3. Tx Planning II Flashcards
Unsolved periodontal disease leads to what complications for fixed restorations
- Compromises crown longevity
- Complicates execution of procedures (gingival bleeding)
Why should perio issues be addressed before any fixed treatment
-Mobility –> occlusal instability
0Inflammation –> difficulty adjusting proximal contacts
What are the clinical indicators of periodontal disease
bleeding and purulent exudate
What is the importance of having an abundance of attached/keratinized tissue
- Resistant to irritation for restorative procedures and cemented restorations
- Reduces the probability of gingival recession (important in esthetic areas)
- Facilitates impression
Non-keratinized gingiva is more susceptible to….
-inflammation and recession
What is the suggested “adequate”/minimal amount of attached gingiva
2 mm of keratinized and 1 mm of attached gingiva
How can you minimize the probability of recession following restorative treatment
- Gingival tissues should be healthy before beginning restorative procedures
- Adequate band of keratinized tissue and attached gingiva
- Health of tissues is maintained
- Restorative margins don’t extend into the sulcus
- Atraumatic retraction for impression
- Final restoration has optimal contours and marginal fit
Compare and contract the appearance of thick v.s thin gingival biotype
Thick biotype
- Flat osseous and soft tissue architecture
- Dense and fibrous soft tissue
- Ledged or rolled gingival margin
- Resistant to acute trauma
- Larger amounts of attached gingiva
Thin biotype
- Highly scalloped osseous and soft tissue architecture
- Delicate and friable soft tissue
- Knife edge gingival margin
- Reacts to insults with recession
- Smaller amounts of attached gingiva
Clincially how can you tell if someone has thick or thin biotype
If you can see a perio probe through the gingiva it is thin- if not then thick
The biologic width measures _ mm from the bottom of the gingival sulcus to the alveolar bone
2 mm (1 mm CT and 1 mm JE)
What is the total distance from the margin of the crown to the alveolar crest (minimum) if biologic width is not being violated
3 mm
What is the recommended amount of space between the occlusal of the tooth and the alveolar crest
8-9 mm
- 2 mm occlusal reduction
- 3-4 mm axial wall height
- 3 mm margin to alveolar crest
Encroarchment on the biologic width can lead to
chronic tissue irritation
Indications for crown lengthening are
- Preservation of biologic width when restoration margin extends subgingivally
- Enhancing resistance and retention form (short clinical crown)
- Provision of a ferrule effect
- Improved esthetics (gummy smile)
If you want to increase the distance between the crown margin and the alveolar crest the three options are
- Gingivectomy
- Crown lengthening
- Ortho extrusion
How do you decide between doing crown lengthening v.s a gingivectomy?
- Based on zone of keratinized tissue
- Based on sulcus depth
Sulcus depth of 1-2 mm and thin zone of keratinized tissue –> crown lengthening or ortho extrusion
Sulcus depth greater than or equal to 3 and thick zone of keratinized tissue –> gingivectomy
What are the downsides of crown lengthening
- Less favorable crown:root ration
- Diminished bony support of adjacent teeth
- Potential furcation exposure
- Altered esthetic appearance (maxillary anterior)
Mobility is treated based on what
the etiology
Different etiologies of mobility include…
- Gingival and perio inflammation
- Parafunctional occlusal habits
- Occlusal prematurities
- Loss of supporting bone –> poor crown:root ratio
- Traumatic torquing forces applied to clasped teeth by RPD
- Periodontal therapy, endo therapy, ortho therapy
- Trauma
Which roots have better support (divergent/conical)
divergent
What is the ideal embrassure space between adjacent teeth (root proximity)
1.5mm-2mm
Why is maintaining an diseal embrasure space important
- Allows you to pack cord
- Close root proximity complicates margin prep
- Complicated OH
What is the minimum C:R for FDP abutments
1:1
What is considered excellent and good C:R
Excellent= 1:2
Good- 1:1.5 (most common)
What can be done for abutments with poor C:R ratio
splinting (less transmission of horizontal forces to the abutments)
Panoramix X-ray (over-/under) estimates osseous destruction
underestimates
(T/F) The terms anatomic and clinical crown do provide information about bony support
f
The fulcrum of the tooth is located where
middle portion of the root embedded in alveolar bone
Crown portion = _ arm and the root portion = _ arm
effort and resistance
Any tooth being considered for a crown requires _ screening
endo
Stressed pulps are more prone to _ after prosthodontitic tx
pulpal disease
When should we undergo elective endo
- When we want to crown a tooth that has a direct and/or indirect pulp cap
- When a post is needed to retain the core build up
- *This is for a PFPD
Why is it better to do endo before the fixed restoration v.s after
endo can compromise the overall success of the fixed tx
What are the important prosthodontic considerations for fixed restorations
- Remaining coronal tooth structure
- Strategic value of the respective tooth with regard to residual dentition
- Opposing dentition and occlusal forces
- Patient preferences
What are the two important aspects of having adequate coronal tooth structure
- Retention for the core
- Adequate ferrule
T/F there is no difference between the long term survival rates of implants and RCT teeth
t
What is the average long term survival rates of implants/endo
94%
T/F there is no difference between the long term survival rates of implants, RCT teeth, and PFDP
F- FDP has a shorter long term survival rate
Review the reading on slide 56 and 31
ok
Risk of Endo failure is higher when…
- Chronic apical infection or RL
- Previously unsuccessful endo
- Multiple roots
- Coexisting periodontial disease
What are the patient and tooth related factors we must consider when trying to repair a margin rather than replacing the crown
Patient related factors
- Age
- Caries risk
- Patient preference
Tooth related factors
- Access (tough interproximally)
- Visibility
- Severity
- Strategic importanve
What factors determine if we treat cracks and craze lines
- History
- Symptoms*
- Occlusal forces
How soon after perio surgery can we prep and take the impression. What factors influences these time frames
Non-esthetic area and thick periodontium (biotype)= 8 weeks
Esthetic area and thin biotype= 20 weeks
-Variables are medical condition, nicotine intake, age, location of the surgery
How long after perio surgery does it take for initial CT and epithelial healing to complete
4-6 weeks
Final maturation and sulcus reformation may take how long to complete
6mo-1 yr
If you are doing a subgingival margin, the restorations can be started once _ occurs which is ~how long
reepithelialization … 4-6 weeks
What is the correct sequence for multidisciplinary definitive treatment
- Oral surgery
- Peridontics
- Endodontic
- Ortho
- Fixed
- Removable
Which are restored first and why Anterior or posterior teeth
Anterior because they form the boarder movements of the mandible and thus shapes the occlusal surfaces of the posterior teeth
Describe the differences in the confirmative and rehabilitative approaches
Conformative= keeping the patient’s existing occlusal scheme
Rehabilitative= Changing aspects of the patients occlusal scheme for example (VDO, Guidance, and Occlusal plane)
