PDI Lecture Part II Flashcards
what are the 3 classifications for PDI
- edentulous
- partially edentulous
- dentate
what are the 4 categories for each classification
class I - class IV
what are the 4 considerations in class 1 partial edentulism
- location and extent of edentulous area
- abutment condition
- occlusion
- residual ridge morphology
describe the location and extent of edentulous areas in class I partial edentulism
- edentulous area confined to a single arch and may include:
- anterior maxillary span that does not exceed 2 incisors
- anterior mandibular span that does not exceed 4 missing incisors or
- posterior span that does not exceed 2 premolars or 1 premolar and 1 molar
describe the abutment condition in class I partially edentulous patient
no need for pre prosthetic surgery
describe the occlusion in class I partially edentulous patient
- no need for pre prosthetic therapy
- class I molar and jaw relationships
what are the biomechanical considerations for partial fixed denture prosthesis
- number of abutment teeth and number of missing teeth - simple vs complex
- splinted or pier abutment
- non-parallel abutments
- combined anterior and posterior FDP
describe class I partial edentulism partially edentulous patient
- ideal or minimally compromised edentulous area, abutment condition, and occlusion
- there is a single edentulous area in 1 sextant
- the residual ridge is considered type A
describe the location and extent of the edentulous area in class II partially edentulous patient
- moderately compromised
- both arches have edentulous spaces and 1 of the following
- anterior maxillary span that does not exceed 2 incisors
- anterior mandibular span that does not exceed 4 missing incisors
- posterior span that does not exceed 2 premolars or 1 premolar and 1 molar
- any missing canine (maxillary or mandibular)
describe the abutment condition in class II partially edentulous patient
- moderately compromised
- insufficient tooth structure to retain or support intracoronal or extracoronal restorations - 1 or 2 sextants
- abutments in 1-2 sextants require localized adjunctive therapy
describe the occlusion in class II partially edentulous patient
- moderately compromised
- occlusion requires localized adjunctive therapy - enameloplasty- prematurities
- class I molar and jaw relationships are seen
what is the most common FDP to replace more than two teeth with success
mandibular anterior FPD replacing 4 incisors
why does the mandibular anterior FPD replacing 4 incisors have a better prognosis than maxillary
direction of forces inward towards arch
what are the weakest potential abutments in a mandibular anterior FPD
lateral incisors and adjacent premolar
what is the optimal abutment in a mandibular anterior FPD
canines
what is the prognosis for maxillary FPDs supported by canines and why
decreased prognosis and higher stresses/forces
what is the PDI for replacing a missing canine
class II or higher
what are the considerations for replacing a canine
- adjacent premolar and lateral incisor are weakest potential abutments
- maxillary replacement- forces outside inter abutment axis and directed outward
what is the best option for replacing a missing canine
implant supported single crown
when are occlusal interferences produced
when FDP made to over erupted opposing dentition
what is done to correct an occlusal plane
- opposing tooth/teeth restored to correct occlusal plane
- may require RCT; periodontal surgery; orthodontics; extraction
- prevents occlusal interferences in restored dentition
are tilted molars good abutments
no
how are tilted molars prepared to be an abutment
- mesial wall must be over reduced/overtapered
- results in decreased resistance
what may intrude on the path of insertion of a tilted molar
- distal adjacent tooth may intrude on the path of insertion
- mesial surface may need re-contouring or restoration or extraction or orthodontic uprighting
what is the purpose of molar uprighting
- places abutment in better position for preparation
- distributes forced under loading through long axis of tooth - helps prevent/eliminate mesial bony defects
- enables replacement of optimum occlusion
what is the purpose of non rigid attachments for tilted molar abutments and and how is it prepared
- allows slight movement - short span
- keyway in distal of premolar to avoid intrusion of molar (mesial seating action)
- must prepare box in distal of premolar preparation (to accomodate the female/keyway)
what are the non-rigid connectors indications
- pier abutment FPD
- long span FPD with multiple abutments
- non parallel abutments- tipped molar
what does the custom incisal guide table do
- provides a record of the incisal guidance that has been established with provisional restorations or a diagnostic wax-up
- provides a record for the lab to create the desired anterior guidance in the produced prostheses
what is the location and extent of the edentulous area in class III partially edentulous patient
- substantially compromised
- 1 or both arches; compromised support of abutment teeth
- posterior maxillary or mandibular edentulous area more than 3 teeth or 2 molars
- any edentulous area including anterior and posterior areas of 3 or more teeth
what is the abutment condition in class III partially edentulous patient
- substantially compromised/ fair prognosis
- insufficient tooth structure or support intracoronal or extracoronal restorations - 3 sextants
- more substantially localized adjunctive therapy - 3 sextants
describe the occlusion on class III partially edentulous patient
- substantially compromised
- entire occlusion must be re-established but without any change in the occlusal vertical dimension
- class II molar and jaw relationships are present
what missing teeth would qualify a patient as class III partially edentulous patient
- any edentulous areas including anterior and posterior areas of 3 or more teeth
- maxillary canine and 2 contiguous teeth
what is the location and extent of the edentulous area in class IV partially edentulous patient
- severely compromised
- any edentulous area or combination of edentulous areas requiring a high level of patient compliance
what is the abutment condition of class IV partially edentulous patient
- severely compromised
- abutments in 4 or more sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations
- abutments in 4. or more sextants require extensive adjunctive therapy
- abutments have guarded prognosis
describe the occlusion in class IV partially edentulous patient
- severely compromised
- entire occlusion must be reestablished, including changes in the occlusal vertical dimension
- class II division 2 or class III molar and jaw relationships are seen
what the tooth condition for a class I dentate patient
- no localized adjunctive therapy required
- pathology that affects the coronal morphology of 3 or less teeth, one sextant
what the occlusal scheme for a class I dentate patient
- no pre prosthetic therapy required
- contiguous, intact dental arches
- class I molar and jaw relationships
what is the tooth condition for class II dentate patient
- insufficient tooth structure to retain or support intracoronal or extracoronal restorations - one sextant (pin retained core/post core)
- pathology that affects the coronal morphology of.4 or more teeth in a sextant
- pathology can be in 2 sextants and can be in opposing arches
- teeth require localized adjunctive therapy for a single tooth or in a single sextant
what is the occlusal scheme for a class II dentate patient
- moderately compromised
- occlusal scheme requires localized adjunctive therapy
- enameloplasty on premature occlusal contacts
- anterior guidance is intact
- class I molar and jaw relationships
what features make a dentate patient class II
- 1 sextant exhibits 3 defective restorations with an esthetic component
- additional variables of gingival architecture and individual tooth proportions increase the complexity of the clinical conditions
describe the tooth condition for class III completely dentate patients
- substantially compromised
- insufficient tooth structure to retain or support intracoronal or extracoronal restoration - 2 sextants
- pathology that affects the coronal morphology of 4 or more teeth in 3 or more sextants
- pathology can be in 3 sextants in the same arch and/or in opposing arches
- teeth require more substantial localized adjunctive therapy for teeth in 2 sextants
describe the occlusal scheme for class III completely dentate patients
- substantially compromised
- requires major therapy to maintain the entire occlusal scheme without any change in the occlusal vertical dimension
describe the tooth condition for class IV completely dentate patient
- insufficient tooth structure to retain or support intracoronal or extracoronal restorations - 3 or more sextants
- pathology affects coronal morphology of more than or 4 teeth in all sextants
- teeth in more than or 4 sextants require extensive adjunctive therapy
describe the occlusal scheme for class IV dentate pt
- severely compromised
- occlusal scheme requires major therapy to re establish the entire occlusal scheme including any changes in the occlusal vertical dimension
- class II division 2 malocclusion
- class III molar and jaw relationships
what are the modifiers for all PDI classifications
- esthetic concerns/challenges
- presence of TMD symptoms
- oral manifestations of systemic disease
- psychosocial factors
- maxillofacial defects
- ataxia
- refractory patient
the higher classification has a direct impact on:
the difficulty of the provided treatment and the prognosis of the treatment
comprehensive evaluation and assessment of all necessary parameters to help in:
diagnosis, treatment and prognosis