for the support of the prosthesis / support of the OCCLUSION
- number and location of the occlusal untis
- analysis of the occlusion
if patient has current RPDS? how get mounted models? what if edentulous?
take impression with the prosthesis in it – then remove RPD from impression and make casts and mount
make daignositc moles of edentulouos ridge and make wax rim and mount case
mount in CR or MIP?
default is CR for most distal extension cases - use CR more often than not
when is MIP mount acceptable
specificaly when?
when there is an adequate number of teeth to provide good tripodization of tooth contacts / support AFTER tooth prep
what do majority of tissue borne RPDs require for mounting?
require occlusion rims for mounting the cases so an additional visit must be planned
when determine the need for occlusal support?
during FIXED THERAPY
prepare rest seats and guide planes when?
on the CASTS to see if we will have problems
survey and design on?
best done on the second model
select abutment teeth
prep and make guide planes on the cast
therapeutic costs assessed consist of? look at ___ for these
- financial
- biologic
- esthetics
- therapeutic
- temporal
- physchological
look as Risk vs Reward abd Cost / benefit analyses
A/P relationship ridge
need to see if parallel to occlusal plane
- often if try and hand articulate this we have an A-P rock
steps for assessment
models duplicated and both mounted
selection of teeth that need fixed therapy
evaluate what worked and what did not work
consultation
patient desires
develop a plan
what do duplicates allow for?
allow you to do a wax up of the proposed therap and execute the design to verify that it will work
- rest seats, guide planes, retention apparatus
rest seat next to an edentulous area? causes
hrizontal forces – class I leveer
what do indirect retainers do
create class 2 levers
which class lever do we want
class 2
think ahead - steps
plan tx
execute on models first
bring the designs and models chair side
take impressions to check your work
during assessment of dentition look at?
occlusal support and stability implication
number of teeth
- occclusal support and stability
- BEFORE TOOTH MODIFICATION
- DURING TOOTH MODIFICATION
location
need for restorative therapy
perio health?
interim prosthesis usually come into play when
after extractions
when do extractions what must be available and why
interim partial denture – maintain support and occlusion
if patient wears RPD may require what in tx plan
unique to this?
diagnostic models with wax rims
two sets of modelfs if patient wears RPD!
unique is that need two models - with and without the RPD
A-P rock
bad
determine need for occlusal support when
during fixed therapy
- prepare rest seats and guide planes on the CAST to see if you will have a problem
assessment steps
- models duplicated and both mounted
selection of teeth that need fixed therapy
evaluate what worked and what did not
consultatin
patient desires
plan
duplicated models allow for
to do a wax up of the proposed therapy and exeute the design to verify that it will work - rest seats, guide planes and retention apparatus
after assessment then?
stablize and confirm on survery
when can you commence therapy
after stabilization
major thing included in stabalization
interim RPD
definitive therapy includes
completion of restorative needs – like survey crowns and new master model for fabriation of metal frame
wax rim try in and mounting of master casts
toth set up try in
deliery of RPD and education on the care of mouth and prosthesis
case he presented with general steps
- clinical and radiographic exam
- smile analysis
- diagnostis casts
- look at static occlusion, ridges (parallelism / lack there of) - diagnostic cast with RPD in
COME UP WITH DIAGNOSIS / PROBLEM LIST
DIAGNOSTIC WAX - UP
- freeway, length width - golden proportion
- look at new static occlusion giving ptd dynamic . an
treatment sequence
- assessment - work up - consent for a plan
- stabilzation
- perio
- pre-prosthteic - interim RPD and provisional corwns
- surgical - definitive
- prosthetic tx - maintenance / re-eval - follow up and maintenance
crown and RPD sequence
perio tx interim RPD and provisional crown extractin PFM crowns PFM survey crowns RPD
crowns are delivered when
with an interim partial denture – then can create a master cast
