PROSTHESIS SELECTION

CONSIDERATIONS IN SELECTING AND PRESCRIBING OF PROTHESIS. 1) FPD 2) RPD

SECTION: DMD-4B PROFESSOR: Dr. ANGELINA T. TAJHD STUDENTS: HOSEINNEJAD M , AVA SHAMSHIRI , SHAHIN SALEH KHORAM , PAYAM

The Basic Objectives of prosthodontic Treatment

Elimination of oral disease. Preservation of the health and relationship of the teeth, and the health of the oral and para-oral structure

* Aesthetics * Speech. * Drifting, tilting, over-eruption. * Loss of masticatory efficiency. * Loss of vertical dimension. * Deviation of mandible. * Loss of alveolar bone

Consequences of Tooth Loss

Removable prosthodontics is the specialty of dentistry that replaces missing teeth with a removable prosthesis.

Removable partial denture, also referred to as a partial, replaces one or more teeth in the same arch.

Removable partial denture

Function of RPD
Give support to periodontally diseased teeth. Restore vertical facial dimension. Prevent T.M.J problems. Prevent tooth drifting or over eruption. Stimulate non-used tissues. Support collapsed structure (muscles of lips and cheeks). Prevent attrition of remaining teeth. Improve oral hygiene by preventing stagnation of food in disused areas.

Extraoral Factors that Influence the Choice of a Removable Prosthesis

*Physical health *Mental health *Motivation *Age *Dietary habits *Socioeconomic factors *Occupation

Intraoral Factors that Influence the Choice of a Removable Prosthesis

*Musculature *Salivary flow *Residual alveolar ridge *Oral mucosa *Oral habits *Tori

a) Dentition b) Supporting apparatus c) Intra-arch relationships d) Inter-arch relationships e) TMJ & musculature f) Arch integrity g) habit patterns h)Crown : root ratios i) Bone levels j) Pulpal considerations k)Tooth alignment

Diagnostic Considerations

Indications for a Removable Partial Denture

*To replace several teeth in the same quadrant or
in both quadrants of the same arch. *As a temporary replacement for missing teeth in a child. *To replace missing teeth for patients who do not want a fixed bridge or implants. *For the patient who finds it easier to maintain good oral hygiene. *To serve as a splint to support periodontally involved teeth.

Contraindications for a Removable Partial Denture

*A lack of suitable teeth in the arch to support, *Rampant caries or severe periodontal
stabilize, and retain the removable prosthesis. conditions that threaten the remaining teeth in the arch.

*A lack of patient acceptance for esthetic

reasons.

*Chronic poor oral hygiene.

Is the field of restorative dentistry where restorations are cemented into place (not readily removable). These can include a single tooth or an entire arch. This course will concentrate on porcelain fused to metal single crowns and fixed partial dentures (aka FPDs or bridges) of differing materials.

Fixed Prosthetics

Examples of Fixed Prosthetics

1. Abutment 2. Abutment Preparation 3. Retainer 4. Connector 5. Pontic 6. Edentulous Ridge/Space

Fixed Prosthetics Nomenclature

 Provide Proper Occlusal Function Maintain Arch Integrity/Tooth Position Maintain Occlusal Relationships Protect & Preserve the Remaining Structures

What are the functions of a fixed partial denture?

a) FPD does not move in function b) Occlusal forces are usually directed down the long axes of the teeth

Differences between a RPD & FPD

 The process of diagnosis and treatment planning helps us attain a comprehensive and complete guide to care for any given patient and their particular situation. It allows for the care rendered to be logical both in plan and action.

Diagnosis & Treatment Planning

 Nature of Opposing Occlusion Desired Final Contour of Restoration or Existing Tooth Conditions Extent of Defective Structure/Disease Intra-arch Harmony

Material Bulk & Usage Requirements Path of Insertion Bridge Span Length Periodontal Health Endodontic Considerations

Diagnosis

 Radiographs Articulated Diagnostic Casts Medical, Social, and Dental Histories Clinical Examination Periodontal Charting Endodontic Vitality Tests Patient Expectations of Treatment

Before a Diagnosis (Dx) is made, thorough data collection is necessary

 Treatment (Tx) Planning is the integration of data collection and diagnosis to form an omniscient & ordered guide of treatment. It can be a very complex and confusing process if the patients needs are great. So, having a well-thought-out plan prior to beginning any treatment is a key to success.

 Tooth Vitality
Ideally, wed like for an abutment to be free of any endodontic complications. However, the use of endodontically treated teeth is not contraindicated as long as it has enough structure or build-up material to adequate serve as an abutment. Teeth with questionable vitality require a choice of doing elective endodontics prior to treatment or seeing what time has to offer

Abutment Evaluation

Inflamed gingiva bleed and make preparation and impression making more difficult.

Mobile teeth may not be able to support any span under occlusal stress for very long.**

We prefer to do any restorative work on stable teeth and around healthy gingiva.

Periodontal Status

Ideally, a clinical crown-to-root ratio of 2:3 is sought after. Minimally, wed like to see a 1:1 for a tooth to be considered for use as an abutment

Crown-to-Root Ratio

 SHORT SPAN EDENTULOUS ARCHES.  PRESENCE OF SOUND TEETH THAT CAN

OFFER SUFFICIENT SUPPORT ADJACENT TO THE EDENTULOUS SPACE.

 CASE WITH RIDGE RESORPTION WHERE A

RPD CAN NOT BE STABLE OR RETENTIVE

 PATIENTS PREFERENCE.  MENTALY COMPROMISED AND PHYSICALLY

HANDICAPPED PATIENT WHO CANNOT MAINTAIN THE RPD.

Indication for FPD

 LARGE AMOUNT OF BONE LOSE AS IN TRAUMA.  VERY YOUNG PATIENT WHERE TEETH HAVE LARGE

PULP CHAMBERS.  PRESENCE OF PERIODONTALLY COMPROMISED ABUTMENTS.  LONG SPAN EDENTULOUS SPACES.  BILATERAL EDENTULOUS SPACE WHICH REQUIRE CROSS ARCH STABILIZATION.  CONGENITALLY MALFORMED TEETH WHICH DO NOT HAVE ADEQUATE TOOTH STRUCTURE TO OFFER SUPPORT.  MENTALLY SENSITIVE Px WHO CANNOT COOPERATE WITH INVASIVE TREATMENT PROCEDURES.  MEDICALLY COMPROMISED Px ( LUKEMIA OR HYPERTENSION)  VERY OLD PATIONTS.

Contraindication For FPD

Case study

The tient, -year- l self-empl yed ilding c ntract r, came t the clinic f r dental treatment. is chief c mplaints `I can't eat.' ' yl er fr nt t th is shaky.' `S metimes my side teeth hurt me.' ere

Patient 1

* PAST MEDICAL HISTORY * EXTRA-ORAL EXAMINATION

* INTRA-ORAL

EXAMINATION

FULL-MOUTH PERIAPICAL RADIOGRAPH

EXAMINATION

 Periodontal examination

* Pseudo-Angle class III * Advanced adult periodontitis * Reduced posterior occlusal support * Missing teeth accompanied by shifting of teeth * Extreme wear due to occupational involvement * Caries * Reduced vertical dimension * Faulty occlusal plane with extrusion and tipping of teeth * Secondary occlusal trauma with primary origins * Periapicallesions

DIAGNOSIS

PHASE 1: INITIAL PREPARATION PHASE 2: TREATMENT OPTIONS Maxilla:

*
* *

Fixed and partial removable prostheses Fixed prosthesis supported by natural teeth and implants Fixed partial prosthesis supported by natural teeth

Mandible:

*
*

Fixed and partial removable prostheses Fixed prosthesis supported by natural teeth and implants

TREATMENT PLAN

*A

75 year old women,employ as laboratory technician,she has Bruxism

* external oral examination

Patient 2

*Intraoral examination:

 Radiographic examination

 Periodontal examination

* Bruxism and severe wear of the anterior teeth * Possible loss of vertical dimension * Deep overbite * Primary occlusal trauma * Moderate with localized advanced adult * Periodontitis

DIAGNOSIS

The patient, a male 49-year-old clerk, presented for dental treatment. His main complaints were the following: `I have difficulty eating.' ` My front tooth is loose and hurts when I chew.' `The spaces between my teeth appear to be getting bigger.' `Due to the spaces between my front teeth, I have problems speaking clearly.'

PATIENT3

* PAST DENTAL HISTORY * PAST MEDICAL HISTORY * EXTRA-ORAL EXAMINATION * I NTRA-ORAL AND FULL-MOUTH PERIAPICAL
RADIOGRAPH EXAMINATION

Radiographs of maxilla and mandible-pre-treatment

 Advanced adult periodontitis Missing teeth accompanied by edentulous ridge resorption , Loss of posterior support ,Loss of vertical dimension ,Secondary occlusal trauma with primary origins Faulty restorations Irregular occlusal plane Caries Periapicallesions

DIAGNOSIS

Fixed prosthesis supported by implants and natural teeth rejected by patient due to cost Crowns on copings on and a removable partial denture. Maxilla and mandible: Fixed and removable prostheses

TREATMENT PLAN

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