Lesson 3 Flashcards
→ increase masticatory efficiency
→ preservation of supporting tissues
→ retain remaining teeth
→ achieve esthetics
OBJECTIVES FOR TREATMENT PLANNING
→ process used to identify an existing abnormal condition
→ determine its cause
→ investigate the abnormality
DIAGNOSIS
→ allergic manifestation either to drugs or foods
o drugs such as mercury, iodine, local anesthetics, penicillin
and other antibiotics
→ patient should be asked if under physician care
→ determine the drugs being administered
→ information about periodontal disease, malocclusion, or other
facial or dental deformities in the family, dental experiences,
and recent therapy should be complete in the dental history
→ causes of loss of tooth and complications following extractions or
other dental measures should be learned
MEDICAL HISTORY
EXTRAORAL OBSERVATION:
should be palpated to disclose whether movements are smooth and free from jerky or spastic action and reveal the presence of swelling or tenderness
TMJ
EXTRAORAL OBSERVATION:
should be observed for possible variations in color, texture, pigmentation, eruption, or lesions that would suggest local or systemic disease
Skin on the Face and Neck
EXTRAORAL OBSERVATION:
should be palpated for the presence of lymphadenopathy or glandular enlargement
Neck
True or false
It is always advisable to test the vitality of the pulp in the remaining teeth because this may show that a tooth that is necessary in the remaining design of the proposed prosthesis is nonvital.
True
→ checked through:
o low voltage pulp testers o hot and cold stimuli
PULP VITALITY
RADIOGRAPHIC EXAMINATIONS
→ panoramic
→ lateral cephalometric
→ periapical x-ray
→ bitewing
INTRAORAL EXAMINATION:
signs of early malignant neoplastic disease or precancerous lesions
Lips
INTRAORAL EXAMINATION:
anemia, leukemia, polycythemia
Gingiva
INTRAORAL EXAMINATION:
carcinoma, tuberculosis, syphilis, pernicious anemia, herpes, glossitis of vitamin deficiencies
Tongue
INTRAORAL EXAMINATION:
variety of pathologic conditions
Palate
INTRAORAL EXAMINATION:
lesions that are cystic
Floor of the Mouth
INTRAORAL EXAMINATION:
site of both local and systemic disease
Pharynx
→ properly distributed and healthy teeth exist to serve as the abutments
→ capable of sustaining additional load
→ FPD is preferred to a RPD
INDICATIONS FOR FIXED PROSTHESIS
→ teeth must have adequate occluso-cervical crown length
→ sufficient retention
→ teeth with short clinical crowns often do not provide satisfactory
retention
CROWN LENGTH
→ some teeth have tapered crown form which interferes with the preparation parallelism, necessitating full coverage retainers to improve their retentive and esthetic qualities
→ some incisors possess very thin, highly translucent incisal edges
→ ex.: peg laterals
CROWN FORM
fractured or carious teeth that are not restorable and should be removed, thereby creating the need for a prosthesis or alterings its original design
DEGREE OF MUTILATION
the distance between abutment teeth affects the feasibility of placing a fixed prosthesis
SPAN LENGTH
loss of three adjacent teeth requires careful evaluation of other factors such as:
o root length
o mobility
o crown-root ratio
o periodontal health o occlusion
SPAN LENGTH
→ must retain stability for the prosthesis to function normally and to preserve the health of the mouth
o stability requires anchorage in an amount of adequate
bone
→ multirooted teeth provide greater stability than single rooted
teeth
ROOT LENGTH AND FORM
inadequate periodontal health results in bone loss that alters suitability of a tooth to support a fixed prosthesis
PERIODONTAL HEALTH
the tooth length projecting out of the alveolar bone and the length embedded in bone has traditionally been used as a guideline in determining the suitability of a tooth as an abutment
CROWN-ROOT RATIO
True or false
the lower the ratio, the less likely the tooth will be able to withstand additional occlusal forces
False
the higher the ratio, the less likely the tooth will be able to withstand additional occlusal forces
ratio is considered satisfactory
1 : 1.5
ratio is considered minimal
1 : 1
→ evaluation of abutment support
→ combined periodontal ligament area of the abutment teeth
should be equal or exceed that of the tooth or teeth to be replaced
ANTE’S LAW
tooth is mobile within the alveolus to approximately 0.1-0.2 mm in a horizontal direction
Degree 0
increased mobility of the crown of the tooth to at the most 3 mm horizontal direction
Degree 1
increased mobility of the tooth exceeding 1 mm in a horizontal direction
Degree 2
increased mobility of the tooth exceeding 1 mm in horizontal
Degree 3
severe mobility of the crown of the tooth both into horizontal and vertical directions which influences the function of the tooth
Degree 4
the crowns of proposed abutments must be well aligned so that retentive preparations can be developed
AXIAL ALIGNMENT
malalignment of abutment teeth can be so severe that it prevents placement of a fixed prosthesis without devitalization of the teeth or orthodontic movement to correct the malalignment
AXIAL ALIGNMENT
a curvature in the arches often places pontics facially to a straight line (fulcrum line) drawn between the teeth immediately adjacent to the edentulous area
ARCH FORM
for retention, extend at least far behind the fulcrum line
ARCH FORM
excessive occlusal forces can cause loosening of the prosthesis through flexure or can induce fracture when ceramic component is present
OCCLUSION
abutment tooth with poor pulpal health should receive root canal treatment prior to preparation
PULPAL HEALTH
