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Treatment Planning for Fixed Prosthodontics Flashcards

1
Q

fixed prosthodontics

A

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

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2
Q

types of fixed prosthodontics (4 main)

A

Veneers

Inlays and onlays

Crowns

Bridgework

Post and cores – mix fixed prosthodontics and endodontics

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3
Q

history and examination for fixed prosthodontics

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)

Lead to provisional diagnosis – problem list and treatment plan deals with this

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4
Q

extra oral exam for fixed prosthodontics

A

TMJ

Muscles of mastication (MoM)

Lymph nodes

Symmetry

Lips

  • Vermillion borders
  • Commissures
  • Smile line

Prosthodontics is largely aesthetically driven

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5
Q

high smile line

A

High – teeth zenith exposed

hard prosthodontics

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6
Q

middle smile line

A

Middle – touch zenith teeth and small interproximal exposed

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7
Q

low smile line

A

Low – zenith and gingiva covered

ideal for fixed prosthodontics
- less technically demanding

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8
Q

intra oral exam for fixed prosthodontics

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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9
Q

part of dental examination for fixed prosthodontics

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)

special investigations and sensibility tests

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10
Q

what to look for on radiographs for fixed prosthodontics

A

? Caries
- ? Restorability

? Tooth fractures
- Able to hold prosthodontic?

? Periapical pathology
- Radiolucency – non vital

? Bone levels

  • Mobile teeth
  • adequate supported as subjected to occlusal loads

Existing large restorations (direct or indirect)

Assessment of potential abutment teeth

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11
Q

study models for fixed prosthodontics

A

can consider options when pt away

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12
Q

facebow

A

record the hinge axis of TMJ can be used to mount casts on semi adjustable articulator
- Replicate pt specific occlusion
Maxilla in the relationship with hinge axis
Mandible need occlusal wax bite or jet bite

Especially if tooth involved in guidance

  • Canines for canine guidance
  • Group guidance – several teeth

Changing anything to do with occlusion

  • OVD
  • Contact areas
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13
Q

diagnostic wax up

A

How teeth may function

  • Contact spots
  • Aesthetics etc
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14
Q

additional information gathered for fixed prosthodontics (5)

A

Diet diary

Plaque and gingivitis indices

Full mouth periodontal chart

Clinical photographs

Microbiology, biopsy, haematology – rare

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15
Q

4 stages of treatment planning

A

immediate

initial (disease control)

re-evaluation

maintenance

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16
Q

immediate treatment planning

A

Relief of acute symptoms

Consider endodontics and extractions

Consider immediate denture/bridge

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17
Q

initial treatment planning

A

(Disease Control)

Extraction of hopeless teeth

OHI and dietary advice – preventative plan

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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18
Q

re-evaluation treatment planning

A

Re-assessment of periodontal status, confirm denture/bridge design

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19
Q

reconstructive treatment planning

A

Perio surgery

Fixed and removable prosthodontics
- Final stage – start with OHI and dealing with making oral cavity in a healthy state

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20
Q

maintenance treatment planning

A

Supportive periodontal care and review of restorations

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21
Q

options for fixed prosthodontics driven by (6)

A

Dentist
- Best long term? Conservation?

Patient

  • Aesthetics? Cost?
  • Need a dialogue

Medical Facts
- allergies

Costs

Time
- Indirect – tooth prep, lab stage, fixed stage and additional apps sometimes

Dental Facts

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22
Q

what decisions need to be made about the teeth in Q

A

Keep the tooth or extract?

If to be kept, what type of restoration?
- What tooth preparation is necessary?

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23
Q

when may extract tooth rather than retain

A

extensive caries beyond alveolar ridge (cut off point for restorability)

Horizontal fracture through furcation

  • Constantly leak and thus fail
  • Sore for pt

LL6 has 2 posts (odd) caused a wedging effect and tooth fracture

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24
Q

alternative treatments to fixed prosthodontics (3 main)

A

Previously traumatised and RCT 21 incisor
- Discoloured
- Want to keep young women off restorative sliding scale
Internal and external bleaching – whitened tooth

large pattern off tooth loss
- Multiple missing posteriors
Bridge unsuitable – need RPD

Implants
- Worth discussing if feasible

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25
preparatory treatment for fixed prosthodontics may include
Endodontic Tx Hard if previous restorations present e.g. posts impinging on RCS - Egger device
26
why place veneers (5)
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
27
gurel mimmal preparation technique for veneers
Wax up Stent Intra-oral mock up Preparation into mock up (can use depth cur burs)
28
when not to use veneers (11)
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) - Consider alternatives – PJC, DBCs MCCs (veneers rely on chemical bond – best to enamel so if into dentine need some mechanical retention too) Labially positioned, severely rotated and overlapping teeth Extensive TSL/insufficient bonding area Heavy occlusal contacts Severe discolouration
29
why restore teeth with inlays/onlays (5)
Tooth wear cases - Increase OVD – prop anterior open due to posterior inlays - Decreased due to grinding (and attrition/erosion) Fractured cusps Restoration of root treated teeth - Onlays provide cuspal coverage Replace failed direct restorations Minor bridge retainers (not recommended)
30
when wouldn't provide inlay/onlay (4)
Active caries and periodontal diseases Time Tooth preparation and laboratory fabrication required Cost
31
why restore teeth with crowns (5)
To protect weakened tooth structure To improve or restore aesthetics For use as a retainer for fixed bridgework When indicated by the design of a RPD - Rest seats - Clasps - undercuts - Guide planes – single POI To restore tooth function - e.g. restore in OVD
32
why not restore teeth with crowns (5)
Active caries and periodontal disease More conservation options available Lack of tooth tissue for preparation very destructive preparation – explore more conservative options first Unable to provide post and core Unfavourable occlusion – want to distribute occlusal contact points evenly around mouth
33
principles of crown preparation
to maximise success of providing crowns 1. Preservation of tooth structure 2. Retention and resistance 3. Structural durability 4. Marginal integrity 5. Preservation of the periodontium 6. Aesthetic considerations
34
preservation of tooth structure for crown prep
Whenever possible preserve sound tooth structure to avoid: - Weakening the tooth structure unnecessarily - Damage to the pulp if tooth still alive (1 in 5 teeth become non vital when getting crowns – risk RCT) Under preparation results in: - Poor aesthetics (bulbous - crown made to right thickness; too thin looks bad) - Over built crown with periodontal and occlusal consequences Over preparation results in: - Pulp and tooth strength being compromised
35
under prep for crown
- Poor aesthetics (bulbous - crown made to right thickness; too thin looks bad) - Over built crown with periodontal and occlusal consequences
36
over prep for crown
- Pulp and tooth strength being compromised
37
what dictates degree of crown prep needed
Degree prep needed depend on material - Metal on outside – thinner prep - Porcelain involved – need to have thicker preparation Porcelain only really needed on visible aspects (e.g. not palatal or lingual) Must balance against criteria for retention and resistance and structural durability.
38
retention crowns
prevents removal of the restoration along the path of insertion or the long axis of the tooth preparation
39
resistances crowns
prevents dislodgement of the restoration by forces directed in an apical or oblique direction and prevents any movement of the restoration under occlusal forces
40
taper for crowns
ideal inclination of opposing walls is 6 degrees
41
length of walls for crowns
Longer walls interfere with tipping displacement | - More distance to slide before being able to slip off
42
2 ways of extra means of retention in crowns
grooves slot
43
path of insertion for crowns
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. - Usually long axis of tooth - Sometimes cusp from neighbouring tooth may impinge so need to alter path angle Check POI from birds eye view Retention is improved by limiting the number of paths of insertion.
44
how is retention improved for crowns
by limiting the number of paths of insertion.
45
structural durability of fixed prosthodontics
Restoration must contain a bulk of material that is adequate to withstand the forces of occlusion. - Thinner metals - Thicker ceramics Achieved through: - Occlusal reduction - Functional cusp bevel - Axial reduction
46
structural durability for fixed prosthodontics achieved through (3)
- Occlusal reduction - Functional cusp bevel - Axial reduction
47
occlusal reduction for fixed prosthodontics
2mm reduction for restoration
48
functional cusp bevel for fixed prosthodontics
Imp – cusp subjected under occlusal load If not – sharp area with constant forces lead to fracture Round off and remove sharp line angles
49
axial reduction for fixed prosthodontics
Tooth curves – convex shape Reduce the tooth in at least two planes labially - follow natural contour of tooth in labial, cervical and coronal aspects
50
marginal integrity for fixed prosthodontics
use chamfer or shoulder margins preserve periodontium
51
margins of fixed prosthodontics restorations should be (3)
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 do not encroach on biological width – height superior alveolar border to base sulcus - Recession and hard to clean
52
be careful with aesthetics Vs function
Consider which material : - Provides the best aesthetics? Will the restoration(s) be visible? Smile lines? - Has the least destructive preparation? - Is least destructive to opposing teeth? Is best suited to bruxists? - Pure Ceramic can cause tooth wear if bruxist - Need MCC metal on palatal is more malleable – softer and stronger - get hybrid MCC available
53
why replace teeth with bridge (6)
aesthetics occlusal stability - prevent tilting and overeruption of adj and opposing teeth function - mastication - speech - wind instruments periodontal splinting restoring OVD pt preference
54
why not replace teeth with bridge (5)
Damage to tooth and pulp Secondary caries Effect on the periodontium Cost Failures
55
bridge design types (2 main categories and then 4 sub types)
Cantilever – held on by one side Fixed-fixed – held on by restoration on either side ``` Adhesive/Resin-bonded/Resin retained “Conventional” (held on by crown) Hybrid Fixed-moveable Spring cantilever old, not used now ```
56
what does the pt need for informed consent of fixed prosthodontics
Invasiveness / reversibility Likely longevity and success rates(evidence based) Possible complications Time involved Costs Alternative options - Bleaching, composite (highlight if more conservative) communication - verbal - written (best)
57
what do pt need to provide informed consent for
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
58
why is it very important to record pt informed consent given
pts 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 alterative options - Did not give consent
59
who makes diagnostic wax ups
chair-side by operator or sent to lab to do | good to try and attempt for tooth morphology
60
veneer survival rate
approx 10 years
61
crown survival rate
10-15 years
62
bridge survival rate
resin bonded 5-10 years conventional 10 years

BDS3 Op Tech (10 decks)

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