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Fixed Prostodontics 2 > Treatment Planning & Biomechanics > Flashcards

Treatment Planning & Biomechanics Flashcards

1
Q

What is a Fixed Partial Denture (Bridge)?

A

-A dental prosthesis definitively attached to remaining teeth or to dental
implants, which replaces one or more missing teeth.

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2
Q

Abutment –

A

Natural tooth or implant serving as attachment for Fixed Partial Denture

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3
Q

Retainer –

A

Extra-coronal restoration cemented to abutment

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4
Q

Pontic –

A

Artificial tooth suspended from abutments

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5
Q

Connector –

A

Rigid (or non-rigid) connecting pontic and retainers

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6
Q

Edentulous Ridge –

A

The site of the alveolar bone and its covering soft tissues that remains after tooth
loss.

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7
Q

Consequences of Unrestored tooth loss.
Tooth Movement
(4)

A

-Over-eruption
-Tilting and drifting
-Disruption of occlusion
-Pain, TMJ disfunction

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8
Q

Consequences of Unrestored tooth loss.
No tooth Movement
(1)

A

for some reason, some teeth never move
after loss of proximal or opposing contact.

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9
Q

— are produced when a FPD is made to the
over-erupted dentition.

A

Occlusal interferences

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10
Q

skipped
Opposing tooth being restored to a corrected occlusal plane
prevents interferences. This however, may require treatment.

A

Odontoplasty, restoration, crown, RCT, crown lengthening, intrusion,
or even extraction.

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11
Q

When teeth have been missing
for a long time, extreme closure
of the inter-occlusal distance
can occur which requires

A

more
extreme treatment planning
and for the general dentist,
likely a referral to a
prosthodontist for treatment of
this complexity.

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12
Q

Partially Edentulous Patient
– Selection of the type of Prosthesis. Options:
(4)

A

-Removeable Partial denture
-Tooth supported Fixed Partial Denture
-Implant supported Fixed Partial Denture
-Always the option to do nothing.

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13
Q

-Tooth supported Fixed Partial Denture
(3)

A

-Conventional
-Resin-Bonded
-Cantilever

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14
Q

Indications for Removable Partial Denture:
(6)

A

-Long edentulous spans
-No distal abutment
-Multiple Edentulous spaces
-Abnormal abutments – Tipped, divergent or
few abutments
-Periodontally weakened primary abutments
(Bridge abutments compromised)
-Severe loss of tissue/bone in residual ridge

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15
Q

skipped
Could a bridge be placed from 11-14 – YES!
What information would you need to know to
determine the prognosis of a fixed bridge for
treatment planning?

A

X-rays
Perio charting
Decay prevention
Home care
Reason for previous tooth loss
Clencher/grinder?
Finances?
Condition of existing crowns #11 and #14
What else?

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16
Q

Fixed Partial Denture

A

A dental prosthesis definitively attached to remaining
teeth or dental implants, which replaced one or more
missing teeth.

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17
Q

Indications for a Fixed Partial Denture
(3)

A

-To replace function of missing teeth
-To stabilize occlusion and keep teeth from drifting and extruding
-To create esthetics and phonetics

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18
Q

Need Properly distributed abutments
(3)

A

Abutment on both ends of the edentulous space
Span length falls within structural limits
Straight alignment of restoration (slight variations)

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19
Q

Abutment strength
(4)

A

Abutments need to be restorable
Peridontally sound and stable
No questionable pathology (PARL, non-vital)
Occlusal harmony

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20
Q

Contraindications for Fixed Partial Denture
(3)

A

Excessive loss of alveolar ridge
Abutments not restorable
Abutments are periodontally compromised

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21
Q

Excessive loss of alveolar ridge
(3)

A

Difficultly cleaning
Difficult to make esthetic
**Possibly able to correct to some degree with bone graft/augmentation with
periodontal surgery

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22
Q

Abutments not restorable
(2)

A

Short clinical crown
Heavily restored already

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23
Q

Abutments are periodontally compromised
(4)

A

Loss of bone
Crown to root ratio
Span between abutments too long
***Virgin or minimally restored abutments? Prefer to pursue implant options to preserve
these potential abutment teeth.

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24
Q

What does an ideal Fixed Partial Denture look like?
(3)

A

-Periodontally sound abutments
-Tissue follows contour of pontic and connector
-Span is within structural parameters

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25
Q

What are the criteria we use for Abutment
evaluation?
Restorative assessment –
(2)

A

Coronal tooth structure
Previous restorative treatment

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26
Q

What are the criteria we use for Abutment
evaluation?
Endodontic assessment –
(2)

A

What is the pulp status
PARL? Previous endo in-tact?

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27
Q

What are the criteria we use for Abutment
evaluation?
Periodontal assessment –
(2)

A

Crown to root ratio, Root configurations, Periodontal surface area

28
Q

What are the criteria we use for Abutment
evaluation?
Abutment positional assessment –
(1)

A

Is the tooth tilted, inclined, etc? What is the tooth orthodontic position? Path of
Insertion achievable?

29
Q

What are the criteria we use for Abutment
evaluation?
Radiographic assessment –

A

anomalies present?

30
Q

What are the criteria we use for Abutment
evaluation?
(3)

A

Clinical exam
Radiographic exam
Diagnostic casts (articulated on full-
size articulator w/ facebow)

31
Q

Abutment Evaluation – Coronal Tooth Structure
Remove all caries, old restorations, then evaluate:
-endo: (3)
-Proximity of cavity depth to
-BWX –
-Adequacy of

A

Pulp Exposure, symptomatic tooth, Periapical
pathology?
alveolar crest
Biologic width violation likely?
retention/resistance form

32
Q

Abutment Evaluation – Pulpal Health
-Vital tooth?

A

– tooth asymptomatic
with sound tooth structure
remaining

33
Q

Abutment Evaluation – Pulpal Health
Non-vital tooth?

A

– RCT if sound
tooth structure remaining. Post
may be needed.

34
Q

Abutment Evaluation – Pulpal Health
Existing RCT?

A

– Assess first. PARL?
Healthy RCT? Over fill? Previous
post adequate?

35
Q

skipped
Abutment Evaluation – Pulpal Health
Questionable?

A

– deep excavation,
near pulp exposure, pinpoint
exposure, inadequate RCT or
post? Address previous RCT and
retreat, replace post

36
Q

Current PA radiographs (less
than — months old) to confirm
health of abutments.

A

6

37
Q

Periodontal health is a prerequisite for any fixed prosthodontic
restorations
(3)

A

-Need a zone of attached tissue
- No mobility
-Patient home care adequate

38
Q

Additionally – (3) all need to be assessed and evaluated.

A

Crown to root ratio, Root shape and configuration,
Periodontal ligament area

39
Q

The ratio of the portion of the tooth occlusal to the alveolar crest (crown) versus the portion of
the tooth embedded in bone (root).
Optimum C:R is
Minimum C:R is — for fixed restorations

A

2:3
1:1

40
Q

Horizontal bone loss dramatically
reduces

A

supported root surface area

41
Q

The — root shape diminishes the
actual area of support more than
expected from the height of the bone

A

conical

42
Q

The center of rotation (R) moves
— and the lever arm (L)
—, greatly magnifying the
forces on the supporting structures.

A

apically
increases

43
Q

The center of rotation (R) moves
apically and the lever arm (L)
increases, greatly magnifying the
forces on the supporting structures.
This can

A

increase tooth mobility, further
bone loss, and ultimately failure of the
FPD.

44
Q

Abutment Evaluation – Periodontal Health –
Crown to Root ratio
Exception to Crown to root ratio
guidelines:

A

If opposing occlusal forces are
diminished such as:
Artificial teeth (Full denture, RPD)
Periodontally compromised
opposing teeth

45
Q

Abutment Evaluation – Periodontal
Health – Root Configuration
(3)
root #
wide/fused
length

A

Multi-rooted teeth are better than single
rooted teeth, conical teeth.
Widely separated roots are better
abutments than fused roots.
Long roots are better abutments than
short roots.

46
Q

Single Rooted teeth –

A

Irregular configurations or
curvatures are preferable compared to a perfect
taper.

47
Q

— Facial-Lingual than Mesio-Distal preferred
to round.

A

Broader

48
Q

Ante’s Law :

A

The root surface
area (embedded in bone) of
the abutment teeth should be
equal or surpass that of the
teeth being replaced with
pontics.
**NOTE – these are
comparative numbers.

49
Q

Ante’s Law
General principle –

A

any FPD replacing more than 2 posterior
teeth has guarded prognosis
-Maxillary arch has longer crowns and less tooth
inclinations and therefore can occasionally be
acceptable.

50
Q

skipped
Abutment Evaluation – Periodontal Health –
Root Surface – Ante’s Law
Shortcomings of Ante’s Law

A

Dr Shashikala Jain. 2011. Heal Talk
-The suggested ratio cannot be made standard for all patients as individual variations
in crown root ratio, root morphology and bone exist.
-Occlusal scheme which is the key factor has not been considered at all.
-Failure in FPD’s are more due to biomechanical factors like caries, gingival
inflammation, poor framework design, poor occlusion and material failure than due to
overstressing of periodontal ligaments.
-Studies have revealed successful FPD’s supported by periodontally weakened teeth.

51
Q

Abutment Evaluation – Periodontal Health –
Root Surface – Ante’s Law
Conclusion:

A

“Occlusion is the key to success. Even the worst cases with doubtful
prognosis had good success rates when occlusion was right.”

52
Q

skipped
Abutment Evaluation – Path of Insertion

A

Axial walls of abutment teeth must
be aligned without undercuts or
interferences with path of insertion
of the bridge.
Tipped tooth? – can be very
difficult to prepare effectively.
-expose mesial pulp horn
-unfavorable occlusal forces if tilt
is too significant
-Possible orthodontic uprighting
prior to preparation

53
Q

Abutment Evaluation – Path of Insertion –
Use of Diagnostic Casts
Casts can and should be used to

A

visualize the
indications and contra-indications for FPD
treatment.

54
Q

Casts should be accurate
(2)

A

–Alginate too dry or absorbed too much water
create defects
–Casts should be mounted with facebow if
needed

55
Q

skipped
Using casts, you can evaluate:
(6)

A

-Edentulous spaces and span length
-Curvature of the arch
-M-D drifting, rotations, F-L displacement of the
abutments
-Inclination
-Occlusion and inter-occlusal space
-Path of Insertion

56
Q

Abutment Evaluation – Path of Insertion –
Use of Diagnostic Casts
When teeth are not perfectly aligned
(which is nearly every time), a
— can be used to identify the
path of insertion and to help you
create the appropriate planes in
tooth preparation to create a path of
insertion.

A

surveyor

57
Q

skipped
Abutment Evaluation – Radiographs
(6)

A

-Caries – Where and how much
-RCT present?– is it healthy?
-Bone levels – C:R ratio,
direction of roots, PDL widened,
bone loss
-Thickness of soft tissue
-Maxillary sinus
**Should be within 6 months for
fixed procedures.

58
Q

Partially Edentulous Patient – Resin-bonded
Fixed Partial Prosthesis
-Also known as
-Conservative — only preparation

A

Marilyn Bridge
enamel

59
Q

Partially Edentulous Patient – Resin-bonded
Fixed Partial Prosthesis
-Used for
-Only areas of
-Not indicated for
-Excellent option in
-Most often used to replace missing

A

single missing tooth with slight to moderate tissue
resorption in missing tooth area
light occlusal stresses and good alignment with
neighboring teeth
deep vertical overlaps (Deep bite)
younger patients where age contraindicates
implant or bridge
maxillary lateral incisors

60
Q

Cantilever Fixed Partial Prosthesis

A

A fixed partial denture that has an
abutment(s) at one end with the pontic
remaining unconnected on the other end.

61
Q

Partially Edentulous Patient – Selection of the type of
Prosthesis. Options: Implant supported FPD
Indications:
(4)

A

-Implant abutments are soundly integrated
-Implant parallelism
-Availability of bone to support implant
-Patient demonstrates adequate home care

62
Q

Partially Edentulous Patient – Selection of the type of
Prosthesis. Options: Implant supported FPD controversial – implant to tooth bridge
-Can natural tooth handle implant stresses?
Implant cantilever bridge
–Clear Choice and others
fabricate full arch one piece
fixed appliance.
–$25,ooo per arch
–Patient cannot
– — is a huge challenge here.
–Need to be replaced around
every – years with current
materials.

A

remove
Hygiene
10

63
Q

Partially Edentulous Patient – Selection of the type of
Prosthesis. Options: Implant supported FPD
Limitations of implant placement
(3)

A

Amount of bone critical
Location of bone critical
Anatomy

64
Q

Location of bone critical
— loading of implants needed for
best prognosis and this can be difficult to
achieve

A

Vertical

65
Q

Anatomy
(3)

A

–Maxillary sinus
–IAN
–Anterior angulation of bone

Fixed Prostodontics 2 (13 decks)

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