Treatment Planning (Pt. II)

Question 1

Replacement of Several Missing Teeth
• FDP is more difficult when ____ teeth must be replaced
• Problems encountered with ____ abutment teeth
– Especially when replacing ____ teeth simultaneously
• ____ of the problems involved in extensive prosthodontics can lead to failure
• ____ helpful for success

Answer 1

several
intermediate
anterior and posterior
underestimation
diagnostic

Question 2

Replacement of Several Missing Teeth

____ can act as fulcrum during function

Answer 2

middle abutment

Question 3

Replacement of Several Missing Teeth
• (1)Overloading of abutment teeth
– (a)____ of forces
– (b)____ area

• (2)Root shape and angulation
– (a)____ disease
– (b)____ length

• (3)Replacing ____ teeth

Answer 3

direction
root surface
periodontal
span
multiple anterior

Question 4

(1)Overloading of Abutment Teeth
• Important to consider ability of abutment teeth to accept applied forces
– Avoid ____ or mobility
– ____ increases forces on teeth

Answer 4

tooth drifting

parafunction

Question 5

(1)Overloading of Abutment Teeth
(a)Direction of Forces
• Difficult to regulate ____
• Want FDP to distribute forces by directing them down the ____ of the abutment teeth

Answer 5

magnitude of force

long axis

Question 6

(1) Overloading of Abutment Teeth
(b) Root Surface Area

• Ante’s Law
– The root surface area of abutment teeth should be ____ than the root surface area of the teeth being replaced
• Useful for determining the ____ of fixed dental prostheses
• Controversial
– Some studies have shown success with reduced ____

Answer 6

equal or greater
prognosis
bone support

Question 7

(1)Overloading of Abutment Teeth
Ante􏰀s Law
• Example
– If missing a first molar and second premolar, a four unit FDP is an ____ risk if no significant periodontal diseas

Surface area of 1st premolar and 2nd molar is greater than ____

Answer 7

acceptable

2nd premolar and first molar

Question 8

(2)Root Shape and Angulation

• When tooth support is borderline, ____ and ____ should be considered
– Example: molar with ____ roots provides better support than conical with little or no interradicular bone
– Example: a single rooted tooth with ____ cross section offers better support than ____ cross section
• ____ tooth provides better support than tilted one
– May need to orthodontically upright

Answer 8

shape of roots
angulation
divergent
ellipitical
circular
well-aligned

Question 9

(2) Root Shape and Angulation
(a) Periodontal Disease

• Healthy periodontal tissues are a prerequisite for all fixed restorations
– without healthy ____, the results can be disastrous
– Successful FDPs can be fabricated on teeth with severely reduced ____ if periodontal tissues have been returned to excellent health and long term maintenance is ensured

Answer 9

periodontal tissues

periodontal support

Question 10

(2)Root Shape and Angulation (a)Periodontal Disease

• Due to conical root shape, when ____ of root length is exposed, ____ supporting area is lost
– Forces applied are ____ because of greater ____ from lengthened clinical crown

Answer 10

1/3
1/2
magnified
leverage

Question 11

(2)Root Shape and Angulation (b)Span Length

• All FDPs ____ when occlusal load applied
• The longer the ____, the greater the flexing
– With long span FDP, pontics and connectors should be made as ____ as possible to ensure optimum rigidity
• Without compromising ____
• Prosthesis should have high strength and rigidity

Answer 11

flex
span
bulky
gingival health

Question 12

(2)Root Shape and Angulation (b)Span Length

• Excessive flexing under occlusal loads may cause \_\_\_\_ of FDP
– Fracture of \_\_\_\_
– Breakage of \_\_\_\_
– Loosening of \_\_\_\_
– Unfavorable \_\_\_\_ response

Answer 12

failure
porcelain veneer
connector
retainer
soft tissue

Question 13

(3)Replacing Multiple Anterior Teeth

• Loss of several maxillary anterior teeth is difficult
– ____ subject to tipping forces
– Need to use ____ as abutments

Answer 13

maxillary incisors

canines and first premolars

Question 14

(3)Replacing Multiple Anterior
Teeth

• Maxillary anterior
– Tooth contours, esthetics, phonetics difficult
– ____ essential
– ____ (provisional) to 􏰀test􏰁 contours, phonetics, esthetics

Answer 14

diagnostic wax up

interim restoration

Question 15

(3)Replacing Multiple Anterior
Teeth

• Severe anterior bone loss
– May need \_\_\_\_ to replace teeth and supporting tissues
• FDP only replaces missing teeth
– Evaluate \_\_\_\_
– Possible \_\_\_\_ to augment ridge

Answer 15

partial RDP
smile line
surgical intervention

Question 16

Fixed Dental Prosthesis
• FDP if possible
– Better ____ than partial RDP
– Preferred by most patients

Answer 16

health and function

Question 17

Partial Removable Dental Prostheses

• Indications
– No \_\_\_\_ abutment
– Long \_\_\_\_ span
– Considerable \_\_\_\_ in anterior region
• Where FDP would have unacceptable appearance

Answer 17

distal
edentulous
bone loss

Question 18

Multiple edentulous spaces often best restored with combination of ____

Answer 18

fixed and removable

Question 19

Proper ____ is very important to avoid mistakes

Answer 19

sequencing

Question 20

(1)Treatment of Symptoms

• Priority to relieve ____
• May not be able to complete full examination until symptoms addressed
• Nonacute problems may also need attention
– Examples:
• Lost ____
• Cracked or broken veneer
• Fractured ____

Answer 20

discomfort
anterior crown
RDP

Question 21

(2)Stabilization of Deteriorating Conditions

• Second phase of treatment is to stabilize conditions
– (a)____
– (b)____

Answer 21

dental caries

periodontal disease

Question 22

(a)Dental Caries

• Teeth restored with plastic materials
– May serve as foundation for future castings
• Cast restorations not recommended in patient’s with ____
– Due to ____ caries
– Recommend ____ and advice, oral hygiene instructions and fluoride treatment

Answer 22

active caries
recurrent
diet analysis

Question 23

(b)Periodontal Disease

• Chronic periodontitis with continuing irreversible bone loss should be treated with ____ and ____ (scaling and root planing)
– Teeth need to be ____ for effective plaque control
• Replace defective ____
• Remove ____ lesions
• Recontour ____ crowns (especially furcation region)
• Proper oral hygiene instructions

Answer 23

daily plaque control
dental cleaning
smooth
restorations
carious
overcontoured

Question 24

(3)Definitive Therapy
• (a)\_\_\_\_
• (b)\_\_\_\_
• (c)\_\_\_\_
• (d)\_\_\_\_
• (e)\_\_\_\_
• (f)\_\_\_\_

Answer 24

oral surgery
periodontics
endodontics
orthodontics
fixed prosthodontics
removable prosthodontics

Question 25

(a)Oral Surgery
• Allow time for healing and remodeling
• Extract \_\_\_\_ in treatment – Hopeless teeth
– Unerupted teeth
– Residual roots and
root tips
• Pre-prosthetic
surgical procedures
(ex. \_\_\_\_) early in treatment

Answer 25

early

ridge contouring

Question 26

(b)Periodontics
• Most periodontal procedures should be part of \_\_\_\_ phase
• Periodontal surgery
– \_\_\_\_ elimination
– \_\_\_\_ procedures
– \_\_\_\_ regeneration
– \_\_\_\_ resection

Answer 26

stabilization
pocket
mucogingival
guided tissue
root

Question 27

(c)Endodontics
• Some may be accomplished as part of relief of discomfort and stabilization
• Elective endodontics, if needed – Example:
• ____ needed for badly damaged tooth
• Treat abutments with doubtful pulpal health

Answer 27

cast post and core

Question 28

(d)Orthodontics
• Minor orthodontic tooth movement common as adjunct to \_\_\_\_
– Upright
– Rotate
– Move laterally 
– Intrude
– Extrude
• Always consider in treatment planning
– Especially when tooth drifting has occurred

Answer 28

fixed prosthodontics

Question 29

(e)Fixed Prosthodontics

• May need to ____ plan if unexpected occurrences in previous treatment
– ex. non-restorable endodontically treated tooth
• ____ possible prior to treatment to stabilize occlusion
– Correct supraeruption or drifting

Answer 29

adjust

occlusal adjustment

Question 30

(e)Fixed Prosthodontics

• ____ restorations – Usually restored first
• Influence ____ of mandible – Shape ____ surfaces of posterior teeth

• Posterior restorations
– Advantageous to restore opposing posterior segments ____
– One side at a time ____ than all four posterior quadrants
• Difficult to confirm accuracy of ____

Answer 30

anterior
border movements
occlusal
simultaneously
easier
jaw relationships

Question 31

(f)Removable Prosthodontics

• Will proceed ____ fixed prosthodontics, but is treatment planned ____ to definitive treatment

Answer 31

fixed

prior

Question 32

(4)Follow-Up

• Essential to develop program for follow- up care and recall visits
– Monitor ____
– Identify signs of ____ early
– Initiate prompt ____, if needed
• Adequate follow up will help maintain long-term health

Answer 32

dental health
disease
corrective

Question 33

Summary

• Basis of logical treatment planning
– Identifying patient’s ____
– Eliciting patient’s expectations and wishes
– Comparing expectations and wishes with available corrective materials and techniques

– Determining treatment options
• Advantages/disadvantages, cost, time involved
• Work with patient to determine best option
– Not just 􏰀ideal􏰁 plan
– Determining overall prognosis

Answer 33

needs

Question 34

Summary

• Rational sequence of treatment includes:
– ____
– ____
– ____
– ____
• Treatment plan may need to be modified during treatment depending on circumstances
– Patient needs to be advised ____

Answer 34

symptomatic relief
stabilization
definitive therapy
follow up care
prior