Treatment Planning

Question 1

What is the role of wax ups (5)

Answer 1

1. Patient communciation tool
2. Visual aid for final aesthetics
3. Guide for occlusal analysis and mock up of projected restos
4. Fabricate well-fitting provisions
5. Helps dentist create a systematic approach for case mgmt

Question 2

Treatment strategy stages for restoration (5)

Answer 2

STAGE 1- Initial assessment + emergency phase

S2- Control/stabilisation
- Exo hopeless
- Perio, endo, preventive

S3- Evaluate outcome/ review pt response to S2
- start thinking about best restos (crco, crowns, implants, etc)

S4- execution of treatment plan

S5- maintenance program (maintain oral health)

Question 3

What is “shortened dental arch”

Answer 3

An acceptable occlusion of 10 pairs of teeth
(no molars)
you dont necessarily need posteriors if pt does not want

Question 4

Conformative approach vs reorganisation approach of rehabilitation

Answer 4

Conformative
- Restoring teeth in existing occlusion without major changes to static and dynamic function
- Simpler, faster, cheaper
- only possible when there is adequate space available

Reorganisation
- for when insufficient space (tooth wear, reduced interocclusal space)
- Dahl approach commonly used

Question 5

why should splint therapy be performer prior to VD increase (4)

Answer 5

• assess pts ability to adapt to increased VD
• can be therapeutic (TMJ)
• can deprogram occlusion and guide pt to RCP
• protect teeth/restorations from damage

Question 6

Restorations to use when opening up bite

Answer 6

Direct is preferred bc more conservative.
Composite resins for anterior teeth and non-carious lesions

If there is sufficient tooth structure, can do indirect restos
PFM or ceramic onlays/crowns for posteriors. If bruxist- can do comp or PFM, not zirc.
PFM with metal palatal good for brux anterior and posterior, esp canines

gold is commonly used for posterior
zirconia and emax is also used but low evidence for long-term outcome

Question 7

pros and cons of single crowns (4 each)

Answer 7

pros:
1. good survival rate
2. aesthetic
3. can be minimally prepped
4. provides seal for RCT

cons:
1. prep can cause necrosis
2. needs enough tooth structure for ferrule, bonding, postcorecrown
3. Technique sensitive
4. Needs proper assessment of occlusion

Question 8

pros and cons of bridges (4 each)

Answer 8

pros
1. simultaneous replacement of several teeth
2. various designs and materials
3. can use when bone not suitable for implant
4. good aesthetic and functional outcome

cons:
1. destructive of abutments- can cause necrosis
2. challenging prep in tilted abuts
3. Cleaning is hard
4. Needs planning with waxups and good temps

Question 9

Pros (2) and cons (3) of rpds

Answer 9

Pros
1. cost effective way of replacing teeth
2. good aesthetics and function

cons
1. needs surveying of casts
2. plaque retentive, requires good pt compliance for OH
3. Clasps may affective aesthetic

Question 10

Pros (3) and cons (5) of implants

Answer 10

Pros
1. good longevity
2. can replace hard&soft tissue
3. good pt acceptance, aesthetic, function

Cons
1. need sufficient bone
2. need to recover from surgical phase
3. Expensive
4. need CBCT
5. possibility of peri-implantitis and mechanical complications

Question 11

4 types of implant placement

Answer 11

Type 1 - immediate
- after exo-1 week

Type 2 - early placement with soft tissue healing
- 4-8 weeks

Type 3- substantial bone healing
- 12-16 weeks

type 4 - Delayed placement
- once completely healed- 4-6 months