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Fixed Prostodontics 2 > Dx & Tx planning Fixed prosthodontics > Flashcards

Dx & Tx planning Fixed prosthodontics Flashcards

(64 cards)

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1
Q

History
(4)

A

Chief
compliant
Personal
details
Medical
history
Dental
history

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2
Q

Chief compliant

A

The inexperienced clinician trying to prescribe an “ideal”
treatment plan can lose sight of the patient’s wishes..

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3
Q

Chief compliant
(4)

A

‰ Comfort (pain characteristics)
‰ Function (difficulties in chewing)
‰ Social aspect (bad oral taste or smell)
‰ Appearance (unaesthetic appearance discoloration –
malposition – misshape may be the main cause seeking
dental tr.)

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4
Q

Personal details
(8)

A

™ patient’s name
™ Patient‟s age: relative size of pulp chamber
determine type of restoration coverage – orthodontic treatment to creat/eliminate spaces
in young ages.
™ Address: sometimes reveals area-related
diseases such as fluorosis, vitamin D
deficiency…
™ phone number
™ Gender
™ Occupation: carpenters, tailors, glass blowers,
(discoloration and fractures of anterior teeth)
™ work schedule:
™ marital and financial status: ability to afford Tr. Cost.

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5
Q

1- Medical history
(3)

A

Any disorders that necessitate the use of
antibiotic premedication.
Use of steroids or anticoagulants.
Any previous allergic responses to medication
or dental materials.

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6
Q

Conditions affecting tr. methods

A

med hx

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7
Q

Conditions affecting tr. Plan
(4)

A

‰Previous radiation therapy.
‰hemorrhagic disorders.
‰extremes of age.
‰terminal illness

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8
Q

Oral manifestation of systemic conditions
(4)

A

‰ Diabetes.
‰ Pregnancy.
‰ The use of anticonvulsant drugs.
‰Gastro-esophageal reflux disease.

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9
Q

2- Dental History
(8)

A
  1. Periodontal History
  2. Restorative History
  3. Endodontic history
  4. Orthodontic history
  5. Removable prosthodontic history
  6. Oral surgical history
  7. Radiographic history
  8. TMJ history
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10
Q
  1. Periodontal History
A

(current oral hygiene & patient
education)

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11
Q
  1. Restorative History
A

(reflect prognosis of future
restorations)

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12
Q
  1. Endodontic history
A

(periapical health should be
monitored for any recurrent
lesion)

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13
Q
  1. Orthodontic history
A

(previous tr
. Associated with
root resorption
& C/R ratio
consideration, need for pre
- prosthetic orthodontic
intervention)

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14
Q
  1. Removable prosthodontic
    history
A

(very helpful in assessing
whether future treatment will
be more successful)

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15
Q
  1. Oral surgical history
A

(any complication during tooth extraction)

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16
Q
  1. Radiographic history
A

(helpful in determining the progress of periodontal
disease)

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17
Q
  1. TMJ history
A

(pain, clicking, muscular symptoms, may be caused
by TMI dysfunction, which should normally be
treated and resolved before fixed prosthodontic
treatment begins)

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18
Q

Examination
(4)

A

General Examination
(patient’s general appearance,
gait, and weight, skin color,
vital signs…)
Extra-oral examination
Intra-oral examination
Radiographic examination

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19
Q

Temporomandibular joints:

A

‰ bilaterally palpation during the
opening stroke.

(Asynchronous movement)
=anterior disk displacement
Tenderness or pain
=inflammatory changes in the
retrodiscal tissues
Clicking
maximum mandibular opening
i=ntra-capsular changes in the
joints.

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20
Q

Muscles of mastication ‰ the (2)
muscles, as well as other
relevant postural muscles,
are palpated for signs of
tenderness

A

masseter and temporal

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21
Q

Palpation is best
accomplished

A

bilaterally and
simultaneously
. This allows
the patient to compare and
report any differences
between the left and right
sides

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22
Q

Lips:
The patient is observed for tooth visibility during

A

normal and exaggerated smiling. This can be
critical in fixed prosthodontics treatment
planning, especially for margin placement of
certain metal-ceramic crowns.

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23
Q

Periodontal Examination:
(3)

A
  • Gingiva
  • Periodontium
  • Clinical Attachment Level
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24
Q

Occlusal examination:
(3)

A
  • Initial tooth contact
  • General alignment
  • Lateral and protrusive contacts
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25
Centric relation:
Maxillo-mandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective disks with the complex in the anterosuperior position against the shapes of the articular eminences. This position is independent of tooth contact
26
Centric occlusion:
maximum intercuspation position anterior to centric relation.
27
Retruded contact position RCP
When the mandible closes on the retruded axis, its position when the first tooth contact occurs is referred to as the retruded contact position (RCP). Approximately 90 percent of the population have a discrepancy between the retruded contact position and the intercuspal position.
28
The relationship of teeth in both centric relation and the maximum intercuspation should be assessed. If all teeth come together simultaneously at the end of terminal hinge closure,
the centric relation (CR) position of the patient is said to coincide with the maximum intercuspation (MI). The patient is guided into a terminal hinge closure to detect where initial tooth contact occurs. This is referred to as a slide from CR to MI
29
Any --- signs or symptoms should be recorded.
collateral (elevated muscle tone, mobility on the teeth where initial contact occurs, wear facets on the teeth involved in the slide).
30
--- contacts on posterior teeth may be undesirable. --- movements (the presence or absence of contacts on the nonworking side) Such tooth contact in eccentric movements can be verified with a ---
Excursive lateral excursive thin Mylar strip (shim stock)
31
The optimum crown root ratio is
2/3
32
Diagnostic Casts 1. Provide 2. examine the 3. Treatment procedures can be 4. Used for (3) 5. Help to explain
valuable preliminary information and a comprehensive overview of patient‟s needs occlusal relationships and the relationship of antagonist teeth to the edentulous area. rehearsed on the stone cast before making any irreversible changes in the patient‟s mouth diagnostic wax-up, preliminary RPD design, surgical stent (surgical procedures), etc. intended procedure to patient
33
ABUTMENT SELECTION Is the tooth Non-Restorable? Does the tooth present the following S&S? * CAL: * PD * FI= * Mobility= * RCT:
>75% >8mm class III grade III previously endodontically treated, PA RL with symptoms
34
CONDITION of REMAINING ABUTMENTS (4)
* Amount of Coronal Tooth Structure * Crown to Root ratio * Periodontal Support * Location of tooth in edentulous space
35
* Periodontal Support * Good: * Fair: * Poor: >50% CAL
Adequate periodontal support <25% CAL <50% CAL * Questionable:
36
* 2 Remaining Intact Canine [Good/Fair condition]
RDP, FDP, Implant, Combination
37
2 Remaining Intact Canines [Good/Fair condition] + Posterior Teeth
RDP, FDP, Implant, Combination
38
* 2 Remaining Canines [Poor condition Are there posterior teeth? yes no
2b CD
39
* Loss of Canines Are there posterior teeth? yes no
2b CD
40
2b- Abutment Distribution? * Unilateral * Bilateral Posterior Support * Intradental Edentulous Areas
RDP/ Implants RDP, FDP, Implants, Combination RDP, FDP, Implants, Combination
41
-SYSTEMIC CONDITIONS
* Absolute Risks/ Contraindications ➸ * Relative Risks/ Contraindications
42
Absolute Risks/ Contraindications (8)
* Cancer- chemotherapy (under active tx) * Systemic bisphosphonate medications (≥ 3 years) * Renal osteodystrophia * Severe psychosis * Acute infectious disease * Depression * Pregnancy [1st & 3rd trimester] * Incomplete cranial growth with incomplete tooth eruption
43
Relative Risks/ Contraindications (6)
* Heavy smoking ≥ pack years [especially in combination w/ HRT/estrogen], alcohol, & drug abuse * Uncontrolled parafunctions * Post head and neck radiation therapy * Osteoporosis * Uncontrolled diabetes * S/p chemotherapy, immunosupressants, long-term steroids, uncontrolled HIV infection
44
BONE ASSESSMENT (4)
* QUALITY * QUANTITY- Favorable/ Ideal * Bone Angulation * Divisions of Bone Dimensions [Misch]
45
* QUALITY
* Type 1-4
46
* QUALITY (2)
* Type 1-4* QUANTITY- Favorable/ Ideal * Height ≥ 10mm
47
Is there sufficient bone for implant placement? yes no
Mock-Up,CBCT Continue w/ conventional RDP/FDP
48
Division A vs D
abundant deficient
49
- EDENTULOUS SPAN (3)
* Number of Remaining Abutments [Go to #2] * Alignment & Distribution of Abutments * Extent of Edentulous Span
50
- EDENTULOUS SPAN * Number of Remaining Abutments [Go to #2] * Alignment & Distribution of Abutments * Extent of Edentulous Span ➸ (8)
1. Ridge Anatomy 2. Tissue Attachment ➸ 3. ACP Classification ➸ 4. Extent of HORIZONTAL edentulous span 5. Extent of VERTICAL edentulous span 6. Cantilever ➸ 7. Maxillo-Mandibular Relationship 8. Occlusion
51
5. Extent of VERTICAL edentulous span a) mm= Class I b) mm= Class II c) mm = Class III OR <10 mm = Class IV
>21 16-20 11-15
52
6. Cantilever ➸ a) A-P b) B-L c) CL
[1.5-2 ratio] [Lip to soft tissue >14mm] <10 mm
53
7. Maxillo-Mandibular Relationship (2)
a) Skeletal Classification [I, II, III] b) Maxillo-mandibular discrepancy
54
8. Occlusion (2)
* Mutually Protected * Bilaterally Balanced
55
VERTICAL DIMENSION of OCCLUSION ➸ (@)
* Restorative Space * Desired VDO compared to Existing VDO
56
* Restorative Space (2)
* Intra-arch Space * Inter-arch Space
57
* Inter-arch Space (3)
* Ridge: Ridge * Ridge: Tooth * Tooth: Tooth
58
ESTHETICS & PHONETICS ➸ qEsthetics (7)
* Incisal Edge Position * Lip Position & Length * Gingival Display * Profile (inclination) * Lip Support * Bidra Classification I-IV Smile line * Horizontal Tooth Display
59
7- RE-EVALUATION * Prognostic Criteria for Abutments ➸ (5)
Optimal Incisal edge position Profile Maxillary Restorative Space Occlusal scheme Maxillo-mandibular relationship
60
RESTORATIVE TREATMENT ➸ * REMOVABLE DENTAL PROSTHESIS (RDP) (3)
* Complete Denture * Removable Partial Denture * Removable Dental Prosthesis with Implants
61
RESTORATIVE TREATMENT ➸ FIXED DENTAL PROSTHESIS (FDP) (3)
* Fixed Dental Prosthesis on Natural Teeth * Fixed Dental Prosthesis Combination of Natural Teeth & Implants * Fixed Dental Prosthesis with Implants ➸ - Screw vs Cement - Hybrid vs PFM
62
Treatment sequence When patient needs have been identified a logical sequence of steps must be decided: 1. Treatment of Symptoms:
a fractured tooth or teeth, acute pulpitis, acute exacerbation of chronic pulpitis, a dental abscess, acute pericoronitis or gingivitis, and myofascial pain dysfunction
63
Treatment sequence 2. Stabilization of deteriorating conditions: (2)
9Treatment of carious lesions 9Chronic periodontitis and plaque control measures.
64
Treatment sequence 3. Definitive Therapy: (5)
1. Oral surgery (removing residual roots and ridge contouring) 2. Periodontics (bisection, pocket removal, gingivectomy, crown lengthening) 3. Endodontics (evaluation of RCT) 4. Orhtodontics (need for any tooth movement; upright, tilt, intrude, extrude) 5. Fixed prosthodontics

Fixed Prostodontics 2 (13 decks)

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