Diagnosis and Treatment planning for single fixed restorations Flashcards
Treatment Planning for single tooth restorations begins with an analysis of each individual tooth AND the patient as a whole such as…
How is their home care?
Is there wear on many teeth?
Do they have a lot of restorations?
Are they in pain?
What are their financial abilities for treatment?
What is existing in the tooth already?
What treatment will maintain the tooth?
What treatment will strengthen the tooth?
What is existing in the tooth already?
What are the patients’ goals?
Is esthetics a concern for the patient?
Is the tooth periodontally stable?
Is there enough tooth structure for a fixed restoration?
Does the tooth need additional treatment?
Order of TX planning for fixed:
1: start with a complete medical & dental history
2: gather further data about the tooth in question (radiographs and perio charting)
3: look at the tooth in question to analyze what might be needed to restore it
4: what are the options for this patient and their tooth?
5: put tx options into categories & present options to pt
What contra-indications should you consider before beginning dental treatment?
- Cardiac issues
- Patients stability with diabetes or other diseases
- Patient home care
What do you need to see on radiographs before doing a single fixed restoration?
- Bone level
- Extent of decay or tooth destruction
- Endodontic condition
What do you need to see when periodontal charting before doing a single fixed restoration?
- Bone level
- Tissue condition
–Inflammation level
–Bleeding level
–Recession
What fixed treatment can you do without a radiograph?
NONE!
If the isthmus destruction greater than ½ intercuspal width what treatment?
Crown or Onlay
If more that 50% of tooth structure is gone and loss of cuspal support what treatment?
Crown (and likely a core build up too)
What should you do for extremely damaged teeth if they have combined central and peripheral destruction?
-Core Build up and Crown
-Possible RCT/Post/Core/Crown
What are ALL the options for treatment for this particular patient and this particular tooth?
Filling
Crown
RCT / Post / Core
Build up and Crown
Onlay / Inlay
Extraction
Other – Bridge / Implant
What is the best way to present the treatment options to the patient?
Best – Strengthen tooth and provide excellent esthetics
Better – Strengthen the tooth
Acceptable – Repair the tooth, but not necessarily improve its strength
Not Recommended – not an option for this patient’s tooth
Loss of cusp and greater than 50% of tooth structure compromised…
CROWN! Is best / ideal choice
What types of materials are used for fixed restorations?
-Gold
-Ceramic (e.Max, Empress)
-Zirconia
-Zirconia Fused to Porcelain (PFZ)
-Composite formulations (CEREC)
-Metal
-Metal-Ceramic (Porcelain Fused to Metal (PFM))
What are the pros of gold crowns?
-Gentle on gingiva
-Low wear on opposing teeth
-Longest lasting restoration we have in dentistry so far
-Can be burnished to seal smallest of margins
-Very low risk of crown fracture
-Contacts can be added to
-Easily polished
What are the cons of a gold crown?
-Not esthetic
-Labor intensive for lab technician
What are the pros of a ceramic crown?
-Tooth colored
-Still stronger than enamel by ~ 2x
-Most realistic and beautiful of all crown materials
What are the cons of a ceramic crown?
-Must use resin cements 90% of the time
-Careful patient selection needed for molar crowns
-Require thicker margins as ceramics need a minimum amount of material to prevent fracture
-Fracture risk
What is the issue with having to use resin cements with a ceramic crown?
resin cements are technique sensitive and not cariostatic (recurrent caires possible)
What are the pros of a zirconia crown?
-Tooth colored
-Some iterations are 4x as strong as enamel
-Becoming more esthetic
-Easy for lab technician to fabricate
What are the cons of a zirconia crown?
-Not all Zirconias are the same
-Cannot easily add material to establish contacts
-Crown preparation design still key for longevity
-Fracture risk with some formulations
When zirconia crowns become more esthetic what happens to the strength?
becomes weaker
What is the most important thing to know about zirconia crowns?
Not all Zirconias are the same
What are the pros of porcelain fused to zirconia crown?
-Tooth colored
-Some iterations are 4x as strong as enamel
-Becoming more esthetic
-No dark metal (like PFM) to cover
-White substructure enhances esthetics with porcelain providing high esthetics
What are the cons of porcelain fused to zirconia crown?
-Not all Zirconias are the same
-Cannot easily add material to establish contacts
-Crown preparation design still key for longevity
What are the pros of CEREC composite formulation crown?
-Tooth colored
-Easy for the Lab to fabricate
-Milled restorations
-Mixture of Composite and Ceramic
What are the cons of CEREC composite formulation crown?
-Longevity still in research
-Cannot easily add material to establish contacts
-Crown preparation design still key for longevity
-Esthetics still challenging
What are the pros of PFM crown?
-Tooth colored
-Metal substructure add strength
-Metal substructure enables PFMs to be used in longer bridges
-Can design where porcelain covers metal to provide excellent flexibility in design
-Metal substructure protects tooth even if porcelain fractures
What are the cons of PFM crown?
-Porcelain can fracture if not prepared correctly
-Metal collars can be unesthetic
-Porcelain can yellow over time
-Preparation is technique sensitive due to metal and porcelain components
What are the longest lasting crowns?
gold crowns
What are the second longest lasting crowns?
PFM crown
What are the types of fixed prosthodontics?
-Crowns (Single crowns, Bridges, Implant Crowns, Partial Crowns)
-Veneers
-Other implant prosthesis (“All on 4”)
-Inlay / Onlay
How long do single crowns last?
Average single crown lasts 10 – 15 years
How long does conservative amalgam last?
10 - 15 years
How long does conservative composite last?
up to 10 years
How long does the average composite last?
6 years
What does tx planning a crown always begin with?
pt history
What are the options available here for this patient?
crown, RCT and build up, filling (maybe)
What information do you need to gather in order to treatment plan #30 for a new restoration?
-medical/dental history
-bite wing and PA
- periochart
