Mouth Preparation Flashcards by sophie rosen

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Patient Treatment
• Phase I:
(5)

– Relief of pain & infection
– Collection of diagnostic data
• Diagnostic cast, Diagnostic mounting
– Develop treatment plan
• Design RPD
– Patient education & motivation
– Occlusal equilibration

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Patient Treatment
• Phase II:
(6)

– Removal of deep caries, temporary
restorations
– Extraction of non-retainable teeth
– Preprosthetic surgery: tuberosity reduction,
etc.
– Periodontal treatment, Plaque control
– Interim prosthesis: function, esthetics
– Occlusal equilibration, may need changes
after extractions

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Patient Treatment
• Phase III:
(3)

– Definitive endodontic treatment
– Definitive restorative treatment
• Surveyed crowns, if needed
• Fixed partial dentures, if appropriate
– Occlusal plane correction

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Patient Treatment
Phase IV:

– Construction RPD

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Patient Treatment
• Phase V:
(3)

– Post-insertion care
– Periodic recall
– Continued plaque control

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Mouth Preparation
(9)

• Relief of pain & infection
• Caries removal
• Extractions, Preposthetic surgery
• Periodontal treatment, plaque control
• Occlusal equilibration
• Endodontics
• Definitive Restorative Treatment:
• Occlusal plane correction
• Enameloplasty for RPD

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• Definitive Restorative Treatment:
(2)

– Amalgams, composites
– FPDs, crowns, surveyed crowns

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Diagnostic Casts
(2)

• Preliminary design of RPD
• Identify tooth modification areas

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Mouth Preparation
• Perform tooth modifications
(2)

– according to RPD diagnostic cast design
– QA Worksheet

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Enamoplasty for RPD
(5)

Develop Guide Planes
Enlarge embrasure for minor connectors
Lower Height of Contour
Create undercuts if needed
Prepare rest seats

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Develop Guide Planes
(3)

– Proximal: adjacent to edentulous areas
– ML: stress-release clasps ML minor connector
– Lingual: reciprocal clasp

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Lower Height of Contour
(3)

– Proximal 2/3 Circumferential retentive clasp
– Reciprocal clasp
– Lingual Guide Plate

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Prepare rest seats
(2)

• Occlusal
• Lingual: chevron

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Guide Planes, Embrasures,
Alter Height of Contour
• Alginate Impression(s)/Snapstone Cast(s)
• Survey interim casts
• Confirm that preparations are parallel to
path of insertion in the following
sequence: (3)
• Confirm that survey line lowered
enough

Prepare guiding planes
Enlarge embrasures for minor
connectors
Reposition the survey line to reduce
interferences to framework placement and
enable most ideal clasp placement

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Undercut Preparation
(2)

• Used when slightly insufficient retentive
undercut
• Sloped buccal &/or lingual surface,
procedure contraindicated
– Need to reconsider other areas for
undercut or may need surveyed crown

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Undercut Preparation
• Indicated:

slightly insufficient retentive
undercut with vertical buccal & lingual
surfaces
• Preparation with round-ended tapered
diamond

Rest Seat Preparations
• After adequate preparation for GP, Survey
line alterations
• Same procedure as lab projects
• Check adequacy occlusal/embrasure rest
seats:
(3)

– Patient close into beading wax
– Measure thickness of wax (Caliper)
• At least 1mm
– If unable to attain adequate depth within enamel
• Remove small amount of opposing tooth structure
– Be sure to remake impression of opposing arch

Master Cast: Class III RPD
Impression Techniques
(4)

• Residual ridge not provide RPD support
• Alginate/stock tray
• Alginate/custom tray
• Custom tray/elastomeric material

Custom tray/elastomeric material
(3)

– Preferred technique UMKC
– Not border molded
– Medium-bodied PVS

Master Cast: Extension RPD Impression
(2)

• Residual ridge important source of RPD
support
• Important to accurately record
maximum tissue support area

Broad-stress distribution concept

• Distribute occlusal forces over as many teeth &
as much soft tissue as possible
• Not overload teeth or tissue
• Increased stability & retention
• Less frequent reline

The Problem with ToothTissue Supported RPDs: (2)

The periodontal membrane allows for 0.25 +/- 0.1
mm and the muco-periosteum allows for 2.0 + mm
movement
• Due to the lever
effect of the distal
extension base,
occlusal pressure is
concentrated on the
distal end of the
base

The Solution for Tooth/Tissue
Supported RPDs
(2)

• Equalize support derived from tissue and
teeth
• To distribute load to both the natural and
artificial dentition & minimize base
movement

Master Cast: Extension RPD Impression
• Custom tray/elastomeric material
(2)

– Border-molded tray
– One-step impression

Master Cast: Extension RPD Impression • Corrected (Altered) Cast technique

– Two-step (Dual) impression • Step one: Impression of teeth & residual ridge • Step two: Impression of residual ridge areas using framework

Master Cast: Altered Cast Impression (2)

• Step one: Impression of teeth & residual ridge – Alginate/stock tray or Alginate/custom tray – Framework fabricated on 1st cast • Framework less precise than with elastomeric impression • Step two: Impression of residual ridge areas only – Sectional trays added to framework – Border-molded – Elastomeric material

Master Cast: Altered/Corrected Cast (2)

Complex technique Prone to operator error •Lift of distal framework during residual ridge impression •Framework on final cast not oriented the same as in the mouth

Master Cast Impression Techniques • Leupold, Flinton, & Pfeifer, JPD, 1992 (3)

– Compared one-step border-molded custom tray/elastomer impression & altered cast impression technique – Concluded clinically insignificant difference in the vertical displacement of final RPD between the 2 techniques – One-step technique less prone to operator error than altered cast procedure

Master Cast Impression Techniques • Frank, Brudvik, Noonan, JPD, 2004 Clinical outcome of the altered cast impression procedure compared withuse of a one-piece cast Compared the efficacy of an altered cast compared to a one-piece cast with regard to base support, abutment health, and patient comfort over time in 72 subjects. Conclusion:

“The altered cast impression procedure does not offer significant advantages over the one-piece cast.”

skipped One-step Impression: Custom Tray

• Fabricate tray on working / diagnostic cast • Apply separating medium to cast – Liquid foil (not vaseline) • Tray extensions: – 2-3 mm coronal to vestibule depth in both dentate & edentulous areas • Wax spacer placed over tray outline – ~3 mm over teeth (red rope wax) – ~1.5 mm over residual ridge (baseplate wax • Tray stops – 3 widely spaced openings in wax spacer • 3 mm openings – Tripod support for tray – Use teeth NOT contacted with rests – Residual ridge stops similar to complete denture tray • Aluminum foil over wax spacer (not vaseline) • Triad tray material adapted over foil/spacer • Polymerize • Add finger rests to tray surface over edentulous areas – Stability during impression – Strengthen tray • Distal tray areas prone to fracture • Narrow, flat residual ridges • Add handle

Custom Tray Impression • Determine final tray extension at impression appointment (3)

– PIP tray flanges: extension & outer surface – Do border molding movements – Areas where PIP removed, shorten or thin tray

Custom Tray Impression • Border mold distal extension residual ridge areas • Elastomeric impression material (2)

– Polysulfide: High tear strength, pour within 1 hour – PVS: Hydrophobic, adequate tissue detail

skipped Master Cast • Survey

– Determine path of insertion • Guide planes parallel, Equalize undercut – Mark abutment height of contour • Facial & Lingual – Measure & mark retentive undercut • RED line • NOT red DOT • Approximate inferior edge of clasp • Tripod lateral sides of cast

skipped Lab Prescription (5)

• Surveyed cast • Work authorization – Lab RX • Send to QA for approval • Send to Lab • Framework fabricated