Treatment planning

Question 1

For routine restorations (3)

Answer 1

1. Which teeth contact in ICP, RCP and is the tooth involved in guidance?
2. Complete the restoration
3. Now check the ICP and RCP contacts again, and
   protrusive/lateral excursions

Question 2

For crowns and bridges define case (2)

Answer 2

Conformative
 Usually smaller no. of units (1-2)
 No guiding teeth
 No interferences
-easier case?
-complex case?
Reorganised – always complex
 Multiple units
-increase in OVD
-full mouth rehab

Question 3

Is the facebow necessary for conformative or reorganisation cases? (1)

Answer 3

Usually only to reorganise the occlusion

Question 4

Steps before preparation of conformative “easier” cases (4)

Answer 4

Assess contacts in ICP – Shimstock or GHM
 Adjacent teeth
 Contralateral side
Assess RCP contacts
Assess guidance in excursions
Study casts

Question 5

Temporary for conformative “easier” cases (1)

Answer 5

Ideally use an impression of the current tooth, or get a lab-made stent to construct a pro-temp temporary

Question 6

Fitting crowns and bridges: try-in (4)

Answer 6

 ICP + RCP - same as on initial examination?
 Lateral excursions - guidance (working) and non working
 Protrusive excursions.
 Check interproximal contacts, contour

Question 7

Fitting crowns and bridges: fit (2)

Answer 7

 Re-check ICP, guidance and fremitus.

 TAKE CARE when cementing that restoration is fully seated

Question 8

Conformative “complex” cases are defined by (3)

Answer 8

3+ units
Any unit if guiding
Difficult occlusions, especially:
 Class 2 div II – If restoring anterior teeth
 Class 3/AOB - If restoring posterior teeth

Question 9

Why use a facebow? (2)

Answer 9

Records the spatial orientation of the upper teeth relative to the condyles.
Allow correct positioning of the UPPER model. Lower model is mounted to the upper using interocclusal record.
Therefore:
 Allows you to assess the casts in occlusion, with ICP, RCP, protrusive and lateral excursions as close as possible to pt’s natural occlusion
 Allows lab to construct a crown/ bridge taking into
account above factors - less adjustment in the clinic
 Can customise guidance

Question 10

When are reorganising cases used (5)

Answer 10

 When changing the current occlusal scheme where current occlusal scheme is detrimental eg. In wear cases where canine guidance has been lost, or changing RCP contact due to recurrent restoration failure.
 Multiple restorations in multiple quadrants.
 When increasing the vertical dimension.
 Full-mouth re-hab cases.
 If restoring a guiding tooth, consider current occlusal scheme and whether benefit could be gained by adjustment