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Operative Dentistry > Treatment Planning for Fixed Prosthodontics > Flashcards

Treatment Planning for Fixed Prosthodontics Flashcards

1
Q
A
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2
Q

What are the types of indirect restoration?

A

 Veneers
 Inlays and Onlays
 Crowns
 Post and cores
 Bridgework

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3
Q

What is included in the history and exam that provides a provisional diagnosis?

A

 Patient complaint (CO)
 History of Presenting Complaint (HPC)
 Past Dental History (PDH)
 Past Medical History (PMH)
 Social History (SH)
 Family History (FH)
 Extra-oral Examination(EO)
 Intra-oral Examination (IO)

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4
Q

What are the extra-oral sites to be examined?

A

 TMJ
 Muscles of mastication (MoM)
 Lymph nodes
 Symmetry
 Lips (vermillion border, commissures, smile line)

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5
Q

What are the intra-oral sites to be examined?

A

 Soft tissues
 Buccal mucosa
 Tongue
 Lateral borders
 Dorsum
 Sublingual tissues/Floor of mouth
 Palate
 Hard
 Soft
 Lips

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6
Q

What other exams do you do during the intial exam?

A

 Periodontal
 BPE
 Dentition
 Chart teeth
 Present and missing teeth
 Restorations
 Caries
 Occlusion
 Incisal relationship
 Excursions of the mandible
 Protrusion
 Retrusion
 Lateral
 Canine guidance?
 Group function?
 Inter-arch space
 Inter-tooth space (mesio-distal)

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7
Q

What are the special investigations?

A

Radiographs
Sensibility tests
Study models
Facebow
Diagnostic wax-up
Diet diary
Plaque indices
6PPC
Clinical photographs
Microbiology, Biopsy, Haematology

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8
Q

What radiographs should you take if the patient is edentulous?

A

periapical

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9
Q

What does a facebow measure?

A

measures relationship between hinge axis of TMJ and maxilla relationship

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10
Q

What part of treatment planning should fixed prosthodontics be?

A

reconstructive

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11
Q

What are the steps of treatment planning?

A

immediate
intial (disease control)
re-evaluation
reconstructive
maintenance

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12
Q

What are alternative options to fixed pros?

A

extract tooth
removable pros
implant

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13
Q

Why place veneers?

A

 Improve aesthetics
 Change teeth shape and/or contour
 Correct peg-shaped laterals
 Reduce or close proximal spaces and diastemas
 Align labial surfaces of instanding teeth

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14
Q

What technique is used for planning veneers?

A

gurel minimal prep technique
 Wax up
 Stent
 Intra-oral mock up
 Preparation into mock up (can use depth cut burs)

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15
Q

When should veneers not be an option?

A

 Poor OH
 High caries rate
 Interproximal caries and/or unsound restorations
 Gingival recession
 Root exposure
 High lip lines
 If extensive prep needed (>50% of surface area no longer in enamel)
 Labially positioned, severely rotated and overlapping teeth
 Extensive TSL/ insufficient bonding area
 Heavy occlusal contacts
 Severe discolouration

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16
Q

Why restore teeth with inlays/onlays?

A

 Toothwear cases
 Increase OVD
 Fractured cusps
 Restoration of root treated teeth  Onlays provide cuspal coverage
 Replace failed direct restorations
 Minor bridge retainers (not recommended)

17
Q

When would you not restore teeth with inlays/onlays?

A

 Active caries and periodontal diseases
 Time
 Tooth preparation and laboratory fabrication required
 Cost

18
Q

Why restore teeth with crowns?

A

 To protect weakened tooth structure
 To improve or restore aesthetics
 For use as a retainer for conventional bridgework
 When indicated by the design of a RPD
 Rest seats
 Clasps
 Guide planes
 To restore tooth function e.g.restore in OVD

19
Q

Why not restore with crowns?

A

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

20
Q

What are the principles of crown prep?

A
  1. Preservation of tooth structure
  2. Retention and resistance
  3. Structural durability
  4. Marginal integrity
  5. Preservation of the periodontium
  6. Aesthetic considerations
21
Q

What does under-prep result in?

A

 Poor aesthetics
 “Over built” crown with periodontal and occlusal consequences
 Restorations with insufficient thickness

22
Q

What does over-prep result in?

A

 Pulp and tooth strength being compromised

23
Q

What is retention?

A

 Prevents removal of the restoration along the path of insertion or the long axis of the tooth preparation

24
Q

What is resistance?

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

25
Q

What aspects of the prep of crowns determines retention and resistance?

A

 Taper: Ideal inclination of opposing walls 6-10o.
 Length of the walls
 Path of insertion
 Extra means of retention (Grooves, Slots)

26
Q

What do longer walls mean?

A

reduced tipping displacement

27
Q

What is the path of insertion?

A

Imaginary line along which the restoration will be place onto or removed from the preparation.
 Is set before the preparation is begun and all the features of the preparation must coincide with that line.

28
Q

What does limiting the paths of insertion do?

A

improve retention

29
Q

What aspects of design acheive structural durability?

A

 Occlusal reduction
 Functional cusp bevel
 Axial reduction

30
Q

What are the 5 finish line configurations for the margins?

A

(a) Knife edge
(b) Bevel
(c) Chamfer
(d) Shoulder
(e) Bevelled shoulder

31
Q

What finish line is used for metal/procelin crowns?

A

chamfer

32
Q

What finish line is used for ceramic/metal crowns?

A

shoulder

33
Q

What should the margins of the restoration be?

A
  1. Smooth and fully exposed to a cleansing action.
  2. Placed where the dentist can finish them and the patient can clean them.
  3. Placed supra-gingival or at gingival margin whenever possible.
34
Q

Why not replace teeth?

A

 Damage to tooth and pulp  Secondary caries
 Effect on the periodontium  Cost
 Failures

35
Q

What are the two shapes for bridge designs?

A

cantilever
fixed-fixed

36
Q

What are the methods of bridges?

A

 Adhesive/Resin-bonded/Resin retained
 “Conventional”
 Hybrid
 Fixed-moveable
 Spring cantilever

37
Q

What should you communicate with the patient?

A

 Invasiveness / reversibility
 Likely longevity and success rates (evidence based)
 Possible complications
 Time involved
 Costs
 Alternative options

38
Q

What should patients be informed for consent?

A

 What 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

Operative Dentistry (4 decks)

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