4.Mouth Preparation

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DDS

YEAR 4

Fixed Prosthodontics

Wednesday

25/September/2013

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Overview of

Fixed

Prosthodontic

Procedures

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•• History taking, examination and diagnosis,History taking, examination and diagnosis, primary impression

primary impression

.

. Articulated Articulated Study Study casts, casts, diagnostic diagnostic wax-upwax-up

•• Shade matchingShade matching Tooth preparation Tooth preparation

Gingival retraction and tissue management, Final Gingival retraction and tissue management, Final impression making

impression making Bite registration

Bite registration

Provisional coverage (interim restoration) Provisional coverage (interim restoration) Laboratory prescription

Laboratory prescription

.

. Laboratory Laboratory procedures procedures include: include: definitive definitive cast cast and and die die fabrication,fabrication, wax-Up, investing and casting, porcelain build-up (for PFM

wax-Up, investing and casting, porcelain build-up (for PFM restorations)

restorations)

•• Clinical try-in and AdjustingClinical try-in and Adjusting

.

. Laboratory Laboratory procedures procedures include: include: Polishing Polishing and and glazing glazing for for porcelain.porcelain.

•• CementationCementation

Home care instructions Home care instructions

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MOUTH

PREPARATION

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Mouth preparation refers to the dental

procedures that need to be accomplished

before

fixed prosthodontics can be properly

undertaken.

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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.

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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

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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

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Sequence of Treatment:

• Preliminary assessment (A)

• Emergency treatment of presenting symptoms (B) • Oral surgery (C)

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• Caries control and replacement of existing restorations (D) • Endodontic treatment (E)

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

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• Orthodontic treatment

• Definitive occlusal treatment

• Fixed prosthodontics (G, H) • Removable prosthodontics (I)

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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

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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.

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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.

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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

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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.

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• 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.

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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

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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

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TREATMENT

PLANNING

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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

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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

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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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