BDS3 treatment planning Flashcards
what are diff types of special investigation?
- sensibility testing
- radiographs
- study models
- facebow
- diagnostic wax-up
what is purpose of a facebow?
to find relationship between maxilla and angles of the mandibular condyles
what are stages of treatment planning?
- immediate
- initial
- re-evaluation
- reconstructive
- maintenance
what do you do during immediate stage for treatment?
- relief of acute symptoms
- consider endo and extractions
- consider immediate denture/bridge
what do you do during initial stage of treatment?
disease control
- extraction of hopeless teeth
- OHI and diet advice
- HPT
- Management of carious lesions and defective restorations with direct or provisional restorations
- endo
- denture design, wax up for fixed prosthodontics
what do you do during re-evaluation part of treatment?
- re-assessment of perio status, confirm denture/bridge design
what do you do during reconstructive part of treatment?
- perio surgery
- fixed and removable prosthodontics
why place veneers?
Improve aesthetics
Change teeth shape and/or contour
Correct peg-shaped laterals
Reduce or close proximal spaces and diastemas
Align labial surfaces of instanding teeth
what do you do during maintenance part of treatment?
- supportive perio care and review of restorations
what is gurel minimal prep technique?
Veneers
Wax up
Stent
Intra-oral mock up
Preparation into mock up (can use depth cut burs
when not to use veneers?
Poor OH
High caries rate
Interproximal caries and/or unsound restorations
Gingival recession
Root exposure
High lip lines
If extensive prep needed (>50% of surface area no longer in enamel)
* Consider alternatives – PJC, DBCs MCCs
Labially positioned, severely rotated and overlapping teeth
Extensive TSL/insufficient bonding area
Heavy occlusal contacts
Severe discolouration
when is extensive prep needed so veneers can’t be used?
> 50% of surface area no longer in enamel
why restore teeth with inlays/onlays?
Tooth wear cases
* Increase OVD
Fractured cusps
Restoration of root treated teeth
Onlays provide cuspal coverage
Replace failed direct restorations
why not use inlays/onlays?
Active caries and periodontal diseases
Time
* Tooth preparation and laboratory fabrication required
Cost
Why restore teeth with crown?
To protect weakened tooth structure
To improve or restore aesthetics
For use as a retainer for fixed bridgework
When indicated by the design of a RPD
* Rest seats
* Clasps
* Guide planes
To restore tooth function
* e.g. restore in OVD
Why not restore with crowns?
Active caries and periodontal disease
More conservation options available
Lack of tooth tissue for preparation
Unable to provide post and core
Unfavourable occlusion
what are the principles of crown prep?
o 1) Preservation of tooth structure
o 2) Retention and resistance
o 3) Structural durability
o 4) Marginal integrity
o 5) Preservation of the periodontium
o 6) Aesthetic considerations
what does under preparation of crown prep result in?
- Poor aesthetics
- Over built crown with periodontal and occlusal consequences
- Restorations with insufficient thickness
in terms of principle of crown prep what is meant by retention?
Prevents removal of the restoration along the path of insertion or the long axis of the tooth preparation
in terms of principle of crown prep what is meant by resistance?
Prevents dislodgement of the restoration by forces directed in an apical or oblique direction and prevents any movement of the restoration under occlusal forces
what is the ideal inclination of opposing walls with taper?
6-10 degrees
what do longer walls of a crown prep interfere with?
tipping displacement
in terms of principle of crown prep what is meant by path of insertion?
- Imaginary line along which the restoration will be place onto or removed from the preparation.
- Is set before the preparation is begun and all the features of the preparation must coincide with that line
what are extra means of retention for crown preps?
- Grooves
- Slots
how is retention in crown preps improved?
limiting the number of paths of insertion.
what is structural durability of crown prep?
Restoration must contain a bulk of material that is adequate to withstand the forces of occlusion.
how is structural durability of crown prep achieved?
- Occlusal reduction
- Functional cusp bevel
- Axial reduction
what are finish line configurations for marginal integrity of crown preps?
- (a) Knife edge
- (b) Bevel
- (c) Chamfer
- (d) Shoulder
- (e) Bevelled shoulder
how should the margins of the restoration be when preserving the periodontium during crown preps?
- 1) Smooth and fully exposed to a cleansing action.
- 2) Placed where the dentist can finish them and the patient can clean them.
- 3) Placed supra-gingival or at gingival margin whenever possible.
o Placement of the margins subgingival may be required
what is considered when deciding aesthetic considerations of crown preps?
- Smile lines
- provides best aethetics so will the restoration(s) be visible?
- Has the least destructive preparation?
- Is least destructive to opposing teeth?
- Is best suited to bruxists?
when planning bridgework what is occlusal stability?
Prevent tilting and overeruption of adjacent and opposing teeth
what not replace teeth for bridgework?
Damage to tooth and pulp
Secondary caries
Effect on the periodontium
Cost
Failures
what needs to be discussed for informed consent?
o What treatment is to be performed
o Why it is necessary
o Consequences of not having treatment
o What risks may be involved (material risks)
o What alternatives are there (and their risks)
o Relative costs
