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BDS3 Operative Dentistry > Treatment Planning For Fixed Pros > Flashcards

Treatment Planning For Fixed Pros Flashcards

1
Q

What is the definition of fixed prosthodontics?

A

The area of pros focused on permanently attached (fixed) dental prostheses. Such dental restorations are also referred to as indirect restorations

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2
Q

Give examples of fixed pros restorations? (4)

A
  • Veneers
  • Inlays and onlays
  • Crowns
  • Bridgework
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3
Q

What do we want to include in a history an examination? (8)

A
  • Patient complaint
  • History of presenting complaint
  • Past dental history
  • Past medical history
  • Social history
  • Family history
  • Extra-oral examination
  • Intra-oral examination
  • All of this should allow you to come up with a provisional diagnosis
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4
Q

What would we include in an extra-oral examination? (5)

A
  • TMJ
  • MOM
  • Symmetry
  • Lips (vermillion borders, commissures, smile line)
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5
Q

What is a high smile line?

A
  • There is a bit of gingivae exposed and can see the top of the teeth
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6
Q

What is a middle smile line?

A
  • Can see a little bit of the interproximal gingival tissue
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7
Q

What is a low smile line?

A
  • No gingivae is seen
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8
Q

What kind of smile line is generally better for fixed pros?

A
  • In fixed pros low is better as sometimes want to hide margins of restorations as they can be hard to look natural
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9
Q

What would we look for in an intra-oral examination? (7)

A
  • Look at whole mouth first before individual teeth
  • Soft tissues
  • Buccal mucosa
  • Tongue (lateral borders, dorsum)
  • Sublingual tissues/floor of mouth
  • Palate (hard, soft)
  • Lips
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10
Q

When doing a dental history how would we check periodontal health?

A
  • BPE
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11
Q

When doing a dental history how would we check the dentition? (4)

A

Chart teeth

  • Present and missing teeth
  • Restorations
  • Caries
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12
Q

When doing a dental history what would we check for the occlusion? (4)

A
  • Incisal relationship
  • Excursions of the mandible (protrusion, retrusion, lateral)
  • Canine guidance?
  • Group function?
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13
Q

When taking a history and examination we would also look at inter-arch space and inter-tooth space (mesio-distal)

A

:)

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14
Q

Give examples of special investigations we might take for fixed pros?

A
  • Sensibility testing
  • Radiographs
  • Study models
  • Face bow
  • Diagnostic wax up
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15
Q

When using a radiograph as a special investigation what would we look for? (6)

A
  • Caries (restorability)
  • Tooth/root fractures
  • Periapical pathology
  • Bone levels (mobile teeth)
  • Existing large restorations (direct or indirect)
  • Assessment of potential abutment teeth
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16
Q

Why is it good practice to get a set of study models made when making fixed pros?

A
  • So when patient is away we can consider our options further
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17
Q

What is a facebow used for?

A
  • A means of recording the hinge axis of the patient
  • TMJ acts as a hinge axis
    Relationship between where maxillary bone is sitting to where the TMJ hinge axis is - face bow allows you to replicate this relationship of the patients on an articulator
    This means the lab has an accurate representation of the patients mouth to work on
    Use bite block/record to place the lower arch in relation to the upper arch
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18
Q

How do we use a facebow?

A
  • Comes in 2 bits
  • Bite fork - put soft aluminium wax on it and press up into maxilla
  • Face bow goes into patients ears and that is because the ears sit very close to where the TMJ is
  • Have a little guide that you then use to line up and swing across an arm that touched just below the orbit
    In order to get this touching might need to slide things about which connects to the face bow - tighten this all together and sent to lab
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19
Q

Why might we want to do a diagnostic wax up?

A
  • Can do a mock on the model to see what the finished restoration is going to look like
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20
Q

What is additional information we might want to know prior to creating a fixed prosthodontic restoration? (5)

A
  • Diet diary
  • Plaque and gingivitis indices
  • Full mouth periodontal chart
  • Clinical photographs
  • Microbiology, biopsy, haematology (these are a lot more rare to do)
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21
Q

When treatment planning, what are the different stages? (5)

A
  • Immediate
  • Initial
  • Re-evaluation
  • Reconstructive
  • Maintenance
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22
Q

What would we include in the IMMEDIATE part of a treatment plan? (3)

A
  • Relief of acute symptoms
  • Consider endodontics and extractions
  • Consider immediate denture/bridge
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23
Q

What would we include in the INITIAL part of a treatment plan? (6)

A
  • Extraction of hopeless teeth
  • OHI and dietary advice
  • HPT
  • Management of carious lesions and defective restorations with direct restorations or provisional restorations
  • Endodontics
  • Denture design, wax up for fixed prosthodontics
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24
Q

What would we include in the RE-EVALUATION part of a treatment plan? (1)

A
  • Re-assessment of periodontal stasis, confirm denture/bridge design (to see if disease control phase had worked)
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25
Q

What would we include in the RECONSTRUCTIVE part of a treatment plan? (2)

A
  • Perio surgery
  • Fixed and removable prosthodontics (this is not something that you should be diving into early on if the patient has active disease etc)
26
Q

What would we include in the MAINTENANCE part of a treatment plan? (1)

A

Supportive periodontal care and review of restorations

27
Q

When deciding which treatment to go for, what factors influence this? (6)

A
  • Dentist (knowledge + examination)
  • Patient preference
  • Medical factors
  • Costs
  • Time
  • Dental factors
28
Q

What are the key decisions to make in regards to fixed pros work? (3)

A
  • Keep tooth or extract?
  • If to be kept, what type of restoration?
  • What tooth preparation is necessary?
29
Q

What is preparatory treatment?

A
  • This is another thing that we need to consider

- For example if we have active endodontic disease we have to provide endo treatment prior to fixed pros

30
Q

Why might we place veneers? (5)

A
  • Improve aesthetics
  • Change teeth shape/or contour
  • Correct peg-shaped laterals
  • Reduce or close proximal spaces and diastemas
  • Align labial surfaces of instancing teeth
31
Q

What is the Gurel minimal preparation technique? (5)

A
  • Wax up
  • Stent
  • Intra-oral mock up
  • Preparation into mock up (can use depth cut burs)
  • Ideally wanting to remain within enamel when preparing tooth
32
Q

When would we not want to use veneers? (11)

A
  • Poor OH
  • High caries rate
  • Interproximal caries and/or unsound restorations
  • Gingival recession
  • Root exposure
  • High lip lines (not a contraindication but need to proceed with more caution)
  • If extensive prep is needed (>50% of surface area no longer in enamel) - consider alternatives
  • Labially positioned, severely rotated and overlapping teeth
  • Extensive TSL/insufficient bonding area
  • Heavy occlusal contact
  • Severe discoloration
33
Q

Why might we restore teeth with inlays/onlays? (5)

A
  • Tooth wear cases (increased OVD)
  • Fractured cusps
  • Restoration of root treated tooth (onlays provide cuspal coverage)
  • Replace failed direct restorations
  • Minor bridge retainers (not recommended)
34
Q

Why might we not want to restore teeth with inlays/onlays? (3)

A
  • Active caries and periodontal diseases
  • Time (tooth preparation and laboratory fabrication required)
  • Cost
35
Q

Why might we restore teeth with crowns? (5)

A
  • To protect weakened tooth structure
  • To improve or restore aesthetics
  • For use as a retainer for fixed bridgework
  • When indicated by the design of an RPD (Rest seats, clasps, guide planes)
  • To restore tooth function (e.g. to restore OVD)
36
Q

Why might we not restore teeth with crowns? (5)

A
  • Active caries and periodontal disease
  • More conservation options available
  • Lack of tooth tissue for preparation
  • Unable to provide post and core
  • Unfavourable occlusion
37
Q

What are the 6 principles of crown preparation that is going to maximise the success of the crown?

A
  1. Preservation of tooth structure
  2. Retention and resistance
  3. Structural durability
  4. Marginal integrity
  5. Preservation of the periodontium
  6. Aesthetic considerations
38
Q

How many teeth prepared for a crown will become non vital?

A

1 in 5

39
Q

The first principle of crown preparation is preservation of tooth structure. Explain this further?

A

Whenever possible preserve sound tooth structure to avoid:

  • Weakening the tooth structure unnecessarily
  • Damage to the pulp
  • Degree of preparation you need to do depends on the material
    Where only have metal material can get away with thinner preparation
    Anywhere with porcelain has to be thicker - so preparation is more extensive to allow adequate depth of porcelain
40
Q

When determining how much tooth structure to remove for a crown what must we have a balance between?

A
  • Must balance against criteria for retention and resistance and structural durability
41
Q

What can under preparation for a crown result in? (2)

A
  • Poor aesthetics

- Over built crown with periodontal and occlusal consequences

42
Q

What can over preparation for a crown result in?

A
  • Pulp and tooth strength being compromised
43
Q

What is retention in relation to a crown?

A
  • Prevents removal of the restoration along the path of insertion or the long axis of the tooth preparation
44
Q

What is resistance in relation to a crown?

A
  • Prevents dislodgement of the restoration by forces directed in an apical or oblique direction and prevents any movement of the restoration under occlusal forces
45
Q

What are retention and resistance largely affected by? (4)

A
  • Taper - ideal inclination of opposing walls 6 degrees (if over taper then have multiple paths of insertion which makes it less retentive)
  • Length of the walls
  • Extra means of retention (grooves, slots)
  • Path of insertion
46
Q

How does the length of the walls affect retention and resistance?

A
  • Longer walls interfere with tipping displacement
  • Want as tall a wall preparation as you can get - if crown is going to become dislodged you have a longer distance that it needs to slide before it can just lift off the tooth
47
Q

What is the path of insertion?

A
  • Imaginary line along the restoration will be placed onto or removed from the preparation
  • It is set before the preparation is begun and all the features of
    the preparation must coincide with that line
  • We want a single path of insertion
48
Q

How can retention be improved?

A
  • By limiting the number of paths of insertion
49
Q

The restoration must contain a bulk of material that is adequate to withstand the forces of occlusion. How is this achieved? (3)

A
  • Occlusal reduction
  • Functional cusp bevel
  • Axial reduction
50
Q

Why do we want to have a functional cusp bevel when preparing for a crown?

A
  • If don’t bevel functional cusp will have a sharp bit which will tend to fracture on occlusal load
51
Q

When doing axial reduction of a tooth how do we want to do this?

A
  • Want to reduce the tooth in at least 2 planes labially
52
Q

What are the 2 most likely margin finishes to be used for a crown preparation?

A
  • Chamfer and shoulder margins
53
Q

Give examples of margin finish line configurations? (5)

A
  • Knife edge
  • Bevel
  • Chamfer
  • Shoulder
  • Bevelled shoulder
54
Q

In order to preserve the periodontium, margins of the restoration should be,,,? (3)

A
  • Smooth and fully exposed to a cleansing action
  • Placed where the dentist can finish them and the patient can clean them
  • Placed at gingival margin whenever possible (placement of the margins subgingival may be required)
55
Q

What is biological width?

A
  • The height from the most superior part of the alveolus to the base of the gingival sulcus
  • Don’t want to encroach on the BW cause will cause patient to get gingival recession
56
Q

What considerations do we need to make in relation to the material for crowns? (4)

A

consider which material:

  • Provides the best aesthetics
  • Has the least destructive preparation
  • Is the least destructive to opposing teeth
  • Is best suited to bruxists
57
Q

Why when thinking about material of crowns do we need to think about the nest material for bruxists?

A
  • Sometimes patients who are bruxists of have heavy occlusion
  • Ceramic can cause tooth wear so sometimes all ceramic crowns on the upper anrteiror teeth is not a good ideal for these patients as they can wear away their lower teeth
  • Better option would be metal ceramic with metal on the palatal part of teeth to prevent wear of the lower incisors
58
Q

What do we need to think about when planning bridgework? (6)

A
  • Aesthetics
  • Occlusal stability (prevent tilting and overeruption of adjacent and opposing teeth)
  • Function (mastication, speech, wind instrument players)
  • Periodontal splinting
  • Restoring occlusal vertical dimension
  • Patient preference
59
Q

When planning bridgework, why might we not replace teeth? (5)

A
  • Damage to tooth and pulp
  • Secondary caries
  • Effect on the periodontium
  • Cost
  • Failures
60
Q

What are the different types of bridge design? (7)

A
  • Cantilever
  • Fixed-fixed
  • Adhesive/resin bonded/resin retained
  • Conventional (crowns on either side)
  • Hybrid
  • Fixed-removable
  • Spring cantilever
61
Q

When communicating with patients we must do this in both written and verbal form. What must we tell the patient prior to treatment to allow us to obtain informed consent? (12)

A
  • Invasiveness/reversibility
  • Likely prognosis and success rates (evidence based)
  • Possible complications
  • Time involved
  • Costs
  • Alternative options
  • Why treatment is to be performed
  • Why it is necessary
  • Consequences of not having treatment
  • What risks may be involved (material risks)
  • What alternatives are there (and their risks)
  • Relative costs
62
Q

We must ensure we have obtained informed consent from the patient and must also ensure to document this. Why is this so important?

A

Because the patient may claim:

  • Did not know what treatment was being provided
  • Did not know the cost implications
  • Received no warnings about the risks involved
  • Was not aware of alternative options
  • Did not give consent

BDS3 Operative Dentistry (3 decks)

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