Diagnosis & Tx planning Flashcards
5 visits for CD and PD
- primary impressions
- secondary impressions
- inter-occlusal records
- try-in
- insertion/adjustments
- primary impressions
- secondary impressions
- inter-occlusal records
- try-in
- insertion/adjustments
for complete
- primary impressions
- compound or alginate - secondary impressions
- PSR or PVS - inter-occlusal records
- record bases and occlusion rims - try-in
- record bases and teeth - insertion/adjustments
-denture bases and teeth
- primary impressions
- secondary impressions
- inter-occlusal records
- try-in
- insertion/adjustments
for partial
- primary impressions
- alginate - secondary impressions
- PSR or PVS - inter-occlusal records
- frames and occlusion rims - try-in
- frames and teeth - insertion/adjustments
- denture bases and teeth
other considerations why removable PD’s may be good tx option other than list from before
can replace missing teeth AND BONE.
specialized esthetics-diastemas, unusual tooth arrangements are easier with removable (wax try -ins with diagnostic denture teeth) – which can then be transitioned into fixed
Great intermediate prosthesis to determine final VDO and esthetics, preserve space and act as a prototype to extensive full arch restorations
RPD a good intermediate prosthesis?
YES-
Great intermediate prosthesis to determine final VDO and esthetics, preserve space and act as a prototype to extensive full arch restorations
tx options for missing teeth
- implants
- fixed partial dentures
- removable cast partial dentures
- removable provisional partials
- complete dentures
- no replacement*
contra-indications for fixed/ implant restorations
- existing oral diseases
- high caries rate/ poor oral hygiene
- periodontal issues
- medical conditions / risk factors
- cost
partial denture design must be completed when? why?
PRIOR to treatment planning REGARDLESS of who will fabricate the partial denture or even when …
what if one of the selected primary abutments needs a restoration or a crown first? – this must be completed prior so you can survey it / locate undercuts/ tell lab information regarding the framework placement and clasps
6 main purposes of the diagnostic cast
- pre-treatment record
- diagnostic and legally need it - visual aid for the patient
- preliminary design
- custom tray fabrication
- practice abutment preparation
- occlusal and spce analysis **
- need for bases/rims
- counter models
- check for anterior modification spaces
T/F preliminary survey and design may be surveyes after mounting as well
TRUE
- you can survey with the cast mounted on a cookie
describe custom tray fabrication for PVS and PSR
PVS
- must do a double tooth blockout and a single blockout on the edentulous ridges and palate
PSR
- single tooth blockout and no blockout on the edentoulous ridges or palate
diagnostic impression requires you capture all occlusal surfaces/ incisal edges because
need this for articulation and occlusion
diagnostic impression requires you capture all surfaces of abutments because?
needed for the framework
diagnostic impression requires you capture all of the edentulous spaces because
needed for location and approximation of the denture base
diagnostic impression requires you capture all folds to be restored
for the flange of the denture
diagnostic impression requires you capture all buccal vestibules and lingual vestibules
for the approach arms –
for the major connectors
diagnostic impression requires you capture all of retro-molar pad
needed if doing a mandibular distal extension
diagnostic impression requires you capture all hamular notch
needed if doing a maxillary distal extension
diagnostic impression requires you capture all of palate and tongue space
need this IN FUNCTION for pt. comfort and knowing they can still be comfortable
what does a design diagnosis require
- diagnostic casts
- opposing cast or counter model
- diagnostic mounting – unless opposing an edentulous arch in which you will be restoring with a complete denture
when do you not need to have a diagnostic mounting for designing
if opposing is an edentulous arch in which you will be restoring with a complete denture
service life of complete denture
roughly 7 years but will likely need a reline or rebase
describe an interim complelte denture. is this definitive or non-definitive tx?
non definitive tx
- SHORT TERM full arch replacement of teeth, bone, and soft tissue used as A DIAGNOSTIC TOOL or when an immediate complete denture is not possible
- they are inserted immediately after extractions or while healing is still occurring
three main characteristics of cast partial dentures
- use CAST METAL SUBSTRUCTURES consisting of rigid major connectors, clasps, rests, and guide planes to distribute forces to remaining teeth
- can be supported entirely by remaining teeth or a combination of teeth and tissue
- rigid major connector provides CROSS ARCH STABILIZATION
which partials are likely to flex
horsheoes and bridges
- so horshoes must be tooth borne to minimize this flexing and the horizontal rotations – use as many guide planes as possible
what prevents flexing from occuring
posterior bars prevents flexing
definition of provisional partial
A SHORT TERM fixed or removable dental prosthesis designed to enhance esthetics, stabilize, provide occlusal support, maintain space and diagnose problems and/or function for a limited period of time, after which is to be replaced by a DEFINITIVE PROSTHESIS
syn; interim prosthesis
definition of transitional partial
a provisional (serving as an interim) where teeth are added, often to “transition” a patient from some remaining teeth to an interim CD
purpose - trying to diangose dentition and we can add teeth to provisional/ transitiona;
* so key here is we can add teeth
definition of flipper/ type
provisional
- common term for a provisional replacing a SINGLE tooth for esthetic considerations / reasons
how long can you assess patient for tolerance on increases their VDO?
1 week maximum
indications for using a provisional partial
- assess patient tolerance of VDO ; 1 week maximum
- supply posterior occlusion during periodontal long term restorative therapy
- decrease forces on anterior teeth (by providing posterior occlusion)
- after recent extractions
- space maintenance
- treatment prosthesis (tissue conditioner, ortho)
- esthetics
biggest difference between a provisional partial and cast
RESTS
how long is provisionals designed to function for
1 week to 6 months
*when worn longer than 1 month must be supported by BALLA OR ADAM CLASPS
if provisional is worn longer than 1 month what must be done
needs to be supported by balls or adams clasps
wrought wire ball and occlusal embrasure clasps prevent?
preventing vertical DISPLACEMENT in provisional partials
- want to limit the gingival movement
- so primarily used as rests NOT direct retainers
(direct retainers use clasps)
major reason for using provisional partial
used for developing or maintaining VDO and Occlusion while other restorative procedures are being performed
adams clasps also called
occlusal embrassure clasps
even though the wrought wire ball and occlusal embrassure clasps may provide direct retention, the PRIMARY use of these critical components is to protect the tissue from?
VERTICAL DISPLACEMENT of the prosthesis
use of a flipper is likely for?
emergency treatment
fractured
avulsed
missing tooth/ teeth (usually single)
problems occuring with all acrylic provisional partials
- no rests / vertical displacement
- no guide planes/ undercuts/retention
- cold cure acrylic
- alginate ‘final’ impression
describe the ‘nesbit’
NOT RECOMMENDED
- a single tooth unilateral posterior partial
- can be swallowed or aspirated
how is bone lost in edentulous arches? for maxilla and mandible
maxillary anterior region
- anterior to posterior
mandibular anterior region
- posterior to anterior
*vertical height and width in both arches lost
in complete dentures does bone resorption happen if patient not wearing denture?
yes- resorption occurs even if no denture made/worn
how does a complete denture have the potential to drastically increase rate of bone loss?
movement
how do we minimize movement in complete dentures?
- adhesion
- cohesion
- posterior palatal seal
- CO=CR
* * denture rules like no anterior contact in CR and no anterior guidance in protrusion and no cuspid guidance in lateral
long term use of provisional partials can lead to? why do we see this?
- periodontial breakdown
- bone loss
- increased caries
why?
- poor adhesion
- cohesion
- border seal
- poor distribution of forces
- no cross arch stabilization and may even be flexible
what is the result of poor fitting acrylic brought close to the necks of remaining teeth?
results in damage to the free gingival margin and recession – resulting in root caries more likely
problems wih thermoplastic* flexible partials
- flexible major connectos ABSORB the stress so does not distribute occlusal load
- no rests
- no guide planes
- clasps interfere with gingiva
- difficult to adjust
disadvantages of flexible partial dentures
- may not help supprt the patients vertical dimension of occlusion
- little or no splinting for weak teeth
- the patient’s soft tissue provides virtually all support during funcion
- little research available concerning the clinical performance of their effects on soft issue
limited indications for flexible removable partial
in certain isolated situations
- allergies
- obturators
T/F you can combine material from the flexible partial and metal clasp assemblies from a conventional partial
TRUE
why are CAST partials a better choice? for non-rotating?
non-rotating
- PREVENT vertical and horizontal movements with rests, clasps, rigid major connectos and guide planes so the minimum movement occurs thus minimum PROSTHESIS -CASUED bone loss occurs
why are CAST partials a better choice? for rotating?
LIMIT vertical and horizontal movements with rests, clasps, rigid major connectos and guide planes so that horizontal rotation and vertical rotation are prevented and limited
limited movement = limited PROSTHESIS- causes bone loss
proper design keeps the prosthesis away from what? benefits?
away from free gingival margin
reduces risk of
- periodontal disease and root caries
- protects the remaining teeth and bone
posterior bite collapse may lead to..
loss of VDO
bite collapse potential occurs with?
no natural occlusion
- so patient could have natural upper anteriors and natural lower posteriors but no teeth in contact
- unlikely to occur if patient has natural occlusion
what must be present BEFORE considering increasing VDO
evidence of bite collapse
evidence of bite collapse includes
- absence of all posterior occlusion
- flaring of remaining anteriors + diastemas
- wear facets on posteriors
- poor esthetics
how do you determine VDO (even when patient has teeth)
- freeway space
- closest speaking space
- space of donders
- esthetics
- phonetics
- swallow
in the presence of NATURAL occlusion it is acceptable to restore/ increase VDO with…
FIXED (including IMPLANTS )ALONE
*only time this is acceptable
tx choices for loss of VDO
- alone with fixed if there is natural occlusion
- fixed with removable combined
- never removable alone ***
describe fixed and removable together for tx
open with fixed so that it is permanent
- so when take removable out vertical is still being held by fixed
keeping naturally occluding teeth APART can cause…
- tooth extrusion
- TMD
- Ridge resorption
provisional partial PD to increase VDO for how long?
MAXIMUM one week
if there is no room to restore and some natural teeth are in contact what are tx options?
CANNOT open the occlusion because whatever natural teeth are in contact must stay in contact so other options for restoring must be considered
- crowning all teeth in contact?
- extracting all uppers and making a complete upper denture?
three main ways (more detail) for increasing VDO by restoring
- one arch with complete denture
- with fixed partials dentures
- combination of FPD’s and RPD
*never RPD’s alone
if posterior contact does exit we must use?
patients current vertical
in the absence of posterior occlusion what is required for mounting?
record bases and occlusion rims
aluwax and notch
in absence of sufficient (anterior or posterior) teeth in contact what do you need for mounting?
record bases and occlusion rims
aluwax and teeth
occlusal plane with mized dentition - where do you get it from in the maxilla? mandible?
maxilla –>get the plane from the neighbors
mandible–> get it from the RM pad
main reasons for needing pre-prosthetic surgery? when do you usually figure out the need?
- Torus / extosis removal
- frenal attachments
- if attached to the crest of ridge - extractions
- redundant tissues
- tuberosity reduction
When you look at your diagnostic casts **
when do you survery restoration crowns whether is it full golf, gold onlay, or PFM?
survery BEFORE CEMENT
only part of abutment on PFM crown that is okay in porcelain?
CLASP TIP OKAY IN PORCELAIN – because it has good compressive strength
rests seats –> in metal
guide planes–> in metal
*because porcelain has poor edge strength
all porcelain for restortation abutment material?
contra-indicated
sequence of restorations..
Before PD?
After PD?
ideally all ABUTMENT RESTORATIONS – should be completed BEFORE PD fabrication to ensure accurate fit of PD framework
After PD
- some restorations can be ‘RETRO-FITTED’ or made to a pre-existing PD, as long as enough RESTS remain to reposition the frame
only way we can obtain a successful retro-fit?
the framework must have sufficient RESTS
how to sequence combined fixed/remo cases
- PD design BEFORE TX PLAN
- PD design before crown fabrication
- PD design accomodations in crown prep
- PD tripod registration for crown casting
- PD survey of crowns before cementation
material of choice for our framework
chromium cobalt
is an immediate cast partial denture a definitive tx?
YES – but will be relined as the bone and soft tissue heal
immediate cast partial denture definition
removable DEFINITIVE cast partial denture fabricated for placement IMMEDIATLEY following the removal of a natural tooth/teeth
- acrylic denture base overlyying the extracted teeth will be relined as the bone and soft tissue heal
immediate cast partial denture have meshwork?
no using LOOPS instead on lingual aspect
- allow us to try in framework
can you use steele’s facings with immediate cast partial denture?
no
after try in (@framework try in) for a immediate cast partial denture what is next?
teeth to be extracted are removed from master cast, and the loops are BENT to simulate meshwork and the denture teeth are set in place
and the processing incoprorates the loops as meshwork
when are immediate cast partial denture usually done?
when there is no time to wait for healing after anterior extractions, where a flange will be used (no facings) and a definitive cast partial prosthesis is required
what do the bendable loops provide?
retention for the acrylic
