Treatment Planning for Fixed Prosthodontics Flashcards
What is fixed prosthodontics?
Area of prosthodontics focused on permanently attached (fixed) dental prostheses
List some examples of fixed prosthodontics (4)
- Veneers
- Inlays/onlays
- Crowns
- Bridgework
What to look for extra-orally (5)
- TMJ
- MOM
- Lymph nodes
- Symmetry
- Lips
- Vermillion borders
- Commissures
- Smile lines
What to look for intra-orally (5)
- Whole mouth
- Soft tissues
- Buccal mucosa
- Tongue (lateral borders + dorsum) - Sublingual tissues/floor of mouth
- Palate (Hard/ soft)
- Lips
What to look for in the occlusion section of the hx + examination
- Incisal relationship
- Excursions of the mandible
- Protrusion
- Retrusion
- Lateral - Canine guidance or grouped function
- Inter-arch space
- Inter-tooth space (mesio-distal)
What do sensibility tests check for?
Vitality of teeth
Examples of special investigations (9)
- Sensibility testing
- Radiographs
- Study models
- Facebow
- Diagnostic wax up
- Diet diaries
- Plaque + gingivitis indices
- Clinical photographs
- Microbiology, biosy, haematology
When do we need a facebow?
If placing any restorations on teeth involving guidance (canines)
If you’re changing anything about a patients occlusion
- Contact points or occlusal vertical dimension
Tx planning headings (5)
- Immediate
- Initial (disease control)
- Re-evaluation
- Reconstructive
- Maintenance
What happens in the immediate phase of tx planning? (3)
- Relief of acute symptoms
- Consider endo + extractions
- Consider immediate denture/bridge
What happens in the initial phase of tx planning? (6)
- Extractions of hopeless teeth
- OHI + dietary advice
- HPT
- Management of carious lesions + defective resto’s with direct restorations or provisional restorations
- Endodontics
- Denture design
What happens in the re-evaluation phase of tx planning?
Re-assessment of periodontal status, confirm denture/bridge design
What happens in the reconstructive phase of tx planning?
- Perio surgery
2. Fixed + removable prosthodontics
What happens in the maintenance phase of tx planning?
Supportive periodontal care + review of restorations
Why is fixed pro’s more expensive and more time consuming?
Requires tooth prep + need a lab stage + fixed stage
Disadvantages of fixed pro’s (2)
- Time
2. Cost
Why are crowns not a 1st option? (5)
- For patients with active caries + periodontal disease
- More conservative options available
- Lack of tooth tissue for prep
- Unable to provide post + core
- Unfavourable occlusion
List the principles of crown preparation (6)
- Preservation of tooth structure
- Retention + resistance
- Structural durability
- Marginal integrity
- Preservation of periodontium
- Aesthetic considerations
Why do we want to preserve sound tooth structure?
Pulp + tooth strength weakened / compromised
Disadv of overprepping for a crown?
Tooth likely to fracture and reach pulp
What type of material requires a thinner prep?
Metal materials
What type of material requires a thicker prep?
Porcelain - as it has adequate strength
Disadc of underprepping for a crown?
- Poor aesthetics
2. Over built crown with PDL + occlusal consequences
What does retention prevent?
Prevents removal of the restoration along the path of I or the long axis of the tooth prep
What does resistance prevent? (2)
- Prevents dislodgement of the restoration by forces directed in an apical or oblique direction
- Prevents any movement of the restoration under occlusal forces
How is retention achieved in crowns?
- Taper between 5-7 degrees
- Grooves
- Slots
Why are longer walls better for a crown?
If the crown is going to be dislodged it has a longer wall to slide up the tooth before it lifts off the tooth
Why are shorter walls worse for a crown?
The crown doesn’t have v far to slide before its over the top of the tooth
How is retention improved?
By limiting the paths of I
What is structural durability?
Restoration must contain a bulk of material that is adequate to withstand the forces of occlusion
How is structural durability achieved? (3)
- Occlusal reduction
- Functional cusp bevel
- Axial reduction
What is a functional cusp?
The cusp that deals with occlusal vertical load
How is marginal integrity achieved?
FINISHES
- Knife edge finish
- Bevel
- Chamfer
- Shoulder
- Bevelled shoulder
When is a chamfer used?
- Veneers
- Any restoration where the outside surface is made of metal
When is a shoulder used?
Crowns
- Ceramics
How is preservation of the periodontium maintained?
Margins of the restorations should be:
- Smooth + fully exposed to a cleansing action
- Placed where the dentist can finish them + patient can clean them
- Placed at gingival margin whenever possible
- Placement of margins subgingival if required
Whatis the biological width?
The height from the most superior aspect of the alveolus to the base of the gingival sulcus
Why might you consider composite ceramic crowns?
Best tooth colour
Why might you avoid composite ceramic crowns?
Nor as strong as metal ones
Can cause toothwear - avoid in bruxism patients / strong bites
OPT for Metal ceramic crowns instead
List the different types of crowns (4)
- Metal crowns
- Ceramic crowns
- Metal ceramic crowns
- All ceramic crowns
Bridgework:
List some reasons why we replace teeth
- Aesthetics
- Occlusal stability
- Preventing tilting + over-eruption of adjacent + opposing teeth - Function
- Mastication + speech + wind instrument players - Periodontal splinting
- Restoring OVD
- Patient preference
Bridgework:
List some reasons we wouldn’t replace teeth (5)
- Damage to tooth + pulp
- Secondary caries
- Effect on periodontium
- Cost
- Failures
What are some examples of bridge designs (4)
- Cantilever
- Bridge held onto an adjacent tooth on 1 side - Fixed-fixed
- Prosthetic tooth held on by 2 restorations on either side - Adhesive/resin bonded
- Conventional
What must we communicate to the patient before any fixed pro’s work? (6)
- Verbal + written consent
- Invasiveness / reversibility
- Likely longevity + success rate
- Possible complications
- Time involved
- Costs
- Alternative options
What makes up informed consent? (6)
- Tx to be performed
- Why
- Consequences of no tx
- Risks (material risks)
- Alternatives
- Relative costs
