Complications Flashcards
Five parts to diagnostic evaluation of the occlusion
- face and lips
- planes of occlusion
- the incisal relationship (like do we have anterior guidance)
- strength of periodontium
- occlusal dynamics
success in creating a stable occlusal scheme begins by establishing what?
by establishing the FUNCTIONAL REQUIREMENTS of the dentition and then by defining the roles each tooth will plat when the treatment is complete
in establishing a stable occlusal scheme what is essential?
separate the dentition into its anterior and posterior components and then evaluate each individually and in relation to each other
what indicates a ‘healthy’ anterior?
overbite and overjet that correspond to having anterior guidance
minimizing the overjet and having a 1-2 mm over bite for natural anterior guidance
what indicates a ‘healthy’ posterior?
having strong attachment apparatus and it holds the dimension of occlusion – the vertical contact and occlusion
what are the most common problems in the ANTERIOR area
- missing tooth/teeth
- pathological migration/ posterior bite collapse
- class II relationship
- class III relationship
- Tooth ware (mandibular anterior)
details of tooth wear in common problems in the anterior area
referring to the mandibular anterior mostly
- lack of posterior teeth
- bruxism
- opposing dentition
- enameloplasty
with a missing anteriors where do we want to place heavy contacts when restoring?
on NATURAL TEETH - vs implants so that we have the propioception
when missing an anterior tooth (like lateral) what do you need to determine before restoring?
how much space you will need – find the M-D dimension and then create the space necessary using ortho (assuming other areas of mouth / health and perio / posterior occlusion is okay)
when missing teeth but occlusal plane is off and no allignment?
work with ortho – create a wax up – to move teeth to proper position and also to obtain and figure out the space you will require before restoring
pathological migration / posterior bite collapse – general implications and what to do
teeth start to move and drift and with no posterior support or contact – the anteriors begin to hit and they can become mobile
if pt. has no posterior support but wants to restore anterior what must be done?
CREATE POSTERIOR SUPPORT FIRST - can be temporary during treatment but cannot restore anterior with no posterior support – will just hit anterior
what class occlusion do we always try to recreate?
Class I
can you fix class II to class I?
yes
can you fix class II with restoration alone?
yes - depends on case
if needs more than just restoration - sometimes use ortho and resto
sometimes nees ortho - resto in combination with surgery
implications with a lot of overjet and class II?
when go into protrusive movements – hit a lot so if pt wants to restore anteriors cannot leave in a large class II because the pt. will just hit everytime
is there anterior guidance in a class III relationship?
NO - there is no anterior guidance – and if there is no contact between maxilla and mandible - teeth keep erupting
can you fix class III with restorations alone?
maybe case where placed implants and achieved an edge to edge occlusion from a class III
implication of edge to edge bite?
potential increase in incisal fractures occuring - so give pt night guard
for mandibualr teeth how do you gain restorative space gingivally? incisally?
gingivally? - do crown lenghtening
increase the bite to gain space incisally
major cause of ware on anteriors?
no posterior support – so occlude in the anterior and cause ware along with parafunctional patient habits
ware on anteriors with no posterior support? what to do first?
GAIN POSTERIOR SUPPORT FIRST
most common problems in the posterior area
- missing tooth/teeth
- furcation involvement
- crossbite
- tilting
- supra-eruption
furcation involvment
problem in the posterior area
grade 1 - you can restore with crown but will need to follow contour of tooth and consider material with a metal colar – patient can clean better
grade 2 and 3 - probably not
posterior crossbite?
problem in the posterior region – treat via ortho
if patient comes in with psoterior crossbite and needs crown do you restore for class I?
ortho if agree firsr
if no ortho – crown in crossbite because this is THEIR OCCLUSION
tilted teeth?
what problems does it cause?
how to correct?
problem occuring in posterior area
sets up interferences in lateral working movements
correct – uprighten the molars (may need to extract the third molar to create space first) so you can then increase the vertical dimension
tilted molar but patient interested in fixed partial
will need to consider the preparation a lot because may involve the pulp – elected RCT may be needed and need a proper path of insertion
but this can be done ith a fixed partial
supra-erupted teeth?
problem occuring in the posterior that will also set up interferences
what to consider with supra - erupted teeth?
is the tooth mobile, can you save it - if not extract it ?
if extensive– will need to cut it then do crown lenghtening but this could also compromise the periodontium
patient comes to you with supra erupted posterior teeth and is jsut interested in restoring the endotulous space on lower arch – what do you do?
DO NOT DO IMPLANTS IN A CROOKED OCCLUSAL PLANE
- have prosthesis now on a crooked plane
this is called a PATCH WORK
SO CORRECT PLANE ON TOP AND THEN RESTORE LOWER
two canines lower than the centrals?
we have a reversed crooked plane of occlusion
likely due to supra erupted teeth in posterior area
reason for retained primary teeth
anklyosis - maybe
problem occuring in the posterior area
CREATES INTEROCCLUSAL SPACE – other opposing tooth will supra-erupt
so need to extract if able to and then restore occordingly
decorination?
reason for doing?
ankylosis in primary retained molar
if extract – can cause injury to bone so will do decorination – cut clinical crowna nd burry the roots
leave 5mm of bone and will resorb
close with ortho or create space for future implant
what do you do before any procedure is preformed?
PERIODONTAL EVALUATION and health must be achieved
what is the foundation for any restorative work?
the periodontium
this will be an exam question
treatment options for pathological migration / advanced perio disease in anterior teeth
extractions, immediate dentures, RPD’s (removable partial denture). FPD’s (fixed partial denture)
treatment for Class II and III relationship in anterior
always try and give them a class I with ORTHO tx if able to and refer to surgery if needed
treatment for tooth wear in anterior region
can treat with veneers but need to consider crown to root ration
if need space gingivally– crown lengthening
or increase bite to gain space incisally and increase the vertical dimension
tx for missing teeth in the posterior
implant
fpd
tx for furcation involvement in posterior
tx depends on the class of furcation -- class 1 you can restore class 2 and 3 - probably not - PERIO MAINTENANCE - then restore
tx for crossbite in posterior
orthodontics - pt not interested – crown as is
tilting teeth tx in posterior
with ortho
supra eruption tx in posterior
set a correct occlusal plane then restore it
when increasing or decreasing vertical dimension what must occur?
MUST HAPPEN BILATERALLY - and during one time restorativev procedure such as a complete denture, full arch reconstruction or a combination of fixed and removable prosthodontics
restore entire arch and raise the bite – CANNOT DO WITH A SINGLE CROWN
steps in order when get a new patient
medical history dental history radiographs extra oral examination - cancer screening too intraoral examination perio probing restorative charting
preliminary impressions (alginate)
mounting of cast on a semi-adjustable articulator in CR (most of time)
occlusal analysis
consultation with different specialties
what do dental records include
medical history dental history radiographs extra oral examination - cancer screening too intraoral examination perio probing restorative charting
ALL BEFORE IMPRESSIONS
do not take bitewing that is what?
overlapping – we need these to be DIAGNOSTIC
when do you probe?
BEFORE - need to know if teeth are strong enough to withstand the restoration
DURING - need to make sure still stromg during and before you take the impression
AFTER - make sure you did not harm or decrease the strenght and it will not fail
does facebow registration always need to be recorded in CR?
For restorative treatments including full arch or quadrant - yes because you will be adjusting their anterior guidance if anterior restoration or changing occlusal scheme
occlusal analysis importance
find their occlusal scheme and restore to this if class I or change if able to
creating a new occlusal scheme?
need the patient facebow in CR
increase / decrease VDO
how to measure?
point on nose and chin
digital caliber - measure from amrginal ridge to marginal ridge from canine to canine
major difference in implant occlusion
no PDL
no propioception
no nerve - no pain
osseointegration
implant bone contact
difference between implant and natural dentition
surrounding tissue
nat - PDL
implant - osseointegration (bone and implant contact)
difference between implant and natural dentition
malocclusion
nat - may be uneventful for years – responds better/ well tolerated by the PDL
implant – crestal bone loss will occur
difference between implant and natural dentition
non-vertical forces
nat - relatively tolerated - since the pdl is shock absorbing
implant - this will be traumatic to supporting bone
difference between implant and natural dentition
loading-bearing characteristics
nat - shock-absorbing functino and stress distribution
implant - stress concentrated at the crestal bone – neck of the implant
difference between implant and natural dentition
movement patterns
nat - immediate movement – NON-LINEAR AND COMPLEX
implant - gradual
movement that occurs in natural teeth
non-linear and complex
vs gradual in implant
difference between implant and natural dentition
signs of overloading
nat - PDL thickening, mobility, wear facets, fremitus, pain
implant - screw loosening or fracture, abutment or prosthesis fracture, bone, loss, implant fracture
fremitus
vibration of teeth
sign of movement in natural teeth
difference between implant and natural dentition
tactile sensitivity
natural - high - proprioceptive feedback mechanism
implant – low osseoperception
thickening of PDL?
radioluscent area around the tooth in a radiograph - sign of overloading in the natural dentition
cantilever
implications
positioned or fixed only at one end while other end of the prosthesis is unsupported
can introduce NON-AXIAL loading onto the tooth – can increase chances of fractures in the implant and cause bone resorption to occur if not done in right area
occlusal considerations for implant-supported prostheses?
if these exist ,,, need to plan accordingly
flat fossa and grooves for wide freedom in centric
shallow occlusal anatomy (cuspal inclination)
narrow occlusal table? 30-50% smaller – can introduce non-axial loading
narrow occlusal table (30-40%) smaller implications?
the dimension of tooth (example -molar) will be larger than the implant diameter and can cause cantilever effects
introduces unwanted non-axial loading
would basically look like a lollipop and not have enough support
anterior guidance of implant supported prostheses?
should be as SHALLOW as possible – to avoid greater forces on the anterior implants
limit the knocking on the implants
excursive guidance on?
what is desires?
well-supported anterior natural teeth with posterior teeth disclusion in eccentric movements
if pt has natural canines?
canine protected or mutually protected occlusion IF THEY ARE PRESENT
group function?
occlusal scheme desired / of choice if canine absent or prosthesis replacing bilateral distal extension
canine missing and implant? scheme?
no contacts non working and share load with posterior teeth = group function
what do we want in MIP?
(occlusion check)
3 things
- WIDE/ LIGHT CONTACT IN THE CENTER (12 microns)
- firm occlusion with shim stock PASSING THROUGH – 8-30 Microns (if this does not pass through that means that the patient has a hard bite on the implant restored and this is undesired)
- working and non-working contacts should be avoided in a single restoration
two designs of implant crown
screw- retained
cement- retained
what does restoration design impact?
aspects of the OCCLUSAL CONTACTS – so this depends on the restoration design
screw retained - general
crown and abundment are one unit and screwed straight to implant fixture
axis is right through occlusal table
cement retained implant - general
two parts
- abutment - screwed onto the implant
- implant crown cemented
no screw axis coming out of occlusal table
occlusal contacts in screw retained
screw occupying the space
.1mm from screw to inner circle available for centric contact
compromised by screw end - not
occlusal contacts in cement retained
entire occlusal table is NOT compromised by the screw
so we can get an adequate contacts in posterior
