Professional Documents
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Outline
1. 2. 3. 3. Objective Developing Treatment Options Complex Treatment Planning Protocol RPD, Fixed and Immediate Dentures Clinical and Lab Procedures 4. Assorted Clinical Cases 5. Summary
Objective
Provide a consistent teaching to train the student to sequence the necessary procedures to diagnose and develop a treatment plan for complex prosthodontic cases in the Primary Care Clinics
Prognosis:
General factors: age, oral environment, etc. Local factors: occlusion, access for oral hygiene
Diagnostic Phase (Complex D&T) Paperwork (Prosthodontic Component) Prosthetic or Reconstructive Phase
Diagnostic Wax-up: Casts/waxing/set-ups (denture teeth) must be completed prior to beginning any reconstructive treatment (castings/prostheses or definitive Periodontal therapy)
One for removable prosthodontics One for fixed prosthodontics/Occlusal analysis Must be completed and signed by Faculty and student
Outline a Tx-plan with an Instructor (Complex D&T) Review Tx plan with complex case managers (Dr. Villarroel CCC2/CCC4 and Dr. El-Gendy CCC1/CCC3) Outline a definitive Tx-plan with sequence for clinical and lab procedures by appointment Stamp the blue tx-plan working sheet Reach agreement: patient, student, faculty Get case manager signature after all previous steps are accomplished and Phase II is completed Student should follow up the Tx-plan with any instructor Advanced complex cases may be referred to Grad Pros clinic
Diagnostic Impressions/Casts
Dx impressions: Irreversible hydrocolloid (alginate)/stock trays High quality with no voids A clinical instructor must authorize impressions pouring
Type III dental stone (buff) is used for Dx-casts pouring Dx casts evaluation criteria: Accurate reproduction of teeth and tissue Base thickness: 15-16 mm Land area width: 3-4 mm
Diagnostic Casts*
Diagnostic Casts
Provide valuable preliminary information and a comprehensive overview of patients needs Treatment procedures can be rehearsed on the stone cast before making any irreversible changes in the patients mouth Used for diagnostic wax-up, preliminary RPD design, surgical stent (surgical procedures), etc. Help to explain intended procedure to patient
Diagnostic Wax-up*
Diagnostic Wax-up
Useful to show proposed treatment to the patient
Used for fabrication of provisional restorations Fabrication of final restorations against the diagnostically waxed cast allows establishing optimum contour and occlusion Provides specific information about desired tooth length and form or occlusal arrangement: dentist-lab technician communication
Wax-rim fabrication, CRR, Facebow (if required) Selection of denture teeth shape/shade Set up teeth
Mount Dx casts on articulator using facebow/CRR Each set is mounted identically (cross-mounted technique) One set of Dx cast is used for Dx wax-up One set of Dx casts is left unaltered (original)
*Rosenstiel et al., Contemporary Fixed Prosthodontics, 2001
Immediate Denture
Definition: A complete denture or removable partial denture fabricated for placement immediately following the removal of natural teeth
The glossary of Prosthodontic terms, 1999
Immediate Denture
Examination and Diagnosis
Diagnostic Cast What teeth need to be extracted? What is the final RPD design? An esthetic evaluation is necessary if tooth position will be altered
Marking Esthetic Indicators Wax Try-in Laboratory Procedures Extractions and Delivery Maintenance Fabrication of Definitive
Immediate Partial
Clinical Case
Summary
The patient should be considered as a human being Successful accomplishment of dental treatment is the result of a multidisciplinary team effort: students, faculty, staff, other dental departments Following complex case protocol helps to:
Provide a higher quality dental treatment to patients Enhance students clinical learning experience and knowledge Increase efficiency: save time/money to patients, students, instructors, and Clinic Improve OSU Clinic/College reputation
Summary
The key of a successful dental case is the planning of the treatment at the beginning Primary care department team approach:
Combine the vast clinical experience of general dentistry faculty with complex case training of specialists
References
Clinic Manual 2003-2004; The Ohio State
University Department of Primary Care Bouchers Prosthodontic Treatment for Edentulous Patients, 11th Edition; Zarb et al., 2004 Contemporary Fixed Prosthodontics, Rosenstiel et al., 2001 Complex Denture Fabrication, M. van Putten, 2000
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