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Diagnosis and Treatment Planning in Fixed Prosthodontics Introduction Patient Interview/History Clinical examination Diagnostic casts Radiographic examination Treatment plan Bicuspid preparation Introduction: Deciding when to restore a patient using Fixed Prosthodontics involves the gathering of much information. Decisions need to be made as to whether the tooth needs a casting or whether a large amalgam will be sufficient. Does the patient need a bridge (Fixed Partial Denture) to replace a missing tooth? Does the patient need an implant to replace a missing tooth? Are so many teeth missing that the best restorative treatment should be a removable appliance (Removable Partial Denture)? Care must be taken to evaluate the entire patient, not just the teeth. Is the patients' health adequate to receive extensive treatment? Is the patients' oral hygiene good? Can the patient reasonably afford fixed prosthodontic treatment? The purpose of Fixed Prosthodontic treatment is to restore the patient's masticatory function, esthetics,comfort and self image. This can be accomplished by repairing teeth that are severely broken down with solid foundations and covering them with cast restorations. Teeth that are missing are replaced with Fixed partial dentures or implant supported restorations whenever possible. By replacing teeth that are missing, the occlusal forces are more evenly distributed and there is less destructive force to the remaining teeth The dentition shown in the photo at left shows
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wear and breakdown of the anterior teeth in part due to the fact that many posterior teeth are missing. Teeth can be lost for many reasons such as: decay periodontal disease trauma systemic disease selected extractions for orthodontics iatrogenic dentistry Many times, teeth that are severely broken down such as shown at the right can still be restored. In this case it would probably involve endodontic therapy, followed by a cast post and core which would provide a solid foundation. Then a cast restoration could be placed on the tooth. When teeth are to be used as abutments for a removable partial denture, it is very important that they be protected from the forces of the RPD as well.

Dentition restored with removable partial dentures. This provides adequate occlusal stability with less comfort and less expense than fixed prosthodontics. Areas with missing teeth that do not have natural teeth on either side of the space can be restored with removable appliances or implant supported restorations.

Fixed restorations - maxillary restored with partial veneer and full veneer castings, mandibular restored with a fixed partial denture replacing one missing tooth.

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