Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
- Introduction
- Definitions
- Ideal Requirements
- Contraindication
- Clinical examination of an abutment
- Diagnostic casts
- Radiographic examination.
- Evaluation of roots and their supporting tissues.
- Crown - root ratio
- Root configuration
- Periodontal ligament area
- Examination of crown of the tooth.
- Biomechanical consideration
Special considerations
- Pier abutment
- Tilted molar abutment
- Abutment for the cantilever FPD
-Endodontically treated teeth as abutments.
-Questionable abutments
-Detection of loose abutments.
Abutments for removable partial dentures
Abutments for immediate over denture
-Summary
INTRODUCTION:
The need for replacing missing teeth is obvious to the
patient when the edentulous space is in the anterior segment of
the mouth, but it is equally important in the posterior region too.
Missing teeth can be replaced by one of the following
prosthesis types.
1) Removable denture - Complete
- Partial denture
2) Tooth supported fixed Partial denture
3) Implant supported fixed Partial denture .
It is not uncommon to combine two types in the same
arch, such as a RPD and a FPD. When a missing tooth is to be
replaced, the majority of patients prefer a FPD. The usual
configuration for a FPD utilizes an abutment tooth on each end of
the edentulous space to support the prosthesis. If the abutment
teeth are periodontally sound, the edentulous span is short and
straight and the retainers are well designed and executed.
DEFINITION :
Abutment : A tooth, portion of a tooth/root or an implant used
for support and retention of fixed or removable prosthesis.
factors.
1) The crown root ratio:
viii) Pulp :
The size of the pulp can be assessed by radiograph chance of
exposure of pulp is more particularly in lower first molar where the
mesiobuccal horn often remains large.
BIOMECHANICAL CONSIDERATIONS :
1)Pier abutments :
An edentulous space can occur on both sides of a tooth,
creating a bone, free standing abutment called as pier abutment.
Studies in periodontometry have shown that the faciolingual
movement ranges from 56-108 m and intrusion is 28 m. Teeth in
different segments of the arch move in different directions. These
movements can create stresses in a long span bridge that will be
transferred to the abutments.
It has been stated that, forces are transmitted to the terminal
retainers as a result of the middle abutment acting as a fulcrum,
causing failure of the weaker retainer.
In this situation rigid restoration is not indicated. The non
rigid connector has been suggested as a solution to this problem.
A non-rigid FPD transfers shear stress to supporting bone
rather than concentrating it in the connectors. It minimizes
mesiodistal torquing of the abutments while permitting them to
more independently.
The location of the stress breaking device in the fine unit fix
abutment restoration usually is placed on the middle abutment,
since placement of it on either of the terminal abutments could
result in the pontic acting as a lever arm.
2. Tilted molar abutments:
Another problem that occurs with some frequency is the mandibular 2nd molar
abutment that has tilted mesially. It is impossible to prepare the abutment teeth for a FPD along
the long axes of the respective teeth and achieve a common path of insertion.
A helical up righting spring is inserted into a tube on the banded molar and activated by hooking
it over the wire on the anterior segment. The average treatment time required is 3 months.
If the tilting is slight, the problem can be solved by recontouring
the mesial surface of the 3rd molar.
If the tilting is severe, the treatment of choice is the uprighting of
the molar by orthodontic treatment.
Up righting is best accomplished by the use of a fixed
appliance. Both premolars and the canine are banded and tied to a
passive stabilizing wire.
There are other treatment options.
For this purpose, full veneer retainers are required on both the
second premolar and the first molar. These teeth must exhibit
excellent bone support.
4. Endodontically treated teeth as abutments:
1) Location of rests.