4.Mouth Preparation

DDS  YEAR 4

Fixed Prosthodontics Wednesday 25/September/2013

Overview of Fixed Prosthodontic Procedures

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History taking, examination and diagnosis, primary impression Articulated Study casts, diagnostic wax-up

Shade matching Tooth preparation Gingival retraction and tissue management, Final impression making Bite registration Provisional coverage (interim restoration) Laboratory prescription Laboratory procedures include: definitive cast and die fabrication, wax-Up, investing and casting, porcelain build-up (for PFM restorations)

Clinical try-in and Adjusting Laboratory procedures include: Polishing and glazing for porcelain.

Cementation Home care instructions

MOUTH PREPARATION

 Mouth preparation refers to the dental procedures that need to be accomplished before fixed prosthodontics can be properly undertaken.

Rarely are crowns or fixed partial dentures provided without initial therapy of a multidisciplinary and often extensive nature, because the etiologic factors that lead to the need for fixed prosthodontics also promote other pathologic conditions (caries and periodontal disease are the most common). These must be corrected as an early phase of treatment.

Comprehensive treatment planning will ensure that mouth preparation is undertaken in a logical and efficient sequence aimed at bringing the teeth and their supporting structures to optimum health. Equally important is the need to educate and motivate the patient to maintain long-term dental health through meticulous oral hygiene practices.

the following sequence of treatment procedures in advance of fixed prosthodontic should be adhered to: 1. Relief of symptoms (chief complaint) 2. Removal of etiologic factors (e.g., excavation of caries, removal of deposits) 3. Repair of damage 4. Maintenance of dental health

Sequence of Treatment: •

Preliminary assessment (A)

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Emergency treatment of presenting symptoms (B)

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Oral surgery (C)

Sequence of Treatment: •

Caries control and replacement of existing restorations (D)

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Endodontic treatment (E)

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Definitive periodontal treatment, possibly in conjunction with preliminary occlusal therapy (F)

Sequence of Treatment: •

Orthodontic treatment

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Definitive occlusal treatment

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Fixed prosthodontics (G, H)

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Removable prosthodontics (I)

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Follow-up care

ORAL SURGERY SOFT TISSUE PROCEDURES

 Any soft tissue abnormalities that may require surgical intervention should be recognized during the initial or radiographic examination. Elective soft tissue surgery may include alteration of muscle attachments, removal of a wedge of soft tissue distal to the molars, increase of the vestibular depth, or modification of edentulous ridges.

Soft tissue surgery to correct unfavourable edentulous ridge.

HARD TISSUE PROCEDURES

Simple tooth removal is the most common surgical procedure involving hard tissue. It should be performed as early during treatment as possible for maximum healing time and osseous recontouring. Other procedures may be: extraction of impacted or unerupted supernumerary teeth, tuberosity reduction and removal of maxillary or mandibular tori.

CARIES AND EXISTING RESTORATIONS  Any restoration on such teeth must be carefully examined and a determination made regarding its serviceability. If doubt exists, the restoration should be replaced.

Even on caries-free teeth, an existing restoration may not be a suitable foundation. Preparation design is different for a foundation than for a conventional restoration, particularly regarding the placement of retention. Generally, when a crown is needed, the dentist should plan to replace any existing restorations.

FONDATION RESTORATIONS •  A foundation restoration, or core, is used to build a damaged tooth to ideal anatomic form before it is prepared for a crown.

• It should provide the patient with adequate function and should be contoured and finished to facilitate oral hygiene. Subsequent tooth preparation is greatly simplified if the tooth is build up to ideal contour. • Selection of the foundation material depends on the extent of tooth destruction, the overall treatment plan, and operator preference. •  Adhesive retention may be helpful in preventing loss of the foundation during tooth preparation.

The placement of a foundation restoration depends on the extent of damage to the tooth and should always be designed with the definitive restoration in mind. A, Cement. This i s suitable when damage is minimal. B, Amalgam. C, Pin -retained amalgam. D, Cast gold. E, Post-and-core.

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The term biologic width refers to the combined connective tissue-epithelial attachment from the crest of the alveolar bone to the base of the gingival sulcus

• This attachment averages approximately 2 mm in width, and any restoration that impinges on it may cause bone loss because of the effort of the host to maintain the 2 mm distance. • If impingement occurs in an interproximal area, it can lead to problems with plaque control and possible osseous resorption.

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• Occlusal adjustment needs to be undertaken in a logical sequence to avoid repetition and improve the efficacy of treatment. 1. Elimination of Centric Relation interferences 2. Elimination of Lateral and Protrusive Interferences.

TREATMENT PLANNING

Treatment planning consists of formulating a logical sequence of treatment designed to restore the patient's dentition to good health, with optimal function and appearance. The plan should be presented in written form and should be discussed in detail with the patient.

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Selection of Abutment Teeth Assessment of Abutment Teeth Radiographs are made, and pulpal health is assessed by evaluating the response to thermal and electrical stimulation.

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Definition •  A post and core is a dental restoration for an endodontically treated tooth used to sufficiently build-up tooth structure for future restoration with a crown when there is no enough tooth structure to properly retain the crown. Post and cores are therefore referred to as foundation restorations . 35

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Root Shape and Angulation the shape of the roots and their angulation should be considered.  A molar with divergent roots will provide better support than a molar with conical roots and little or no interradicular bone. Similarly, a well-aligned tooth will provide better support than a tilted one.

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• Usually oral surgical procedures are scheduled first, followed by periodontics, endodontics, orthodontics, fixed prosthodontics, and finally, removable prosthodontics.

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Dr. Maan Ibrahim Al-Marzok

2013