Treatment Planning for Fixed Prosthodontics

Question 1

Treatment plan should be presented in….form and should be

Answer 1

Written from, discussed in detail with the patient.

Question 2

Developing the treatment plan steps

Answer 2

1. Collecting diagnostic data.
2. Sequence of mouth preparation:
    evaluation of oral hygiene and occ. Analysis. Oral surgery.
   periodontal treatment.
   Endodontically treatment.
   Orthodontic treatment. Operative
   Fixed and removable treatment.
3. Rational for proposed plan of treatment i.e. choosing a particular plan of treatment.
4. Prognosis and its justification.

Question 3

Treatment planning for single tooth restoration:

Answer 3

INTRACORONAL RESTORATION:
When sufficient coronal tooth structure

EXTRA-CORONAL PROSTHESIS:
If insufficient coronal tooth structure

Question 4

Removable partial denture:
Indications:

Answer 4

1) Edentulous space greater then two posterior teeth, anterior space greater than four incisors.
2) Space that include canine and two other contiguous teeth.
3) An edentulous space with no distal abutment.
4) Multiple edentulous spaces.
5) Bilateral edentulous spaces with more than two teeth missing on one side.

Question 5

Multiple edentulous span: Distribution

Answer 5

each can be restored with a fixed partial denture yet due to expenses and technical complexities a removable partial denture is used

Question 6

When a missing tooth is to be replaced, a…. is preferred
by the majority of patients.

Answer 6

FBD

Question 7

Resin bonded tooth supported fixed partial denture: Indications:

Answer 7

1) Caries free abutment teeth.
2) Maxillary and Mandibular incisors replacements.
3) Single posterior tooth replacement.
4) Young patient with favorable occlusion.

Question 8

Implant supported fixed partial denture: Indications:

Answer 8

1. Insufficient number of abutment teeth.
2. Inadequate strength in the abutments to support a
   conventional FPD.
3. Patient unable to wear RPDs.
4. Where there is no distal abutment.

Question 9

Implant supported fixed partial denture: Indications:

Answer 9

1. Insufficient number of abutment teeth.
2. Inadequate strength in the abutments to support a
   conventional FPD.
3. Patient unable to wear RPDs.
4. Where there is no distal abutment.

Question 10

No prosthetic treatment:
If

Answer 10

a patient presents with a long standing edentulous space

Question 11

poor prognosis =

Answer 11

extraction might be the best choice in such case.

Question 12

Questionable prognosis ex

Answer 12

advanced bone loss, grade III furcation involvements, inaccessible area, presence of systemic factors.

Question 13

Consequence of removal without replacement:

Answer 13

a. Supraocclusion of the opposing tooth or teeth.
b. Tilting of the adjacent teeth.
c. Loss of proximal contact.
d. Disturbance in the health of the supporting structure and the occlusion.

Question 14

Correction of overerupted opposing tooth

Answer 14

1. 2.
2. 4. 5.
      6.
      Orthodontic repositioning.
      Simple contouring of plunger cusp and topical application of fluoride.
      Occlusal veneers or Onlay. Crowning of over-erupted tooth.
      Endodontic treatment and crowning of over- erupted tooth.
      Extraction.

Question 15

Factors affecting the selection of prosthesis type:

Answer 15

1. Biomechanicalconsiderations.
2. Theprospectiveabutment.
3. Estheticrequirements.
4. The patient desires.
5. Financial factors.
6. Clinicalskills.
7. Laboratorysupport.
8. Patient’smotivationandexpected cooperation.

Question 16

In addition to the increased load placed on the periodontal ligament by a long span fixed partial denture, longer spans are….

Answer 16

less rigid.

Question 17

If a single tooth pontic span is deflected a certain amount a two pontic span will bend 8 times as much and three teeth will bend 27 times…. Etc.
If a pontic with given occ.gingival dimension will bend certain a mount, if it’s thickness is decreased by half it will bend 8 times as much.

Question 18

Clinical sequels of bridge bending:

Answer 18

1. Fracture of porcelain veneers.
2. Connectors breakage.
3. Retainer loosening.
4. Unfavorable soft tissue response.

Question 19

How to overcome bridge bending

Answer 19

the solution will be :
Pontics with greater occ.gingival dimension.
Alloy of high modulus of elasticity.
Increase retention form in preparation.
Connecters should be as bulky as much possible.
Use of double abutments ?
Alternative treatment modalities for long span edentulous area:
Implant supported F.P.D R.P.D

Question 20

Biomechanical considerations:
On Arch form:

Answer 20

has its effect on the stresses occurring in a FPD constructed in the anterior segment, especially in the upper anterior region.

It was suggested to involve the two 1st premolar together with the canines in the replacement of missing four maxillary incisors to gain excellent retention.

Question 21

Ideal abutment =

Answer 21

Caries free

Question 22

After caries removal and undermined enamel the remaining sound
tooth structure should be assessed to:

Answer 22

1. Select the most suitable type of restorative materials and retentive means.
2. Doubtful pulpal condition or capped pulp shouldn’t be used as fixed prostheses abutment

Question 23

Endodontically treated tooth is contraindicated to be used as retainer for

Answer 23

cantilever bridge

Question 24

Endodontically treatment is done

Answer 24

intentionally for suspected or malaligned tooth to improve the arch relationship.

Question 25

sufficient retention: a. over-erupted teeth: they should be adjusted to normal occlusal plane even restored or endodontically treated. Best known through

Answer 25

mounted diagnostic cast analysis

Question 26

Short crown design and preparation?

Answer 26

Design: • Fixed-fixed bridge must be done. • Full coverage retainer with retentive means. • Pontic and connectors should be of considerable occluso-gingival to enhance resistance to bending. Preparation: • Sub-gingival finish line. • Decreaseconvergence • Decrease occlusal reduction (metal). • Crownlengtheningprocedures.

Question 27

Crown form

Answer 27

Tapered crown form: • decreased retention so must use full coverage. e.g. anterior teeth with poorly development cingulum, mandibular with short lingual cusps. Incisors with very thin labio-lingual dimension– increase incisal translucency in the incisal edge, nor partial coverage neither resin bonded bridge.

Question 28

Root portion and periodontal ligament condition , aspects should be evaluated

Answer 28

1. Crown/Root ratio (C/R ratio) . 2. Periodontal ligament surface area (Ant’s law). 3. Root shape and alignment. 4. Mobility.

Question 29

The optimum crown / root ratio for a tooth to be utilized as a fixed partial denture abutment is

Answer 29

2:3

Question 30

The C/R ratio is liable to change throughout life (aging or periodontal disease) A C/R of 1:1 is the minimum acceptable ratio to be used but under the following conditions:

Answer 30

a) Favorable opposing occlusion ( artificial prosthesis or mobile periodontally involved teeth). b) NormalOcclusalpattern. c) Abutment teeth with good periodontal condition. d) Highly motivated patient. e) Favorable root configuration.

Question 31

Periodontal ligament surface area (Ant’s law):

Answer 31

the sum of periodontal ligaments area of the abutments teeth should be equal to or exceed the total periodontal ligament area of tooth or teeth to be replaced.

Question 32

Factors modifying Ant’s law:

Answer 32

1. Well motivated patients and highly proficient in plaque control. 2. Opposing occlusion (sound natural dentition or artificial removable prosthesis). 3. Decreased in mesiodistal length of edentulous span due to bodily movement of teeth.

Question 33

Root shape and alignment

Answer 33

• Larger and longer roots are more favorable abutment teeth. • Form of the root is equally important tapered or conical roots are unfavorable

Question 34

Multi-rooted teeth with…..and…are better than single rooted or Multi-rooted with fused roots.

Answer 34

divergent and curved roots

Question 35

Position of roots of adjacent tooth is also important, in case the roots are

Answer 35

close with little interproximal bone separating them even a moderate irritation of force may be destructive.

Question 36

The magnitude and cause of mobility should be evaluated:

Answer 36

Grade I : suitable Grade II : can be used in short span bridges. Grade III : contraindicated.

Question 37

Special problems:

Answer 37

1. Pier abutment 2. Tilted molar abutments

Question 38

movement can create stresses on the abutment teeth as well as between the retainers as a result of the middle abutment acting as

Answer 38

a fulcrum causing failure of the weaker retainer

Question 39

The use of…… (stress breaking mechanical union of retainer and pontic ) has been recommended to reduce this hazard.

Answer 39

non rigid connector

Question 40

The location of the stress breaking device is important usually located on the…. of the pier abutment.

Answer 40

distal side

Question 41

Early loss of a mandibular first molar with mesial tilting and drifting of the second and third molars. Treatment options ?

Answer 41

It is very difficult to make a fixed partial denture with a common path of insertion without interference with the adjacent tooth and over-reduction of the mesial half of the 7 Treatment modality: Extract the third molar and upright the tilted 2ndmolar orthodontic ally. If orthodontic correction is impossible: Modified preparation design. Proximal half crown : 3⁄4 crown. Non-rigid connector on the distal aspect of the premolar retainer Telescopic crown: used as a retainer on the distal abutment A full crown preparation with heavy reduction is made to follow the long axis of the tilted molar inner coping is made to fit the tooth preparation the proximal half crown that will serve as the retainer for the fixed partial denture is fitted over the coping.

Question 42

In Canine-replacement fixed partial dentures , Maxillary more difficult than mandible due to

Answer 42

labially and lingually acting force respectively,

Question 43

Cantilever fixed partial dentures is

Answer 43

FDPs in which only one side of the pontic is attached to a retainer,