Escolar Documentos
Profissional Documentos
Cultura Documentos
SECTION: DMD-4B PROFESSOR: Dr. ANGELINA T. TAJHD STUDENTS: HOSEINNEJAD M , AVA SHAMSHIRI , SHAHIN SALEH KHORAM , PAYAM
* Aesthetics * Speech. * Drifting, tilting, over-eruption. * Loss of masticatory efficiency. * Loss of vertical dimension. * Deviation of mandible. * Loss of alveolar bone
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.
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.
*Physical health *Mental health *Motivation *Age *Dietary habits *Socioeconomic factors *Occupation
*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
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
Provide Proper Occlusal Function Maintain Arch Integrity/Tooth Position Maintain Occlusal Relationships Protect & Preserve the Remaining Structures
a) FPD does not move in function b) Occlusal forces are usually directed down the long axes of the teeth
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.
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
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
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.
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
* INTRA-ORAL
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
*
* *
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
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
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
THANK YOU!