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Complications Flashcards

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1
Q

Five parts to diagnostic evaluation of the occlusion

A
  1. face and lips
  2. planes of occlusion
  3. the incisal relationship (like do we have anterior guidance)
  4. strength of periodontium
  5. occlusal dynamics
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2
Q

success in creating a stable occlusal scheme begins by establishing what?

A

by establishing the FUNCTIONAL REQUIREMENTS of the dentition and then by defining the roles each tooth will plat when the treatment is complete

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3
Q

in establishing a stable occlusal scheme what is essential?

A

separate the dentition into its anterior and posterior components and then evaluate each individually and in relation to each other

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4
Q

what indicates a ‘healthy’ anterior?

A

overbite and overjet that correspond to having anterior guidance

minimizing the overjet and having a 1-2 mm over bite for natural anterior guidance

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5
Q

what indicates a ‘healthy’ posterior?

A

having strong attachment apparatus and it holds the dimension of occlusion – the vertical contact and occlusion

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6
Q

what are the most common problems in the ANTERIOR area

A
  1. missing tooth/teeth
  2. pathological migration/ posterior bite collapse
  3. class II relationship
  4. class III relationship
  5. Tooth ware (mandibular anterior)
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7
Q

details of tooth wear in common problems in the anterior area

A

referring to the mandibular anterior mostly

  • lack of posterior teeth
  • bruxism
  • opposing dentition
  • enameloplasty
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8
Q

with a missing anteriors where do we want to place heavy contacts when restoring?

A

on NATURAL TEETH - vs implants so that we have the propioception

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9
Q

when missing an anterior tooth (like lateral) what do you need to determine before restoring?

A

how much space you will need – find the M-D dimension and then create the space necessary using ortho (assuming other areas of mouth / health and perio / posterior occlusion is okay)

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10
Q

when missing teeth but occlusal plane is off and no allignment?

A

work with ortho – create a wax up – to move teeth to proper position and also to obtain and figure out the space you will require before restoring

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11
Q

pathological migration / posterior bite collapse – general implications and what to do

A

teeth start to move and drift and with no posterior support or contact – the anteriors begin to hit and they can become mobile

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12
Q

if pt. has no posterior support but wants to restore anterior what must be done?

A

CREATE POSTERIOR SUPPORT FIRST - can be temporary during treatment but cannot restore anterior with no posterior support – will just hit anterior

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13
Q

what class occlusion do we always try to recreate?

A

Class I

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14
Q

can you fix class II to class I?

A

yes

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15
Q

can you fix class II with restoration alone?

A

yes - depends on case

if needs more than just restoration - sometimes use ortho and resto

sometimes nees ortho - resto in combination with surgery

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16
Q

implications with a lot of overjet and class II?

A

when go into protrusive movements – hit a lot so if pt wants to restore anteriors cannot leave in a large class II because the pt. will just hit everytime

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17
Q

is there anterior guidance in a class III relationship?

A

NO - there is no anterior guidance – and if there is no contact between maxilla and mandible - teeth keep erupting

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18
Q

can you fix class III with restorations alone?

A 
maybe 
case where placed implants and achieved an edge to edge occlusion from a class III
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19
Q

implication of edge to edge bite?

A

potential increase in incisal fractures occuring - so give pt night guard

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20
Q

for mandibualr teeth how do you gain restorative space gingivally? incisally?

A

gingivally? - do crown lenghtening

increase the bite to gain space incisally

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21
Q

major cause of ware on anteriors?

A

no posterior support – so occlude in the anterior and cause ware along with parafunctional patient habits

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22
Q

ware on anteriors with no posterior support? what to do first?

A

GAIN POSTERIOR SUPPORT FIRST

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23
Q

most common problems in the posterior area

A
  1. missing tooth/teeth
  2. furcation involvement
  3. crossbite
  4. tilting
  5. supra-eruption
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24
Q

furcation involvment

A

problem in the posterior area

grade 1 - you can restore with crown but will need to follow contour of tooth and consider material with a metal colar – patient can clean better
grade 2 and 3 - probably not

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25
posterior crossbite?
problem in the posterior region -- treat via ortho
26
if patient comes in with psoterior crossbite and needs crown do you restore for class I?
ortho if agree firsr | if no ortho -- crown in crossbite because this is THEIR OCCLUSION
27
tilted teeth? what problems does it cause? how to correct?
problem occuring in posterior area sets up interferences in lateral working movements correct -- uprighten the molars (may need to extract the third molar to create space first) so you can then increase the vertical dimension
28
tilted molar but patient interested in fixed partial
will need to consider the preparation a lot because may involve the pulp -- elected RCT may be needed and need a proper path of insertion but this can be done ith a fixed partial
29
supra-erupted teeth?
problem occuring in the posterior that will also set up interferences
30
what to consider with supra - erupted teeth?
is the tooth mobile, can you save it - if not extract it ? | if extensive-- will need to cut it then do crown lenghtening but this could also compromise the periodontium
31
patient comes to you with supra erupted posterior teeth and is jsut interested in restoring the endotulous space on lower arch -- what do you do?
DO NOT DO IMPLANTS IN A CROOKED OCCLUSAL PLANE - have prosthesis now on a crooked plane this is called a PATCH WORK SO CORRECT PLANE ON TOP AND THEN RESTORE LOWER
32
two canines lower than the centrals?
we have a reversed crooked plane of occlusion likely due to supra erupted teeth in posterior area
33
reason for retained primary teeth
anklyosis - maybe problem occuring in the posterior area CREATES INTEROCCLUSAL SPACE -- other opposing tooth will supra-erupt so need to extract if able to and then restore occordingly
34
decorination? | reason for doing?
ankylosis in primary retained molar if extract -- can cause injury to bone so will do decorination -- cut clinical crowna nd burry the roots leave 5mm of bone and will resorb close with ortho or create space for future implant
35
what do you do before any procedure is preformed?
PERIODONTAL EVALUATION and health must be achieved
36
what is the foundation for any restorative work?
the periodontium this will be an exam question
37
treatment options for pathological migration / advanced perio disease in anterior teeth
extractions, immediate dentures, RPD's (removable partial denture). FPD's (fixed partial denture)
38
treatment for Class II and III relationship in anterior
always try and give them a class I with ORTHO tx if able to and refer to surgery if needed
39
treatment for tooth wear in anterior region
can treat with veneers but need to consider crown to root ration if need space gingivally-- crown lengthening or increase bite to gain space incisally and increase the vertical dimension
40
tx for missing teeth in the posterior
implant | fpd
41
tx for furcation involvement in posterior
``` tx depends on the class of furcation -- class 1 you can restore class 2 and 3 - probably not - PERIO MAINTENANCE - then restore ```
42
tx for crossbite in posterior
orthodontics - pt not interested -- crown as is
43
tilting teeth tx in posterior
with ortho
44
supra eruption tx in posterior
set a correct occlusal plane then restore it
45
when increasing or decreasing vertical dimension what must occur?
MUST HAPPEN BILATERALLY - and during one time restorativev procedure such as a complete denture, full arch reconstruction or a combination of fixed and removable prosthodontics restore entire arch and raise the bite -- CANNOT DO WITH A SINGLE CROWN
46
steps in order when get a new patient
``` medical history dental history radiographs extra oral examination - cancer screening too intraoral examination perio probing restorative charting ``` preliminary impressions (alginate) mounting of cast on a semi-adjustable articulator in CR (most of time) occlusal analysis consultation with different specialties
47
what do dental records include
``` medical history dental history radiographs extra oral examination - cancer screening too intraoral examination perio probing restorative charting ``` ALL BEFORE IMPRESSIONS
48
do not take bitewing that is what?
overlapping -- we need these to be DIAGNOSTIC
49
when do you probe?
BEFORE - need to know if teeth are strong enough to withstand the restoration DURING - need to make sure still stromg during and before you take the impression AFTER - make sure you did not harm or decrease the strenght and it will not fail
50
does facebow registration always need to be recorded in CR?
For restorative treatments including full arch or quadrant - yes because you will be adjusting their anterior guidance if anterior restoration or changing occlusal scheme
51
occlusal analysis importance
find their occlusal scheme and restore to this if class I or change if able to creating a new occlusal scheme? need the patient facebow in CR
52
increase / decrease VDO | how to measure?
point on nose and chin digital caliber - measure from amrginal ridge to marginal ridge from canine to canine
53
major difference in implant occlusion
no PDL no propioception no nerve - no pain
54
osseointegration
implant bone contact
55
difference between implant and natural dentition | surrounding tissue
nat - PDL implant - osseointegration (bone and implant contact)
56
difference between implant and natural dentition | malocclusion
nat - may be uneventful for years -- responds better/ well tolerated by the PDL implant -- crestal bone loss will occur
57
difference between implant and natural dentition | non-vertical forces
nat - relatively tolerated - since the pdl is shock absorbing implant - this will be traumatic to supporting bone
58
difference between implant and natural dentition | loading-bearing characteristics
nat - shock-absorbing functino and stress distribution implant - stress concentrated at the crestal bone -- neck of the implant
59
difference between implant and natural dentition | movement patterns
nat - immediate movement -- NON-LINEAR AND COMPLEX implant - gradual
60
movement that occurs in natural teeth
non-linear and complex vs gradual in implant
61
difference between implant and natural dentition | signs of overloading
nat - PDL thickening, mobility, wear facets, fremitus, pain implant - screw loosening or fracture, abutment or prosthesis fracture, bone, loss, implant fracture
62
fremitus
vibration of teeth | sign of movement in natural teeth
63
difference between implant and natural dentition | tactile sensitivity
natural - high - proprioceptive feedback mechanism implant -- low osseoperception
64
thickening of PDL?
radioluscent area around the tooth in a radiograph - sign of overloading in the natural dentition
65
cantilever | implications
positioned or fixed only at one end while other end of the prosthesis is unsupported can introduce NON-AXIAL loading onto the tooth -- can increase chances of fractures in the implant and cause bone resorption to occur if not done in right area
66
occlusal considerations for implant-supported prostheses?
if these exist ,,, need to plan accordingly flat fossa and grooves for wide freedom in centric shallow occlusal anatomy (cuspal inclination) narrow occlusal table? 30-50% smaller -- can introduce non-axial loading
67
narrow occlusal table (30-40%) smaller implications?
the dimension of tooth (example -molar) will be larger than the implant diameter and can cause cantilever effects introduces unwanted non-axial loading would basically look like a lollipop and not have enough support
68
anterior guidance of implant supported prostheses?
should be as SHALLOW as possible -- to avoid greater forces on the anterior implants limit the knocking on the implants
69
excursive guidance on? | what is desires?
well-supported anterior natural teeth with posterior teeth disclusion in eccentric movements
70
if pt has natural canines?
canine protected or mutually protected occlusion IF THEY ARE PRESENT
71
group function?
occlusal scheme desired / of choice if canine absent or prosthesis replacing bilateral distal extension
72
canine missing and implant? scheme?
no contacts non working and share load with posterior teeth = group function
73
what do we want in MIP? (occlusion check) 3 things
1. WIDE/ LIGHT CONTACT IN THE CENTER (12 microns) 2. firm occlusion with shim stock PASSING THROUGH -- 8-30 Microns (if this does not pass through that means that the patient has a hard bite on the implant restored and this is undesired) 3. working and non-working contacts should be avoided in a single restoration
74
two designs of implant crown
screw- retained | cement- retained
75
what does restoration design impact?
aspects of the OCCLUSAL CONTACTS -- so this depends on the restoration design
76
screw retained - general
crown and abundment are one unit and screwed straight to implant fixture axis is right through occlusal table
77
cement retained implant - general
two parts 1. abutment - screwed onto the implant 2. implant crown cemented no screw axis coming out of occlusal table
78
occlusal contacts in screw retained
screw occupying the space .1mm from screw to inner circle available for centric contact compromised by screw end - not
79
occlusal contacts in cement retained
entire occlusal table is NOT compromised by the screw | so we can get an adequate contacts in posterior

Occlusion (10 decks)

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