Treatment Planning (Pt. II) Flashcards
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
several intermediate anterior and posterior underestimation diagnostic
Replacement of Several Missing Teeth
____ can act as fulcrum during function
middle abutment
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
direction root surface periodontal span multiple anterior
(1)Overloading of Abutment Teeth
• Important to consider ability of abutment teeth to accept applied forces
– Avoid ____ or mobility
– ____ increases forces on teeth
tooth drifting
parafunction
(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
magnitude of force
long axis
(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 ____
equal or greater
prognosis
bone support
(1)Overloading of Abutment Teeth
Antes 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 ____
acceptable
2nd premolar and first molar
(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
shape of roots angulation divergent ellipitical circular well-aligned
(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
periodontal tissues
periodontal support
(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
1/3
1/2
magnified
leverage
(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
flex
span
bulky
gingival health
(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
failure porcelain veneer connector retainer soft tissue
(3)Replacing Multiple Anterior Teeth
• Loss of several maxillary anterior teeth is difficult
– ____ subject to tipping forces
– Need to use ____ as abutments
maxillary incisors
canines and first premolars
(3)Replacing Multiple Anterior
Teeth
• Maxillary anterior
– Tooth contours, esthetics, phonetics difficult
– ____ essential
– ____ (provisional) to test contours, phonetics, esthetics
diagnostic wax up
interim restoration
(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
partial RDP
smile line
surgical intervention
Fixed Dental Prosthesis
• FDP if possible
– Better ____ than partial RDP
– Preferred by most patients
health and function
Partial Removable Dental Prostheses
• Indications – No \_\_\_\_ abutment – Long \_\_\_\_ span – Considerable \_\_\_\_ in anterior region • Where FDP would have unacceptable appearance
distal
edentulous
bone loss
Multiple edentulous spaces often best restored with combination of ____
fixed and removable
Proper ____ is very important to avoid mistakes
sequencing
(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 ____
discomfort
anterior crown
RDP
(2)Stabilization of Deteriorating Conditions
• Second phase of treatment is to stabilize conditions
– (a)____
– (b)____
dental caries
periodontal disease
(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
active caries
recurrent
diet analysis
(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
daily plaque control dental cleaning smooth restorations carious overcontoured
(3)Definitive Therapy • (a)\_\_\_\_ • (b)\_\_\_\_ • (c)\_\_\_\_ • (d)\_\_\_\_ • (e)\_\_\_\_ • (f)\_\_\_\_
oral surgery periodontics endodontics orthodontics fixed prosthodontics removable prosthodontics
(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
early
ridge contouring
(b)Periodontics • Most periodontal procedures should be part of \_\_\_\_ phase • Periodontal surgery – \_\_\_\_ elimination – \_\_\_\_ procedures – \_\_\_\_ regeneration – \_\_\_\_ resection
stabilization pocket mucogingival guided tissue root
(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
cast post and core
(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
fixed prosthodontics
(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
adjust
occlusal adjustment
(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 ____
anterior border movements occlusal simultaneously easier jaw relationships
(f)Removable Prosthodontics
• Will proceed ____ fixed prosthodontics, but is treatment planned ____ to definitive treatment
fixed
prior
(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
dental health
disease
corrective
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
needs
Summary
• Rational sequence of treatment includes:
– ____
– ____
– ____
– ____
• Treatment plan may need to be modified during treatment depending on circumstances
– Patient needs to be advised ____
symptomatic relief stabilization definitive therapy follow up care prior
