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Occlusion > Complications > Flashcards

Complications Flashcards

1
Q

Five parts to diagnostic evaluation of the occlusion

A
  1. face and lips
  2. planes of occlusion
  3. the incisal relationship (like do we have anterior guidance)
  4. strength of periodontium
  5. occlusal dynamics
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2
Q

success in creating a stable occlusal scheme begins by establishing what?

A

by establishing the FUNCTIONAL REQUIREMENTS of the dentition and then by defining the roles each tooth will plat when the treatment is complete

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3
Q

in establishing a stable occlusal scheme what is essential?

A

separate the dentition into its anterior and posterior components and then evaluate each individually and in relation to each other

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4
Q

what indicates a ‘healthy’ anterior?

A

overbite and overjet that correspond to having anterior guidance

minimizing the overjet and having a 1-2 mm over bite for natural anterior guidance

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5
Q

what indicates a ‘healthy’ posterior?

A

having strong attachment apparatus and it holds the dimension of occlusion – the vertical contact and occlusion

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6
Q

what are the most common problems in the ANTERIOR area

A
  1. missing tooth/teeth
  2. pathological migration/ posterior bite collapse
  3. class II relationship
  4. class III relationship
  5. Tooth ware (mandibular anterior)
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7
Q

details of tooth wear in common problems in the anterior area

A

referring to the mandibular anterior mostly

  • lack of posterior teeth
  • bruxism
  • opposing dentition
  • enameloplasty
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8
Q

with a missing anteriors where do we want to place heavy contacts when restoring?

A

on NATURAL TEETH - vs implants so that we have the propioception

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9
Q

when missing an anterior tooth (like lateral) what do you need to determine before restoring?

A

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)

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10
Q

when missing teeth but occlusal plane is off and no allignment?

A

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

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11
Q

pathological migration / posterior bite collapse – general implications and what to do

A

teeth start to move and drift and with no posterior support or contact – the anteriors begin to hit and they can become mobile

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12
Q

if pt. has no posterior support but wants to restore anterior what must be done?

A

CREATE POSTERIOR SUPPORT FIRST - can be temporary during treatment but cannot restore anterior with no posterior support – will just hit anterior

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13
Q

what class occlusion do we always try to recreate?

A

Class I

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14
Q

can you fix class II to class I?

A

yes

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15
Q

can you fix class II with restoration alone?

A

yes - depends on case

if needs more than just restoration - sometimes use ortho and resto

sometimes nees ortho - resto in combination with surgery

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16
Q

implications with a lot of overjet and class II?

A

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

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17
Q

is there anterior guidance in a class III relationship?

A

NO - there is no anterior guidance – and if there is no contact between maxilla and mandible - teeth keep erupting

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18
Q

can you fix class III with restorations alone?

A 
maybe 
case where placed implants and achieved an edge to edge occlusion from a class III
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19
Q

implication of edge to edge bite?

A

potential increase in incisal fractures occuring - so give pt night guard

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20
Q

for mandibualr teeth how do you gain restorative space gingivally? incisally?

A

gingivally? - do crown lenghtening

increase the bite to gain space incisally

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21
Q

major cause of ware on anteriors?

A

no posterior support – so occlude in the anterior and cause ware along with parafunctional patient habits

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22
Q

ware on anteriors with no posterior support? what to do first?

A

GAIN POSTERIOR SUPPORT FIRST

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23
Q

most common problems in the posterior area

A
  1. missing tooth/teeth
  2. furcation involvement
  3. crossbite
  4. tilting
  5. supra-eruption
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24
Q

furcation involvment

A

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

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25
Q

posterior crossbite?

A

problem in the posterior region – treat via ortho

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26
Q

if patient comes in with psoterior crossbite and needs crown do you restore for class I?

A

ortho if agree firsr

if no ortho – crown in crossbite because this is THEIR OCCLUSION

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27
Q

tilted teeth?
what problems does it cause?
how to correct?

A

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

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28
Q

tilted molar but patient interested in fixed partial

A

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

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29
Q

supra-erupted teeth?

A

problem occuring in the posterior that will also set up interferences

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30
Q

what to consider with supra - erupted teeth?

A

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

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31
Q

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?

A

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

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32
Q

two canines lower than the centrals?

A

we have a reversed crooked plane of occlusion

likely due to supra erupted teeth in posterior area

33
Q

reason for retained primary teeth

A

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

34
Q

decorination?

reason for doing?

A

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

35
Q

what do you do before any procedure is preformed?

A

PERIODONTAL EVALUATION and health must be achieved

36
Q

what is the foundation for any restorative work?

A

the periodontium

this will be an exam question

37
Q

treatment options for pathological migration / advanced perio disease in anterior teeth

A

extractions, immediate dentures, RPD’s (removable partial denture). FPD’s (fixed partial denture)

38
Q

treatment for Class II and III relationship in anterior

A

always try and give them a class I with ORTHO tx if able to and refer to surgery if needed

39
Q

treatment for tooth wear in anterior region

A

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

40
Q

tx for missing teeth in the posterior

A

implant

fpd

41
Q

tx for furcation involvement in posterior

A 
tx depends on the class of furcation -- class 1 you can restore 
class 2 and 3 - probably not - PERIO MAINTENANCE - then restore
42
Q

tx for crossbite in posterior

A

orthodontics - pt not interested – crown as is

43
Q

tilting teeth tx in posterior

A

with ortho

44
Q

supra eruption tx in posterior

A

set a correct occlusal plane then restore it

45
Q

when increasing or decreasing vertical dimension what must occur?

A

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

46
Q

steps in order when get a new patient

A 
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

47
Q

what do dental records include

A 
medical history
dental history
radiographs 
extra oral examination - cancer screening too
intraoral examination 
perio probing 
restorative charting

ALL BEFORE IMPRESSIONS

48
Q

do not take bitewing that is what?

A

overlapping – we need these to be DIAGNOSTIC

49
Q

when do you probe?

A

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

50
Q

does facebow registration always need to be recorded in CR?

A

For restorative treatments including full arch or quadrant - yes because you will be adjusting their anterior guidance if anterior restoration or changing occlusal scheme

51
Q

occlusal analysis importance

A

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

52
Q

increase / decrease VDO

how to measure?

A

point on nose and chin

digital caliber - measure from amrginal ridge to marginal ridge from canine to canine

53
Q

major difference in implant occlusion

A

no PDL
no propioception
no nerve - no pain

54
Q

osseointegration

A

implant bone contact

55
Q

difference between implant and natural dentition

surrounding tissue

A

nat - PDL

implant - osseointegration (bone and implant contact)

56
Q

difference between implant and natural dentition

malocclusion

A

nat - may be uneventful for years – responds better/ well tolerated by the PDL

implant – crestal bone loss will occur

57
Q

difference between implant and natural dentition

non-vertical forces

A

nat - relatively tolerated - since the pdl is shock absorbing

implant - this will be traumatic to supporting bone

58
Q

difference between implant and natural dentition

loading-bearing characteristics

A

nat - shock-absorbing functino and stress distribution

implant - stress concentrated at the crestal bone – neck of the implant

59
Q

difference between implant and natural dentition

movement patterns

A

nat - immediate movement – NON-LINEAR AND COMPLEX

implant - gradual

60
Q

movement that occurs in natural teeth

A

non-linear and complex

vs gradual in implant

61
Q

difference between implant and natural dentition

signs of overloading

A

nat - PDL thickening, mobility, wear facets, fremitus, pain

implant - screw loosening or fracture, abutment or prosthesis fracture, bone, loss, implant fracture

62
Q

fremitus

A

vibration of teeth

sign of movement in natural teeth

63
Q

difference between implant and natural dentition

tactile sensitivity

A

natural - high - proprioceptive feedback mechanism

implant – low osseoperception

64
Q

thickening of PDL?

A

radioluscent area around the tooth in a radiograph - sign of overloading in the natural dentition

65
Q

cantilever

implications

A

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

66
Q

occlusal considerations for implant-supported prostheses?

A

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

67
Q

narrow occlusal table (30-40%) smaller implications?

A

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

68
Q

anterior guidance of implant supported prostheses?

A

should be as SHALLOW as possible – to avoid greater forces on the anterior implants

limit the knocking on the implants

69
Q

excursive guidance on?

what is desires?

A

well-supported anterior natural teeth with posterior teeth disclusion in eccentric movements

70
Q

if pt has natural canines?

A

canine protected or mutually protected occlusion IF THEY ARE PRESENT

71
Q

group function?

A

occlusal scheme desired / of choice if canine absent or prosthesis replacing bilateral distal extension

72
Q

canine missing and implant? scheme?

A

no contacts non working and share load with posterior teeth = group function

73
Q

what do we want in MIP?
(occlusion check)
3 things

A
  1. WIDE/ LIGHT CONTACT IN THE CENTER (12 microns)
  2. 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)
  3. working and non-working contacts should be avoided in a single restoration
74
Q

two designs of implant crown

A

screw- retained

cement- retained

75
Q

what does restoration design impact?

A

aspects of the OCCLUSAL CONTACTS – so this depends on the restoration design

76
Q

screw retained - general

A

crown and abundment are one unit and screwed straight to implant fixture

axis is right through occlusal table

77
Q

cement retained implant - general

A

two parts

  1. abutment - screwed onto the implant
  2. implant crown cemented

no screw axis coming out of occlusal table

78
Q

occlusal contacts in screw retained

A

screw occupying the space
.1mm from screw to inner circle available for centric contact
compromised by screw end - not

79
Q

occlusal contacts in cement retained

A

entire occlusal table is NOT compromised by the screw

so we can get an adequate contacts in posterior

Occlusion (10 decks)

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