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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

Prosthesis Selection

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Page 1: Prosthesis Selection

PROSTHESIS SELECTIONCONSIDERATIONS IN SELECTING AND PRESCRIBING OF PROTHESIS.

1) FPD

2) RPD

 

 

 SECTION:

DMD-4B

PROFESSOR:

Dr. ANGELINA T. TAJHD

STUDENTS:

HOSEINNEJAD M , AVASHAMSHIRI , SHAHINSALEH KHORAM , PAYAM

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Elimination of oral disease.

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

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*Aesthetics

*Speech.

*Drifting, tilting, over-eruption.

*Loss of masticatory efficiency.

*Loss of vertical dimension.

*Deviation of mandible.

*Loss of alveolar bone

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* 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.

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• 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.

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*Physical health

*Mental health

*Motivation

*Age

*Dietary habits

*Socioeconomic factors

*Occupation

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*Musculature

*Salivary flow

*Residual alveolar ridge

*Oral mucosa

*Oral habits

*Tori

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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

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*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.

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*A lack of suitable teeth in the arch to support, stabilize, and retain the removable prosthesis.

*Rampant caries or severe periodontal conditions that threaten the remaining teeth in the arch.

*A lack of patient acceptance for esthetic reasons.

*Chronic poor oral hygiene.

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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.

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1. Abutment

2. Abutment Preparation

3. Retainer

4. Connector

5. Pontic

6. Edentulous Ridge/Space

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– Provide Proper Occlusal Function

– Maintain Arch Integrity/Tooth Position

– Maintain Occlusal Relationships

– Protect & Preserve the Remaining Structures

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a) FPD does not move in function

b) Occlusal forces are usually directed down the long axes of the teeth

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– 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.

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• Nature of OpposingOcclusion• Desired Final Contourof Restoration or• Existing ToothConditions• Extent of DefectiveStructure/DiseaseIntra-arch Harmony

• Material Bulk &

Usage Requirements

• Path of Insertion

• Bridge Span Length

• Periodontal Health

• Endodontic

Considerations

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– Radiographs

– Articulated Diagnostic Casts

– Medical, Social, and Dental Histories

– Clinical Examination

– Periodontal Charting

– Endodontic Vitality Tests

– Patient Expectations of Treatment

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• 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 patient’s needs are great. So,

having a well-thought-out plan prior to

beginning any treatment is a key to success.

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• Tooth Vitality– Ideally, we’d like for an abutment to be free ofany endodontic complications.– However, the use of endodontically treatedteeth is not contraindicated as long as it hasenough structure or build-up material toadequate serve as an abutment.– Teeth with questionable vitality require achoice of doing elective endodontics prior totreatment or seeing what time has to offer…

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• 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.

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Ideally, a clinical crown-to-root ratio of 2:3 is

sought after. Minimally, we’d like to see a 1:1

for a tooth to be considered for use as an

abutment

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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

PATIENT’S PREFERENCE.

MENTALY COMPROMISED AND PHYSICALLY HANDICAPPED PATIENT WHO CANNOT MAINTAIN THE RPD.

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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.

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Case Case studystudy

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The patient, a 56-year-old self-employed building contractor, came to the clinic for dental treatment.

His chief complaints were

`I can't eat.'

' My lower front tooth is shaky.'

`Sometimes my side teeth hurt me.'

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*PAST MEDICAL HISTORY*EXTRA-ORAL EXAMINATION

*INTRA-ORAL EXAMINATION

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FULL-MOUTH PERIAPICAL RADIOGRAPH

EXAMINATION

Periodontal examination

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* 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

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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

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

*external oral examination

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*Intraoral examination:

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Radiographic examination

Periodontal examination

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*Bruxism and severe wear of the anterior teeth

*Possible loss of vertical dimension

*Deep overbite

*Primary occlusal trauma

*Moderate with localized advanced adult

*Periodontitis

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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.'

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*PAST DENTAL HISTORY

*PAST MEDICAL HISTORY

*EXTRA-ORAL EXAMINATION

*I NTRA-ORAL AND FULL-MOUTH PERIAPICAL RADIOGRAPH EXAMINATION

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Radiographs of maxilla and mandible-pre-treatment

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• 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

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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

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