Dx & Tx planning Fixed prosthodontics Flashcards
History
(4)
Chief
compliant
Personal
details
Medical
history
Dental
history
Chief compliant
The inexperienced clinician trying to prescribe an “ideal”
treatment plan can lose sight of the patient’s wishes..
Chief compliant
(4)
Comfort (pain characteristics)
Function (difficulties in chewing)
Social aspect (bad oral taste or smell)
Appearance (unaesthetic appearance discoloration –
malposition – misshape may be the main cause seeking
dental tr.)
Personal details
(8)
patient’s name
Patient‟s age: relative size of pulp chamber
determine type of restoration coverage – orthodontic treatment to creat/eliminate spaces
in young ages.
Address: sometimes reveals area-related
diseases such as fluorosis, vitamin D
deficiency…
phone number
Gender
Occupation: carpenters, tailors, glass blowers,
(discoloration and fractures of anterior teeth)
work schedule:
marital and financial status: ability to afford Tr. Cost.
1- Medical history
(3)
Any disorders that necessitate the use of
antibiotic premedication.
Use of steroids or anticoagulants.
Any previous allergic responses to medication
or dental materials.
Conditions affecting tr. methods
med hx
Conditions affecting tr. Plan
(4)
Previous radiation therapy.
hemorrhagic disorders.
extremes of age.
terminal illness
Oral manifestation of systemic conditions
(4)
Diabetes.
Pregnancy.
The use of anticonvulsant drugs.
Gastro-esophageal reflux disease.
2- Dental History
(8)
- Periodontal History
- Restorative History
- Endodontic history
- Orthodontic history
- Removable prosthodontic history
- Oral surgical history
- Radiographic history
- TMJ history
- Periodontal History
(current oral hygiene & patient
education)
- Restorative History
(reflect prognosis of future
restorations)
- Endodontic history
(periapical health should be
monitored for any recurrent
lesion)
- Orthodontic history
(previous tr
. Associated with
root resorption
& C/R ratio
consideration, need for pre
- prosthetic orthodontic
intervention)
- Removable prosthodontic
history
(very helpful in assessing
whether future treatment will
be more successful)
- Oral surgical history
(any complication during tooth extraction)
- Radiographic history
(helpful in determining the progress of periodontal
disease)
- TMJ history
(pain, clicking, muscular symptoms, may be caused
by TMI dysfunction, which should normally be
treated and resolved before fixed prosthodontic
treatment begins)
Examination
(4)
General Examination
(patient’s general appearance,
gait, and weight, skin color,
vital signs…)
Extra-oral examination
Intra-oral examination
Radiographic examination
Temporomandibular joints:
bilaterally palpation during the
opening stroke.
(Asynchronous movement)
=anterior disk displacement
Tenderness or pain
=inflammatory changes in the
retrodiscal tissues
Clicking
maximum mandibular opening
i=ntra-capsular changes in the
joints.
Muscles of mastication the (2)
muscles, as well as other
relevant postural muscles,
are palpated for signs of
tenderness
masseter and temporal
Palpation is best
accomplished
bilaterally and
simultaneously
. This allows
the patient to compare and
report any differences
between the left and right
sides
Lips:
The patient is observed for tooth visibility during
normal and exaggerated smiling. This can be
critical in fixed prosthodontics treatment
planning, especially for margin placement of
certain metal-ceramic crowns.
Periodontal Examination:
(3)
- Gingiva
- Periodontium
- Clinical Attachment Level
Occlusal examination:
(3)
- Initial tooth contact
- General alignment
- Lateral and protrusive contacts
Centric relation:
Maxillo-mandibular relationship in which the
condyles articulate with the thinnest avascular portion of their
respective disks with the complex in the anterosuperior position
against the shapes of the articular eminences. This position is
independent of tooth contact
Centric occlusion:
maximum intercuspation position anterior to centric
relation.
Retruded contact position RCP
When the mandible closes on the retruded axis, its position when the
first tooth contact occurs is referred to as the retruded contact
position (RCP). Approximately 90 percent of the population have a
discrepancy between the retruded contact position and the intercuspal
position.
The relationship of teeth in both centric relation and the
maximum intercuspation should be assessed. If all teeth come
together simultaneously at the end of terminal hinge closure,
the centric relation (CR) position of the patient is said to
coincide with the maximum intercuspation (MI). The
patient is guided into a terminal hinge closure to detect where
initial tooth contact occurs. This is referred to as a slide from
CR to MI
Any — signs or symptoms should be recorded.
collateral
(elevated muscle tone, mobility on the teeth where initial
contact occurs, wear facets on the teeth involved in the slide).
— contacts on posterior teeth may be undesirable.
— movements (the presence or absence of contacts
on the nonworking side)
Such tooth contact in eccentric movements can be verified with a —
Excursive
lateral excursive
thin Mylar strip (shim stock)
The
optimum
crown
root ratio
is
2/3
Diagnostic Casts
1. Provide
2. examine the
3. Treatment procedures can be
4. Used for (3)
5. Help to explain
valuable preliminary information and a comprehensive
overview of patient‟s needs
occlusal relationships and the relationship of
antagonist teeth to the edentulous area.
rehearsed on the stone cast before
making any irreversible changes in the patient‟s mouth
diagnostic wax-up, preliminary RPD design, surgical
stent (surgical procedures), etc.
intended procedure to patient
ABUTMENT SELECTION
Is the tooth Non-Restorable?
Does the tooth present the following S&S?
* CAL:
* PD
* FI=
* Mobility=
* RCT:
> 75%
8mm
class III
grade III
previously endodontically treated, PA
RL with symptoms
CONDITION of REMAINING ABUTMENTS
(4)
- Amount of Coronal Tooth Structure
- Crown to Root ratio
- Periodontal Support
- Location of tooth in edentulous space
- Periodontal Support
- Good:
- Fair:
- Poor: >50% CAL
Adequate periodontal support
<25% CAL
<50% CAL
- Questionable:
- 2 Remaining Intact Canine [Good/Fair condition]
RDP, FDP, Implant, Combination
2 Remaining Intact Canines [Good/Fair
condition] + Posterior Teeth
RDP, FDP, Implant, Combination
- 2 Remaining Canines [Poor condition
Are there posterior teeth?
yes
no
2b
CD
- Loss of Canines
Are there posterior teeth?
yes
no
2b
CD
2b- Abutment Distribution?
* Unilateral
* Bilateral Posterior Support
* Intradental Edentulous Areas
RDP/ Implants
RDP, FDP, Implants, Combination
RDP, FDP, Implants, Combination
-SYSTEMIC CONDITIONS
- Absolute Risks/ Contraindications ➸
- Relative Risks/ Contraindications
Absolute Risks/ Contraindications
(8)
- Cancer- chemotherapy (under active tx)
- Systemic bisphosphonate medications (≥ 3
years) - Renal osteodystrophia
- Severe psychosis
- Acute infectious disease
- Depression
- Pregnancy [1st & 3rd trimester]
- Incomplete cranial growth with incomplete
tooth eruption
Relative Risks/ Contraindications
(6)
- Heavy smoking ≥ pack years [especially in
combination w/ HRT/estrogen], alcohol,
& drug abuse - Uncontrolled parafunctions
- Post head and neck radiation therapy
- Osteoporosis
- Uncontrolled diabetes
- S/p chemotherapy, immunosupressants,
long-term steroids, uncontrolled HIV
infection
BONE ASSESSMENT
(4)
- QUALITY
- QUANTITY- Favorable/ Ideal
- Bone Angulation
- Divisions of Bone Dimensions [Misch]
- QUALITY
- Type 1-4
- QUALITY
(2)
- Type 1-4* QUANTITY- Favorable/ Ideal
- Height ≥ 10mm
Is there sufficient bone for implant placement?
yes
no
Mock-Up,CBCT
Continue w/ conventional RDP/FDP
Division A vs D
abundant
deficient
- EDENTULOUS SPAN
(3)
- Number of Remaining Abutments [Go to #2]
- Alignment & Distribution of Abutments
- Extent of Edentulous Span
- EDENTULOUS SPAN
- Number of Remaining Abutments [Go to #2]
- Alignment & Distribution of Abutments
- Extent of Edentulous Span ➸
(8)
- Ridge Anatomy
- Tissue Attachment ➸
- ACP Classification ➸
- Extent of HORIZONTAL edentulous span
- Extent of VERTICAL edentulous span
- Cantilever ➸
- Maxillo-Mandibular Relationship
- Occlusion
- Extent of VERTICAL edentulous span
a) mm= Class I
b) mm= Class II
c) mm = Class III OR <10 mm = Class IV
> 21
16-20
11-15
- Cantilever ➸
a) A-P
b) B-L
c) CL
[1.5-2 ratio]
[Lip to soft tissue >14mm]
<10 mm
- Maxillo-Mandibular Relationship
(2)
a) Skeletal Classification [I, II, III]
b) Maxillo-mandibular discrepancy
- Occlusion
(2)
- Mutually Protected
- Bilaterally Balanced
VERTICAL DIMENSION of OCCLUSION ➸
(@)
- Restorative Space
- Desired VDO compared to Existing
VDO
- Restorative Space
(2)
- Intra-arch Space
- Inter-arch Space
- Inter-arch Space
(3)
- Ridge: Ridge
- Ridge: Tooth
- Tooth: Tooth
ESTHETICS & PHONETICS ➸
qEsthetics
(7)
- Incisal Edge Position
- Lip Position & Length
- Gingival Display
- Profile (inclination)
- Lip Support
- Bidra Classification I-IV
Smile line - Horizontal Tooth Display
7- RE-EVALUATION
* Prognostic Criteria for Abutments ➸
(5)
Optimal Incisal edge position
Profile
Maxillary Restorative Space
Occlusal scheme
Maxillo-mandibular relationship
RESTORATIVE TREATMENT ➸
* REMOVABLE DENTAL PROSTHESIS (RDP)
(3)
- Complete Denture
- Removable Partial Denture
- Removable Dental Prosthesis with Implants
RESTORATIVE TREATMENT ➸
FIXED DENTAL PROSTHESIS (FDP)
(3)
- Fixed Dental Prosthesis on Natural Teeth
- Fixed Dental Prosthesis Combination of Natural Teeth &
Implants - Fixed Dental Prosthesis with Implants ➸
- Screw vs Cement
- Hybrid vs PFM
Treatment sequence
When patient needs have been identified a
logical sequence of steps must be decided:
1. Treatment of Symptoms:
a fractured tooth or teeth, acute
pulpitis, acute exacerbation of chronic pulpitis, a dental
abscess, acute pericoronitis or gingivitis, and myofascial
pain dysfunction
Treatment sequence
2. Stabilization of deteriorating conditions:
(2)
9Treatment of carious lesions
9Chronic periodontitis and plaque control
measures.
Treatment sequence
3. Definitive Therapy:
(5)
- Oral surgery (removing residual roots and
ridge contouring) - Periodontics (bisection, pocket removal,
gingivectomy, crown lengthening) - Endodontics (evaluation of RCT)
- Orhtodontics (need for any tooth movement;
upright, tilt, intrude, extrude) - Fixed prosthodontics
