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THE ULTIMATE GUIDE STUDY FOR CONQUERING THE (lIlt|NTAL PERI ASSESSM IAGOSIS ENT/O N ANtl PROSTH(lD(lNTICS COMPUTER SIMULATION EXAM
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CHAPTER I

N(lTES

PERI(|Dlll{TICS
The most two critical factors determine PR|)Gll|)SlS that ihe 0l a peri0dotltally inv0lved (the t00th l 0B|UIY ATIACilME are and T[0SS m0st critical factor). PERI0D0NTAL PRoGtl0SlS l0recasi possible ponse trcatment long a 0fthe rcs to and term outlookmaintaining for a healthy, functional dentition. patient at 1. G00d Prognosis, has least 0fthese, 1 healthy slight adequate 0r CAL, peri0dontalsupport, n0furcation, control0fetiologicfact0rs n0m0bility, and t0assure paiient the tooth would relatively maintain be easyt0 underfull compliance. patient at Fair Progn0sis: has least ofthese: I moderatesevere and/or 0r CAI Glass proper I mobilityfurcation 0r involvement. The furcation and depth location allows maintenance 0atient with full comDliance. (>5mm) patient at Prognosis' has least 0fthese:severe 1 CAt causing ouestionable a p00r crown-ro0t p00r lorm. ratio, r00t Classturcali0ns easily ll n0t access'ble t0 mainienance, lll furcations. ll 0rlll mobiliiy, 0rClass Grade significant proximiiy. r00t pr0gnosis ll0peless Pr0gnosis: more the I or 0f factors questionahle under with inadequate attachment i0 maintain tooth health, the in comf0rt, function. and E)(IRACTI0 iSsrggested because periodontal (surgical active therapy or n0n-surgical) isunlikelyt0 improve t00th's the status. T00TH M0BltlTYi00th movement s0cket anexternally inits dueto applied Measured force. pushing t00th gently a F-L in directi0n theblunt 0ftwometal using by the ends instruments. Afinger notacceptable is t0 assess mobility. l. Classmobility, F-Lt00th I movement lmm. of< total 2. Classm0bility:totalm0vement with verticaydepressihle 2 FL l-2mm N0 m0vement. > 2mm 3. Classmohility:totalmovement and/or 3 FL movement ina vertical/deIressible directi0n. (PD)-each has measurementsMB, DB, Measured (8,L, l!ll, DL). P0CIGI DEPTH t00th 6 from sulcus " GlV. base CEJ"GM distancemm in lromtheCEj"gingiyal iveasurements atthe margin. are taken probing saflre sites t0rec0rd six used depth. . Gingivaltissue abovethe isrecorded IIEGATIVE CEI asa number . Gingival bel0w CEJ recorded P0SlIlvE number tissue the is asa Ctll{loAt ATTACHIIIEIIT(GA[) distance ctl in ana0ical [0SS from direction the to = p0ckevsulcus CAL {PD) (distance G t0 CEJ).disease, locati0n lrom In base. GIV's may migrating base, is only beunrelatedtheapically t0 sulcus its position used t0calculate CAL. (llormallD0cket isc0r0nalt0lhe with CAL. CEJ n0 Heallh deDth l. Slighi Periodontitis-pocket deepened, gingival depth is but the marginunchanged. is CAL l-zmm. greatef ch ent blt iloderate Periodontitis atta m l0ss, since isattheC CAL PD. GM EJ, = GAt 3-4mm. greater Severe oisease-even attachment and loss, because 0frecession, is theGIV below CEJ. CAL CEJ thepocket (0rrecessior the Thus, = t0 base measurement + PD). > CAL smm. i! 3mm, attachment = 7nm. l0ss Ex: a probing is4mm recession lf depth and total

0pening. Radi0graphshelpful. bone but furcation entrance visible. ll Furcation oIma{llary molars theP00REST 2d have hy0lvement PR|)Gtl0SlS therapy. indicates creviculal gleeding pe (bleeding) is ulcerated t0 active odontal dae disease.butsome lilV0wt grafts noteffective only increas accessibility fff plaque treatments rem0val. sc0res is REI-|ABIE indicat0r lhegingival period0rhl 0l 0r inl{ammation. 3. destructi0n llssue isdeeler 2mm lhan measured horizontallythe from furcation's coronal most aspect. N{1TES ll{V()LVEMEtlT in RID thepatients Use Nabels t0 CATl0tl n0ted on chart. the the side. enters the furcrtion roof. destructi0n thro0gh Jlssue exiends theenlire lurcati0n a blunt s0 Naber's can between f00ts emerge Probe pass lhe and 0n other Total loss. after . Bone are t0 H0wever. by Grade I Grade ll Grade lll of lurcaii0nsl0 ELltllllATE IAll{ 0biectivelrealing is FURCAT|l)il tilT. successlully &TR treatsGrade furcati0ns. tie clinical L Class )-incipient |( involvement. Class (Z):Thr0ugh-&-Through lll involyement. D0ES but fi07 C0iIPLETEIYIHRoUGHfURCAT||)tl. a Probe and clinically diagn0se a furcaiion. are are but oNLY adjunct an examination. PASS THt Partiatbone Probetip under loss. b0ne 2. way eyaluate success ll0 BtEEl)lllS Iritl"in sec0f 30 BEST t0 SRP is 0ll indicates inflammatory active G(BoP dise 80P Deriod0ntal ase\. tjpfeels depression Probe the 0f thefurcation Incipient {0ss. Class (Z): Cul-de-sac ll involvemenl. destruction l-2mm Tissue extends measurcd hoizontallyfrom thefurcation\ coronal most aspeci.(B0P) indicated patient's bya 00Tforsites lll0 0l{PR0Bll{G on the chart RED that prohing. Ueatfurcati0ns. still is not but coveredgingiva.

. forrnation and/orgingival recession. a with HEAITH facultalive anaeroies. s0me may periodsrapid progression. strictly anaer0hic C). when . (+). . l-2mm .calculus Code'l: colored iscompletelyvisible. Slight Periodontitis. Gingivitis-gingival inflammationeiiherchanges contourgingival with incolor. (*)can added other An be for clinica' abnormaliiies. Chronic periodontitis prog. attachment bone pocket and loss.6 sitespert00lh lecorded. . .lf < 30% sites inv0lved = Chronic of are L0calized Peri0do[titis. C0de c0lored isiloTvisible. Code colored isc0mpletely n0B0B 0: band visible.SS-bone isparalleltoimaginaryfrom CU CEjof B0llE loss an line the t0 adjacentteeth. 0lAGlll)SlS 0FPER|000i{TITIS 0nRAIE PR0GRtSSloll isbased 0F & oISEASE SIVERIIY. ntes0fprogression experience short of Thus. from bel0wthe tothe ileasured 2mm CU t00th's based the apex. bacteria.all0wsthe dentislt0 rapidly assess and periodonial but NOT recordpatient's a slatus. Moderate Period0ntitis: CAl".essive but patients isa SIoWLY disease.l't0TEs (PSR) PER|0D0llTAt SCRIEI{ll{G & REC||RDItIE a screening thatpromotes exa$ earty period0ntal PSR detection treatment and 0f diseases. present. Inperiod0ntal disease. band B|)P No 0rdefective margins. Code c0l0red iscompletely but 2: band visible. . crest Alveolarcrest's position more 2mm the normal isn0 than below CEl.5mm) inserted iniothe gingival crevice under contact resistancefelt andis walked the until is DISIAIESIAI. band visible. Aggressive Periodontitis-rapid attachment &bone loss destruction.5mm tipand probe uses ball c0lored from hand 3. band *. CAL. watchingthe band colored relativethegingivalmargin. intissue 0rchanges consistency. 2. byt00th furcalion involvement. Classified aseither L0calized Aggressive Peri0dontitis 0rGeneralized Aggressive Periodontitis. Amounts of microbial deposits ri?corsijtedwithseverity are the 0lperiodontaltissue destruction. 0n normal bone p0siti0n. Chr0nic Period0nlitis-inflammati0n within supportingteeth progr€ssiye tissues. are but0nlythe HlGHESTscore per is rec0rded sexlant. & muc0gingival delects. . H0RlzotllAt t|. calculusdefective 0r margins ptesent. 3-4mm possibly accompanied mobility byt00th and lurcation involvement. begin 0ccur any but t0 at age. Severe Period0ntitis: 5mm usually atleast CAt. isa criteria pe0ple being used exclude from t0 diagnosed Chronic with Peri0d0ntitis. t0 Scoring uses sysiem se\tants.defective 0r margins. 0f papillae/margins. defects. inLocalized Aggressive Period0ntitis around fimolars incis0rs and inchildren. bacteria the shiltst0gram m0tile. Rate Progression: of . . 4. conmon lllost i[ adults. mobility.5-5. . Code lurcation involvement. PSR a special (0. lf > 30% sites involved = Ghr0nic 0l are Generalized Pe. l.0imal Comm0n 0f horc. accompanied mobility.iodontitis. VERIICAL L0SS angulaf loss B|lt{E bone al0ng side the the 0f tooth themost from c0r00al aspect theinterp. d0es replace need d0acom0rehensive the t0 peri0dontal and exam charting warranted. calculus. SeverityPeriodonlal 0l Disease. are Code colorcd ispartly 3. mucogingival recession. Bacte ass0ciated PERI0D0ilTA[ aregram non-m0tile.

gingival 3. the as mass and ahundant bacleria a ilEALTHY in Sl. is anaccumulation mixed of a bacterial c0mmuniiya DtXInA ATRII( in formed 0n t00th surface within minutes c0m00sed80% 0l waier 20% & solids/bacteria. . increased transition and/0r t0red bluish elevated la tem red. likely is most i0 accumulateinter-pr0ximal surfaces 0n tooth first. ontitis. plaque acc!mulates matures. yertical res0rption. bone & wideningPDL of space). But. N{lTES UE-I1{DUCED DISEASES GIl{GIVAL plaque predoninanceGRA(+) FACUTTATIVE of dental development early is an 0l (-) (r0ds. E-ll{0UGE0 GIIIGIVAI DISEASES. is a c0ndition for Gingivitis notalways l0 does lead gingivitis. Clinicalsignssympt0msassociated stable and are with attachmeni 0na levels periodontium attachment 0r0na stable.Gram & filamentous bacteria are the in dant a healthy sulcus. t0the plaque initiate 2. beaffected local loss 0rwith that Can by and bemodifiedspecific may by systemic folnd thehost. a.mUS STREPT0C0CCUS are & ACTII{0i|YCES (+) cocci (Sirept0cocci) (Actinomyces) most ies. periodontitis pr0gresseslrom but atways lg8-the immun0globulin ahundantgingival in exudates common gingivitis. faciors in is oingivitisthe 0illllAllT Deriododal dtsease.gingiyitis peri0d0nta PLA0llEIGY ETl0t0GlC AGEllTin causing and I disease. changestissue and cannot t0 and in c0l0r tone lead a diagn0sis 0f periodontitis V{|TH0UT radiographic evidenceb0ne Periodontal ol loss. su r lcu BoP. reduced periodontium. the role 5.theinflammatory are to but resp0nse initiated gingival in prerequisite peri0d0ntitis. CAil be lrom cteristicsAllGingival 0l Diseases: L Signs sympt0ms and conlined gingiva. hetes). p0ckets 0T determined radi0graFhs. 4. Possible asa precurs0rt0 attachment around loss teeth. severity (enlarged contours toedema/fibrosis. with n0 loss but 5. Dental t0 and/or exacerbatetlre 0fthelesion. I diseases limited GINGIVA. gingivalexudates). Disease is reversible byrem0vingetiology. t0 a laterdomination GRAiI AIIAER|IBIC 0l bacteria fusiform. GlllclVlTlS ll0TCAUSE 0R 00ES B0tlE pocket > Bleeding. there radiographic are features periodontitis of lamina horizontal 0f dura.occuronleriodontium can a without attachmeni attachment 0na peridontium is notprogressing. in are l{0 radiographic leatures gingivitis 0f appearance 0f bone is kadiographic (ioss l). Clinical 0finflammation signs due c0l0r perature. depths snm.

exudates. {actors may abuse.12%) when lor bacteriasituati0ns used 30sec in GLUC(II{ATE . HIV stress.obia adday. (plaque. additi0nal does and pr0phylaxis micr0bial assessment c0ntinu0us frequency. correct anti micr0bial plaque ill-fitting fixed0r open embras!rcs. rsatallages occu atlhe duet0 inflammation bacteria gingival disease. temperature and/or Presence and tenderness. through renaining and thegingival margin spreads removal. gendergenetic aging. Bay required. contour c0nsistency c0l0r gingival changes. and evaluati0nbe monitoring after PERl0DoNTlUtl periodontal GltlGlVlTlS A REDUCED 0l{ PLA0UE-|I{0UCED periodontaltissue the in periodontitis. open/overhangilrg na(ow t0 may Surgical i00ih removable denturcs. margins. drugs. goal lactors eti0logic Treatment 0di0ns: is to eliminate patient 0f calculus.The effeciive m0st (plaque) moditied specific host by but by lactors are diseases affected local Gingival systemiclactorsviatheEilD0CRttlESYSIE. calculus). . Characteristics: at thegingival it Changesgingival plaque margin changes. histologic B0B increased change. nutriti0n. increasing debridement. clinical loss indication 0factive n0 attachment (no with progressive loss gingiYitis. (patient remaining n0n-compliance.l ishealthy. ne hematologic via lactors theendoc system. I agent red plaqueand for ucing antinic. lf condition notimprove.substance predispositi0n.enlargemeni. L Gingivdl hy h0st fact0rs. Gingival diseases diseases.debridement educaiion features) through retentive (over plaque cruwns. with reduced atiachment alveolar height.lhe margin. anti& 0Hl.hematol0gicdiseases. (where slarts). sensitivity. at Fl)n 0t PtRl0DoilTA[ Colllill)il and 0fdentate 00DUlation isIHElil0sT gingival Reversibleplaque with unit. bacteria. factors contoured retentive agents. not t0 contributethecondition resolving other that medicaiions. sulcular (redness). sk by may Treatment beaffected systemic lactors pregnatcy.kills CHL0RHEXIDIIIE gingivitisover long{erm. malposition). but a periodontium gingivalmargioredqced ona the inllanmationt0 return bacleria-induced 0f Same lindings disease).dr GlllclvlTlsl t0ss EIII0R TfltRE floATIACHI Bl)llE lvlTH tS . inflammati0n 0f treatment resolutionperiodontal and Characterized bythe bone and C. correction berequiredcorrect is ptaque active therapy complete. periodontal smoking. erythema. 0r malnutrition. gingival common 0l Plaque-ass0ciated type P[A0UE-|I{DUCED Slt{GlVlTlS most . medical/denial 0Hl/educati0n.l{0TEs Gingival 2 Categories 0l Plaque-lnduced Diseases: by diseases affecledlocalfactors. 0lcalculus plaque. furthel isrequired t0determine course evaluati0n (diabetes. consultation. & B0B edema. attachment is asplaque-induced butthere pre-existing (0. gingival lt is Begins 0ISEASE. in . Attel gingival def0rmities hinder that oftreatment. contacts. plaquecalculus. modifiedspecific systemic bul affectedlocal by 2. contr0l.

gingiva inflammatory response. with contour. onset 0r Change ingingival color (bright contour. testoster0ne llustbe > 8. zrd 3dtrimester. increase ingingival exudates. occurANYT|l!'lE PREGNANCY. ingingivalc0l0r. (bleeding) gentle Iain clinicallinding isgingival hem0rftage upon Fressure. Increase ingingival exudateatleast during by 20% ovulation. after li0TEs .' alCycle-Associated 0ccurs 0ingiviiis: duingthe menslrualcycle sex due t0 (estr0gen pr0gesterone) gingival hormones & causing inflammation an and in gingivalexud(GCF) ate especially ovulati0n. Gharacteristics: atthe plaque gingival pronounced margin. Plaque gingival atthe margin. Reversible after ovulation prcn0unced Pregnancy-Ass0cialed plaque thegingival Gingivitis: ai margins.7). can performed. levels . lilore commonlilAXlLLA in & ll{ItRPR0XlilAttY. during Characteristics: . to . . inflammat0ry rcsponse 0{gingiva. exaggerated buta[ inllammat0ry response pregnancyt0 during an polyploidy irriiation causing a solitary capillary hemangiomableeds on that easily provocation. Reversible BoP atparturition. modest inrlammalory priol response otgingivaJ ovulation. Must attheovulatorysurge luteininzing be when h0rmone are 25mlu/ml levels > and/0r estradi0l >200pg/ml. lf aw0meninherl310r trimester. and (Pregnancy not tumor Pregnancy-Associated Granuloma Py0ge[ic Tumorf a (neoplasm).Cingival oiseases modilied Eil00CRlilt bythe SYSITI' iated Gingivitis: dramatic in SIER0l0 the rise fi0Ril0ilE I-EVEIS in b0th sercs a transient 0ngingival has eafect inllammati0n Duherty ivalinJlammationdevelop 0nly can with small amounts plaque 0f during the pubertal (this what period is distingrishesdisease). . Features: mushroom-like 0rpedunculated sessile mass gingival atthe margin inter-proximalspace. 0rcompletely Can DURING Regresses disappears parturition. trcatment betojusi 0Hl may reapp0int childbirth her after forscaling p0lishing. this Characteristics: pronounced atthegi'rgival margin. polishing. May developearly thelsttrimestel as as . 5% pregnant or Affects upt0 0f women. is 2'd scaling. 0fthe (gi s estradiol boys circumpubedal > 26. gingival Increased exudates BoP and after Reversible puberty. Clinical painless protuberant. possible Change changes insize. &0Hl be prudent It she well her3i is into give and trinester. Faque inflammatory response gingiva. red).

isswollen. is 0n and 0RAt Pronounced present. yrith l. conaour. organ transplant rejection). malnourished l'rave and host defense thatmay system aflect infeciion susceptibility. &calcium-channel (llifedipine bl0ckers Verapamil. cootr0llingthe induced erceFt diahetes is m0re important plaque than plaque in control lheseveritythegingiyal 0l inllammation. Characteristics: pattern. with loss. Acid-Deficiency Ascorhic 0ingiyiiis: (Scunl) vitamin(ascorbic deficiency especially C acid) ininfants. 2. . and size. ulcers. 10 . in Enlargement obseryedinterdental isfirst at change gingivalcolor. alcoholics at risk. red. leukemiascause maniJestations Acute can oral like petechiae. Gingiya and tissues red deep are t0 Gingival bleeding probingcommon istheltllTlAt SlGil. slongy purple. GCF BoP Reversible after disc0niinuing contraceptivetheoral Plaque-lnduced Diseases Gingival Associated SYSTEilIC with DISEASI. Reversible contrul diabetic Plaque Iype if can the state. Gll{GlVAt DISEASES & MAttlUTRlTl0l{ nutriiional deficiencies significantly can worsen gingiva's plaque people acompromised the responset0 bacteria. found gingiva orwiihout BoR in with bone hutisl{0Iassociated attachment loss. S0dium Valpr0ate). Diabetes l{ellitus-Associated f0und Clllll)REll p00y controlled Gingivitis in glucose Iype Lil (plasma I levels-insulin dependent). il0stcommoncbildren BoP in witi c0tltrolled I Dil. inflammatory 0fgingiva. instituti0nalized & elderly. Characteristics: at gingival pronounced nargins. with 0rbone . oralC0ntracedive-Associated pre-nen0pausal taking Giryivitis w0mer these plaque gingival pronounced gingiva hormonesdevelop atthe can margins. plaqueNoT inflammal0ry 0fgiigiva relati0ntheplaque resp0nse in t0 but is required condition forihe t0occur. possibly Increased (crevicularfluid). in increase exudates. oral hygiendpiaque removalcan severilyenlargement. teukemia-Associated (Hematologic Gingiyitis 0ingivitis)-malignant bl0od disorder (bl00d gingivitis)0f dyscrasia-associated abn0rmal leukocyte developmeni and proliferation and inbl00d marrow. reduction limit can thec0ndition's severity. gingival cervical aden0pathy. Calcium & channelblockers cause 0vergroMhoftiBe. Phenytoin gingival causesthe highest enlargement 0fpatienlsi in50% Cyclospori 2530%. inthe 0flittle changes ingingival color. 20% . and susceptible to bleeding. in onsetwithir 3 m0nthstaking 0f meds. more inAtlTERl0R occurs often GUGIVA and children. response change in col0rhontour. 2. are Causes gingiva appear the t0 bright swollen.t{0TEs (Medicati0ns) 0is€ases: DRUGltl0UCtD Gingiyal (Enlargemenv0vergr0wth):antil. Biltiazen. Drug-lnduced llyperplasia Gingival caused by (0ilantin/P[enyt0in). shrinkthe Plaquenot is required t0producethe enlargement. Similarfeatures t0 plaque gingivitis.lirst observed inPAPlLlA associated attachment l0ss. variation inier-patient in & intra-patient change gin in c0ntour causing changessize. (Cycl0sp0rin c0nvulsants imnun0sup0ressants A-prevents (Pr0cardia). mucosal and inllammalion & glazed. increased poorly exudates. inflanmatory response presence plaque. enlargement. ulcerated. ll0l limitthe 0f but does gingiva.

Primary flerpetic Gingivostomatitis aanifestatofHSV-l class c 0n infection. ple. 3. bone lritial rfira-oral symptomsbepain paresthesia U tIAIERAImay and beforethe rEsr0[s 0ccuR. Histoplasm0sis:0matous oral a granu disease. tooth afdalveolar necrosis. {genetic-derived gingival generalized gingival ditfuse enlargement. Fungal Inf€ctions cause that Dlagnosed by culture. Candid0sis (C. highinflamed va. I\4zinly y0ung gingivitis ! cerations in children. infection t0 host !sually infection oral a superficial 0fthe mucosa. biopsy. Temova . atypica y ging 0ral mucous oras non-ulcerated. & leave fibrin-c0ated feyer lymphaden0pathy.rpression asa djstinct red I mited appearing llfear band tothe FREE CINGiVA. Features: Classic VESICLESRUPTURE.gic may be by reactions 0r toric VA foreign reactions. wth and edema accompanied by stomatitls. thcofs is and w derab e disiodion 0lnormal c0nt0ur. tl . Viral Intecti0ns cause that Mainly Simplex 2 and 1& Varicellaper due Zoster reactivated therr when from atent ods t0trauma. llssue dense lirm. & . extensjve t0 c0ver often enough the teeth. Recurrent Intra-oral Herpes-cluster painful inATIACHED 0fsma ulcers Gl AlVA. and smear.INDUCEI] LESI()NS TON-PTAOUE GINGIVAL IIIDUCED GINGIVITIS is causedspecilic l)ll-PLAoUE by bacteriai.N()l tlactions. But quattitative s nce Abcans common C. Strcptqcocci. Apr0gressive GEIIETIC 0lthegingiva fibrolic enlargement). er!4hemat0us are rcsu0fsecondary color but chafges a t bacterial lnvolvelirent. lesions occ!r t0 host Gingrva may due gonufiea. . LGE dOes resoond lesion f0t t0Dla0ue . infecti0n lorms. sed cafcause tissue severe destructior exloiration. s inheaithy duals. lmnun0c0mpfom sed are risk the .iections.va painlLr 0ns.assavs. Both chickenpor shingles allect and can thegingiva initiaie VESICIES RUPIIJRE fibdn-coated and as THAT t0leave llcers patients the that coalesce t0irregular lnimmurocomprom (HlV). and vrral. d OT i€n lst ls: & nc gingivitis. occur HIV other lvlay n and patients girgiva mmunocompromised erythema as 0fattached .$sT[$ G ctvtTts. . Gingival isnormal. Albicans) oppoltLrnistic due redLrced delefses. Bacterial Infections cause that Infective slomatitis ngivitls &g in immun0c0mpetenl and immun0c0mpr0mised occuring n0nindividuals. Herpes 2. & periodontilis. ulcers. Pseudomembranous (Thrush) patches wipe leaving Candidosis white that off a y n0 lJsual major s ightly bleeding surface symptoms. Cinically. isa glfgval LGE manifestation 0fimm!fosr. inmaif anogenrtal.also ts. when paque pathogens overwhelmresistance. als0 cause infectiors. fungal This . sp0nn 1T rg va1 It . cancres patches. Less than severe herpetic Diagnosjs by efzvme. g ngival inflammatioralso caused alle. rfEcTt0us gingivitis. Clinically may fesemble a malignafttumor' pr0lilerati0n 4. lesions rr'raymay beaccompanied or n0t bylesi0nsother sites. oRAL while HSV-2 but may g ngiva. ght. "4. body ormechanicaland thermalirauma. may appearflery edematous u cerat asasymptomatic or as red. n body gingivitis. fever IJV 0r y HSV!s!ally I causes maniJestations. nked PCR . indlv assessmert and noticing changesneededa reli. 1. methods.frcponena pallidun. primary girgivostomatitis. patients atircreasedofacquiringlffection. THAT c0alesce. H|V-Associated = tinear Gingivitis Gingival Erythema. iniiiating asn0dular 0rpapillary latet afd ulcerate are and painful. Varicella-Zoster Virus: lnthe latent dorsal gang oftrigem until s root 0f nal it reactivated inadults cause t0 SHINGLES. Hereditary fingivolibromatosis-a rare DISEASE. fieclions lleisseria by & Gngi. lesions any ofthe affect area Ofal muc0sa. s made cultures.Pa severe but ad! fful.has found th€ ora HSV been n ANUG.ble clinical are for d agnosis.

0rcutting amalgam abrasion g. 0r cresl. h0t rmpression PERIllD()I'ITITIS Biiewings be peiodontilis. 0esquamative byerythematous.l material thegingival via into Body all0ws 0f 8.5-l 0lonly . alveolar is 1-2mm adiacentteeth. Lupus. Advasced h0riz0ntal loss bone being Enensive and indanger0f lost. orextensive defects. Pemphigus Planus. role (lichen BMMB with diseases planus. in alfected periodontal In health. and u disease istreated clears mediated by are lype reacti0nseither | (immediate) Reactions: muc0sa oral 6. usually aredermatologic. p. dura posterior in ea pe extends alve0lar destruction heyond y c[anges bone l{oderate odontitisgeneralized plate buccal lingual resorption. materials. and slough coagul labial 0f hydrocolloid piza. Gvidenc€ loss 0l hone MUST evident. Ioxic Reaclions: C. a pai (peels gingiva desquamates away). dental surface. diseasecharacterized chronic Gingivilis-a gingival involvemenl &ATTACHED 0l FREE desquamative vesiculobull0us. & 10. lf extensive l0ss bone B0llE accurale to assess L0SS tool arelhet{0ST > 30% m0re as reveal 0fperiod0ntium. byT-cells dental duet0 lv mediated lgE Type (delayed) 0r and food. entry a forcign (i. bony t0 radio$aphic is thickness ical 0fc0 Areduction 0. an exposing layer where condition iheouter with but are Many diseases conditionsass0ciated DG.omm Plate ssflici€ntallow yisualization b0ne The of cancelloxs trabeculae. Peri0dontal 0l rate severiiy inanincreased and (cytokines) tie p€rs0n\ attack inmune factoN where Uilt AUT0lM DIS0RDER thebody's own and cells tissues. 0l thegingiva gingival 0r lesions away) DES0UAiIATIVE lilultitolme. aspirin induced desquamation. F0reign Reactiofls. DG & pemphigus).gingival inthe 0J manifestati0ns form Diseases: present Dermatological may (peels Lichen ulcerati0n. DG is FEI{ALES are Most Gltl0lvA. bull0us reaclion isass0ciated skin 0r generally when alle. brushing scratching gingiva a fingernail. lilechanical "gingivitis artefacta causedexcessive bv lesions lrauma: intlicted sell in with lvlost the force. Er$hema Pemphigoid. muc0sa most arethe common Painful. common children (2/3 females). m0 and red acutely surlace.crest alveolar is 0fthe 0ldestruction inner bel0vr CEI the 0f crest the disease. nay sites. wax. are and mobility drifting. rounding thecrest anterior in regions). chlorehexidine mucosal 7. young people are Palatal are (hot therma 0f nucosa rare beverages). may thealveolar and include and tooth vertical erosi0n. horizontal 0rlocalized defects possible mobility. and/or er0sive. 12 . . Allergic restorative materials. radiogralhic T0 diagnose (RES0RPIl0ll).lreatment: Topical corticosteroids. Chatlges Radiographic inPefodontal 0f h0ne (blunting periodontilis-areas er0si0n alveolar crest 0fthe 0flocalized l. (polymorphonuclear leukocytes) results 0F 0R AREDUCTI0II ll{ llUi[BER FUtlCTl0il PMtls period0ntal disease be may an destruction. Early junction and between crest lamin the and 0fthe in regi0ns. remaining show teeth periodontitis l0ss s0extensivethai bone is 3. Body tatto0). burn. with handlinghot keatment improper Cotfee. patients postmenopausal ages{0-70yrs. etc. Vulgaris. in height beevident t0 a crest be mass alveolar must lostlor changebon€ thebone atthe onradiograIhs. "Foreign Gingivitis".gic reaciionskin or resolves the pemphigoid. due DG 0ccurs t0anallergic Plaque's isvague. Themal Trauma: I bums oral the red. toothoastes. mouthwash. ol bitewings be siould iaken they vertical occuned.e. Disease.

(Neutropenia. immune defects. 0ste0p0r0sis.. odontal surgery and maintenance). Adjunctive antimicrobial combined SRB therapy with and/or evaluati0n counsellng and of family memberstoitsDotential nature. Leukemias). drugs. am0unts mlcr0bial 0f dep0sits inconsisient theseveritv are with 0f periodontal destruction. l000llTALTHERAPYG0A[S 0r eliminate t0 alter microbial eti0logy contributing and progression preseruing factors periodontilis. Disease. lunction. HIV/AIDS. byActin0bacillus Caused A. is Localizedld t0 (vertical loss) inteFlroximal & molarsincisors bone with attachment 0natleast loss 2 permanent (one a ld molar. can 0r Patients clinically are periodontitis. medications. treatment objective ist0 tstemic progression". often t0 Fact0rs canincrease that Periodo Gironic al fioTEs risk: parrlu m0st ikrn by (pregnancy).n tu5. is Pronounced naiure destruction of episodic 0f attachment alveolar Generalized and bone.' & t|}tlRS lllc|S0RS. tissue elevated of AA& P levels Phag0cyte (elevated o1PGt2 lLphenotype abnormalities hyper-responsive and macrophage levels & lb). due familial L0calized Aggressive Period0ntitis stve 0ss ngs loss 6of lent ults t al xl-s tmine in iic et s 0f t3 . Regeneration 0f -l apparatus beattempted. lggressive Period0ntitis Treatment: rcinforcemert evaluationpatient's 0Hl. (major preventablefact0r). lyif isuns!ccessful. medical Additional evaluati0ndeiermine t0 if systenic ispresent disease inchildren &young especia initialiherapy adults. lupus erythematosus. gingivalis. genetic WBC Rare disorders Agranulocyiosis. horrnone imbalances unc0ntrolled I & ll Type Diabetes melliius.microblal a reasonable & flora. and 0f (occlusal plaque pe control. absencelocal 0l fact0rs t0 the destruction genetic predispositi0n (a Possible etiologic factors: 0r neutr0phil dysfunction chemotactic SIJDDEIi defect). 'slow disease the RESSIVE PER|0D0l{Tlns belocalized generalized. & Caused M. arresting disease lor thus the and the prevent in c0mfort. serum responseinfecting P00r Ab t0 agents detected. interpr0ximal attachrnent affecting IEAST PERMAIIEI{T |lIllERTHAII loss A1 3 TETTH 1. attachment & bone Ithy except the for Rapid loss destruction. tdols thatcontrihute Pefi0dontitis: sex etc. stress. involvesmo. control other factors SRB 0f local therapy. be0f L4ay ilialaggregation/nature. Secondary Fealures. P & neutrophil function abnormalities. 0F lll (but people 30yrs patients Aggressive Peri0d0ntitis affects Generalized usually under nayhe older). and loss (l0rmerly Aggressive [0calized Peri0d0ntitis iuyenile Peri0d0ntitis) circumpuberta] 0nset a robust with serum rcsponse Ab t0 infecting agents detected. predisp0sition.Progressim 0l attachment bone nayhesell-arresting. hormones. general treatment considerations.e two teeth is and no than teeth other l"' than molars incis0rs). c0ntrol thediseasenot may When 0f is possible t0 Itachment due -fltition factors. I t0 smoking. esthetics and t0 recurrence. Downs syndrome. smoking isk & Cr0hn's RA. gingivalis. oneoutsianding by negatile feature therelative is (plaque)explain severe period0ntal present. DRlFIlllc TETTHCHltlREl{. gingivitis leads Peri0d0ntitis.

Initial t0 risk that alter. arycliflical t0 and thetary with to anenpts contoltheinlection cqnYentional Ioss rcpeated after . hut PEnl0D0ilTAt FoR llll)ST bone. depths t06mmvrilh tooth may bone and Radiographicloss increased mobility l0ss attachment upt0 4mm. Periodortal gingival regenerative (grafts. is PERll)ll0 ll treatmenteffective. reducing and toward occlusal lesions. therapy rooi GTR). resective pe disease 0f apolies alllorms destructive odontal t0 PERl0D0llTlTlS REFRACToRY (Re{ractory Periodontitis & Refraciory Chronic t0 treatment are non-resDonsive that previously with diagnosed peri0dontitis. oiagnosed in palients Periodontitis). molars. Ct}MM|)lt 0FDESIRUCTIVE have rates 0l but 0l Slow-t0-moderate pr0gression. . also localiTed t00th and oossible . periodontal hpallh.advanced loss DISTRUCTI0tl of up WITH CHR0I{lC PERl0D0l{TlTlS StIGHT-T0-M0DERATE is clini peri0dontal In if tissues. and/or increases age.gingival and supporti 0f l0ss t0 Clinical aDDaratus. IAI PER|000 SIJRGERY (bone grafts. Surgical gingivalaugmentation. initialiherapy become s0 to in may treatment notbelntendedatta optimal maintenance. actiye c0nventi0nal therapy 1{ . 33%of supporting Pr0bing uP clini not Class loss attachmentshould exceed l(incipient). Aggressive vrell-executed therapy sites loss 0r attachmenl at 0ne more despite who have addili0nal Iealute additiqnal is Prim patient the eftorts stop progression. trauma). Incertain due thesevedty extent thedisease patient and age/health. include peri0dontal timely which end-point . wilh compatibre attachm extending theadjaceni into inflammation CHRoI{lC PtRl0D0tlTlTlS . and 0f cases t0 may t rcsults. Periodontitis (reshapin localcontrihuting factors remove agents. Treatment: eliminate.treating lhe d0esnot resolve chroni lf initialtherapy is SCHE0UtE0.SRB anti-microbial & restoring0 odontoplasty.initial 0r occlusal contacts. Treaiments: surgery). ized 0rgenera Can be increased m0bility.sa CHR0ltlC l0ss but as to-moderatewithadvanced 0f > l/3 0l supporti clinical features slight is ll inthe if attachment furcationpresentclass 0rlll Loss tissues. smoking.may a wide raflge ages. rapid . C0ilil0tt edema. (involving area thetooth's 0r generalize attachment) present. t{AlllIEtlA}lCE isconsidered: peridontitis. belocalized one 0f May (involving teeth dentiti0n). 0r conirol faciors coniribule Chr0ni pregnancy. nuirition) systenic aging. . movement. resective (flaps. Localized 30% sites affected. if < 0f are peridontiiis slig . Deriods progression. correcting restorations. erythema. siress. 0Hl. t00th illfittingprosthesis. diseases. 0rgain stabilization 0f clinical plaque I detectable i0 progress stability. Clinical ill)ST t0R[l0 BoP suppuraiion. Features. thefurcati0n involved. 0sse0us thempy with resective (flaps 0rwlihout DESIRUCTI0 WITH PERl0D0l{TlTlS ADVAT{CED-I0-M0DERATE . with & severity ltsprevalence PEll0D0ilTlTlS. Patient simultaneously with 0f and have ateas health chronic can and desiruction moderate. therapy. gingivectomy). regenerativetherapy GTR). attachment due destructionthePDL adjacent DISEASE lil ADULTS. "Refractory" c0mply 0Hl in who isl)tllY diagn0sis made [atients satislacl0rily wilh and pr0gram.N(|TES and depth inflammati0n probing reducti0ngingival 0f significant Desired 0utc0mes: of radiographic 0f resohti0n0sse0 evidence attachment. several 0rentire . (diabetes. is diagnosed ATIER peri0dontal and maintemnce who lolloyredrig0rous a has c0ncluded. therapy Surgery C0nsidered: augmentation. if > 0f are Gefieralized30% sites affected. 0fclinical 0eriod0ntal evidence bone 0l Radiographic loss > with Pr0hi[g depths 6mm attachment > 4mm. & gingivect0my.

physician. ocessive bleeding. (anti drugs convulsants. Ehlers-Danl0s Syndome. GHR{|lllC IEU|(EI{lA. 15 . 0l 0r ideective treatment peri0ds exacerbati0n malignancy during 0f 0fthe orduring active periodontal when 0f ses chemotherapy. anomalies.patients recurrence body disease. identifiable conditions increase wh0 have system that have areas suscepiibility. Administer Deriodontal antibiotics caution with lanesthesia ispreferred t0generalanesthesia sedatl0n. ol providers laboratoryneeded refer consult other as and 0r with healthcare walranted. should their take medicationmaintainappropriate theday and an diet 0n 0f Itherapy. naprn g0 0utc0metheperi0dontal of treatnent therapy bedirectly may affected c0ntrolllng by systemic condition. pr0gression. COI{DITI()I{S AFFECT PERII)DOI{IIUM TREATMEI{T MAY THE AI{l) OF pregnancy. t 0ISEASE Physical disabilities. Can emergency treatment anytine during Perform ancv. maintenance asneeded. storage disease.-graft are for disease drug-induced and aJter marlow bone iransplantation. calcium (Diabetes cyclosporine). antibi0tics emergency Consider for therapy gingival ulocyte counts lowl\40nitor host-vs. Chronic Granulomatous Leuk0c'4e Disease. period0ntaldisease. Chediak-Higashi Syndr0me glyc0gen axis abn0rmal). xe6t0mia. ional iherapy.localized 0frapid attachmert relatedroot loss t0 fracture. 0f bl0cke6. orroot 0r with of years periodontal iveperiodontitis many 0fsuccessful after maintenance. anintensified (i. Cohen's Syndr0me. risk with program shorter ntalmaintenance with intervals between appointments. Papill0n-Lefevre (skin palmar plantar (neutr0phil lesions. Efapt (80t{E DIS0RDERS ASS0CIATE0 PERl0DOtlTlTlS L0SS) Down's WITH e. foreign impactiOn.nme portrn 00ve o0s Periodontiiis diagnosedpatients: received is iloT in who incomplete 0r te conventionaltherapy.once Goal: arrest slowthe 0r disease thereffact0ry diagnosis is c0llect subgingival micr0bial samplesanalyze. historyrecent smoking. chronic diseases Mellitus psych0l0gical family facto6. keratosis). (decreased alkaline phatasia ph0sphates b0ne blood and l0ss). ie?lth. Period0ntal and therapy surgery fine is with 0atients stable. physican.hronl ntion. nipatientswith p0stponing c0nsultwiththeir c0nsider perf0rm periodontal duringthe l"trimester. mucocutaneous gingival gingival overgroMh. history disease. to administer antibiotics with periodontal c0ntrcl factors smoking). N{]TES ICCIII{DITI(]NS AFFECT THAI llDllNTAT DISEASE uI linic finic nay . me l h e grafts.. b€ase €ct0rl rtitis. pe c0nsiderali0ns: c00rdinate patient's with minimize 0d0ntal prior ions pr0viding hy treatment to treatmenl leukemia lransplantation. Adhesi0n Deficiency Syndrome.e. 0rconscious llAGlCGlt{GlVAL EllLARGEMEltTcommon manifestation ACUTI a early 0l Awhere chem0therapy 0r bone marrow transplant therapy adversely may alfect iva.

Anatomic variations maycomplicate that treating mucogingival conditions: positi0n.medicatio with with reqlire pri0r probing SRP t0 and Usually Amoxicillin pri0r treatment non-penicilli 2g lhr t0 in patients. acquired 0r (neoplasms). Mrcogingival gingival C0nditiofls: recession. bacteremias are intensified in cardiovascular disea patients periodontitis. smil gummy beyond [4GJ. allergic MUG il{G C0t'tll 0t{s 0G tVAt tTt MUC0GIIIGIVAL DEF0RMITIES deviations then0rmal fr0m anatomic relati0nship junction gingival (li|cl). c0l0r. Pregnancy: increased0fprelerm bidh risk low weight delivery. in ridge anatomy may ass0ciated mucogingival with c0nditi0ns. . pectoris. frenu positions. increase risk0l ce(ain the conditi0ns Pregnancy. excessive displa gingivalenlargement. also lvlay increase risk the cerebral ischemia non and hemmorhasic stroke. IE . . issignificant t0ne There increase insulcus with depth pocketl0 p0cket). delormities around implants. with . lrflammatory Gingival Enlargement 0fgingivitis aform easilydifferentiated fronsimp glngivitis.l{(lTEs PERI|)D()NTAI. . 0fkeratinized aberrant ]ack tissue. in edentulous These occur teeth. Periodontalpath0gens angina &Ml. Inlective Bacterial End0carditis. (keratinized a gingiva mucosa the tissue) adjacent nucosa. gingival gingival Excess: incOnsistent margin. l)iahetes periodontitisaffect glycemic lilellitus: can control increased risk and the cardiovascular complications ass0ciated diabetes. periapical infections. abn0rmal . oingival pseud0pockets.AFFECTING DISTASE SYSTEMIC HEATTH lheperiodontiumreservoir bacteria produce isa for that inflammatory immune and medi thatinteract body wiih organ systems besides oral the cavity. liluc0gingiyal del0rmitics ll0T0ETECTED are 0ll RADI0GRAPHS. Gingival (Atropiy) Recession 0ccurs thegingival when marginapical theCEJ. is t0 . . ass0ciated muc0gingival with delormities. the excess gingival hyperplasia). 0f and tissue change. depihs. pobings gingival (pseudopockets. pseu0dp0cket byexpansi0n 0rrelalive The iscaused {pseud0p0cket 0fthe marginal coronally. naycontributet0 atherogeni changes thromboembolic in corcnary and events arteries. and rid Infecti0ns peri0d0ntitis. Pseud0pocketing pocket" "relative ("gingival pocket"lcondition pockeli 0r where 0ccurs WITH0I. Cli[ical are distortionnormallorm. Mucogingival-0ral covering alveolar pr0cess. Period0ntal i[fecti0ns (Diahetes. frenulum inserti0ns. findings increase gingivalsize.N4ay congenital (missing margin mucogingival & be teet (tooth devel0pmental eruptiona F0r L position. butradiographs help when c0mbined a medical/dental probing wiih history. with Patients IVIVP rcgurgitation pre. palate. vesiibule Variations and depth.t bevond itsphysiological level. tissue ratherthan m0vemeni apical 0fepithelial attachme. & Cardiovascular Disea The periodontal dentist should inform patient possible the of interactions establish and hea period0ntal influences t0minimize negative 0nsystemic health. clinic and examination. in cleft cysts). CoronaryArtery individuals peri0dontal may increased Disease: lllith disease have risk head disease. . alveolar .TATTACHMEIIT expansion marginaliissue l-0SS t0 due 0fthe C0R0llALLY . peri-implantitis.

iluc0gingiyal (l Glfseparates gingiva alveolar Junction attached lr0m mucosa. -KtRATI epithelium. controlling and etiologic lactors intlanmation & via y'aque c0ntr0l. functions t0 support. textured. Fimly attachment. .lt s composed ofl IATTY gingival part margin-the coronal ofthe glngiva. . lngual & llarrow zones ais0 nay (associated proinjnent and occur llB r00l 0l maxillary molars at first with rcots bony sometimes dehiscences). BAll0 SURFACIS IARRoWEST is 0nFACIAI 0l mandibular canine l. ridge vestihul0plasty. alveolarsupporting lvlain & b0ne.lfibers epithelial and periosteurn.measured sulcus (periodontal onto base oocket) junction gingiva ([4GJ). (Marginal gingiva)non GlilGlVA keratinized 0ftjssue attachedt00th collar not t0 girgival (sulcus to thegingival groove bone from base) dre0laf thatextends thefree keting in. of pr0tect.Jrest0ration tUrlace. thickness 0tepithelium. t00th ad0ntoplasty.JE eyond interdenta I gingiva occupies dental intel spaces coronalthealve0lar to crest. palate. is measured anestablished nafgin)to probe ment a periodontal with l7 . attached the Nataon gingivalsulcus-shall0w groove gingivat00th between marginal the & surface. surface the mucoginglval t0 Calculated suhtracting by depth fr0inthewidth gingiva thefreegingival 0l from margin the t0 ngival margin.numherbl00d and 0l vessels. via angmentaii0n. lining sott and mucosa. regenerati0n. JE p0int 0r lt from reference (CF.ound support leeth. C0nsists N0 IZED loosely c0ntains elasticfihers isloosely toperiosteum and bound olalveolarb0ne. laterally. most free mple groove gingiva.located attached 0n APICAIt0 lingualsudaces. gingiva lVidth FACIAt 0l attached ranges l-gmm. efech ldges. Indisease. thelE is onenamelattheCU. bound he by sulcular epitheliuflr and aplcally. & renufn snlle elar0 rspray. Well-adapted movement. movement. crevicular eoithelium.r[remolar. depending the degree on 0f presence leratinizati0n. from WIDESTfacial0f maxillary 0n incisor. periosteum undedying 0falveolar and Attachedt0 bone cementum byC. . to reduce isk of and and the gingival p0cket recessron r00tcoverage. of mouth. but lricti0nal to!ermit gingiva. free is S0UA EPITHELIUiI tral mucosa STRATIFIID 0US resardless is keratinized if it 0r (]ral (ventral) buccal alveolaf & lon-Keratinized ilucosa: mucosa.tl tiators s may iease). are and proper. l)rall{ucosa: palate attached hard & lcratinized l{0TEs risk ol 0genic risk ol lsease catt0n l|icillin .tween teeth). health Its'( 0T lreatmenl: non-surgical & surgical c0rection helpmaintain dentition lts to the 0r in health g00d with replacements function esthetics. tis.cann0twithstand stresses. & and surfaces adiacent mandibular t0 incis0rs canines. bteral & 0n of canine gingival gingival gro0ve boundaries from MGJ thetree extend the t0 Ittached (sulcus hase). beginring freegingival separates gingiva attached free from The 0f and gingiva. tooth ol{TllrM tissues sur. ccmentum. Free (base gingivalgroove ofsulcus)-separates from gingiva attached gingiva. Attachment apparatus-consists at bone ol alveo t may PDL & inical um attaches r0ot alveolar that the t0 bone. fibers. anM0r SRR antimicr0bials. Ht0 Gll{GIVA from tl(ERATlt{IZE|)) .narrowestlacial mandibular & firstpremolar. or the migrates apically the along rjfi. augmenlati0n. teeth. ATIACHED GlilolVA n0rmally is CoRAL lts c0l0rvaries PlllK. mandihular and at 3dmolars. reduction. Alve0lar gingiyafacial& Mucosa a LlNlllC llSSUE. 0fmelaniB. col. 0fthin. t0 tooth & bone. orogressive papilla croy/n leflgthening. joined underlying structure. tongue's inferior gingival and fl0or surface. that raybe and the Conslststhegingiva.

is faclors except is loss clinical there 0l attachment bone and at clinical etiol0gic of NtlG. and immunosuooression. . breath pseudonembrane may secondary formation be diagnostic featu. resolves a fewdavs treatment debridement NliG within after with a antimicrobial rinses. Etiology. & affected sites. red Brighi marginal which factor is ll{l{Ull|)SUPnESSl()il. .e blunted s ough and cratered. characterized D|SC0 byPAIN. llUG fusiforms. counseling at Paiient antimicrobial but .antibiotic gentle llljG dehridement lymphadenopathy). Herpetic Gingivostonatitis .drginal). severe HIV). stre withall 0f its (HlV). papillae (yell0l'1/ish "punched-0ut" 2.es. measurcs combined systemic with antibiotics ora . belocalizedgeneral 0r not t0 0r p0ssible manifestations. ( UG) G[{GtVtTtS "V[{CEl{T'S FECT|0lt" ECRoltZnG UtCEMTIVE (i infeciion gingiva. Gingival gingiva. beassociat may Predominant inlllrcdevelopment predisp0sing pre-existjng gingivitis. ilEUTR0PHII dominant intheinflammatory ofANUG. and 0f and PDL.. 0r warm water sali llUGTREATMEI{T (Penicillin if systemic (fever.e.ca'e. Peri0d0ntal Acute Inlecti0ns: wiih systemic . malnutrition observed with systemic conditions. 0ingiYalAhscess . F0Rl& liltECTI0 or associated ll'lay or ihatmay may berelated gingivitis peri0dontitis. after recurrcnces L0ss attachment bone uncOmmon. .N{1TES DISEASES ACUTE PERI()DllI{TAL ACUTE PER|0D0I|TAL BISIASES clinical conditions 0f RAPI0 sEIthatinvolve 0 period0ntium structures. l{ecrotizing (ilUG Peri0dontal Diseases & ilUP) .3 characterislics be present diagnose lllJc. neglect 0ralhygiene). Peric0r0nalAbscess(Pericornitis) . ore fetor ex (fetid breath). Fetid and rapid 1. WBC iniltrate trauma. l TEtiSE (hallmarkilUG). fev ADolTI0l{At SlGl{S SYMPT0MS palh0gnomonic asthey often 0ccur many in other foms malaise. (least with bleeding distinctive sign) 0ccurs 0rwith0ut clinical that 3. Papillaetips a. Treatment:I hygiene (SRP) ( letr0nidaz0le). infection a distinctive with erythema necrosisfree attached and l0ss and hone. & maaise also l\4ononucleosis. provocati0n. not are symptoms periodontal Fever may suggest Primary Herpetic Gingivostomatitis disease. 0ral lluid !moking cessati0 nutriti0n. has 0f alveolar Theresevere 0l attachment alveolar NUP many the bone. & Prevotella intermedia. 0ccurs 0ften adults m0st in Debride necrotic & t00th areas surfaces. 0ccur multiple of and is butcan 0f the disease. inlake. l8-30yrs. 0fthe Necrosis 0fgingivaltissue 'IREIICH M0UTH' anacuie MIJST t0 as & F. t8 ( UP) a severe rapidly progressive PERl0D0tlTlTlS and tlECR0TlZltlG UTCERATIVE gingiva. Conm0nlv inindividuals (i. an immune suppressi0n malnutrition. vJith Patienls Hlv-associated require rinses. isthe l{UG & lymphadenopathy. (p00r gross fatigue. psychologicai factors: smoking. patients remain riskfor recurrences. Periodontal Abscess . PAlil 0f usually 0nsei.Anintecli All "punched-0ut" gingival presenting papillaewith lrygingivalnecr0sis bleeding an characterized pain. CombinedPeri0d0ntal-End0d0nticlesi0ns. Inter-dentalgingival necr0sis ulcerated white grayish pseud0 brane mem formati0n ofgingiva). Spir0chetes. v) involvement malaise and therapy rinses/irrigati0n.

abscesslimited may be lf the is t0 palillawithn0preyi0us 0r narginalgingivainterdental disease.e-erisling 0l CHR0lllC peri0dontitis patients. in lppears an0V0lD gum" a common is complaintAbscesses often are als0 found furcations. if it occurs. purulent progresses. bea common llY BE Can clinical feature in periodontitis. may painful Lesion be pointed. lJsually results islateintheexudatespeiqdmtal lgtan periodontitis. change. 0ccur F0d0ntal but it inchlldrcn. elevation t00th. gingiva. teeth tract formati0n. t0 incomplete 0fcalculus ordue femoval 0r into lissues.()F CESSESIHEPERI()DllI{IIUM ingperiodontal abscesses is prmarily 0nlocation theinfecli0n. ASS0CIATEDEllD{]o0tlTlC Wllil PATH0SIS.onic ils purulent if Gontents throughFISIUU lhe0uter drain a into Dy become 0rinto p0cket. become it can a chronic condition. anomalies periodontal invaginated can cause acute r00ts) aiso rlsinm0larfurcations & an abscess- N{lTES fdenlal fection mgan0 fiiteor { )crated stress. col0r m0bility. may sensitiyepercussion mobile. Within 24-48hrs. but some irgivalsurface pain. Treatment: eliminate acute and the appear signs sympt0ms viaDRAlllAGt ASAP lfthe abscess not does resolve.anc ofthe one al u0tel |ntr0n 1S . 0r shinysurface. based of Abscesses purulence. extrusi0n. gingiva PDt bone. shiny swelling. tenderness t0percussion. (enamel trauma perloration lateral during anatomic via 0fthe wall RCT. ano . 0fthe alveo present. periodontal cause taken with advanced disease $temicantibiotics bya patient untreated by 0rganisms a peri0dontal causing abscesses. Causedgram ) anaercbic (SPIRoCHETES). is ol ahscesses C)anaerob icrods). oD0ltTAt ABSCESS llll)sT THE Cl)MM0tl ABSCISS. suppuraUon.bea common cases Ca[ clinicallinding in tom p. allofthese painfu lVAlABSCESS lOcalized. cell Diabellcs have vascular also changes altered and lsrstarce gen metabolism nayincreasethe that r susceptibility. smooth swelling its early shiny in stages. fevel. vitidans XDnostcqnn\n gatients moderate with 0radvanced Strcp. It is usually acute an inflamflatory response toforeign substances intothe f0rced asa red. swelJing. with beassoclated pain. fevef rmsol titis or esol saine atalse ent & m ano ng0n essive l. diabeles. lghgiva interdental with red. lf ii the ruptures Pulpal sp0ntane0usly. S{'ns Symptoms: 0f t00th.lhe is usuallygingival lesion a x trauma abscess. swelling purulent with exudate inlection the . ciinical features not are always . by & swelling. of furcation tificesdue f00d systemic antibiotics. and radi0lucency affected arbone. feel slight 0fthe and t0 tightly and Ftients a d! I abscess become if lhesinus orilice blocked. slightternperature eevation. af0reign and rnaterial exists.lesion fllctuant and with exudates. associated a preusually with ngperi0d0ntitis.is it appearlng pointed. e. loss attachment T00th he t0 and Rapid 0l ( rods occur. purulent with area swelling to touch. lorces ch. a$perinfecti0n0pp0rtunistic periodontal diahetics prone acule are to abscesses duet0l0wered host hrly conk0lled (impaired immunity). desue bite grind. can acute tract is *onic reri0dontal "pressure as GlllclvAL ELEVATl0l{ THE AI0NG IATERAL Feeling R00T. in ilost ae abscesses in 0LARS.a 0t papilla a sm00th. and bosening. the 0f tender and exudates increase and/or in ngdepth. istrumenlation bacteria the -rclvemefll.is usually t0 a foreign int0previously due body healthy ues. A l0calized infection/accumulation thegingival 0f a in 0f pus wall pocket may that destroy & alveolar Srnooth. lymphadenopathy. r0derate-t0-advanced period0ntal associatedthe with formation factors 0facute abscesses: occlusion 0l pocket prevents t0 impaction 0rloreign h0dies draiflageerudate. the Achr0nic abscess isusually asympi0matic. extrusionthe involved rcdness. hypersensitivity a symptom.

Thermal changes notcause cha d0 0r thatis constant. also from fractured ll4ay arise a tooth.lrealments the 0ther calculus. Treatrnent: of the antibi0tics. Clilical painfult0 rod.l0ST |)tlsymptom a patient report a periodontal will with abscessACIJTE is G0 and throbhing. swollen tissu€ malaise. leuk0cltosis be may exudates. Meth0dsdistinguish t0 a peri0dontal from pul abscess a (peri-apical) isdone pr0hing. bygamO anae Caused lymph n0de5. 0rextracliontheinvolved opposing Home i 0f and/or tooth. fever. alsoarise hone communication through canals and communicating accessory 0f thet00th or apical pulp. extra to T00th Surgical {flap) be periodonial ins0me A evaluaiion should may necessary cases. Aperialical radi g00d method distingrish t0 a period0ntal pulpal and ahscess. Clinical Pain swell teatures: smooth. PR08lilG reveals P0CKETS DEIP ass0ciated the0eriod0ntal with abscess. a EPT pulp theunlikely asthetooth a peri as cause vrith thermal exclude tests the abscessusually is VITAL. the t00th causing increased t0getier striking involved first. DIBRIDEI{EI|T & IRRIGATI0il fla!'sundersurface. antibiotics. itAl{olBUutR . and area and base inv0lve InJection spread theor0pharyngeal t0ihetongue and can into rcgio Patients have may 0IFFICUUY SWAL[0WltlE. lymphadenopathy. in and/0r tissues. loss Rapid 0fthePDt aitachment periradicul and FISTUL0US l{AyBt TRACI( FACIAL SWELUNG CELLULITIS present. touch. trismus. is (Penicillin andinstrucled rirse withwarm V) t0 sali llaced0n antibiotics isused allergic Clindamycin inpenicillin paiients.l'l0TES Treatment: ESTIBLISH DRAIIIAGE by debridirg pocket rem0ving the and [laq incising abscess. Puru Fealures. with shiny 0l 0r Tooth be t0 and tendert0t0uch purulent and/or exudate. Radi0graphic associated theperiodontal fidings in the acute lesion. sec0ndarily the infect . limited 0cclusal procedure foraccessdebridement may c0nsidered. swellingthegingiya mucosa. inflanmation infection restore to healthy and and tissue functi0n. managing aid com irrigation. . is often there may n0change be radiographically early localized discrele radiolucemy lateralt0 r00t in a lurcati0n can the 0r which rapid alveolar destruciion bone i. lf the ahscessnotlocalized. lesion. is nota diagn0stic . llapis localized. thermaltesting. sayit is dilficult close and t0 their also notice increaset00th an yrith0st pain. . with abscess ll0T are specific. may sensitivepercussion mobil PREStilT. However. andior may be tissues occur' may 2n . Goal t0 relieve is ABSCESS circumscri C||MBltlED PER|0D0t{TAl"-El{D0D0tlllC (tEsl0tl) localized. (PERIC0R0l{lTlS) ABSCESS a localized accumulation within 0f pus PERIC0R0NAt gingival sirrrou0ding 0f tooth ove.comprehensive be periodontal patient resoluiion acute 0fthe conditi0n. care rec0ntouring. severe. 0ther and irrilants and/or patient adjustment.lying flap a crown a paiially0r fullyerupted {USUA 3'd t{01rR ARtr). lilFECTloil ARI areas infection 0riginate theperi0dontal pulpal 0f that itself FR0l{ PUtPAL llltllil All0N ilECR0SIS 0n ex0ressing through PDL lhe l{AllltY May mainly lroma periodontal alye0lar l0 the oral cavity. 0f discomfort onset and in mobility. ilEUIR0PHILS ar€thB 0SIilUilER0US inthei[flammatory cells exudatesanaD 0t periodonlal abscess. abscess via EPT. dull is rapid progressively intensifiesPatient thediscomlori.

is it is likely PIRIAPICAI a ABSCESS. inflammation. the conditi0n reis 2-3 ated moflths RCT com0lete. antibiotics. Periodontally endodontic can occurthr0ugh derived lesi0ns also grooves. du or isthe symptorn. lhe pocket irrigati0n. be tender hypermoblle.and sallvary and ACUTE GltlG|V0ST0MAI|T|S. periodontal arcm0st tissues likelythe ofinfecti0n. 0ll THE not PAlll t0A0lllcCUSPS IIII}ICATE FRACTIJRE ARl}l)T lltRPETlC Gltlc|V0ST0MAT|T|S a HERPES INFECTI0N oralmucosa VIRUS ofthe pain geieralized in thegingiva oralmucous and membranes. exam mucosa. 7-3 atter access. sweliing. on. tender. extensi0ns cresial ory ofgranulomatous along esi0ns lateral and roots. and basic oral Treat gentle with debridement and t0pical anesthetic forpain rinses relief. cemental hyp0plasia. the LATERAL CANALS. lever. lSTRTATED then FIRST. malaise. A "conbined" ahscess qnewhere endodontica is an involved e stson a pe odontally t00th. and facial fever. debris covers gingival free margins lills and embrasures. and anti old complains mouth hurt 4 days. Patient ing possible virals. oiscrete areas ulcerations 0l wiihinrings intense aer pr0ximal 0f papilla in the muc0sa palate. oral lymphadenopathy. VERTICAI FRACTURT n0n-RCT canaloearas combined R00T 0l a t00th c 0eri0dontal Pain ngocclusi0nmasticati0n main lesion. pulpal ucencytheperiodontium 0l and rootapex. periodontal PULP rred sone in cases. pdlpinleclion/inltrmmaiion A can !nicate spread theperidontium and into thr0ugh rcotapex. signilicant and y induced apical pe . most Usually lt ses occur singly. help the Purule ples rcgl nrc i. & Thecordition selflimiting conlagiouscertain is and at stages.and ulcerati0n gingiva 0fthe and/0r muc0sa. ispaln t0facilitaie Goal maintenance 0fnutriti0n. 0n facial and Interdental are tact. oral lymFh and generalized 0f oral reveals inllammation attached 0f lhe Hperature 101. subnandibular nodes. occlusal limited adjustmeni. and abscess sinus or tracts als0 are p0ckets usually Pulps 0r may respondEPIbutdeep may not t0 are detected on Wideningthe PDL 0l space periapical and radiolucency peiodonial and/or may wilh diagnosis. origin ll is the mmatr0n passes that throughlateral a canal apical 0r foramen iheperiodontium into ofendodontic origin. $crl mts P0r p0c |l)nan 21 . swelling. days his has for 3 belore onset ihe 0f fL A6-year boy he bcalsympt0ms. trauma-induced HOTES resorption.thepulp NlCRoTlC. t0 percussi0n. lovrishea\ry viscous. gingival perl0d0ntal sensitivity.i: Poc c0mf0 ftracI ld foll atient i salin ic. periapical exacerbati0ns 0fchrcnic infections 0ften are associated P gingivalis with IIEPTI cnan enl t rl P endodontalis. a pocket then lfthe is but exists. hydration. ESTABIISil AGE debriding pocket DRAI hy the and/or incising abscess. marked phaden0pathy. and Extraction be mav . may efiruded.2"F. periapical ie t00th |)fl-VlIAl". r00Vt0oth fractures. trss aL fractuTes occur RCT andarcassociated a dee0 r00t often with teeth with Docket which or thet00th surface may may beabscessed. Ireatment: reliet ive. s pprl0rmed moni'rs c0nplelirg RCI lhe EPT a iodon a pulp na tiin t [SUA is essentialfor a diflereltialdiagn0sis.The otten tn ca probingdepths. hadpalpable. HERPETIC -flammati0n uctio n. foramina. after is Periodontal canbed0ne needed surserv if bl.pulp vital. h dentinaitubules. white and alveolar Loose.

multiple in 22 .remoyes bone) eliminating pocket by b0[y walls. (contour)wounds physiological a||d the coronal t0provide mosl margin the shape ma thicknessadequate hygiene s0 oral techniques heperl0rmed. removing After thepocket w0rth price the 0ftheloss attachment the pocket some pr0vide walls. REIVoVES SUPPoRTIVE because BoNE eliminati is in apparatus. delormities and the with & objectiveNoT is periodontal pockets. Indicati0nsr pseud0pockets. Similar a gingiv0plasty it is [0t directed t0 since t0ward elimi pocket walls. flattened inteFdental & ledges). gingivectomy)i accessb0nei amountexisting gingiva. 0Jaccess b to post defects. re-contouring t0 is done 0ptimal osseous architeciure for gingival 0verlying tissuesconform bemaintained. suprabony gingival andgingival hyperplasia. 0SIE0P|-ASTY reshaping recontorring 0r alve0lar thatdoes bone nol ([0n-supp0rting witi0ulremoving anachment peri0d0fltalfihers f0r b0[e) sulp0 alveolar b0ne. and a open . a RESHAPIil0 is the from C0mmonly t0 c0rrecttissue used contou[ AllUG. . l{0n-supporting (bo bone-alveolar notdirected b0ne related t00th t0 supp0f ridges. can . to when t0 a rather a (if depth thepocket is attheMGJ apical thealveolar d0notperform base 0r t0 crest.I'l0TES PERI|]Dl)NTAL TREATMEl{TS SURGICAT (peri0dontitis GI GIVECT0MY t0 tllillilATEP(ISKET DTPTHS that -surgicalprocedure notrcsp0nd initial i0 treatmeni) removing cor0nal lhe pocket hy tissue t0 B base. pockets (pockets {)SIECI|)MY osseous defecls inlrahony 0r helowthe crest . wound surgically. by involving teeth a segment. to provide more physi0logical contour. ex0stoses.cdl the & to pr0vide gilgiva normal lunctionall0rm. gingival treat hereditary enlargement. Itaiorcontraindication crestal bone il the rcmoval weaken will 0f rem0ving adiacent tooth's support. t0 t0and . Factorsconsider electingpedom gingiveclomy than flap. need for t0 and 0f attached procedureRESHAPEgingiva papilla l0 GltlGlV0PLASTY surg.iut REC0ilT0URltlG & RESHAPIIIG underlying osseous (supp0rting 0sse0us reducti0n not does reduce bone thePDL attached ihe that is . hony pattern bone periodontilisbehorizontal0. eiiminate but a tissue portions thegingiva excised of are during gingiv0plasry. contours Walls some 0sse0us may deferts consisl n0n-sulp0ning 0f bone. Corrects contours Herediiary for Gingiv0fibr0matosis gingival drug-induced inf lammatory enlargement. edentulous tori. DEFECTS 0l losslr0m can 0SSE|IUS H0RIZ0I{TAL t()SS thepattern inter-proximal loss BotlE 0f bone parallels cEi the generalized adiacent Usually teeth. havingbroad. Contraindications: pockets inlra-b0ny and tiss {delecls) lack 0f attached Limitations include esthetics l0nger with lack c0mpr0mised teeth.

may further be classifieda. the (e[ithelial base attachment) is C0n0 t0thecrest alveolar Su0rabonv AL oI bone.llGRAT|0l{ epithelial ]|dergoes 0l the attachment its level which ator leyond physi0logical isnornally nearthe CEl. BotlY P0CIGTS lattern fi|)Rlz0ilTAL lossandnotintra the 0f h0ne osseous. B(}tlE t0SS interproximal l0ss CAIh0ne d0es laralleltheCEJ. crestal The bore and in is horizOntal parallel CEJ. CharacterDed byAPICAI [.naI . bottom p0cket corcnal theadjacent t0 The 0f is t0 r bone. f'ltlTES tissu to bo l:PocK Eriotm r l'{0T I r . occurs not hut |S0|-ATED BoH0r pockF'apical theddjacpnl teeth.W hl urp provl d Iorti rinati 00neJ t (bol falls rrdiograph illustrates h0rizontal loss theposteri0r b0ne ln sextant. lachment ("truepocket") deepened pocket gingival od0ntal a sulcus wherc epithelium ulceration. the"crateFirke" Note lnterproximal comnonthemandibular defect t0 arch. . 0 rs t0 alveoldr 00re. Pocketing 0ccurs WITH|)UT loss. lfibers usually are normally arranged. as ("relative "pseud0pocket"fa where is expansion pocket 0r thgival conditi0n there 0f (not marginai tissue coronally apical m0vement).form a more but at apical and level.

of s0 is 0r i! F APICAIthecrest hone there a delecl h0le theborc t0 (i. zero-wall surgery. i. Transseptal extend a sloping cementum adjacert ofthe base alongthe and 0ver crest bonei0the bone down the of 0ocket in 0f bone wilhin 0SSE0US CRATERS -concavities thecrest inteFdental c0nfined facial (02%) compise (35. defects). defecls: alyeolar dehiscences &lenestntions. ramps. 2. & moat I bone. rcgenerati0n c0ntainment and t0ur-walled defects moat 4. 0lallmandibulard l/3 0f lingualwalls.3. l-vJall delects: Hemiseptum the 0nly a facial ispresent. 24 . 4-wall defects: circumferential defecls. 0sse0us (ll{FRAB0tlY P0CKETS) classified number bythe PERl0D0llTAt 0SSE0US DEFtGIS pocket (epithelial the Ihe hase attachment) bony remaining surr0und t00th. fibers With infrabony interproximally thetransseptal runin anangular direction fibers in configurati0n thecementum fr0m below horizontally. wall Raml-only 1.not with D0 treat 5. m0al also bone c0ntainmentperi0dontal and regenerati0n thebest opportuniiyJorgraft procedures. 3. Craters with t{0RE C0t{il01. ust tiemiseptums. orlingualwall inleFdental crater. intrabonydefects. areclassiliedfollows: within and as proximal is present. 2. andarebest treated 0SSt0tS (recontouring).or4 walls. interdentalcraiers. walls defects are bythe 0f Periodontalosseous classified numberosseous present/remainin When evahating atthetime theirsurgical 0f exposure.| posteri0r in segnes. and have a WAY thenumher nE Allllllt ossGous d 0sse0us defect. 2-wall defects: pocket. 3-wall defects: intrabony an offers 0pponunityDone periodontal procedures.2%)alldefects.e. exact left plale buccdl and/fi lingual 0[bone masks lhe epithelialattachmeflt a dense because it and blocksontheradiographs.e. walls that ARt C0llTRAlllDlCAI|0l{SilUC0GllllGVAt tl)R S FRAB0ilY 0EFECTyP0CTGTS p0ckets. (AtltUtAR) with Bl)ilE [0SSthar bonypockets associated VERTICAI are holevdelecls thebone. D0tl|)TSE|)Wlie nu surrounding t00th byEXPL0RAT0RY Radi0graphs the the the c0nligurati0n defect l0cation 0f the 0r 0l walls surr0undiu t00th. thebest graft fo. |)tltY T0DETERIilIilE the is SURGERY. or letely a defect have bony it m beintraosseous partially comp within lveo t0 a wall. 0. may l.l{0TEs (intra-0sse0us).

graft placed a viable bed GRAFT aliogenous 0fgingiva an on Gll{GlVAt C. d0n0r from were The where graftis taken buccal labial site the region edenlulous 0r palatal The epithelium area. nes physical & barriers calcium sullateJ a bony 0ver defect. success and itt0 FGG depends graft 0n the gingiva immobilired recipient FGGused increasethe 0lattached atthe site. further recession successlully and increase width attached the 0f tDyent non-path0l0gic dehiscences &lenestrations. by epithelium and ion suruiving basal In2 weeks.umDer ment) |s). rapid and sometimes healing and defect recurrence.| 6 weaks. Inlecti0n is nason FGt isdisrupti0n vascular hefore most reason FG0lailure. difliculrygetting r00l 0f during The in c0mplete graft lies an coverage inihefactthat avascular isplaced a r00t 0ver surface devoid also supply. lldefects mainly theltlTERDEtlTAt Successbestwith 3-walled 0ccur in REGl0tl..T PDt bone t0 . arYerage 25 . reforms. is a pocket IEAST and successful a thr0ugh-&-thr0ugh with furcation defect a 0n m0rar. ll()llE its own 0l hl00d supply is totally and dependentthebed0l on tGGretains b. n esdirectly lhenumberbony oJ defect vllth of walls the 0sseous arca). there occlusal The walls osseous delects VtRTlCAt.l where 0r muc0sa present. Indicali0ns: 0TR attachment patient plaque exemplary control before after exhibits both and regenerative therapy. terlormed a lrenectonyprevent with denudation.hichnp until ti is lo . ihe RESoRPTl0tl m0st c0mmon effect an aut0gen0us graftin side 0l hone pocket often postoperative aninlrabony and extends dentin pulp. trssue but is not nTrc att RGERY Donn .ood vessels. is t0 zone pssibility gaining coverage recessi0n. (GTR) REGEllERAT|0ll placing resorbable or res0rbable TISSUE n0n barriers (bovine. into and 0ther ing graftexloliation.ecells delect techrique theperiodontal (this assumes PDL can only cells regenerate the a00aratus). rcceives nulrients theviable hed. may may yield successful FGG or not a tovera r00tsurlace a narow (FGG is predictahle when to obtain coverage result nothighly used r00t in r00t Esult cases). prolo0ged rates.mounl \l irhage s lail']rn ft. Anarrow 3-walled inlrabony defectyields greatest the success. Co/er with reformationghfrenal t0 ofh attachments.he lhF gealesl .greater the regenefattve success. inveqely thesudace 0f ther00t and wilh area against thegraft which is . s thatsonetimes atter 0ccur 0sseous kansplants: infection. For alve t. graft degeneratesit is placed. 1016weels. patient not does smokeis stability teeth theregenerative o{the at site. Al FGG its from t. common 0f ae 2'd hdications: ting s wal IU tron | 0eTec: gingiva. m0re 0fbone are remaining. o[ occu . Bt|lCKS GIR regingival t0 allow and ion0l ther00tsurlace long & by lt C. Haaling e reqLiredproporional grdtl).owt dtooth lacial t lelects ln0tRl natnln (hard gingiva anotherarea mouth palate a secti0n 0lattached lron ofthe or lEmoves region) sulures therecipientsite. alter Epithelium is reconstructed in I week theadjacent sloughs.l ctea lacial successlul a 3-Walled with Delect. [g is M0ST Successperiodontal of bone (vasculaized.l Ecipient a fails 0lthe supply engraftnent. a 2-wailed then (infra defecyhemiseptal = least then I walled a defect bony defect successful). maturation 0f donor cells.

tissue contours.l withoul ditfers a in is epithelial covering. PR|I{ARY periodontal 0B. flapbase be thin thin ihick). . may in Incisi made tissues harbor in that uncontrolled inlection cause i[fection may rapid proceduresperformed after spread. periodontal M0si surgical are 0nly anti-infective is therapyconplete. a segmentmarginal 0f s coronally its underlying from support blood and supply.l ARE Cl|ilil0t{ allperiod0ntal 0l surgicaltechl|i the must unilormly be Flaps sh0uld uniformly andFliable. as delay 4.N{lTES . During heal (necrotic epitheliumFGG 0f degenerates sl0ugh). Flap isWIDER thefree base lhan margin allow to sufficient circulation bl00d toi flap's margin. Surgical G0als treat Periodoltal pe disease reduce eliminale 0r flap lo regr0w alveolar maintain h0rc. Used widen gingiva recession afler occurs. is ditficultthan and often FGG. Flap corrcrs r0unded. is PR0VlDt ACCESS instrumentation allow clinician visualize r00ts for and the t0 the can more calculus beremoved comDletely.sharp are p0ckets often peri0d0ntal treated llapsurgery. eslablish adequate nockets. laterallyrepositioned grrft) more the (especially onlacial lingual 0r surfacesmandihular 0l 3'd m0la$ facial). Incisions traverse eminence that a bonv arc bony eninences and isthin healing and result scarformation. attached and apically a pedicle by supporting vascular FIIPS l0ST C.IECTIVE SURGERY 0f FIIP in treating disease t0 is goal l0r Common 0l allflapprocedures access r00t t0 sqrlaces debridement. Epithelial differcntiation isinducedtheunderlyings0that grafts dense by C. recession theband attached where 0J is and . is used giryiva CAlllllES littlekeratinized where efists create band t0 a 0fgingiva-like periodonta thatissurgically FIAP I tissue PERl0D0l{TAl. thenecrotic the dies slough. reepithelizati0n byproli and occurs graft 0fepithelial from cells adjacenttissue and surviving cells basal 0fthe tissue. bestindicator periodofial The 0f plaque successp0stoperative is maintenancepatient and control. free 2.israrely flap FGG cases. allllap and coners R0lJNDEll.l free 0f in taken fromkeratinized result formaiion keratinized even arcas 0f tissue transplanted t0non-keratinized Fl\44more zones. oEEPWIDE RECESSI0ilS.ln (pedicle is predictabe. 4 Rules tlap0esign: of 1. l0players re-vasculdri/ed Grdfl's dre I producing Thus. cases result by These often Deep are (soft pockei byformationa l0ngJE tissue reduced depth 0f reattachmeni). pr0phylactically t0 attached and gingivana(0w thin. biological and vridth. p0ints healing. FREE MUC0SAL AUToGRAFT from FGG thatthetrans0lant C. are . ifthere even is change thep0sition thegingival in 0f margins. . grall FGG HtAtlN0 involves revascularization. C0rrect localized naff0wrecessions hntill]T 0rclefts. epithelium olf (degenerates). 26 . (carine) av0ided because mucosa 3. isslow. Incision notbeplaced any must over defect bone prevenl in to delayed healing.

is for surgery. apically positioned issutureda place requlred the flap t0 at a more alical level. an gingiya. reduced preseryeadequate a new attachmenl more byestablishing ata cor0nal leyel. the areas little n0thickening Sications: 0f 0r 0f pocket bone. Flap mucoperi0steal a high llapwith degree 0f l0ically thatisthe"w0rk horse" periodontal 0f surgery/iherapy. gingiva 0fbone the 0fthe and gingivathe width attached 0f at donorsite. lns elyu ense c )n 0sed periosteumt0 ICKNESS MUC0PERI0STEAI refiects 0fsott ueand FIAPS ALL tiss gingiva T (< 2mm underlying Used bone. When additional gingiva grarulates thePDL covers barely attached from and the exp0sed This bone. Indicatiofls. 0rdeep furcati0nnvolved and teeth. galning t0underlyrng tissue 0fflap after access osseous and perl0rmingthe therapy. a 27 . intheabsence by root creating awider 0f band and 0f recession t0widen zone gingiya. jn pr0cedures. 0r recession providing coverage. Positioned pedicle physically & Repositioned arereally tlaps flaps attached attheir pedicle apical by base a 0flining muc0sa anintact supply. where exposure tooth w0!ld beunesthetic. the 0l . in rhfecis morphology. presence on facialsurface d0nort00th. crown . lanterior Flaps: replaced lVWl exc.l 0rattachment). a nainstay periodontal 0nsingle rative and is ol surgery pockets teeth onflapsurfacesmolars and 01 atfected moderate andinfrabony by pocket ist0 obleclive gain access underlying & r00t t0 hone surfaces. . pocket located bases c0r0nalt0 ltlcj. when and estheiicsimp0rtant is targinal region).. Contraindicationsr atriskfor caries. where narrowgingiyal areas recessi0n isadjacentio band a wide of gingiva can attached that beused thed0nor C0rrectsprevenls as site. joins positioned gingiva form broader tissue theapically additional attached t0 a zone gingiva. and bl00d . lengthening. Apically & p0sitioned are flaps fullthickness flaps Widman ( WF)-a Flap full-thlcknessused 0pen debridement flap in flap and periodontal procedures. thisisd0ne. thickness. ist0 0hiectiye Fedictability EUll|I deep ATE pockets p0sitioningllapapically retaining $rgically by the while gingiva. and are Fcedures. t0 pr0vide environmenthealing primary ofattached and an l0r by cl0sure. where attached is wide). reduction gains clinical Pocket isachieved by mainly F[et reduciion mediated byrepart . of P0siti0ned fullthickness Flap-a muc0peri0stealflapexclusiyely alm0st Cxonally gingival and 0fattached gingiva lS0I. Inthe coulse surgery. defect coveredstretchingflaplaterally thelree covers until end tt. exp0sing alyeolar the margin. gingiva. gingiva. reduce shallowt0 m0derate depths.ITED t0 [eight zone 0ver AREAS teed restore gingival recession. 0finfrabony access0btainedosseous treatmeni rut planing.tachment FUIPS. lm porlant p0sitioned lactors evaluate perfoming t0 before a laterally llap. . excesslvesurfaces 0ften patients root r00t as are performingapically p0sltioned and AFIER an exposed flap. l't0T€s trssue epata e e0lc iniqu h (2m ES tS ro0ts iodo Ete I cov lncisi tl lective Flap Positioned positi0ned tlapfa full-thicknesst0 correct Pedical (Laterally flap position.sional attachment ositi0ned include flaps. c0mm0nly inconjuncti0n osseous l\4ost used with surgery surgical Ctached as (intrabony) and pockets. . and new (by These by heal repair a l0ng and adhesion JE C. Indications: moderate pockets. oramount attached 0f tisually a ful (recipient flap ai thickness attacheditsbase itsfree adjacentt0 delect with end the The is by the site). Positioned alull-thickness.

padicular RCTola lilllsT in R0otAmputati0n & Hemisecti0n bedone c0njunclionwith first. 0f R00T AMPUTAIIoI{S 1d Burs diamond severthe stones c iny0lve llAXlu. when dehiscence orfenestration lillcfi (> zmm).t{0TEs p0sitioned carry flaps flaps 0l There n0 necr0iic is slough Dositioned iecause yascular healing inv0lves revascularizationgraft.ARY& 2d oL. the necroiic and FIAP 0NLYthe mucosa epithelium I PARTIAI-THlCl0lESS PER|0D(ltlTAL incises bysharp dissectiofl. patients plaque control maintain optimal SRP hythe and abilityt0 28 . allows accessunderlying goalis PER|0D0ilTAt P0 SIIRGERY-main to EtlillilATE 0SSE0US REC0I{T0URlllG pockets. and carrythese parallel incisions 2 distal0r at (the gingivalwallt0 awedge wedge isthe[eriosleum base ove. 0sse0us lact0rs caused thal should bedone etiologic l{0I until resection surgery must detectable inflammation beeliminated are Clinicallv osseous delects arrested. su. bef0re extractingr0ot f0rceps. peri0dontal therapy: Endod0ntic isperlorned then therapy root lllost selaration an individual lromthe crown.0nly if sufficientspace di exists n0n-leratinized tissue c0vered byunattached. the tooth thearch. a FGG. iher00t by tip androot regi0n re-c0ntoured shape are t0the and remaining area thecrcwn furcation apical of pontic maximal fororal hygiene is pr0vided. region tissue involved inthedistal tissues base elininating and to bone. epithelium off last.s a uslally leaving muc0sa. with oral dentition routine hygiene . the & Used vedical sectioningthetooth 0f llEMlSECTlotl the region. and is if t00th extractedonespecific hasexcessive i[ osseous is as 0UR. In supply grafts layers revascularizedThus. Bef0re osseous t0treat defect. resecti0n 0rrecontouring aninfrab0ny c0nsiderth using reattacfiment maintenance periodic i0negratts. Alve is from 0f underlying Mucosaseparated theperi0sieum C.l gi0gival gatts. (in gingiva bepresent thiscase. aper and isthe coronal pocket reduces bulk.[RS. mesial mandibxlar relromolar triangle & distalt0 last area. with SRe alternatives: treatment procedures. Detachingthe hone. gingiva attached is present a promineni Used 0n r00t. hemisecti0n amputati0n0rr00t . maintain theirown but accessto cure pr0cedures.lying form the 0uter gingival wedgefromperi the surface). region occupiedglandular adi . Distal in maxillary tuber0sity wedge flapsare perf0rmed lheseareas: in 0r area. distal may as a of thelastmolar. lllake leastincisions mesialt0thet00th. can . the dies top are producing slough.gery periodontal This does t0 Fxisting topography b0ny is changed eliminate periodontium givesthe patieni periodontaldisease. remaining 0fthemolart00th nowtreated a PREI half (PR0Xll{At pr0cedure distaltlap used FIAP WED6E) simplest the DISTAI WtDGt because b0ne the fill after molar extractions RETR0I{0LlR reduction. periodontal This by and defect. access s0 through cr0wn r00t.50% 0f region werethe isdivided crown through biJurcati0n nandibular molar r00t l0ss suppoll. oi the with lhem.Qtwh prcpare sites Used t0 rccipient lu lrce borcis note40sed. and amputations is After amputrti0ncomplete. approximales anedentul0us a t00lh lhat . perf0rmed 3'd 0tten p0or.band attached operation beperformed).

ngs ass0ciated |]cclusalTramua. be important incausing hyperfactors trlociry occlusal may more t00th (common clinical 0focclusa uma). js trauma There because the danges force exerted exceeds peri0dontium\ the adaptive reparative ard capabillties. PDI lanina dura (veirical) loss. occasional necrcsis calcificati0n and oer I nentused inated 29 . ta. loolh 0r lyrng pflost a bull. fibrosis alveolar marnw 0f bone spaces. Friodontium penodontium a adapiive capaclry compromised ft€thwith reduced and may then when subjected t0certain occlusal Factors Jrequency. level facets beyond n0r'ial rclative thepatient's arddiet. SlGtlS 0CCLUSAL lremitus. are perjod0ntal pockels. resulting tissue anllammation b0ne Injury in changes normal from 0r occlusal appliedtooth/teeth rcduced forces t0 with support. othersigns. 0cclusalTrauma occlusalf0rces excessive appliedieeth normal ?rimary are i0 with (n0 periodontal ngstructures disease).inffa g/disruption. pocket angular bone b0ny formation. flRl)itB0srs Br00D 0F 0cclusal lrauma-0ccurs theperi0d0ntium when isalready Sccondary c0mpr0mised and l0ss. and forces. mig'ai . with alternating 0fres0rption repair areas and r bone. cemental ankylosis. local . cemental resofption to leading pulpal resorption. features be These tooth may use other conditions. the t0 age Chipped enamel lracturesatown/root I t US . & hypercement0sis. ss0f mucles masticaiion TiVl 0f and/or dysfuncti0n. 0cclusal tnumadoes cause not A irritant and ion necessary anaplcal 0fthe (attachment are t0cause shift JE loss). sign I tra robility n sign 0cclusal 0l trarma T0lllH is ill)BlUTY. migration. of forces. 0r occlusal Iesence bone attachment and occlusallorces may that 0lherwisewellt0lerated healthy Consequently. thermal sensitivity. tears. tct€ I 00es I|uma is asbodycan repairthe ijexcessive damage occlusalforces traumareversible. - €rall€l rg pd mobility. llke rigrate duration.always other s0 diagr0stic criteria EPT evaluate like 0r ional habits attain definitive t0 a diagnosis. Pathol0gic occlusallorcesthe are etiol0gy periodoniium Usually for changes. l00l"r 10nc\Fw orperru5sion.TRAUMA USAT (functi0nal0raJ nct io alf 0rces)ca! sin par u n g inj!ryfrom TRAUMA occlusalf0rce (trauma) theattachment within apparatus. early occlusal trauma HEM0RRHAGE is & lt0TEs PDr vEssEr-s. fractured tooih/teeth. peri\dontiun pe odqntiun anintact ot rcduced inflannatory hy disease.e-e{sting effects t0 disease. root radi0lucencies furcation apex a vitalt00th. inthe occurs @essive 0f loss. migrationteeth 0f & percussr0nt0 !sed re fill t a 0r p distal lC SlGl{S 0CCtUSAt 0F TRAUMA widened sDace. inthe 0r 0f 0t TRAUMA mObilih. reversible theexcessive when Fmary An eflect0f primary lces arecontr0lled. occiusal wear Drematurities. be ina periodontal have deleterious due p. n0rmalexcessive forces. l0ss.

. Temporary stabilization is achievedsplinting 0rmore by one teeth t0each otherandt0 stable ina positi0n facilitates more teeth that a moreAXlAtand (geneally pertunedon teethytitltteduced distfibution 0ccfusaf 0t torces rctil paiient $rpporo. during clinical . Ihere n0reasonsFliltnon-m0bile asa preventive is t0 teeth meas0rc. Direct occlusal centrally thelong 0fthe forces rl0ng axis t00th. Reduce orelimirate fremitus. may remain l!l-D. sh0uld used and be with needed measuresr00t like planning. many When teeth l00se. 0rthodontic movement. SPLll{Tll{G primary the reason splinting is io ttrtil0BlLlzE lor teeth ercessively teelh patient for comfort. 4. adjaceni sextants beincluded s0lint. is function plaque and c0ntr0l. distdbution 0focclusal and forces. pre-maturities 3. when d0n0ttighten. p0sition the 2. targe chambers sensitivi8 pulp ort00th .mance. Achieve fav0rable a morc directi0n disiribution and 0ff0rces. tend loosen sh0uld inthe Teeth t0 B-1. Rationalfor splinting impr0ved c0mfort. splint firm Even teeth the serves an0rth00 as permits bracethat usefulfunction teeth. Temp0rary term 0rlong stabilization 0fm0bile with RPD FPD. protrusive movements. reestablish physi Then the polish 0cclusal and anatomycarefully allground surfaces. t0 0r excessive 0rstress thet00ih f0rce 0n Treatm fora patient Chronic with Periodontitisocclusal with traumatism include: may . C00rdinate themedian occlusal with terminal position hinge 0f the mandible. relationships occlusion no thus 0cclusal beevaluated 0foeriodontal asDart maintenance. 0r masticatoty 6. and lateral excursive n0vements. occlusal orextracti0n. . . 5. are signs 0cclusal adiuslnent0btain t0 "ideal" provides benelit. improved staiility to0th procedures. P00rcandidates mouth forfull reconstruction psych0logic duet0 factors. Accomplish 0cclusal adjustmeni without reducing andbyretaining acce VDo an inter occlusal distance. elimination. C0nlraindicalions t0 Selective Grinding llatural the Dentiti0n: . 30 .occlusal and adjustment. is c0ntraindicated. reconskuction. pocket 0Hl. t0 loose Reasons t0 Perl0rm Selective Grinding llatural inthe 0entition: 1. Splinting is periodontal one 0f measure t0 treat type used disease. pr0piylactic lf there n0clinical 0rsymptoms. STEPS ADIUST rSl0l{ eliminate I0 |}CC [rematurities in centric relation {CR). 1. ll4aj0r 0cclusal discrepancies require thatmay odh0d0ntics 0rreconstructi0n. 0cclusal parfunctional adjustment management and/or 0f habits.l'l0TES 0CCLUSAI IRAUMA (except TREATi|ENT usually addressed initjat during therapy a conditi0ns)eljminate minimize (teeth). Eliminate inexcursive m0vements gr0up t0 gain function canine 0r protected occlusion. teeth a 0r . L00se splinted adjacent may teeth t0 tecth hec0me stabilized. lmprovemaintain perfo.

proper Paiient isshown brushing/flossing and techniques technlques. oniheevaluation Eased ol clinicalfinding duringthe maintenairce. flygienist 0rdefltistteaches. peri0d0nta 0th efl]ergency). wear pr0duced forces ive byiruxism cause can increased mohility. Re-examination thatinvolves ngprobing chart depths. rthoped 3l . 0r er | Therapy)-plaque extracl c0ntrol. increased rnobility dysfunction dlfliculry the tooth in rnorning). isp00r. lreparali0n (i0itial full-m0uth scaling. frequencybe may m0dified the the 0fthe patient bereturnedactive may t0 treatment. occlusal facets. muscle tension. pping/hollowed 0nthe0cclusaltable mostterminall00th)during out areas olthe (chewing and/or in other functi0nal night than activities 0rswallowing). ngs 0 th ot Iment. patients a history period0ntilis have gingival every lll()ll]Hs rnaintain esiablish 3 t0 and health. l)cclusa (if I adiustmenls. phase 0factive therapy extension by the The where periodontal and diseases conditionsm0nitored etiologic are are and factors reduced 0r I{ost with ol should maintenance eliminated. t00th : behavioral. these are repeated ifthey t0see undentand you sh0wing lloralhygiene what are them.includes: Als0 . t€eth I B-l-. and conlinues atvarying for 0r An periodontal superulsed dentist. are &sympt0ms: P0Lwidening &thickeninglamina sore 0f dura. 0Hl themost part is important 0finitialtherapy. hopeless molth Plase (lnitial leeth.anaggressive. guards bruxism night exists). & interceptive modalities l|(]TES TREATMENI tlDllNIAL PTANNING (pulpal. emotional. surgeryC0 lRAlill)lCATED.definitive & r00t-planing). ll Surgery) Phase{Periodontal lll Phase) Phase (Restorative (llaintenance Phase lV Phase)-startedc0mpleting peri0dontal after active therapy intervals thelile0llhedentili0n implant. 0fcontinu0us 0r 0f . spli0ting (stabilizingteeth). clenchingthe repetitive. and (especially and 0pening mouth. is . emotional and lactors causes. m0tivates. loose . NARY PHASE treats E[4ERGENCIES 0NLY l. grittiflg. 0cclusal ities.rtaina hrps m grinding. guides patienttheperformance and the in 0fmeasures fordisease conkol. muscles jawpain.

endotoins. BESI CLlillcALAlD t0 determine if sub-gingival calculusremoved is isan BITI-WIilGS inter tosh0w proximal calculus. supragingival andsubginval calculus.At{E0us AIVE0LAR PRl)CESS part thenaxilla mandible HoUsEs 0f & that IEETH. neryes. in patient.est horiz0ntal. and . l0 Slpragingival Calculus-main 0f its minerals lromSALIVA. mmoves and orthod cement. . AB0VE s0urce is occurs yellow. SCALII{G & R00IPLAlllllGremoves calculus. overhanging and restorati0ns. best SRP be must the approach scheduleSERIESaFpointments isto a 0l t0 (subgi a segment quadrantteeth a time. schedule supragingival) entire 0fihe then a se. and usually distributed evenly thr0ughout m00th. like band0f stratilied squamous epiihelium lirmlyaltached the t00th l0 10-20 HEM|0ESM0S0ii|ES. C. are . scaling gross priort0 debridement ANUG 0{an extractions. the . vibration. & cavitation. layers cell thick. t0uch tip 0t llever the ultras0nicthet00th. lllAlil provide |)BJECTM R00T lilG: 0F Pu optimally r00t smoolh surlaces red t0 bacte accumulation al t0achieve tissue soft reattachment. cells FIBR0BLASIS. & more Sllgingival Calculus-darker bl00d due t0 breakd0wn harder. interfadicular C0il ECT & fibers. easily margin is white pale freegingival and 0r and ren0ved prophyl by 0ccurs mosl0ften thelingual mandibular and 0n 0I incisors buccal malillary 0l due thesalivary thatsecrele richin minerals to ducts saliva needed itsformation. Princilal FibeG-PDL collagen fibers include.ies appointments 0l l0rline polishing. removing and stains. lt is the EilTlRttY tilAlilEL theCEJ. Peri0dontal ligament specidli/ed. 0nly sides.T. c. teeth c0nnecting cemertum alveolar ilostabundant r00t with booe. 0f is FLUID. 0n rse the Ullmsolic instruments IJSED sc ARE l0r clreiting. difficult remove supragingival lvore t0 thelreegingival than calculus. exte & When performed. AVEnAGI Eforthisentire TI calculus tormaii0n is orocess occur 12 days. for pigments.In IDEAI GlilGlVAL HEALTfi.onbining c vessels. lts source minerals fr0mGREVICUIIR than supragingivalcalculus. Age(PDL thinner age) t0 incrcased gets with due deposit cenentum 0f and primarilyTypeC0tLAGEll Comp0sed 0l I tlBIRS . .. bonding material. 0bli apical. VASCUIIR HIGHIY & CEttULAR C. ll0l d0gross 0r 0f at D0 debddement m0uth. extra-cellular & suhstances. 0il ah0ve ULTRAS0I{IC SCAtltlG oEVICESbased HlSH-FRE0UtilcY DWAVTSin 0n Sl)U & Removes lavage.25mm inan is . imposed applied Pl)fs thickness adult . -the (PDL) a Lomplex. R00T CEtlEllTUl{ [wE0LlRB T0 portions Distinguished l0cation directi0nbyiheir and Sharpey's Fibers-terminal 0f PDIprincipal collagen embedded cementum fihers into & alveolar Diameter b0ne. margin. Contraindications: pace (n cardiac rnal(ers unless pacemaker the is shielded models). bacteria. greater thcB0llE than Sharpey's ismuch fibers 0n SIDE cementum side. consult patients tirst with cadiol0gist. librous soft. Re-evaluation SRP 4-6 aller is weekst0 time repair thedentogingival allow for 0l lunct .il(lTES MtscEu. alveolar fibers. lE specialized epithelium surrounding i00th begins thesulcus Acol each that at base. 0rthodontic treatment ispossible PoL asthe c0nlinu0usly responds charges al|d 0nlunctional requirements 0nil byexternally f0rces.f surrounds r00ts.

implants den is NoT important ihataffects n0re girls l8y6 inboys a better prognosis when placed younger have than in chlldren. (penetrates theginglval below margin).brush margin tryand thebristles t0 intothe The ltrlaceatthegingival moved a back-andjodh tor-20 stokes. manual 0l The toothbrush have should S0FT. oral However. eflectively inhibil microbial cs. 0f dst oS peri-implantLrcency. ilY[0il hristles r Ac o l tooth head. m0 ary isCAfl SUCCESSFAIU RE TREAIED IMPU|IIS WITH . in and IID. etts witha strung susceptihilit! t0 )r0pnyrax ated /at 'matr0n.direct level. neuropathies.& chlorhexidine }t0Trs c.2'nm t{egligible b0ne (< annually) physi0l0gic after remodeling durlng hescali year function.subDeriosteal. l{0 signs/symptoms infecti0n. tr causing )ns0f ameter BRUSlllllG METH0!S effectiveness the 0ftoothbrushins measured is BEST bvthe and location plaque. imm0bilityn0contifu0us and rad 0 Inplant €ingiYal progressiveoss 0. Patienydentlst satisfaction theimplant redu i to have g0% > success for both rate maJdllary& rnandihular implants.Ihere are p0sthea\ry e" c0ntraindicati0ns: unc0ntolled diabetes. dlble higher ARE ABS0IUTE ll0 lilEDlCAt C0llTRAlllDlCAT|0lls tl)RPIAClilG IMPLIilTS.BET and llus. !!pragingival tno D devices C0ilTRAIIIDICATED are tll PAilEllTS PERll)00llTAt WITH tal irdgation Water ifligation devrces bec0ntra]rdicated may in patients requiring f. placed age factor implant but after ar survival. (the lMPLAl{I SYSTEMS transosteal. sites. lmplants with pr-0RtR placedthe implants. first of the with restofation. hforwide embrasure Interdental spaces.t P dant lesba ave gation notremove plaque does acquired pellicle cannot t00th and rcmove adherent ll removes non-adherent lromsubgingival bacteria & hner lhar l0ollbrLshe\. for and (wood I margins). smoking. is currently prelerred ln motion Thls lhe b then toothhrushing.fuil All0t{. obliqu trtihiotic premedicati0n dentaltreatment prioft0 sincethese have p0tefltial devices the IR B() a bacteremia. implants in sudaces advantagessn00th 0ffer than surface and have success than the rates in maxilla. deiivers and antimicrobial Fluoride. & invol us. Stim-U-Dent wedges)forgingival and massage inter-dental ecess1on. 0tl BEI{EFIISreduces reduces/alters microbial subgingival flora. . pr0cedure. l0r success: Placing end0sseous isa predictable implants Criteria I extensl persistent pain. Inl rthodo i polt r scalin e{ in PI-ANTS IEGRATI0t{ bi0chemical 0f b0ne theimplant b0nd t0 surface theelectron at . ABl)VE jaws. ac0h0lisn. stimulaiorrubbertip attacheda handle to gingiva massages stimulates 0fa toothbrush that and circulation interdental 0fthe gingivitis. a small ("Sulcular Technique")-t00thbrush placed t0 thet00th 45' bristles arc lassileth0d get gingivalsulcus. Independent mechanical o1 any interlocking.p00r hygiene. agents. & Eil00SSE0US most . plaque.Ingce Al0S ll0Tlllllc REPIICES BRUSHIIIG & Ft0SSlilGdisru0t remove t0 and perio (round p0lished g00d furcati0ns Patient also a can use aid toothpick. paresthesia. efleclive Ihemost rethod manual 0f l0othhrushing technique.

imaging. 0fa fu0cti0nal. medical/psych0togical patient patient m0tivation home ability. distrnce. and type. edhetic reDlacenent. bone radi0lucency un and pr0bing inflammati0n/inlection. the locati0n. contour. increased depths. quantity. and and Diagn0stic used pre-su aids in considerations t0 determinenumber. occlusal fractured/loose conponents. canal. Surgical c0nsiderations evaluating anat0my locati0n vitalstructures. tissues. c0ntact f PRE-IREATMEI{T Col{SlDERATl|ll{S health oral status. {m0unted unmounted Placing implants inv0lves anallzing number location missing the & 0f teeth. anica ilurcs at 0f lvlech I fa 0ftheimplant comp0nentspro and superstructures been have ass0ciated 0CCIUSAL witl'r 0VERI0AD. persistent peri-implant functi0n. ASA high periodontal hruxisn.implant mobility loss. & locati0n implants beplaced.HBTES (CI) 3-D computerized tomograpiy scans provide can accurate lnf0rmation about (max anatomy sinuses. neuropathy/paresthesia. fixture mobility. Sl lmplants al can placed thetime extracti0n. bone inplant-bone andixati0n. aogulation implants 0fthe abutments 0r diagnostic CT casts. cortical 0rovides ol Thus. t00th prosthesis lilPtAl{TC0MPtlCATl0tlS instability. f0ramina. and care expectations. require the and of quality. A"staged" approach been toplace has used Elllll)SsE|)t Pt-AllTS. peristent Al)DlTl0tlAt I{EGATIVE ES pai 0UTC0 . softtissues. t t/ t Ll)W[n success areassociated CAIIGEIL0US (20-25% density) rates with B0ilE bpne withcortical (80-90% bone volume density bone).assessing and (alcoholism. diseas€. radiatiu and theraly). surgical temDlate). progressive0f ha excessive l0ss pain. conditi0ns increase risk0f implant that lie lailure smo*ing. 0r progressive loss. inflammation/infection. number. mandibular adjacen t ee h r00 s). desired The outcom implanttherapy is maintenalce stahle. oftheplanned design restoraiion. 0f to existing/prop0sed occl schene. implant lracture. type. 34 .

2 CHAPTER I also [0stn( bome d.ol f$il$It1$$$ltll$$ . traun hard/s rut0ss !ni. bo -surgir a ants b).I stat !abtu t sco rDs.

0nabutment l0rsupp0d. Rnle l{ost 5: area determinesclassificationlh€ areas those theclassification are 6.not is and classification. 8: evenly distribute lunctional stresses l{AloR illl{llR & connectors BE I{USI RlSlDt0 mouth. BlLAItRAt l. posteri0rt0the naturalteeth. Rule theexlent 7: 0fthemodification considered. lllajor con0ector 0fmovabletissues not isfree and does impingegingival 0n tissues.Atooth-borne t€causedepends RPI (it 4. are I . subjacefit tissues. areas Class Rule ll0 modification ina lGrnedy lV. 36 . totheRPo throughoutthe between sides thearches. must a ilESIAL 0ntheabutment t0the haye REST next Class edentxlous space.L overlying alveolar the Alveolar resorption ridge underthe exters:0n c0verage 0fthese supporting Peri0d areas. distal C. be . be it\ c0nsidered inthe Rule if a 2"d 4: molar missing willnot replaced. 1. distributed entire .l0ST resiored. Rule edentulous otherthen determinins 6: "modifications". bilateralmust themidline). Ato0lh-bome type RPD becausedepends it ll0THAVE ltl||olFlCATl|)ll SPACES.lGnnedy | & ll. Rel should provided. Rule il a 3'd 2: molar m is issing willnot replaced. I by Class residualridges. is a concern. and used anabutment. lii and RPDS supported are byatutmentteeth. Class nila eraIeden ul0us area ll:u t t t0 DrsTAr" St0lt.NoT rt0fthe and be classification. Malor most encounter interferences lirgually fr0m inclin c0nnectors faequenily mafldihular orenolars. p0steriorremaining naturalteeth2.NoT 0fthe as it's part R0le il a 3'd 3: m0lar present not is classification. Class a single. 0f I{ ilAloRC0t{llECT0RS c0nnects c0mponents b0th must s0 applied any t0 area thedenture etfect 0f are c0lneclor beRIGID stresses overthe supporting area. Although lll & lVRPDS entirely Class are supportedabutmentleeth. the pr0cess. is rcduced maximizing but by (maintaining damageabutment is avoided firmtissue t0 teeth with support a stable tissue relationshiD). Bony softtissue prominences and are avoided placement during and .t{0TEs REMI}VABLE DENTURES PARTIAL based P0STERI0R EDEilTUI0US to AREA lGl{llEDY CLASSlFlCATl()llS 0nthel. Classbilateraledentulous l: areas Drsrar ExTEilst0lt. EXTE . Rule: classification AFTrR I pa it\ 2. Class unilateral lll: edentul0us with arca naturalteeth anterior oosterior both and il entitely ahutnenl forsuD[0 0n leeth it. are and the theremaining naturalteeth. Dosterior 3. lV: but cross edentulous area Anterio. teeth entirdy . teeth missing across midlin€. |)cclusal REsTs PUGED ]fit DlslAt THt aRr 0[ 0f flRsT PREil0lIRs! Applegate's l0rlpplyiuthelGnnedy Rules Classification: isdone extmcti0nsd0ne. p0sterior always 5. is not 0nlythe nurnber additi0 0f edentulous areas.

tA to assl & dt i st0n fl0do (RPD a c0mponent c0nnectsthe c0nnector base)t0 mai0r C0l{llECToRSRIGI0 that (direct components retainers. SHAPTD . l. tlpped and are an alternate framework 0rcrowns recommended. stabilizing components ("abutment-to-prosthesis" functi0n) ast 0fthedenture preserves idoes impinge gingiva) is highiy polished. t0s 37 .l0TES bleba RPD OIBUTAR MAJOR CllNI{ECTllRS $e l0rm SHAPED above tissues asfar but coss-section is HAIF-PEAR l0cated moving marginspossible. There lunclion) gingival 7mn beiween margin m0uth and nustbeat least 0l space/clearance the fl0orHAtF-PEAR incross-section. when severely prem0lars m0lars present. Indication: when Used sufficient exists space between slightly the elevated alveolar gingivaltissues. a minimum vertical lingual and sulcus lingual frlust be 0l7mm height between gingival the margin mouth (inlerior and ll00r horder 0llhehar).superior must at least helow gingiyal (tooth-tissue plaque t0 prevent collecti0n margin and infLammati0n. be wide . and and the 0f rests. retainers). tissue not marginal and = joins rightangle. thick. as To determine mandibular connector which maj0r t0 tie gingival gingival sure theheight ihefl00rt0 lingual fron 0f the margins. 3mm space between superior hofder thebar gingival 0f and margin thebar + musl 4mm = 7mm. transfers effects theretainers. gingival exposure at um 0f5mm space between vertical components. BAR: border be 4mn the margins UilGlJAl. are terior $p0rt line. translers indirect Also funciional t0 stress teeth. Contraindication.

. Anticipated oione more remaining l0ss 0r 0fthe teeth. ltsbulkiest portiont0thelingual its taperedtoward labial. ltt a thin. tised theheight m0|Ih is< ommfr0mthe gingival when 0flhe fl00r lree gingival orwhen isdesirablet0 thefree it keep margins remaining 0fthe anteri0r teeth exposed. LlllGU0Pt-ATt. axial plate when bar is but the align theanieriorteeth thatexcessive is such blockout inteFpr0ximal 0f undercuts isrequired. C0ntraindicaii0n: natural remaining anie. Requires a FUilCTl0ilAt lMPRtSSl0il. Contraindicalions: anteriorteeth severelytilted wide lingually.ngulum bedisplayed. 3. c suluM (C0I{IU0US BAR BAR): . Used stabilize periodontally t0 weakened {splinting) linguallytilied teeth 0r mandibular incisors. narr0w strap on 0f scall follow inter-proximal embrasures itssupeior with b0rde6 tapered t00th t0 surfa 0riginates bilaterallyfrom oiadjacent rests abutments. . .teeth. 38 . over a there h 0f . ljsed a lingual 0rsublingual indicated. used Class in I designs residual have where ridges undergone excessive verticalresorption. there inadequate olthemouth t0place lingual is and depth fl00r a . . . High (< fl00r0fthe m0uth 7mm vertical height) high lingualfrenum.iorteeth are severely linguallytilted. Bar\inferi0r horder attheheight alveolar is 0I lingual sulcus theD when is tongueslightly elevated. illlsl Smm free . be . 0r lingualbarwhen is ll0 space lhefloor themouth. (3mm) l0catedthecingula anterio. HAIF-PIAR SHAPEO. Iil0PERAB[E mandibular ling(al torithat cannot rem0ved.N(lTES S|JBUllGlJAl used there INSUFFICIENTfora lingual BAR: when is SPACE bar. Bar's sxperior border beat leasl bel0wthe gingivalmargin. diastemas anterior causing &etal teeth the c. is and is the . bart0 . lndications: . .

llandibular lingualtori requirelinguoplate a because is often 7mm there not 0f slace a lingual llssue for bar. t0ri are interlering removedav0id a labial l0 using bar. cover orfood 0rt0 relieved t0 that irritate tongue. . .IBIAt BAR: . . inter t0the 0n t0the and anterior cinguli. Indications: severe premolars when lingual inclinations ofrenaining & incisors preventing a lingual When placing cannot c0rrected he orthodontically. USE SEVERT 00ll0T lF AllTtRl0R EXISTS.. Extends rests iheterminal abutments. linguallori cannot removed prevent a Lingual 0rplate. have on bar the 3S . lllust rests thesuperiof 0natleast canines. c0veringtoriisthinand the cann0t t0lerate vertical from vertical oressure themaior connector. Trauma congenital produce arrangements and deficiencies occasionally dental where isfeasible.E BAR LIIIGUAT (WITII CI)IITIIIUl)US BAR). Best CASTS . b0rder . not if there wide anterior D0 use are 0pen contacts because c0ve6 0r overlapping exists it isunestheticif anterior . tocover inter spacesthe t0 contact . be and using bar Also severe prevent a lingual when and lingualtissue undercuts uslng baf used severe abrupt orolate. Superior isatthemiddle 0fthe border l/3 teeth's lingual surface extends and upward proxima point. indicated PERI0SURGERY Wl0E l0r FoR EMBRASURES. ftients . Inferi0r isinthe (imm0bile) border labiallruccalvestibule olattached atiuncti0n & (mobile) unattached mucosa. the areas w0uld . Superi0r isatleast below labial buccal gingival 4mm the and margins. . . NEED 7-8rnm themouth 0rcannot above floor use. Used avoid gingival generously irritation entfapment. UlltESS f0RISURGERY lSABS0IUTEIY Cl)llTRAltlDICAIED. bar.E|rgl rcn0t rgual agrn. onlv lablal a connect0r |1I}UBI. . inter-proximal Placed the above cingula bel0w and contacts. c0ntacts proximally. cR0wDNG NOTES gnmenr 0ts 2I0pe0 r surl I.ljsedwhen future replacement more ofI or isfacilitatedadding by retention incisors loops anexisting to linguoplate .

I. UsEo 0ll lilAl0R t0 BEAD (BEADED Lll{E B0RDERS} olltY ilAxlLLARY C0llllEcloRs major the lt otf theinterfaceihemaxillary connectort0 tissues. It4eialinintimatetissue is contaci. groove the wide The fades Bead made is gingival margins fades a hard and over midline sutu approaches 6mm the within 0f . 2. Posteri0r 0fthemajor PARALLELT0 theresidual t0 ridges t0thepalate midline exiend and backward tongue sensitivity. I{AXILUIRY Tt)ATMI)ST ATWAYS FOR KEIIIIEI)Y USE AI. BE Superior MIIST atleast belowthe gingival b0rder be mean 0lthe gingival margin. Exposed are 1. . iIAIOR COIIIIECTOR .75-lmm anddeep. where is 6-8mm t0 r00m oJ for tori there Major c0nnect0rchoice inoperable cases vibrating line. borders headedproduce t0 a positive contact the with tissue. .t{0TEs MAXI MAJllR TLARY Cl)l{NECT()RS 6mn free USI nlcl0. two to pal and entirely thehard 0n Posterior is lhin.tapers asit approaches 0f gingiva marginal around abutment the teeth. palataliorus posteri0rly vrhen exteds 0nt0lhe s0ft 00ll0l USE aninoDerahle 40 . Beadingdone it is along border themai0r the 0l connectorseal t0 thesoft t0 byscoring casi. . must 6mm be below the The and straps anterior giogival and interterence. located strap at 8mm (n0t p lt t0 t0 protect I0tlGUt. l. least wide. 6. Anterior border 0fthemalor coflnect0r is perpefldicllarl0 midline [u the and intheVALLEY 0FRUEAE. better A choice a single mininal mlatal snrlace area). 0rstraD j Ante is maryin avoid t0 rugae c0verage tongue p0steri0ra rugae 0r ina valley crest hetween crests. CIISSES. with EDEilTUL0USl(cnnedy lll mod RPDS SPAil Class I Primarily for a TARGE used when edentulous spaces resldual and ridges str0ng abutment (not t0 use teeth g00d palatal because than strap it covers tissue less snall). Sealis thick (deep)t0 provide wlTH lmm P0SIIIVE IURE DE C0ilTAGI IISSUE p t0 when entrrpnent under maxillary connect0r retenlion placed the major and at f00d plate conneclo' poslerior ofapalatal maior b0rder PAIITAIAIITERIl)R-Pl)$TNOR STRAP. (anlerior palatal AllTERloR to indirect retainers coverage lltVER PIACED isavoided). b/c shaDe b/cits metal and straDs li GREATEST SInEilGTH & RlGll)lIY 0f its circular different !lanes. . is tltvER the right angles themidline diagonally) onmobile (soft tissue palate). . 15mm the and straps! l{ust at TEAST tetween anteriff posterior he posteri0r are6-8mm and wide. llsemetal il exists must at border connector cr0ss palate RI6HTAilGUS the 3. . malgins parallelt0the curve lree and plating< 6mm fr0m gingival the margins.

It 0 1che51 ft iesas iuture. quality. can 0f KS and pinge during tissue occlusion. lll I residual are ridges g00d fora I-ARGE-SPAN modwhen Class but palatal r abutnent weak. palatal ldbeanteriort0 p0sterior seal. PI"ATE TI)VENAGT): AKA PI. especially theresidual when ridges undergone have excessive al resorption.actsmore I DIRECT lt in RETENTI0 . 0p m at l sEs. MIOI rPsl e dth ECeS |le (us ft ef t pi sl Palate n pbr It Fa lE0PAtlTAL PLlTE: formaxillary ll designs may may include used Class and or not lplating. d/0r Deriodontally weak beused a Class vvhere aremissing in ll there anteriors a posteriof with modi{ication . does extend the is 0f & bui not to parale.SHAPE PAI. only PAIATAI 0r Lised palrtaltorus prevent palatal inoperable using coverage posterior inthe enlarge area (S LES t0p NOTES dburi (unless is bulky). cause RlGlDllY it can lateral flexure abutments. inv0lved abutment teeth. supportdesired a wide is and stfap preferred. d odyt0 g0ar0und lll0PERABLE T0Rl withlilfll)RGA0G[RS. (does posterioranterior width kept is within b0rders therests the 0f extend of restsl. rating g00d uires residual and ridges strong abutments. lll I when palatal is within 8mm the in Class mod designs and/ff a torus 6 0f line.eplicates anatomylhepalate.lAXlttARY C0il ECT|IR MAI0R has because iheTEAST slreldh rigidity. rsal least olthehard 50% and the 0l Falate iorborder at theluNCTl0Nthehard softpalate.ITI" mainly Classdesigr. are Provides additional supporttheRPD io enahutmenls weak arc palatal weak abutments Ciass m0re ina lll. WI|)E {iIIl|PATAIAI) STRIP: in lll inly used GtAss designs. INDICATI0N: thelastahutment oneither in I IVAIN when t00th is t 0f a bilateral distal ersion a CAt{l 0r ls PREM0IIR e c0mDlete oalatal ge is advised. 4l .l)E(U. C(]IIIIICTI)N): 0ESlRABtt [. the (s0me rctention problem can isa and interfere thepatient's and with tongue taste rect ients cannot tolerate). I DISTAI edfor l0ng span Class BILATERAT EXTEtlSl0tlS poor with residual ridges.AIAI. is latal (COiIPIIIE "MTTAI.

Decreases r0 p0st eri0 i ilting leverages anis0lated is anabut ante when t00th (hut avoid this). Ihegreater distarce the helween fulcrum and them0re li[e lR. long along . May asanauxillary t0support 0lthe act rcst major connector providethe visual 7. lRmay include. the eflective the . fulcrum willpass the line thr0ugh most the REST each on side. most 0n the oosteriort00ih non-disialextension side. FUTCRUM (AXIS R0TATl0t{) axis RPD tlllE 0F the the r0tates ar0und the when base moves {r0m residual AWAY the ridse. Protects softtissues impingement major bythe connector d0wnward during (limits m0vementcervical/gingival ina direction). PIITES. . Stabilizes lingual against 0fanteriorteeth used. movement when part 6. Helps stabilize againstoriz ntaldent ure movement h o byc0niact theminor ol conn (guide with axialt00th the surfaces planes). Class fulcrum passes p0slerior l: through most the ah[tment t0 theedent next space. Indirect Relainer Funcli0ns thedenture when basetriest0 AWAY theresidual M0Vt from l. . DISLI)DGE0l thehase the EilT lr0m tissue 0pening eating f00ds). when sticky (clasps) the triesto Increases the effectiveress retainers oldirect when RPD disl0dge. ilAlilFuilCTloil: Preverts VERTICAL DISLI|I)GEI thedistal EII 0l extension base (sticfty lrom lood). away tissues 2. is in seats d t0 lorces lheabufireni's axis. passes Iulcrum through rigid the metalaboyethe height cortourand iooth's 0t totheedentulo||s soaee. Fulcrum is rnainly (location)prinary line determined placement bythe 0l rests. Class lulcrum isdiagonal passes p0sterior ll: line and thr0ugh most the abutment thedistal extension and side. . Class & lV:T00TH-BoRNVSUPPoRTED notm0ve lll RPDSthat d0 t0ward tissue du funclion (physiologic relief/adjustment required). Fulcrum isthe line center 01rotation asthedistalextension base movestoward su000 tissues anocclusal isa00lied.l{0TEs (Rests l1{lllRECT RETAII{ERS & Proximal Plates) lndired netainers: . May first indication need relinedistalextension forthe to a by (i. lhe line 0f lRshould 90' (right be angles)the{ulcrum and placed rest t0 line. (n0 CLASSdesign nothav€ lllcrunline aris0fr0tati0n). C|)llllECT0nS. 5. when load Class& ll always a lulcrum | have line! . r 3. 4. asa reference forseating frameworksmaking and altered jmpressions cast if is in lellyou therest notfully seated ih rest seat). Are placed faraway ihedistal as from extensi0n aspossible base toPRwEilT VIRTI (i. PR0XIMAL & lillll0R RESTS.e.e. lftheframew0rk is properly desjgned. lll does a 42 .Class & lVd thus is not In lll rests placed are immediately t0theedentulous next space. prevents nPD r0tating the lron around fulcrum (axis rotati0n).

cast IIEI]AMII{II{UII.occlusal isATWAYS rest PREPAREI THE AFTTR PRI)XIMAI PUIIS! GUIDE placed theocclusal 0CCLUSAL RESTthemost common indirect retarner on p0ssible. Rest isslightlyCl-lE0 (deeper). a dufl rsrgns t DIST posteriOr RIST in lt l) 0E00CCIUSAI.5mm in deeper thel. REST. Angie formed occlusal and bythe rest vertical connectorthat nates min0r isorig from THA fOrces the long musi IESS 90't0direct be occlusal a ong abutment's axis. mLst RlGlD. a o dir tie IR alr base ovenl ment T sts. Functi0ns. 2. posterior rest llere [4UST a MESIAI onlhe most be abutment witha dista] l00th ertension. Allows mnimum lnm metalthickness. frOm extension as base easfaraway ihedistal I design:isplaced it bilaterally lt4-marginal oi 1"prcmolars. Iaintains Iaintains established relationships occlusal bypreventing 0fthedenture. C0tICAVE (sD00n-sha0ed) surface. EMBRASURUII{TERPR()){IMAI. lge. long the more ]. PRIMARY Full0TlolllS T0 PnoVlDE VERTItAL RPD SUPP0RTI Prevents vertical lslodgement. M and the [xtends than thet00th\ Dwidth is 1/3 B Lwidth. 43 . Rest is preparat is extended just seat 0n LINGUALLY k strength. . contact . 0n Class design: N(}TES ERTIC ts). REST' only material to l.5mm de t0 bulk l0r of and connector strength rlgidity therest minof and . 0f with Rounded seat rest preparati0n n0undercuts. Rests entmechanical retenti0n. 0CCtUSAt prepared inenamelany 0r restorative pr0venresist l/vher lractLre dr\Lortion a forLedDoLred and r\ .used Class (m0d & lll RPDS themost when abutmentMESIAIIY is TIPPED. occlusal . l\4arginal isreduced/lowered prov sufficieni 0fmetal ridge 1. DEI{TURE. ct0 enIUt0 ent0n ide. sh0uid Rests restore originaltooth the t0pographythat existed Rests be Rest therest was seat DreDared.occlusa isaslong it iswide.5mm formolarspremolars.5mm than thatthe marginal ridge islowered).zmmdeep thecenter (0. settling inpingemeni cervical if a kevents tissue soft directl0n. the1. prepared forbu but like occlusal an rest. 0UTtlllE F0RM. wide & . . R0Ull0El) TRIAI{G[Etheaoex with toward center the the 0f occlusalsurface. . and occlusal (vertical t0theabutment long l0ads forces) Directs distributes tooth's axis.5mm 0fthe APICAILY fl00r l than depth marginalidge. occlusal isalways attacheda igid minor resi be t0 confect0r. the rcst as and triangle (marginal isat base ridge) least 2.gasslvrfulcrum passes line rests thruugh MESIAI nextt0 edenlulous the the space.5mm ridge abutment . Avoid groovet0 prcventthe creating a vertica minorconneciorfrom torquing 0fthe abutment tooth. . .I RESTS ANY OT 3 Il)R PARTIAI. Ilinimizes lurther MESlAL t0 help tipping direct lorces abutments axis. .l\4arglnal islOwered 0neach 1. retainer wilh major united lhe by S-the indirect connectora nin0f connect0r. onthe ridge Class placed IVI ll 0n marginal 0fl" premolarthenon ridge 0n distal extens side. ljsed prevent to inteFproximal 0fthe wedging framework shuni away and food lom points. com0onents inDosition. Rests prepared the lmpression and are BEF0RE final isilrade master ispoured.

enough t0minimize abutmenttorquing . planes clasl Failureparlials to poor 0f due Suiding ensure planes retention canbeavoided alterilg by t00th contoufs. Strbilizes RPD controlling the by itshoriz0nial t00th. Limitedmaxillary with to canines centrals exaggerated and cingulums. is IESS EFFIGTIVEl00th is can s0me but than supp0rt. . [{ctsat REsT: AS RETEI{T|0I{ RP0s Broad WITH coverage over MAXlttlRY RU0AE ltlDlRECT pr0vide sulport. due 0f mel Arisky preparation onlower i[GisoF. cast . Used mainly anauxillary 0rindircct as rest retainer. M-D . Not onmaxillary used incisors it isthe0nly unless 0pti0n. wide .2mm F-1. Helps palh 0ftheRPD. Rounded is placed (canirDs inci trom notch 3-4mm either Ml0r Dledge the 0r . lVinimum deep 1. Provides with adjaceni contact the Should justpast DL angles pr0vide encirclement.undesirable. extend the line t0 180' bracing. . inthe 1/3 surface.5mm (deepest isapical the deep t0 incisaledge). 4. t0 abutment plates used l-bals mesial 0[ [rem0la6 av0id are with afid rests t0 lingual When must HfiCItY theheigbt cont0ur.l{0TEs c tcutuit 0-[{GUA|" REST RtsT): . Guiding serve design predictable retenlion. at 0l lie plate end prediclable retedion. Preparation placed irncti0n isa slightly rounded inverted V(semi-lunar) atthe (iust U3 the lum. Canines Dreferred incis0rs. F-Lwidth determined butits by tooth's contourplates Class & IVdesigns extend theabutments 0fc0 height Guide for lll can above movement. establish a delinite ol inserti0n/dislodgement position. Beveled and labially lingually.5mm and wide l. and reciprocaiion. L0 an . because is n0 there tunctional plates bebelowthe height with | Gxide iIUSI abutment's ofcortoff Class& ll d prevent torquing functional during movements. The saiisfactory rest suppod placed a prepared seat lingual for is 0n rest i most restoratioo. . . are over .5mm (incisal-apically) . Prepared occlusal 0nthepr0ximal plane is Guide is-2-3mm height in occluso-gingivally. IEAST ISIHETIC andnostlikely caxse RESI l0 orthod0nlic movement duet0 unfavorable leverage. Preferred incisal because more resl il is eslhelic. indireci retention a PAUIAI with H0RSESH0I beca l)ESlGil av0ided. thehorseshoe\ oosterior retention Plate Guide Functions: . Rugae provide can isinadeouate. . Rarely satisfactory 0nmandibular anteriors to lack ena thickness. Preparation portion is2. assure clasF 44 .2. Sl GlVAt&IDDIE 0lthelingualsnrlace above cingu butI forces).5-3mm len$h.

tntra-C0ronal ("Precisi0n support . is facial n0 are .0i ECT RETAIIIERS.00r seNe 45 . sbutnent lt is brushedtheVvax and analyzng is passed wax the and surface removes Powder. seat AWAY basal tissues disllacement from t to resist (gingival)thetooth's 0f helghi contour' t0 cervical 0r ion. 0f and of represents paih placement removalanRPD the arm vertica! (greatest convexity) height contour 0f ihe t0 markefused determinetooth's is Garbon (height contouf) a crown wax-up l0r 0f line caf the Powder identify survey Zrc Stearate over rod up the 0n tooth. RPD thatengages ihe T REIAIIIERgives RPD a engaging using fricti0n. . lt iscast attached within abutment's the totally 0r !1/alls vertical . Has 0lefabricated keyway 0pposing parallel t0limit wlih key & a removalfriciion by and movementresist unless . an Any unit mechanical retention. undercut Cast . Advantages: esthetic tetainer Providesbest the vertical direct themost axis hotizontal favorably totheabutmeni's lelatlve mole seat ihroughrest l0cated a (does allow movement) horizontal not natural contours restored .(CTASPING) RETAII{ERS GT placed are & hothsuprabulgeinlrabllge IEVER RETAITIERS) ctlSPS {DlRICT (axis rotation) d0ring function release because w0uld they 0l line i0 thelulffum (Wr0ughtt'Jires) are hreakers relainers stress aId 0nly theabutment. Ertra-Co.onal (Clasps). Has REIIilTIVE am thatisFLE)(IBtEplaced areas claso a (t0oih's gingival Pr0vides resistance t0 l/3). llotused exlensive distal tissue-supportedextensions a shesswith RPD and attachment. height contour 0l t0 thet0oth's generatesretentive 0i action the force disl0dging This from deformati0n a vedlcal until with the relationship abutment a dislodging Which a ihe clasp. Lingual 0nmolars usually retentive b/c there usuallyusable arc arms 2"d molars 0nnandibular0f3'd unde(cuts gual cla . 0f suppoft theabutment and 0f t0the rferences path insertion. bases. indirect li[e. maj0r deniure and ncll reto li0TEs )ly rl ction of I Arm SurYeyor: t00th. tooth/tissue 0n areas 0f areas retenti0n. 0nEXTERNAL 0fabutment (cervical) in helow and .25nm Clasp Attachment"): Attachment 0r "lnternal Retainer t. with connectorsunderlying planes. has passive lorce aDDlied. lhelulcrum to anlerior = class t0 in 0f ine lnumher clasps use anRPI] [Xennedy + l] lV apply Hass designs to not placing 0n elemenis the by R[TEllTl{)Nprovided mechanically retaining t teeth connector with c0ntact pr0vidediniimate 0fminor by relaiionship RETEtlTl0tl DARY tissues. between movable base rigid the is hreakerused teeth placed surfaces netainer 2.

decides clasp tEllTlST which designbest is plan 0nthediagnosis keatment established. bracing and 46 .l{0TEs Arm Clasp Flerihility: . UilotRCUT t0GATl0N most isihe imp0rtant when factor selecting a fordistalextensions. guide plates contribute 180" all tothe enci abutment arms.MUST RlGl0. rigid 0f and the the bracing must arm maintain Tllillllc lll REClPR0CATloll. . 1-2 rests at least min0r & I connector. RIGID (thicker) theretentive because greaterdianeter it is in than arm. circumference)abutmeni VERTICAI Rest should lrovide only SUPPoRL RETAII{ERS suprabulge & infrabulge MUST I retentive clasps have EXTRA-C0R0l{At (flexible) I rigid reciprocal arm. Retentive arm clasp t0engage terminate and inundercuts. Clasp should completely and retent'vefunciion be only forces applied. Longer thinner (smaller and diameter) clasp = m0re the arm . . 0ccurs lhe arm bracing C0I{IAGIthe arm RECIRP|ICATI0I{ 0nlywhen retentive and and RPD. tooth's 0fcontour height middle BE . . TaDered dimension inone onlY. and . dislodging are (bracing) arm 2. Has BRACI(stabilizing/recipr0cating) placed clasp arm 0CCIUSAL a S tothe (cr0wn's l/3). Each retenfive must opposed reciprocal clasp be bya clasp 0r horiz0ntal exerted thet00th ttre forces RPD element capable resisting 0f 0n by retentive arm. When RPD fullyseated. the arm atthesametime during seating rem0vinglhe As retentive tip passes theheight c0ntour engages undercut. clasp should EXERT PRESSURE is ihe tips NoT ANY against an abutmentteeih. retentive isactivated when The arm 0lltY RPll from tissues. Retentive must flexible provide reliefforthe arm be t0 stress abutm . (flexible) 2. l. (bracing) arm 3. Recipr0cating clasp (rigid). with abuiment. less 0fchromium-cobalt give . lSCRITICAL the pr0vide Clasp Assemtly C0mp0nents: assembly Ctasp comp0nents 180'encirclement 0f (clasp minorconnect0rs. betotallv lt must 0assive. Composed greater alloys t0 rigiditywith bulk. Most in A clasps tt r0und form. Horizontal istransmitted placing portions clasps ll0tl-Ullll rigid force by of in areas abutme ot teeth. dislodging attempt unseatth€ anay theiasalseat f0rces t0 Principles Clasp Assemhly: Fundamenial 0ta passive its is activated l. round form theonly are clasp is circumferential form can safely t0 engage u clasp that be used an ontheside anabutment 0f awayfrom distalextension the base. Each must designed claso be t0encircle than more 180'(more hthe then 0lihe t00th.

ctRcur{rEREt{flAr ctAsP {A|(ER's ctAsP). Used almost exclusively 0nmandihular thatdrifted molars |tlESlAtl-Y GUAIIY &U to engage GUAT a UilDRCUT.gh 0rh tissue attachment. . toengage t0 a ltll 0rIVIL a NIB undercut. Consists retentive arm I non-retentive 0fI clasp + reciprocal arm. surlace. engages!ndercut itstaper and an as decrcasesflexibility and increases. Clasp choice Class & lV{t0oth-borne posterior 0l in lll designs) them0st when ahutment undercutAV{AY theedentulous {i. . Has n0n a liexible lingual arm stabilization/reciprocation. Allows undercutbeaolroached theto0lh's the t0 from distal. 0riginates occlusal tooth's 0fcont0ur. t00th.e. D0ll0T when undercut USE an isadlacenttheedentulous (DB Dt).e. . Has mesiai primary & dlstal ary ljsed rest a auxl rest. . . REVERSE (HAIRPIII) ACTIl}I{ CI. inc . lndicated t0engage undercut MESIALLY-LlllGUAI an ola TlLTED when M0IIR a seyere undercut that tissue erists prevents anl-bar. . tilted shallOw vestibule. 3. . Used y 0nabutments (Class 0f 0f"t00th bOrne" dertures 3 & 4)where a proximal (iffra-bulge) isBELoWp0int origin whenbar undercut ihe 0f 0nly a clasp is contraindicated tissue due a to undercut. ljsed when DB Dtundercut a molar a 0r 0n cannot approached fr0m be directly prevent the0cclusal and/or lissue rest when undercuts engagementa har with (inlrabulge). nearly from of . a prox undercui lllI undercnl0n mandihular cannot molar hedireclly engaged 0l itspro{mity theocclusal and b/c to rest cannot be (iffra with bar approached a clasp bulge) tothe due molals lingual inati0r. t0 space or . Used lingual prevent ng when undercuts plac a supportingwith0!t strut tongue interference. nt ofl cleme rinst i Yen tn0Ine' Z RING CTISP. used protected 0n abutments because it covers 0ft00th l0ts surface. tncifcles all0fa tooth itspoint 0rigin. using . . Term end itsretentive arm (buccal)engaging nal of clasp povides reteniiOn by anunoetcut. Indicated inrcverse abutment t0a "tooth-bound" 0nan anterior edentulous space. clasp . almost exclusively 0nML tilted molar abutmenls. crosses terminal 0nor t0the height then inthe thifd. Clasp originatetheN4B can 0n surfaceengage undercut. ol mesial + d stal Clasp consists rest circumferential clasp.ASP: . Used caries isLOW ir NoN-ESTHETIC when fsk and areas. . . Engages oftheabuiment\ > 180' crrcumference. used a supporting 0nthenon-retent Always with strut ve side 0rwthout aLxillaryon opposite with an rest the trargina I dge. .0nlythe paft lower 0fthe arm clasp (afterthe isflexible curue) toengage theurdelcut. lJndercut beontheopposite 0fthet0otl/rest where must side from the clasp originates.Rexib BUTGE RITAIIIERS approach retentive the undercui ABoVE t00th\heisht fr0m the (usually anocclusal r from rest) HOTIS unc utrnet: rgac . . ! tive 41 .ljsedt0engage mal ( . IIDER .t ba r. . is fron space MB) . . RPI guideate p + Assembly. c asp for lVust kigid) lie always ai 0rab0ve height contour the 0f because it canf0t t0geiinand flex out olundercuts.

.F-&-HALF ClASP. . distal rest. .ASP: ARIi . INDICAIED tl GUALtY (LlllGUAI roR lllctltlED PRE0URS UllDtRCUrS) .l. Can used a prem0lar be 0n abutment anteriort0edentulous an space.5mm marginal reductionnrevent ridge t0 lracl{re ihe 0l clasp assembly.lilostcommonly when abuiment t0a disblextension Il. 48 . when flexibility required anabutment t0 a distal is next 0na weak abutment a bardirect when retainer contraindicated. . MUTIIPI.Wroughl arelltVER with wires used embrasure clasps. Use when undercnt or lheside the is 0ltheabutment lromtheedentu away space because more it is llexihle a cast than clasp thus dissipate arm can lunctiolal stresses. HAI. no . Aretentive and reciprocaling must present arm rigid arm be foreach ab have donot to beonthe same side. Used maximum (i.E ClISPJ . C0nsislsa bracing wroughtwire 0t arm. Aring you clasp modificati0n. forboth c0MBrlraTr0il cusP: . 1. (Class used an next where preventbar 0nlya undercut 0r if large l{B exisls tissue undercuts a lrom being used. for t00thborne dentures toanedentulous next space. . 5. . . . Two 0pposing circunferenlial ioined theterminal 0lthetwo clasps at end reciFrocal arms. . used additional (tooth-supp0rted when rctention stabilization and isneeded . Requires at least l. is 0rwhen rsa concern]. . Consists I circumferential 0{ retentive from direction. ATWAYS WITH USED DOUBLE oCCLUSAt t0 preveni RESTS inteFproximat wedgi the framework. NEVTR with used Class ll (distal I& extensions) b/c functi0nalf0rces cause ar0und rest upward the and movement clasp Used abutment 0fthe tip.EXITIIDTD CI.l0TES ETIBRASURE CI-ASP.e. . Disadyantage: two embrasurc approaches necessary are ratherthan a single embrasure clasps. reci0rocati arm 0ne and thaiarises thenin0r from connect0l BAC|(-ACTI0lt CUSP. isditficult justily ltsuse t0 because could easily a conventi0nal circumferential clasp. rclentive circumlerential and arm. used n0edentulous exists theopposite 0fanedentulous when space 0n side C ll orlllwith modifications. Used sound withretentive 0rwhen on teeth areas multiole rest0rati0nsiust are . s.

0n lacial guide (RPl plate SYSTEM) BEST l-barretentive witha MESIAI and arm rest distal isthe assembly placed theterminal to be on clasp abutment distal ior ertensions.01 exists cervicalthird abutment. I atng kisesfrom frameworkmetal and the or base appr0ach abutment's the reteftive undercut (BEI0W HEIGHI C0llT0UR).bar's sLperior s located than from lree border more 3rnrn the gtngival mafglf. lhe ti0is0laced a l)B greatestlrl-D Itsverticalarm mustapproach engage and MESlALt0the curvature the 0n lacial t0 the from dlsl0dged back. ftom GI GIVAI a DIRECTI0N THE 0F (0. place tip0f I har's Iways the retentive l ESlAt thegreatesl curvature arm t0 M-0 0n facial to retenti0nlheundercut. : tent. a small when undercut lnch) inthe 0fihe (i00th abutmeft forClass & lVdesigns supported). l-bar the should release theundercut. chance due t0the border. Tbar.be with mesiald stal Can used a or occllsa restintoothdesigfs no since funct mOvement 0fal suppoded 0ccurs. hdicatl0fs. covers tooth surface poss and as ble. proxil]ral location ESTHETICS. (suryey in distal lhel00t0l thel-bar completely theheight contour is below 0f line) designsit can s0 release lurcti0nal rrtension during movements extensi0n 0fthe base. inter ldyantages. at Claps:T Modilied I bar. displayslittle as metal portiontheapproach crosses gingival Vertical 0f afm the rflargin90'. undercut in fie abutment's su. Indicated a Class0r ll RPDS a [4ESlAL wher for | using REST there notissue is undercut. bar. sticky routh N OTFS r 5 yLl mod I clasp en€t rslnel nd ntulo T FIED BAR: for undercuts theheight count0ur 8ar0f choice DB helow 0l immediately lo an nert soace. Wlef ona terminal lsed abutment CLass l0ra I design. aslittle possible.lace ensure The must (in of) |||-D l€ MESIAt lront thegreatest curvaturetheabutmeflt's surlace. I. edentulous Primary indicat is when 0n abutmeft undercuts immediately t0 anedentulous are neJd . t0 a l\41 when is tiss!e Usedengage undercut there no undercut the below abutment. used atissue undercut (because exists isi0thers tongue !0defcut the and (shall0w traps debris) with lrenum food or high deekand attachments vestibule) or buccal 0l ercessive 0rlingualtilt theabutment t00th.rea r0t ssle ard uideTcuts. Y Roach Hrabulge Clasp. extension teeth lll m indrstal base ons.= RETAItIERS CUSPS R0ACH UtGE {BAn CTASP): ustiliE sC l a . when isa iituat and estheticscofcern. lhen a [atient bites down. upand abutment's surlaceprevent RPD being 49 . Tiey 0f bar type clasp insigr is ficant long it is mechanicaily as as Jlrctionally and gilective. bar. for ll m0d0na lvlL molar little | Indicated Class tilted with iissue Lirdercut.Ihe from retentive (opening . lsed a mesial and it is with rest arm into undercut. retenti0n for ncreased witholtabutment proximity denture less ofaccidental d stOdlon t0its hpplrg.rm sh0uld tuncti0n there anattempt dislodge RPD only when is to the the when chewing food). a DEEP cervrca undercut 0rwhen exists lontraindications:when a severe 0rtissue t00th l{01 il exists.

simplest 0l The form {it reliel.0nly can used a distalrest a WW be with hecause 0l(l0r rete it is its (lulcrum). l/3 abutment isprepared t0receive a proximal iIESIAT ARE RESTS PIACEO THE OII TERIilIIIAI" ABUII{IIII TOI]TII AIT FOR DtsTAt EXIEilStoltS. lt occlusion prevents a mesial 0nthem0st posterior using rest abutmenta in extension. ductile resilient. lllust 180 be degrees the around iooth guiding extending themarginal to thejunction midd plane Distal from ridge of gingival oithe plate. "RPl"SYSTEM PR0XIMAI PIATE. Used teeth indirect (both anterior thefulcrum on wiih reiainers them 0n are to I Provides reliei theabutment due itsfJexibiliiy thedistal stress to tooth i0 when exten moves theresidual toward ridse. arm be and n0 0n 0TUSED Class & lV (t00lh-b0rne) in lll designs because is n0fun there novementtheRPD. lJsed with 0nly Kennedy l0r ll (DISTAI Class t)tTtilSl|)tls). 0ften with liltslAt in class & ll designs themost posterior used a rest I 0n (terminal t0oth abutment) there a tissue when is undercut. Potentially harmfult0rque is avoided. 0rpart thef0rces ofall 0l byocclusal lunction. RPlsystem isdesigned vertical t0allow r0iationa distalextension intothe 0f saddle de bearing mucosa occlusrl under loading without damaging supporting the structures 0f abutmentt00ih.i't0TEs (REST. more and .est. llp 0f its retentive should arm engage undercut the AIITERI0R fulcrum t0 the line placed therniddle 0f rolati0n). RPD STRESS BREAKERS SIRTSS-BREAIGR a device relieves ahulment to which FPD that the teeth an 0r generated attached. thepartial compleiely When is s thereteltiye should passive applyi0g pressuretheteeth. distal and connect0r into ML hut contactingadiacent the tooth. WR0UGHT RETEI{TIVE (STRESS-BREAKER)breaker WIRE CIASP astress used 0f its increased flexibility minimizing abutment torquing). t0ie infront theaxis rotati0n 0f 0f . greaterthan castalloyfrom it was Has. H0wever. greater higheryield strength.e Adva and base.tensile strengthleast at 25% the which clasps greater Wr0ughl-t!ire have flexihility adjustahility thecastcla and than t0ugher m0re and drctilelhan clasps. a slres When is incorporated t0afree-end next distalextension thelunctional RPD. frenum orhigh attac thatprevents anl-bar using .thedenture ab0ut point t0 themesial Both distal guide and barmove plate la cl0se .acceptahle it atthe to place thegingival middle 0ftheclinical and l/3 crown. Asthe saddle ispressed denture intothe bearingmucosa. have cast and greater tensile strength. a flexible Has connection thedircct between retainer dentu. stress directed is theresidualridgeonly and ninimaltransler 0llunctional toabutmentteeth stress 0 Since vertical horiz0ntall0rces and are concenirated residual increased 0nthe ridge. ol 00ll0l USE wr0ughl through wires embrasures embrasure 0rwith clasps. llexibility. I-BAR) anl-bar clasp consistsa that 0f guide with ninor plate the placed the embrasure.Thus 50 . the in directions indicated disengage thet00th and from surlace. Terminal 0l its retenlive is optimally end arm in jt is gingiyal 0ftheclinical j l/3 crown. resorption f requently occurs. resi. .

. Locati0n linishing atthe junct 0fihe ofthe line 0n major minor and connector is palatal while the based restoringnatural on shape considering the location ofreplacement teeth.meshwo. wrought iluslbeatleast long tapered 18gauge wire. surveying thecorrect CA by When casts. Internal External lines normally lr0m other avoid finish are and 0FFSET each t0 framework weakness/lracture. and beused smaller NOTES llroughtwireisincorporatedintotheRPDbysolderingitt0theminorconnector. .TRlP00 and of and areas. hcation tsps. ch the 0f survey p0sition. =.luncti0nminor 0f connect06bar and clasps 90'butt-jointsf01lOw are that the gudelinesbase for c0ntour clasp and length.0r lhe Ldsts allow. denli\l reco thedFltures of inserl'01. procedure ist0lirst adjust tiltt0 permit establishment planes.is embeddedtheacrylic (makes it into 0r into incorporating thewax resin it the gauge 20 nost flexible). The external line0na maxillary I RPD finish Class originates thelingual the from 0f guide 0fthe plate terminal abutment ands the and at HA|ULAR N0TCH. the parallel oforal Survey0r i0 determinerelative !sed the sm anatomy.smm round wire. Thus . needed. 0l the t0 Recofds Doint view ensurerepr0ducible casi\posilion. plastic base denture .75mm lSNOTIUSTIFIED. by the surface alignmenidisking pr0imal t0 0f cast surveyinganges path insertion. the the 0fguiding The edentulous will space Jrequently the dictate angulation Nomally. and -03 ltEs: joint) metalframework Externalfinish exiernaljunction 0fthe tine-the and {butt (acrylic). d0 MARKS are t0 the orientation survevor. pattern. Finishing linejunctionthe with majorconnector no sh0uld greaterthanthus be 90'. Internal Finish tine-the buttj0int between metal acrylic theTISSUE of the and 0n SIDE the edentulous area. entu iofi rOIAI )r n rstn 'RPDi brca rd 0cc { rid RPD RVEYIl{G ABUTMENTS IM lhe path posil. line and Iiltingthe during 0ltheundercut non-undercut 0feach ald areas t00ih. . locati0n undercut n0n-undercut T0 this. undercut. used Areas oental hr suppori iloTbedeterminedsurveying. anterj0r sone guideplane re-contouring prox walls abutrnent is needed improve 0f the mal 0f teeth t0 parallelthepath insertiOn.]ut n greater in diameters t0provide llexibilib/ without fatigue lracture. 8mm and Jl2=. l0 d 0l rchme adi mtve rmlrne {tens Ine tar leol nction t seat rnction asmad line. . wrought is2r more lvire flexible an18-gauge than wirc. Juncti0nthemaj0r minof of and c0nnectorpalaial at finish lines 2mm al ng are med posterior from imagrnary would line that the cOnnect surfaces lingua 0fmissing denture teeth. being somewhai . t0the d onlhecast record cast's placed3 different marks spots 3 at locati0ns abutmeftteeth a single around from lripod 0l t0 a 0rientation cast lhesurveyor.

the alter 0n altering (either restorations dentures).then one {0r adjust occlusi0neach needed. meial . dentist RPDS making maxillarymandibular 0nthesame & the should tryeach framework at a time fit. When patient. locati0n thehinge recofd be the 0f point must first center opening-cl0siBg). for and areas . llilge-afis bowtransfer lace enables deniidt0 VD|) thearticulator. surfacesguiding for for . Prepareaccurate for mouth an chading any t0be Determinedelineatet0oth\ and the height contouf. lf atiempts fit theframework mouth unsuccessJuladjusting. is the on 0fthemaxillary lf thetransfer done should du0licatethe oatient's arc cl0sure. facebow The iransfers axis tothe during ofthe maxilla/hinge relationship articulator m0unting maxillary ca A lace-how transfer rec0rd D0ES all0w dentist locate hinse ll0T: the t0 the axis. tl're in cast and framework forsharp fins. l0 t0 the are after and will assume impression is inaccuratelheimpressionneed berem the 0fcast t0 AliASItR CASIl0r RPD a should blocked be outand du0licated BEF0nEthe lra is waxed up. Determine tooth path if a and/or areas bony require surgical removal if another or insertion willsuffice. other but fits all Dossible sh0uld causes eliminaied makingnew beforc a impression. t0 maxillary t0 the hinge cast axison the articulalor. Axis opening cl0sing themandibl and 0f FNA EWI)R(TRY-III: . 0l {axial Facehoyr transfer ll0Ta maxillo-mandihular bula record 0rient is record. lf theframeworkthecast notinihemouth. path Determine most the suitable 0f placement willdesign retainers teeth that 0l and bemost esthetic. 52 . true 0f . Before accurate bow an face transfer can made. adiust occlusion b0th .il|1TES (lJsing PURP0SE 0FSURVEYIII0 oiagnostic Casts): . Determine most the desirable 0l Dlacement willeliminatemini oath that or placemeniRPD. ldentit planes theprosthesis.caliper 0evice record patients Bl)W to axis (openingand axis) closing andt0transferthis relationship articulator mou t0the during propeiy. bedetermined. transfer cast thearticulator the t0 maintaining pr0per the i 0cclusal relationshi0s inthe Dresent m0uth. should m0unted VDo via 0rwith casts be on Bow t0record hinge Hinge Face used axis. llamaged 0nthecast thefirstareas areas are adiusted framework not ifthe does . reliably. for if with frameworks in0lace. preparati0n made. . 0f like the maxilla/hinge relation FACE . the interference t0removal and . position maxilJary pr0perly relati0n n0r in rec0rd more CR the casi t0 mandibular nor cast. Locate measure ofteeth retention. arc0f closure thearticul cast. Belore inspect master for damage inspect trying a framework.

a secondary lt is impression thatuses metal system the framework functional imDression forthe cust0mized trays edentul0us areas. 53 . short FPDS. maintainins occlusal contactdistribute t0 occlusal 0ver naiurai artificial load both and td1l d. 0l oxide C0balt-increases thef. cAsItMPRtSSt0 possihle theedenlulous in Class istoobtain maximum from ridges urpose the support & ll designs. are 0n0f Chromium l{etalAllovs RPDS. isone lhemajor This 0f reasonsaltered impressi0n an cast isdone. ptures ridge ln edentul0us tlssues relation theway framew0rk lNTHE t0 the lits lVl0UTH !d cast us. duciility malleability c & RIGID N0 0r afte. cast helps s0lt support aidabutments to in resisting Altered technique oblain tissue stresses. avoid overextensionis c0mmon a stock+ray that when alginate impression is used. l0 hold t0ils: nade RPD must a It a mandibular abutment becrowned.ES0F RPD CHR0MIUM-C0BALT corrosion ALL0YS resistance. RPD 0fa base alloy l0larnish corrosion and becauseilssurface layer. long-span & RPos FPDS . must an tooth reduce thanthe normal m0re Y{hen occlusal reduciiontherest for seat. while that would create 0n tteeth. inthe otl N{lTES |Untr c!l t[0Y cusstFtcAlt0lt: l: used small for inlays. strength. and span lV. Base for Chr0mium responsible f0rC0RR0Sl0 nESlSTAtlCf inc0balt-chr0mium all0ys. goal t0 provide The is maximum fOrthe denture RPD e metal supp0ri base. FPD the impressi0n includefull should pads. cdentul0us CAST TECHI{l0UE DUr00se record form the ist0 the 0ftheedentul0us secmenl tissue displacement accurately theedentul0us and t0 relate segmenttheteeth 0f framevJork.th r0t )Ut0 minimizing movemeff the base 0f leverage the s. inlays lll:0nlays.thinveneer cr0wns. poorer in areas where emain reatively in tray adequately teeth but I st0ck will ped0rm areas. high gravity VERY (inflexible). ll: larger & onlays. isthemetallic via how llickel component 0f potential ALLERGIC a RPl| thegreatest with for REACTI0IIS mouth.they cast. crowns. to rin ont dible hotcast). strength. ll. Ensurcs all0y resist the will tarnish c0rosion f0rmingc0mplex and by a chr0mium oxide An made metal is resistant film.omolar all and the arch you crowing abutment for an RPD. impressi0n isrequired tocapture abutmentteeth ret.leasuredpercentage asa 0felongation determines and much margins be can closed burnishing. and llickel-increases DlJCTlLllY.ainework's RlGlDITY. hardness.

muscle attachments. Atfects portionthelingual flange.lhe for DB border a determined thep0sili0n action theMASSETER The extension hy and 0f MUSCLE. AREA an cast 0verextensi0n mand 0f a base area dislodgement denlure fun ofihe during denture inthedistolacial causes 0ftheaction 0fthe ASSETER. dentures. ridge Support imp0rtant characteristic health. Retenti0n the resists force gravity.contributedenture clasp t0 stabi VIRTICAt forces 2. conlrol impo patient\ because muscles tohold dentureplace chew learn their in and efficiently).support: & 0f muc0sa.t{0TEs Cl)MPLETE DEI{TURES Complete Denture Design Characteristics: quality 0r t0 be steady. andneuromuscular {them0st saliva. 0f stickyfoods. tactors impact that alve0lar ri contour. & indirect Ilirect retainers retertion. and positi0n forces a[plied. .T. overextended flange cause An lingual most distal 0f can a throai. 0ST criticalarea border in moldinga llN(lLtARY DEIIIURE MUC0GlilGlVAL isthe area is important maxi for above malillary the tuberosity asthisarea extremely reteniion. . (most imIortant). 1. CI-ASPS lrovide inundercnt 0fahuiment Dr0vide areas teeth retention. 0I impression a complete for dentlre limited theaction is hy 0f ihe mandibular SUPERIOR Cl)IISTRICT|)R MUSCLE. 54 . RPDs. buccinat0r the DBcorner the denture durins S 0IST0BUCCAI durjng altered impression. Anoverenendedcornerofa DB mand astheresult pushes denture against ASSETER function. design fororal theIVoST 3. it can the relief/space area inthis because Iimit denture's ertension. Su0eri0r Constrictor Muscle: shaDes DlST0LlilGUA[ the BoR0ER 0l0lilG. Support resists seating Frovidedresls denture by and bases. exceptthe retentive tip. critical other areas thelabial are lrenum themidline. &torsionalf0rces lateral. . B0RDER l'l0LDll{G: . l{asseter powerlul whose run muscle liber superi0Finleri0r l{uscle: [hdIpushes into 0f base c0ntracii0n.IAR IEI{TUREafinalim0ression. the during . IAL . {rena in and in inthese often t0 retention ti bicuspid Overextension areas leads decreased area. supportprovided is byocclusal and rests edentulous areas. and irritation. constant. quality oral retention. AllRPD c0mponents. stahility. provide FREIIUMfoldsof nucusmembrane containing fibrous l\4ust C. suhiectt0 change when are In stabilitythe is relationship denture t0bone resists 0fthe base that dislodgement denture olthe a HoRlZ0 direction.forces and associated with mandibular m0vement. When moldinsilA DIBI. Stability{he 0fa dentureprosthesis firm. Stability involves resistance io horizontal.

occurs ridge (UPWARD b0ne occurs laxillaryarch: loss/resorption lna VERTICAt & PAIATAI direction (0. finalform0f the b0rder molding should represent accurate an peripheral 0l tissues. product adding piate t0 a record t0 Sl0l{RIMS theresultant after base wax base positl0n arch expected compieted imate t00th the and form lnihe Functions: deniure. bone is4)( nandible. varies. and lips. However. smooth. preliminary Make maxill0-mandibLlar iaw relati0n rec0rds. border The modeling c0mpound have hpression the sh0uld a polished appearance. rim is and rim Maxillary 22mm nandibLlar18flm. partial rec0rding anRPD. compound Excess istrimmed inside from and qitsjde cust0m The the tray. (arch position Establish locatethefuture 0fdentureteeth forthe cheeks. geni0glossus are and muscles influentialborder in m0lding LlllcIJAL the borde.eated wax The is with b ensure hy foil0verthe masier priort0lorming tray. lsdependent oral onthe conditions Best impression techniquea patient loose for with hyperplastic ist0register tissue the positi0n. t0the and room adequate fortheimpression material. space c. remaining modeling compound refined repeating is then by The tie pmcess. €dentulous extraction. is oriented thecr0ss-sectional 0f the Bone loss al0ng shape I\4andibular res0rpti0n faster inthemaxilla. but (DoWNWARD arch. mylohyoid. cast the royered aluminum is in two The lorderm0lding c0mpleted stages. tongue). s). varies. Signilicance 0fCampe/s line:the occlusal established wax by the 0cclusion parallelt0 surlaces is Camper's & interlupillary line line. than but Severe resorpti0n ca!se Pseudo lll malocclusi0n bone can a Class appearance.primary the indicator h0rder 0l m0lding accIracy STABILIIY is and 0f displacement cust0m inthemouth 0fthe tray should plete m lray a linalndndrbLld lor 0rmarillaryc0 denrure imprpssi0n havF N TE C t a bi l ' s. -ine fvelicJl '5h patiertVDo Detpr ardestab t'rF s dimension Js0n) level 0[occ aro of hes t dibu dibu u naxtnl tn I dtiss occlusalplane. m0lding should approximate thetray and be horders should slightlyoverextended.1mm/year issustained).b0nel0ssoccurs VERTICAI landibular in direction & [0RWARD/0UTWAR0). For ports spacer tissue t0ensure tray with stops the seats prcper in rclationship arch. Resultsminimal displacement thedenture in tissue under tissues their n kegisters position). loss first isgreater. is done firstchecking bordersthefltouth then the in and immed t0allow down uniiorm thickness2mm modelins 0f 0f c0mDound theborders when molded. 0cclusion is attached thecompleted for CR the rim t0 metallramework instead a recofd asused a complete 0ft0 base with denture. passive present. must irtimate in its PASSIVE tissue Ihere he contact lhe impression 0f material thetissue. with 55 . 0nmaking Complete 0f 0entures Rec0mmend a technique using that: placement control theimpression Affords and 0f material recording tissues in border (border moldirg). superior Palatoglossus. themandibular ol inpression an for paiient.Tray Border & lllolding: trayfabdcated a preliminary is trimmed on custom cast ofthemucosal -2nm short and This by ti lection frenae. r surface themaxillary 0f occlusion sh0uld PARAttEt CAMPER'S (the rim be t0 LlllE plane running theinlerior 0fthenose t0the from border ala supedor oJ ear b0rderthe plane. alveolar resorption because is nol0nger stimulation ridge 0ccurs there bone hy supp0rting ol structurcs kesidual resorption). Initial in year & IilWARD). pharyngeal c0nstrjctOr.

Covering area provides boder Anoverload the mu this also s0me seal. establishi8g D0tl0TPTACE mandibular molars theascending 0f the mandible ove. mu but inthe Lies captured inpressi0n. atthecrest 0fthe mandibular ridge. Euccal shelf-the suFport l0r a mandibular area Euccinat0r denture. tongue lips.more the tissue. inthis The buccal the dentuae suooort. residual keratinized thebetter ftralinized tissue. denture support and comfort. totheocclusal peripheral arca a mandibular A StC0ilI)ARY seal for complete denturethe is lingual horder. a primary Retr0m0lar not 0r ll0T supponarea. RESIDUAt il large broad. and determines the 0fa mandibular arch. ASEC0NDARYarea theCRESTRESIDUAL WHENlSSHARP relief is 0F RIDGE IT l{andihular Support Areas: prinary 1. rely0n dentnre but stahility coverirg much in as hasal b possible with0ut impinging tnuscle 0n attachmenls.AR C|]MPLETE DEl{TURES (stress-bearirg) is MAiIDIBUIAR C0MPLETE DEIITURES a primary srpport area (resists BUCGIL iecause its bone SHELF 0f structure resor0tion becauseis ii (parallel) corticalbone d0es change) itstrabeculati0n and not and rightangle relali plane. .e .t0TEs MAl{DIBUI.lrnderextension peripheral baseterminates0fthe sh0rt retrum0lar 0lthe bord a complete mandibular denture decreases tissue-bearing s laces. (does pad) Underlying b0ne basal (umer retromolar resists resorytion the hone resoft). of occurs bases ifthe coverinsthe are small outline. ilarkedRES0RPTI0il alye0lar willoccur a mandibular 0f the ridge if complete de pad. muscle a denture's limits extension area. beFrimary RIDGIS and may areas. are support but usually SEC0ilDARY STRESS-BEARI hecauseis cancellous GAREI it hone. active Tlre border molding peripheralareas bythe cheeks. ridgearea ol dentu. . The boundaries buccal are buccalfrenum retr0molar 0llhe shelt lhe tothe ( crest ther€sidual t0theexternal 0f ridges 0blique line Alevoalar SEC0IIoARY mandibular supFort. maximal bone basal coverage.l. biggerthe shelf. area ramus DISI0DGE mandiiular occlusalforces theinclined 0ver the denture. patient a "knite-edged When fabricating a rnandibularcomplete denturefora with you naximum need e*ensi0n thedenture help 0f i0 distribule occlusal torces atgetarca.es notrely suction a peripheral for retention 0n from d0 seal maxillary dentures. afle thus deniure STABILITY. 56 . area too in Mandjbular dentu. masseter atfects nandibular muscle ihe denture. pad-does change resorb.

= Tuberosity lTubercle Lingual and nGUAI SULCUS space between ridge tongue. bel0werheightthe in in anteri0r pharyngeal 0f the corstrict0r & ClJRIAlll-c0mp0sedsuperior ItTR0l{YL0HY0lD g0. the -the onwhlch the IILARYSALIVARY CARUIIC[E eminenceon eithers]deihefrerum 0f open. S-CURVE in a mandibular impression totheMY[oHY()lD due iIUSCIE is seen the the and F0SSA wh toward buccal. sharp mylohyoid ridges. sub inguai and ducts submandlbular ducts on lr lbo lorm i. anleri0r tonsillar and bythe $diallyhythe (slopes . antedor region. the gland p0rtion theirylohyoid 0f flruscle theLINGUAL cause FLANGT blingual and 'n0TRUDED.is This FossA-located distalend alveotar atthe 0fthe |[TRo|tlYt0HY0lD "S-CURVE" the flange towad ramus turns the making famous the with therethelingual Bordered sl0ping toward tongue themolar the in region themyl0hy0 0f d muscle. I removai thefabricationnew before position in A with affects denturc stabiliU retenti0n the mouth. frange pillar p0steri0rly retromylohyoid curtain. patient a & tongue denture candidate D/RETRUotD is a p00r aflectsthe slopeofthe lingualflange impression molar 0lthe inthe Y0lD MUSGtt (atits most (distal) toward the PoSTERI0R aspect) causing llange slope the t0 Ft|l0R M0UTH. Epulis and fissuratum areevaluated 0f dentures besins. far lingualflange can Determines posteriorlythe how Dalatoglossus. th 57 .AR lying the & RAPHEa TEltDoil between buccinatorsuperior ictor muscles. from mylohyoid 0fthe Arises the ridge F()RilS IiIUSCUtAR 0FIHE THE REGIoN becof0es 0n higher the inferior border theINCIS0R n and iblenear mandible\ just p0stei0r until terminates distal thelingual body lt t0 tuberosity. t0ward tongue) RETn0MYI0HY0|0 chslopes NOTES ()MATI!IBUI.is in area mandibular (mandibular tori dentures) and nuc0sa lound myl0hyoid & over palatinus (maxillary dentures). andible's ||lA 0E when lS at and C0nnectsthemidline cantlFI THE DIBUUR TURE theT0I{GUE lt influencesm0laf the regi0n slopes and toward tongue. midline thepalatal and a torus 0f vault 0ver prominent for rtori. tltlcUAtSUIDUS.

Compensates shrinkage isin I 0VABIE foracrylic and TISSUE. of . Posterior saliyaryglands ma help peripheral seal. never . Prevents impaction food beneath denture's surface. thisarea the . Compensates l0r polymerization and cooling shrinkage denture 0tlhe resin processing.lark inthemouth aThompson and it with stick carve/scribe into cast. Aposterior palatalsealis necessarywhen ac0mplete ona patient fabricating denture aflat palate. -5mm . from pterygoid plate. . . (imaginary thatdictates distal palatal linelSANAREA line) the termination 0l posteri0r 0fa maxil maxillary c0mplele denlure rec0rd base. is but slightly t0 0l & rcar nosteriortheiuncti0n thehard soft [alates themidline.3mn themidline. Butterfiy and shallower center hamular areas. [.[R tie I)TCHES maxitta. .li0TEs MAXILTARY C()MPLETE DE]ITURES (stress-hearing is theRESI0UAL PRIARY supp0rt denture bearing areas area) RIDG PAI. . during (PTERYG0MAXILIIRY) 0f loose thai extends HAMUIAR I{0TCH . Completes the border seal0fthe maxillary denture.IIESEC0il0ARY suFport areasis the PALATAI RUGAE. VIBRATIilG -2mmanteri0r the f0vealalaiinae ATWAYSTHt LlllE: t0 and 0ll palatethat thedivision PAlllTE. 2. Smrn inthemidiaieral and wide areas. at . the tissue physi0l0gic 3. in anarea imm0vable lt is 0f tissue pr palaline conpensates l0rdenture0cessingerr0rs. Posterior seal palatal outline depth patient and ditfers every for according t0the form thepatient. inthe passes in lr0nt 0l the F0VEA 2mm PAI-ATIilAE. Posterior Palatal landmarks: Seal . 4. lviddle theposterior seal 0.a cleft C. Placemeni posterior palatalseal 0fthe isalways bythe done 0EilTlSL Posterior Palatal Functions: Seal 1.5mm extending onboth palatal is of deep 3mm sides 0f midline. Carried AtlTERl0R VIBRATIIIG T0THt tlllE. 58 . Secondary RETEIII|VE is area glaldular regio! each 0Iihemidlile. maxillarytuberosityt0 0fthe the hamulus medial gland FoVEA PALATll{l group muc0us ducts 0f -a wh0se locaiion varies. . WIDER P0SI[R|0R IilE THE THE TllE PAIAIAI SEAL.In determiningthe limit denture thehamular is0llthe[osterior base n0tch h0rder.lhe imaginary acrcss posteri0r line the narks between movable & immovable lissues. is l-l. shape in inihe and notch . . WIDTH sealanteriort0 posteriorchamcterized concave ofthe is bva surface.T. lmprovesdenture's the retenti0n. Posteri0r (vibrating and ontline formed "ah"line is bythe line) passes through the pteryg0maxillary (hamular) notches is 2mm and anterior thefovea t0 Vib Dalatini. 0n side P0SIERIoR PATATAI SEAL extends through HAill. Posteri0r seal palatal should beremoved. Excessive 0Ithe palatal usxally depth posteri0r seal results unseating I in 0lthe .5mmhigh L Width and broad itsbase.5mm lateral themiddle theseal sh0uld is deep to 0f and extend t0the up (hamular) boundarythepterygomaxillary of notches. Seal l.L. FLATTERPALlTE.

a Y-incisi0n palatal Use Large tori cause with t0 palataltori . is all extracted0nce. i med for Palatal ons Removing Iori: lmpinges soft 0n the tissue toriisundercut.more in llsually covered thinner less by and rcsilient mucosa ridge. s Due ill Fitting t0 C0mplete Dentures: inihe i0chronic candidiasis.bony enlargements hard atthe midline. Closed l/vho vertical dimension most cause cheilosispatiert !l/ears isthe likely 0f in medical isnon-contributory. of lhe soft Nt]TES palate ToRl. area the the 0t Ftientcomplains I smile. occurring 20-25% in ofthe prevalent w0men. Angular bya L0SS VERTICAI 0l Dl EilSl0 0rvitamindeliciency. history a complete and denture whose ne xa t1 d t ui 59 .0routline-formed "blow" (valsalva l0catedthe bv the line line). bl0w isanteriort0 vibrating which moves the hard The line the line freely when ient attempts blowthrough nose it is squeezed Blow js a close t0 the when tightiy. 2 1 {.rdand palat€. is best coverthe is lt to 0perated with surgical site a stent -operative lf a patient having maxillaryteeth d witha sedative dressing. mandibular ARE usually tori usually pior to denture fahrication. healingslow. or Chelitis-crackingc0rnerthelips 0f secondary l. line imdrionrhp lo Jdncl.0n h.Ireatwith Nystatin t0 undersurface anti-fungaltherapy: powder applieddenturc 3x/dayfor weeks. paiatal can problems pOsterior seal. thebuccal 0f ions. 0rthe vault prevenis formation adequate base. S0 large lillsthe it and 0fan dent!re palatal Extendsfarposteriorlyihus with posteri0r seal. B caused . . ion. act and rocking themaxillary 0f theresidual s0it may asa lulcrum cause ause softtissues thetorus generally with p00r the over are ti'n a bl00d supply. Bt lll THIS naxilla together. over "when my denture doesn't h0ld". at distal extenl 0l palate. t.reline remake denture. 3-4 or 0r the llystatin ininelfectivel rinse . iswhere palatine pr0cesses This theincisive t0 0f the 0f join ilAxlLL"[RY DENIURE SH0ULDREIIEVE0 AREA. at isbesi also t0 remove toriatlhaitime the removed denture for labrication. too interferes the Psych0l0gically tothepatient disturbing {cancerphobia).emove directly thetori. it onthe border causing denture the to e loose (SUTURE) 0fvery and attached extending PAIATAL RAPHE area thin tight t ssue papilla theend thehard palate. However. upper base needs headiusted buccal t0 isthe notch huccal & flanse t0 E)(tISSIVE due postedorly smiling other As frenum m0!es during 0r facial ESS thearea. encroaches denture thatis toothick.

tissue anti-fungal therapy resilient condition tissue and well-fitting new. fabricationnew 0f dentures. (redless Denture Stomatitis-a l0calized 0rgeneralized inllammation chronic and p burning) lhedenture-iearilg 0l nucosa. nasses f00d The as FlRlil. tissue c0nditioning.l{ost patients lnay/are ib presence. Gl| . oralhygiene. cleft-like are This lesion caused mainly overextension by 0l denture flanges. trealment IPH dependsth on lesion Although nodules not size. The likely most tissue reaction gross t0 0VEREXTtllSl0l{ 0fa complete denture (caused has worn a l0ng is anEPULIS been l0r time FISSUnATUM hyanill-litti denture flange). Traumatic occlusim naturalteeth 0l opposinganificial an denture also may cause epulis an fissuratum. papilla smaller g00d usually regress treatment with the soft {removing denture. Discomfort be0rmay be may not by lungal Cassed denlure trauma secondary inlecti0ns. a change denture and in habits nay sufJicieni toarresttissue changes. Treat:with SURGlCAL EXClsl0ll. Treatment. overextensionresultJrom The may long-term neglect 0rsettling sxbsequentto ridge residual resorption.e-induced hlperplasia tissuralum). lt occurs theyestibular in mucosa thedenture coniacts where flange tissue. 0entu. lnextreDe surgical cases.theamounthyperplasia lf denture 0f is minimal. Inflamnatory Papillary Hyperplasia-second aryl0 ill-fitting ltlAt(lLURY IEilTURES and s0metimes com0licated bv chr0nic candidiasis.N(lTES (fpulis Intlammalory Hyperplasia Fissuralum) asatraumatic Fibrous begins u secondaryt0ill-fitting an denture flange. thirgyou tirsl must is CUTIHT d0 0EIIURE FUlilGt hecause denture|lVtnEXTtllDEll. topical fungal anti medication. the are completely reversible. Ap[ears PAlllLESS 0ffibr0us ssroundingth€ as F0IJS tissue oyerertended llange. However. relatedchr0nic t0 trauma byan denture. esptcially dentures a relief with in chamber lroducedresD0nse t0irritati0n delture from movement and presentPAlilIESS. excisionusually surgical is requ Ihe0atient alsoleave denture 0fthe can the out n0uih. excision. and Treatment: improved (Nystatin). may involve residual but also the ridges. c0ndition tissu the Iherapy.consider BACI is lhe Then tissue conditionins. dentures. rest. clefts (tpulis fibrous duet0 f0und pr0duced ill-fitting hyperplastic isalso tissue. oral and Nystatin therapy). . Frequeltlyfound anill-fitling under denture. are 0l lt usually inv0lves onlythe HAR|) PAUIE. . relines. . 3. 0r proliferati0ns muc0sa. becaused c0ntinued Can by denture andirritati0n. pink red accunulating debris. n0dular ofthe Candida Albicans contributet0 may the inflammation.

put pressureon papillae.l that fOramen ISIVE the areas theME|)IAL are PAIATAL & lllClSlVE SUTURE PAPILIA burnins when occurs ort0 blood compromise supply.0r removal surgical (for ue extensive changes). a VERY 0f bone use FL0WABLE |I4PRESSI0N IIATERIAL t0 flabby like EUGEtl0t PASTE. of hygiene. A maxillary ridge anterior under complete a denture frequently is associated with I{EO I{ATURAT MAIIOIBUUIR AI{TERI|]RS. indicates much area This too being F0RA[4EN. during chewing. stahle forthe base denture. dentLre theINCISIVE on rybe tre:l [ii I Ing I I lne I (0pefing). denture (n0twearirgthem change habits 24hrs/day). and loading Causes reDlacement byfibnustissue.ea bv 0nthe Elt nt returns your t0 office fewdays a afterdelivery new 0f dentures complains and oJ ralized irritati0n thehasalseat. 0f Potential Causes: = ATURE C0 irritation PRE 0CCIUSAL TACTSM()ST common cause seneralized 0f 0l the basalseat. rec0rd ridges ZltlcoXIDE isindicatedt0 impfovdpromote wherethere littleridge n$IUEilTUER healing. is by Al{TERl0R (loss 0sseous RIDGE 0f IIARY structure theanteri0r in maxillary arch). ridges due unstable flabby are t0 occlusionorexcessive 0ftissues. nssensation mandibular in the anterior is caused Dressure MEtlTAt a.imp0rtaft reasontreat t0 hyperplastic bel0re m0st t'ssue makingc0mpleteRPD t0 a 0r is alirm. & premaxilla resorpti0n. a previously edenlnlous patient now aged who wears complete a maxillary denture years. reline istrng dertures. Thus. (decreases pressure a natural oppose teeth a mandibular denture full 0rwhen maxillary 0n ndge causes damage and less t0vascularitywhich bOne lhe decrcases resOrpti0n.caused anedentulous is0pposeda partially (anteri0r 0nly). nutritionaL and hormonal Lmbalance. isvery left. PAPItLAsoft fibro!s elevati0n covers incisive C. tissue drn NSTES c e Bl ATl0 SYtl0R(}ME when marilla by . mandible teeth causing B0 StVERt ERES0RPIl0 AilTERI0R 0f lll. tuberosity 0cclusa problems. Lack denture kcessive V00 tI eni €d els 61 . is very anterior l0r many the6 mandibular teeth it commonhave doa to t0 due loss bone lheAilTlRl0R to 0l in maxillary Thls evident a FUBBY arch. hyperplastic tissue s0ft Treat lissue: rest..the patientfeels incisive T0treatrelieveincisiye hurning. plane Gharacteristics. patient wearscomplete A a maxillary complains burning defture 0f a pressLfe exerted i0ninthepalatal 0ftheirm0uth.the tips deninre anteri0rlympress mucoperiostieum c0 the p. (flbr0us flaxillary hypertr0phy hyperplasla). the who laearea.e-maxilla.

Increased phoneti for bulk more space better stfen$h allows less t0allow t0ngue and . thepatieni Permit t0 2. s0 better is betterthermal . . pain.ed lhp points undercuts ridge can perfomed.rdL-aartr procedure a 24hr sequencetheclinical 0f tor ulceration. 1. Duplicating cast cOnsiruct a surgical stenvtemp ist0be at ate that lsed a master t0 made wax afteI eliminati0n aftef and the denture inseirionbest is time irnmediate 0l a set 6 istrimmed. Ask the about additional complairts. i0 stimulati0n salivary 0lthe immediate d ls the & ldeal treatment t0 labricate maxillary mandihular maxillary to thelikely teeth malpositions remaln ol the t0 avoid simultaneously setting mandibularteeth.s willsubs and th de return normal.g. slerl lempate. Remove the dentures the from mouth thoroughly the patient theareas tissue 0f trauma observed. and dentules. more METAT otl{TURE . After lecting diagnostic c0 all problem cure. Has fortissues.N|1TES is irritatingt0 tissuethan and accu acryJic. lf the inan immediate denturepr0cedure elimination 0f mastercastsareallered a second transparent base denture using surgi a undercuts). describe information. llestenl 0a. (e. notmake 2'ddenture for at least m0nths. basic and Ihe appointment is: and examinemouth. advisableconstruct it is t0 \ over ridge afterthe a'e teetl" et'rdcted. the . weighi is for denturc DEI{TURES IMMEDIATE correct undetecied any sh0uld evalualed afterdeliveryt0 be 24hrs Allnew dentures manifesl hyperemia. 0vertiflre. patjent the should expect s0 During firstfewdays inserting after complete the and saliva t0 difficulty masticating loods excessive due reflerparasymp in m0st glands. conductiviiv.netal LEss BASI fits tissues. dentist determine s0!rce the can the 0f 3. as inflammati 0uted dpnlLrp l0 [unction lcsue. are readily and visible surglcal conectionbe and . D0 62 . lrcreased which better mandibular stability.

the dent[res should scheduled REtltiES5 months 10m0nths be for at and ediate 00stfor changes.mmedrate become Due dentures progressively fitting. dentures ofly 0f lnproved while denture trcatment requircs lone ext. case be dny when agqosric d intormalr0r ale\d 'alire. can Anlerior areextractedthetime teeth at of denture insertion. often (i. get thepatient through lirst day wearing the 0l imnediate dentures. all teeth first a maxillary premolar itsopposing and l. care relining ng Contour Increased period. natural When teeth lostandnotreplaced. ldi I tlEll{l1l0All()Ns dentlre al t-E (Vvhen lysolve patieni's complaint thedenture base the chief record adaptat isthe 0n in defect theprosthesis. are another the exlraction from sites trauma byacting a bandage as overthe clot-filled sockets.eatmert io theneed relines repeated total ol occlusion.actions iwo after and adaptation. tDngue Dentu. are the Prevents e4ands theavailahle into space. THE lti THt 0UTH 24hrs delivery. Protects perception acceptable masticatory lunction.e. (a t{Ec0t{TRA[{0 0t{s excessive tcATt 0ver-closure 0f vertical dimensi0nlarge inVDl)). tothis. Step e*{fact posterior EXCEPT "stoD" to a oosterior to maintarn VDo. the t00ih Dr0vide Step after posterior 2: the residual exhibit ridges acceptable ng. of l0 the lbility duplicate positionthenaturalteeth. 63 . !1. must but lelinilg/rebasing caned withinl2 morths out 8 dependirg rate alveolar resorption. be post fora days be increased delivery soreness few can enco!rtered. tongue enlargement. 2"d heal the treatment phase (denture iabrication) begin. when teeth due for and equilibratof 0n lligher cost t. return 24hrs lhe tirst THt eat in for and lll KIEP F0R envevaluation. on the ol ridge Als0. Patient retains some oJ Continuously during chewing healing. combinati0n The 0fpost-extracti0n and hcreased grcaier dur fLrst after related trauma produces discomfort ngthe fewdays inserti0n.. pr0ceduresborder complexity 0l clinical molding & ljnalrnpressions are Greater more ditficult natural remain). is a monthly if necessary. performed. conveftional atter dentures dellvered). healing 0ccur residual during 8 l2 month ridge the changes inthe post-delivery pair denturesoreness.softl00ds. and relines altimel aseach must evaluated ne. post-inserti0n(including or remak thedentures). collourirB 'he fe"ling'idgF Re of ctiont0 compensate contour ilOTES c tgaa 55_! post ses fapidly 4-6months does stabilize until 12months for and not inform 10 more ill This ion. try-in evaluate t0 esthetics t00th is t00th thedenture isrequired months. instruct them REM|)VI DII{TURES. acceptahle esthetics thepatient never as is withoui elther natura 0r Sontinuously arUficialteeth lmmediate require oneperi0d speech speech adaptati0n. case. dentures indicatedtheproper Inthis new are at vertical dimension. in8-12 Relinifg issimple.prior schedule t00th for removal t0 delivery immediate 0f complete dentures: l. after aleComplete Denture Advantages ts tAril n0rcATr0ilEsTflETtcs.e Disadvantages ateComplete have Ill0R disadvantage 0fimmediate denturetherapy being isnot ahlet0 ananterior (anterior lry-in impossible).

IIl|TES

due spots t n if a dentures, pat ie t c0nstant lyre urnsforadjustments t0sore 0n After relining the contacts. have changed CR may the occlusion because relining checlthe ridge, IISSUE CAUSE IRRIIAIIl)II DTIITURES CAII PARTIAT IIITERII{ provide an posterior andallow to iissue healio teeth rernove DEiITURES littlEDlATE point pr0vide reference premolars a VDo t0 Can the forsupport. keep

l)VERllEl{TURES
all0f t0 c0ver ano{i whose is 0VERDEI{TURE -a denture base constructed G0 PIETE prevent ri 0fthe res0rption alve0lar r00ts roots. residual and aidge selected Retained help sense some the retention, allow patient pr0prioceptive 0f"naturalnl and denture improve (root-retai bemfit an ovedeniu.e 0f it|lsl imnorlant in function thedeniures. 0f RlllGE. 0FTllE is denture) PRESERVATIllil AwE0IIR However,r00t if a . lt is notalways heneat[ overdedure. an coYer necessaryto a r00t The susceptible t0 decay patient's are surfaces highly the notcovered. exDosed root i0 prevent decay. nust hygiene beimpeccable pa r0utine when taking . Retairud lindings r00tsare the mostcommon (not over-dentures) dentures necessarily who complete orpatients wear radiographs SUPP hecause provide they . For bilaterally canines retain overdentures, mandibular pr0vides (a retenti0n). retentionlocator ll0T

0ccLusl0l{
(ARTICULAIE0 with G0I{0YLE)an articulator its ARTICUIAT0R ARC0il
path 0n col articulaioland ylar elemefis the nember0fthe 0n elem€ntstheL0WER plane 0n and inclination occlusal is FIXED thecondylar between member. angle The PtAl{E & 0CCLUSAL REilAl lllCLlllAll0ll C0llllltAR AllGtt BETWEE}I articulator. COIISIAIII AGCURATE). OTORE ofoccl examinati0n casls . C0mmonly fordiagnostic 0f mourtingsludy t0allow used during excu p0sition analysis t00th 0f contacts and contact in contacis theretruded models. movements mounted ofthe forsetting b0th are . 0cclusal excursionsnecessary and recordsright leftlateral in guides c0ndylar medial superi0r and contacts . Fabrication and t0ensure restorations c0rrectt00th inocclu 0fcast p0rcelain movements. and mandibular

64

(I|0I{-ARIICUIATED |}tl ARIICUIAT0R C0I{DY[E) condvlar has elements 0n path member condylar elementsthelower and upper 0n member. (ll0T condy,ar inclination occlusalplafle C0tlSTAllT FIXED) and isll0T lnglehetween WHEII (IESS populart0 l|PEil CL0SED ACCURATE). vs. This desjgn more is fabricate dentures. a SMALL 0F Ion-adiustahle-has AXIS R0TAT|0N. gives cl0ser Semi-adlustable a approximation axis rotati0nteeth does ofthe of & and not intemediate trackingcondylar 0f elements. all0w progressiveshiltand reproduces ALL border movements lncluding fullyadjustable: slde (BtllNFI'S |0VEi,{ENT). immediate shitt side

t{0TEs

l{GSIDE teeth theside mandiblemovins 0n the is toward. themafdible When t0therightand maxillary mandib! teeth theRIGHT isthe and af 0n side working side. e workifg contaci, a denture have canine al least other must the and 4 acceptab cusps cting opposing the leeth. CltlG SIl)E the 0PPoSITE side mandible side t0the the ismovinstoward. the When ble movestothe right,the maxillaryand mandibularteeth 0n LEFIis balancing the the (with natura{ thebalancing = n0n-working For teeth, side side). acceptable balancing must contact,least cusps t0uch, il(lT CAI E. at 3 but THE llSlVE forward movement otthemandible which must at least during ihere be 3 (the incis0r, one 0n nts c0ntact anteri0r and tooth EACH 0fthearch far posteri0r of slde as oossible). Pr0tr!slve records relati0nthemaxillamafdible, is used set record, the 0f & and t0 the lrorrontalcondylargurdance0ntheartlculato.l\4adewlthmandlbularanteriorieeth6mfl forwardCR, with 0f 0r mandibular lary & naxj anteri0rteeth edge-to-edge). posterior during Christensen's Phenomenon thespace opens tlrat b/t teeth anterior movement mandible. 0fthe Amouft posteri0r 0f separati0n is affected b0th ifclsal by the guida'rce. gudance the zontal and h0 condylar Protrusive Movement-accomplished mandiblemoved when the is straight f0Mard unti "edge-t0-edge". ncisors themaxillary mandibular contact and This movement is svmmetrical both inthat sides themandible inthesame 0f move bilaterally directi0n. The mandihle orotrude can - lomm.

65

tl0TES

(ilAxlttARY CURVE SPEE 0F ARCH) anterior-posteri0r fr0mincis0rs m0lars curve t0 maxillary and arch concave respect themandibular with to CoNVEX respect the with t0 . Gomle$ating Cune-the anteroposteri0r and lateral curvature alignment inthe 0f is 0ccluding surfaces incisal and edges artificial which used develop 0f teeth t0 The curve under denli the balanced 0cclusion. form0fthecompensating is entirely (i.e. during tryin evaluation protrusive notes conkol if a a dentist thata excurs movemeni intheseparati0n rcsulis 0l posterior theproblem becorrected teeth, can simply increasing c0mpensating the curve). . Conpensating all0ws dentist alter elfective angulation t0 the cu$ curve the denture The 0f cianging l0rm themanufactured teeth. lunction thiscurve the 0f is providebalanced help a occlusim.pr0ninent A compensating is required curve path guidance. with degreeincisal of there a steep is c0ldylar associated a low from side CURVE Wltsotl mesio concave acr0ss one 0fthemandi 0t distal curve arch theother to side. BAIAI{CE0 the simulta0eous 0f 0pp0sing contact BII.ATERAI 0CCL|JS|0ll stable gliding p0si &lowerteeth CR in position a smooth with bilateral contact aiy eccentric to range lu|lciion, devel0ped to lessen limits 0r tipDing within normal 0f mandibular the ilAxlilulltlUl{BER rolation denture in relation thesuDD0rtins 0f bases t0 structures. (CEllTRlCECCEIITRIC IEETH lll & P0SITl0ilS) DE l0r C0IIIACT ALt EXCURSIoIIS Contacts Balanced ina occlusion: STABILITY. P0sleriorleeth (lvllCP) l0cclusion. Cuso-t0-Jossa incentric contact occlusion inanideal Class During lateralexcursions,opposing 0nthe cusps c0ntact W0RK|N0 SIDE. (lingual side, liflgual cusps incli During lateral excursi0ns, balancing maxillary 0nthe (lingual inclines). c0nlacl ndadibular cusps [acial occurs a denture balancetheworking has 0n side, Balanced occlusi0n when c0mplete w0rking and protrusion. assumes denture been side, in This the has constructed in prcper BAUttlCt0 IllE 0CCtUSl0ll C0i{PLETE lS FoR DEIITURES. and VDo. BIIATERAI (some Balanced Articulation ofthese, notall,are it control 5 Factors G0vern Estahlishing bY dentist), the guidance iscompletely which dictated PATIE bythe l. Inclination condylar 0lthe guidance (horizontalertic loverla ). p 2. Inclination incisal o{the and a v plane of 3. lnclination occlusal {plane orientation). ofthe 4. Convexities compensating 0fthe curve. and of 5. Angle height cusps. ("Ut{lLATERAl, CED BAIA GR0UP CTI()N FU oCCtUSlol{") Arr TErfi 0rl woRxlllc [0llIACT 0URlllc WoRlflllc tl0vtilEilT. v{0rking contacts oNtY side SIDE posteri0rteeth non-working conbcts. and n0 side anterior and . Attposteriorteeth side 00a c0ntact eve[ly the movest0wardside as jaw that D0ll0T onthe w0rling side). Nlteeth then0n-workingside contact. teeth 0n 0nly contact duringlateral a ercursion. . llon-worfting (balancing) interlerences: oninner occur inclines FACIAL 0l cusps mandibular molars. . Working (n0n-balancing) interferences: inner occur aspects LlllGUAL 0f cusps side maxillarv molars. . Protrusiye between inclines FACIAL 0l 0l cusDs lnterlereoces-occur DlSTAL p0sterior and p0ste teeth MESlAL inclines FAClAL 0f maodibular 0. 0l cusps path relationt0 registerthe is condylar a Purp0semakingrecord protrusive 0f a 0l patient's p ofthe s0 equalthe cordylar adiusttie condylarguides aniculatorthey

66

veriical theusual causes Cl"lCKll{G 0f ceintherest Excessive dimension s remount fabricate complete and a new denture). m0ld reline. space the rlms/occl!sal adequate speaking betweenocclusal in t0 supporting tissues. [Etl0TH thefaceis theocclusal t0n il{]TES Vl)l) evaluated 4 methods is using 0ffacial l. CLoSED A vertical VD() result trauma unde. position themandible is mosily The Rest 0f postura isthe stretch rellex asthebasis themandible's position tonic cited for usuai position.teeth lf touch d!ringspeaking. V00 theusuai ofcontacling/clicking rE bf sa SJ [3. due underexlension. nning end and poirt0f most ("FREEWAY DISTAI{CE SPACE") vertical the dislancesoace 0r created 0CCtUSAt posit lnclsal occluding mandible itsphysiologic 0nbetweef and isin rest sLdaces the rims. central bearing are denture when teeth. makingCR a record. position "rnuscle-guided" and the This is a 0n is ce"and averages mandibular movements.observaiionwhen"s"soundisenunclatedaccuratelyandrepeatedlyt0ensure plane. to0verextension. adversely tissues strain elevator/closifg and freeway causing 0f inter0ccLusal l0ss rnter0cclusal (decreased space) clearance position. muscles.llF I|CCLUSIt]N TICAI DIMENSIl1I{ t: loc e{ point rims.5mm. when are l. asindicated PIP discl0sing also clicking. visual observati0n betweenocclusal atrest. (V00) may VERIICAt DlMENSl0l{ result trauma underlying from t0 ESSIVE (defture pporting patient). vD0 too position). b/tdots face 0n a[d with 3. occlusal and complete patient. To treat. 0verall 0fspace the rims 2.Phonetics esthetics rims) if in and help substitute material a satient's vertical dimensi0n 0foccluslon.due il t0 b0rder and mandibular reduce with and wax. lllCRtASE freeway the space max andmandibular or occlirsron EVEI llary teeth than 1. lack t00th This of contactlhe"freeway is space" "inter0cclusal 0r cular posit 2-6mm.treat.Increased resin Porcelainteeth causedenture T0 use can is cause 0fposteriofteetha patient when speaks. evaluating appearance support. ngofthe muscles. tstablish VD0 the BEF0RI c0niact during swallowing. the is the 0f vertical and contact. DETURE (t0 IEEIIi treat of & Clicking dentures als0he caused lack0f retention the maxillary of can by ll dentures. N0T but during speech. acrylc teeth. D0tl0I G0TACL is in rest TEETH themandible it'sphysiol0gic {p0stural muscles i0l0gc position when mandibe all0f itssupp0rting (8 rest 0ccufs the and (ihere posture is ln resting cles mastication 0f + suprahyoids & infrahyoids) thelr are equllibiufl).t €u a|| flis 67 . (postural posltion)determined bymusculature. measurment 0nthe (placed thetip0fn0se chin a Thompson and ihe are stick) thejaws atfest when r ms incontact. rest The posjtion "muscle-guided" isa rellex theelevat0r 0f (Vl)0) measured 0F0CCtUSl0ll thevedica ofthefaceas ersth TlCAtDlMEtlSI0ll when 0r een arbitrary tow selected (one and bel0w m0uth) iheteeth the 00ints above 0ne (0cclusal are contact CR. theriandible in CR. Teeth is great.lying may patients wear c0nplete is likely 0f in who a denture sion themost cause IHElLl)SlS medjca a n0n-contributory hist0ry.

belly digast lateral anteri0r 0f & omohyoid. (TMl) a combi0ed &gliding Ginglymoarft0di j0int TEMP0R0MAiIDIBUIAR . their pr0file). the (VD0) VIR= Veftcal Dimensi0n 0f l)cclusi0n + Inter0cclusalllistance. mandible fibers retract lf the fractu UPWARD displacenent fractured 0fthe segment becaused elevator would bythe mu (masseter. Intheupper (mandibular (translati compartment l0ssa-disc) sliding only movemeds pterygoid When lateral muscles car 0ccur. a physi0l0gically individual. Inthel0wer (c0ndyle-disc) (rotary c0mpartment. medial &temporalis). 68 . 0lthe (VDR) thevertical VERTICAL DIMEt{Sl()ll REST 0F lensth theface 0f measured points twoarbitrary (1 point above 1 below mouth) themandible the & the when is in positi0n. move c0ndyles l0ni/ard overthe slide d0wn articuJar eminence orcan (retrusi0n)during and together 0pening closing mouth.dges influence stability. Example: withn0teeth pe0ple 0rwho worn have dentures a longtimepresent for with p0rtion theface (p00r lower 0f scrunched0rd0notshow lipsanymore up. (speech Phonetics sounds). Apure hinging only hinge . franework's and design relationship teeth 0fthe t0the r. Factors c0nsider verifying when V00: t0 . l{uscles Acting theTru: on . the contact simultane0usly. Ginglymus loid)that "rotation" arihr0dial "freely and flreans movable". pterygoid. decreases inter-occl (freeway distance space). UNLESS[a the prosthesisopposed a conplele is by denture. a thediscs (protrusion). Protrusi0n (individually. the rest . (facial Esthetics harm0ny facial and expression are considered). Balanced 0cclusi0n pa.l0ll{T hinge permits hinge rotati0n gliding (sliding) both like and m0vements. Depress0r (0pen) ilxscles mandible/m0uth: pterygoid.tial in denturesnecessaryappliance is Centric for stability. .a hinge-lype m0tion) only can This rotaiional terminal 0r hinge-axis opening themandiblepossible when 0f is 0nly mandibleretrudedCR aconscious by patient by dentist's is in wjth etfort the or ttre m0vement is possible intheterminal positi0n. medial & temp0ralis fibers)P0steri0r 0i iemD0ralis themandible. veriical The relation RPDS usua for is determined remaining teeth by the natural {unlike complete dentures). is alwaysvertical ln healthy there a space between (freeway when mandible therest position. als0 RPD Bilateral Eccentric llcclusi0n tl0Tanobjective RPD is in construction. pterygoid. Lengththelipinrelationiheteeth. lateral together lateral cau pteryg0ids mainly positioning lateral exclrsi0n). DECREASEo V00 ofien results CHEE( in BlTlilG. Lateral are responsible for a the translating condyles. T0 rnake dentures increase This new and V00. Pre-extraciionrecords (freeway t0which patient Am0unt interocclusal of distance space) the wrs previously accustomed. 0fihe respectively. to 0f Conditionamount and 0fshrinkage ridges. . positionimportant teeth space) the isin This is complete fabricati0n denturc because it prcvides a guidet0 VDo.NOTES DECREASED VERTICAL lllilEl{Sl0tl vertical fl00) an occludins dimension IXCESSIVE DISTAilGE lllTER-|lCCLUSAI (increased lreeway space) themandible when is physiological position. . correcl. pterygoids pierygoids l{uscles. . Elevator (Close) (a l{uscles mandihle: masseter.

$rsTIs t?'. is i0 uniformiywhile recordbeing soft the is made.lalposed 0rsuper-erupted can teeth cause discrcpafcy a beiween & C0. int0 from rest lvandible cannot forced CR be tlre position because patient's the reflex neuromuscular would theapplied Raiher. 0n articulator a previous can veril the 0runtii years. positl0n This position rclative between anatomic all an0ptimum components. when Rapid setting zinc & and plaslic ideal. is a REPEATABLE and positionmount 0ntheadiculator rence t0 casts positi0n mandibular is retruded CR themostundrained.ecord anundistorted in c0nditi0n untilthe have accurately casis been mounted record be ed. occlusion isestablished t0coincide the with CR for a REtATl0 record when fabricatingRP0: aryRequirementsmaking CEI{TRIC a Record corrcct the horizontal 0fthemandible maxilla. thejawmuscles. thecase a distal 0f extension base RPD. oftheteeth WhenCR a recordtaken imprjnts should confined be pedorated. llyrigid not but brittle set. plates and Ginga ZoE rims should placed theframework. il. anatomic lunctional and 0fthe glenoid condyle inthemandihular lossae theTMJS. have erialssedtorec0rdjawrela 0nships varied u t widely 0verthe Anidearecording ium easy hafdle. The presence 0rabsence and 0focclusi0fn0t ofteeth type are factors. sott Avoid waxes a rec0rding are as material because never they procedure. is CR a "ligament-guided" CR thecl0sing is end-poinltheretruded 0l border (terminal-hinge movement novement). relation t0the Stabilize lower the rec0rd with base equalized pressure. rigid are t0 during castmounting the come and likely distort naturaposterior occlusion them ndibular cast m y be mounted C0 exists.position ICREtATl0l{ C0IITACT T"RETRUDEl) P0SlTl()tl')a "ligament-guided" position is thesupero-anterior 0l thecondyle thearticular along eminencethe 0l dylewiththe adicular interposed disc hetweenthe and condyle eminence.s0opposing CR not when teeth sh0!Jd contact naking CR a record mount to diagnostic becausethe casts contact causes mandlble the t0defleci move fr0m 0r away CR. t0CUPS and registration should be TIPS the material n0t p0silion. and into relaxed gently place patient CR. the should guided CR. t!rning tongue the upward tOwards the palate. be h fixed removable and CR sh0uldestablished t0designing PRIoR the ltamewofts. d setting. Tra$verse Horizontal (Terminal Position) one AIis Hinge the rclation thecondyles 0f t0 ihe fossaewhichpure in a hinging movenent ble. mandible be defense resist force. a a in I sufficieft wax In relnforced bite. prosthodontics. is a "bone{o-bone" heads 0f CR jaws) (bones relationship 0f thelpper lower and independent 0l t00th contact. thepatient be 0n and closed sottened into acclusi0n paste wax Whether record beinC00f this will lccording 0r zincoxide-eugenol (preferred)posteriof dependsthecase. rap and plaster oxide eugenol pastes. Incomplete denture thepositl0f 0ftheplanned 0fthe lVlC teeth centric in = patient's(C0 CR). resl u? r tl| Ttrc I is inthe naturaldentition. isposs prosthodontics. thepatient To a in have swallow. isdictatedthepresence on and by 0rabsence natura ofany CR inthe @clusion oatieni- rtC lat\ p )an! cur Ina u0l [on) anc ards erior lres icles itric ause and 69 . rela( orprotruding retruding mafdible beeffective and the can wavs helo to record CR. veftical Retain the.

1.lorward. and used (arg!lation) thecondylar The incline 0f element thearticulaioranatomicallv 0n is rela (c0ndylar t0the sl0pethe 0f condylar articular eminences inclination). (intenuspal position).il()TES (MICP) a "t00th-guided" CEIITRIC 0CCtUSl(ltl position defined the maxi as "empty intercuspation teeth.done 11 properly. by . incisal the the adlculator be pr0trus sh0uldraised ofcontact the out wtth incisaJguideThe table. T00th conlacts longer are during peo swall0wing chewing. guidance protrusive When adjusting condylar the guide for pin relati0nship. m0isten oralstructutes. The guidance inclination 0lcondylar depends 0n:shape 0fthe contour & slze bony of (fossae disc). UTTERAI ill)VEMtilTS. 3. to limiting etfects thelrgaments. braced lheinter-cuspal in . bythe 4 Dentition Features Directly that Efiect llealth Hard PDL & lissue Anchorage lo 0cclusalForce. Tll4J afd action themuscles of attached themandible. Rlsht left & TIVUS . n moves and and working condyles d0wn. 00ti occlusi0n requires minimum adaptation patient. occlusal isat right table anglesihet00th's axls. is the mechan hy tt rcovemelt device or aricJlal0r on intended similat to produ. move and path The inati0n ihecondylar during protrusive inc 0f tr'tovement anavefage lorms a plane. protrusive with the condylaf inclinat inflLences tlre mesial inclines mand cusps. laterally. mandibular cr0wns inclired molar are 15-20'towafd linsual. c is the height beobviously Jftheinclinati0nshallow. thts than but varies among ART|CULATl0l{ relationshipteeih oJ during movements andaway the into from posrtion. CotlDYtAR GUII)AiICE factor a T0TALLY dictated thepatient. cusp . 0cclusal surfaces teeth theneur0nuscular The ol and system. . cusp beshoder may l0nger is the will Th guidance affects selection lactor theM0SI is important 0l condylar aspect that the posteri0r with teeth appr0priate height. hourly 0l non-masti of and the The rate swallowing isrelated amount0l t0the salivaryfiow isusually involuntary activ and an refler . it results minimum 0ntheteeth rcquires in stress and min! perf0rming etf0rtbythe neuromuscular when system mandibular movemerts. themeth0d fof registration. 0eterminants ol 0cclusion: .t harmony theJIIIJ neuromuscu teeth with and system. the 70 . thew0rking c0ndy]e down. rec0rd pr0bably TEAST is the reproducible maxillomandihular rec0rd. 0f the During typical mouth swallowing" mandible the position. Condylar guidance completely is dictated thepatieni cann0t varied by and be "adiusted"thedent'st. Masseter muscles contract thet0ngue touches r00l0l themolth and tip lhe duri normalswallowins. ante0rteeth slight n0 have 0r contact inMlCP 2. o1the bular RETRUSIVE Tre0uires c0ndylesmove M|)VEME the t0 BACXWARD & UPWARD. to long 4.p in arliculalor th BUidances pr0duced c0ndyle dudng paths are bythe rnandibular movements. Incomplete path dentures. path When restoing entite the mouth cr0wns.lorward. the while teeth contact.medially. . occlusal is< 60% the tahle of 0verallLwidth the F 0f t00th. of-30' with h0rizontal ihe relerence lf theprotrusive inclinaiionsteep. condyle duingfree the l'tandibular m0vements isg0verned mai (articular and muscular bythe SHAPE fossa meniscus 0fthe and disc) the inltuence. concepts0cclu ol arrangenent t0 place aim artificial i. Empty nouthswallowing frequently theday is animportant rid occurs during and t0 mouth saiiva.

ofthe plane p0int Anterl0r 0ftheOcclusal s determined position anterl0r by the 0fthe teeth. 2. lack contact thenon-workjng the 0l 0n side those from destructlve. 0flaieral inthe shift 3. (protrusion). r P steri0 detern inants arcanatomica 0 landmarks theheights theretrom0lar 0f Thus. changecanine ijy0u a occlusi0n i0 gr0up you function. protrusive case ALL in Inany the condylar (disial inclinati0nhave primary will its iffluencethesame 0n incljnes 0l maxillary & mesialol mandibular). occur placingcrown a maxillary pr0tected When a 0n canine. Canines 0ISCLIJDE the iorteeth during wOrking non-working and m0vements. path rcstorative involvlng teeth themouth. side" side" on which the m0ves irterferencesdepending side mandible towards. ifclination cusp. Ina protrusive c0ndylar movement lnterferencesoccur can between 0ISTAL posterior and posterior of cusps I{ESlAt inclines mandibular inclines maxillary 0f cusps. profrusrve During movemeni. ll{Ctll{ATl0ll e nade ang bythe sl0pesof acuspwith a perpendicular line bisecting measured mesiodistally 0rbuccolingually.0eterminants Re0uired ll€0retical t0Restore a C0mIlete & Functi0nal 0cclusal Surface a Toothl N{OTES 1. thejawrelationship comm0nly intheACTUAL olrestorations pulp particular is ll0T RED centric 0cclusi0n. surface mandibular faclal inclines mandibular inclines. and saves the holding (i. The istlre 0fthe US: lular rm2 im2 ('CAil uAttY PRoTECTED 0CCtUSt0lt tE GUtDED" 0RGA 0CCtUSt0t{) 0R tC iorteeth orotect Dosterior inall mandibular the teeth excursions. Tooth in most used design isihe . gr0up functi0n teeth theworking evenly 0f on side This distributes occlusal the load. height the The 0f h0rn a ol t00th a ired determinantt0 a complete functional restore and occlusalsurface PtAtlE dn . is relati0nship where vertical Canine Guidancean 0cclusal exists the overlap 0f (separation) posteri0r maillary mandibular & canines causes disclus'on ofAtL teeth moves either All when mandible the t0 side. 0biquely direcied found n0n f0rces in working interferences. represeirts a but themean curvaiure surface. isdebatablet0theextent controlthe it as of may se dentist ererc overthe orientation oftlre occlusalplane. m0n0plane etc. (Forward Interlerence Slide)-corrected bygrinding IVIESIAL INCLINES ary oJ maxil Centric teeth DISTAL and INCLINtS 0fnandibular teeth. the 0fthe (lingual) maxillary and incisors c0ntact guiding will the inclines 0fthe incisors canines. 11 .mandibular the condyles 00WIWARD move & F0RWARD. 1. Ina protrusive movement. side positionthearch. is of teeth. teeth.). n0t lt is reallyplane. cusps mandibrlar cusps marillary fr0rn buccal and centric cusps) excessive wear advantage maintenance 0cclusion. other teeth rot contact they do once move "working or "fof-working from lf there contact other CR. anterior The determinant olocclusion is thehorizontal vertical and overlap rclatiOnship anteri0r 0fthe teeth.increase the chance"n0n-w0 side" for ing interferefces. pathwayfollowed anterl0r during protrusion notbesm00th straight by the teeth may The 0r because olcontact between anteriOrleeth the and s0metimes theposteriorieeth. Cusp ls under dentistt the | (choosing 30'teeth. are there occlusal contacts occufiing themaxillary on distal and mesial Anteriorlv. C0nt0ur articular 0fthe eminence.magindry e reated srrla aralomicallyLle cJanLm CLUSAt to and ically touchesincisal 0fthe the edges incisors tips the and 0f occluding oJ srdaces the riorteeth.e. Amount vertical 0f overlap anterior ol teeth. prevents teeth receiving While. Amount directl0n and working condyle. (2/3 pads).

space. chewing during ridges cusp p.N(lTES overlap &verlical (AI{IERl0R result C()UPtlt{G) 0l h0rizontal GUIDAI{0E At{TERl0R andmandibu maxillary 0f 0pp0sing relati0nship overlapping A teeth. rounded dges n0n-supp0rling 5.. Esih. theinne. ol Suppofting 5 Characteristics n t l00th theinercuspalpositi0 ' opposing in 1. Dh0nelics. space' tittuencing controt. are closer theF-L for has ouier 4.ma 0R CUSPS tl0tl-SUPP0RTltl0 C'GUlDltlG" "SHEARII{G" t00th the overlap opposing wit cusps These lingual + cusps mandibular cusps {facial) to thatserve SHEAR cusp and nafi0wer sharper ridges anl tie contaciins tooth have strokes.tics& arethe factors LllVlT and 0fh0rizontal equivalent isthe . midline cusps Jrom suppoding away ihe they movements.. SUPPllRTII{G with {ie cusp that . guide contact postl 0f cusps) themaxillary 0{ inclines buccal inclines thebucco-occlusal (lingual 0fthe inclines inclines and linguo-0cclusal(buccal 0flingualcusps)mandibu ieeth. their incline a potentialcontact cusps lhan cusp more broader. CUSPS.ss t0 asthey cl0se thesupporting guiding becausF inclines" . in m0ves lateral height.. Centric 0fcontact a supporting makes opposingteeth st0ps-areas ihe with contact cusp) l"t {a 0f MLcups themaxillary m0lar supporting makes 1'tm0lar' (centric 0fthemandibular stop) f0ssae Cusps.the degret.Ihe at I and 0f 0fthe a GUI0ANCEmeasure anount movement theangle which lllclsAL occlusi0n 0f from must Dositi0ncentric and incis0rs mandible move theoverlapping l0wer guidanc thesec0nd eis lncisal incisors with relaLionsnip themaxillary anedge-|o-edge der under.. inter-ridge c0ntrolincisal 0f a deniist\ the pholelics nain .lling arch ridge are tactors eslhetics. have CUSPS) llary . tightly anterior protrudes the teeth the that and incisors canines DISCIUDEposterior when mandible 0l p0s1 morphology lhesurface guidance atfects also Anterior excursion. lncisal 0nihe suidance articulator mechanical verticaloverlaP. supp0rt vertical cusps than 0f center thet00th non-supporting t0 3. contactthe face 0fthe dimensi0n the 2. the greater the oYerlaD. l0nger cusp teeth. and movement is t0 some fa. are cusps opposite and slpp0rting guiding situati0n' cross-bite In a posterior cusps lhe now supporting and are lingual and buccat mandibular cusps maxillary cusps' buccal the lingual mandibular are guiding maxillary and 12 .torin articulator cont.occlusalinclineslpading1olheguidingcuspsare there Thus. the posteriorteeth. cusps these contact CUSPS') 0R CUSPS" "GEI{TRIC CUSPS SUPPoRIltl0 ("STAMP 0riossa cusps a marginalridge These t-Lcenter0n intheircorresponding opposingteeth al posterior arein a norm ir teeth l00d t0 suited CRIISH When more ro'bust hetter and are cusps considered huccal + cusps mandihular lingual maxillary relationship. relali0ns.

Check gr Selectiye Grinding inWorking (non-balancingRelation. The maximum dislribution 0focclusalstfesses relati0n ir centrlc 2. involved may sensitive The teeth be t0t0uch when Inthese an and brushing. cases. take teeth ofcentric IIEVER the out occlusi0n. gdfld 0nly cusp 0nmaxillary tips buccai mandihular (BlJLL) if tiey are & lingual cusps premature incentric. selectlve sh0uld lr cusp contacts upper 0fall lower (and f0ssa marginal 0f prenolars). cusps lf interfe.foMadslide CR becorrected A from can by the inclines 0fmaxillary and teetlr distal ines mandibular inc ol teeth. When centric occlusi0n isestablished. interferencesincentric. serl e aT: t€ri0' D0ta. t{ever these cusps. exist not lateral in exculsiors. lateral. torces occlusi0n be 0f shouldborne much possjble l0ng 0fteeth. 5. When surface sLrface t0 0ccurs. slde grind Primary centric h0lding arethemaxillary cusps lingual cusps. thelossa marginal opposingpremature is 0f ridge the cusp ned. tooth's d. grindinginner Selective of inclinessecofdary h0ding 0f centrc cusps d0ne a ls if (n0n-working)ifterf balancing side erence exists. 73 .e each with other in gr0und preventdecrease rsions. belore nding.ll0T idges and D0 grind upper the lingual 0r grinding fltes:al lower huccal cusps. Selective Grinding Comllete in Denture Fabricati0nCenlric in Relati0fl holding arcthe cusps mandibular Secondarycentdc buccalcusps. as as by the axis coniactflatcusps of it should changed 3. immedrate correction ofocclusion bemade. occlusion the bechecked in p0sitions any centric bef0re adjustment is made. IIEVER 0f buccal and GRltll|A(ltt"ARY Llt{GUAt cusPs (pimary holdlng centric cusps). 0nly n0n-holding are then the cusps t0 a inVDo. usion the tooth after The common m0st c0mplaint cementation frxed atter 0fa bridge sensitivitt0 & cold is hot and indicates a deflectiye 0cclusal c0ntact. grindlng result harm0ri0us fossa ldeally. 1. must lmportant plan changing if you 0n a patienl\ veriical dimension crowns. prolrusive or movements. infer of grind Selective Grinding l{on-W0rking (balancing Relati0n: the inner in Side side) inclines mandibular cusps. rule selective Side side) the Jor grindlng (huccal intederences wOrking movements theruleof BULL during side follows cusp inclines inne. lymarginal and cusp 0f ridges fossa. 0fupperteeth & lingualcusp inclifeslowerteeth). llever adlust tips. when without cusp Thus. purposeselective Ihe 0l is interterences destroying height. (CR). s imporiani whenever lt that a premat!rity isfound. NOlES ThE I IflE Adiustment: 0l 0cclusal lasicPrinciples (CR). be toa "p0int-t0-surlace" (lhe c0ntact cusp 0fthet00th tip 0ccludes theflatsurface with of it'sopposing cusp). brldge partial lrequently 0r is constructed ideal tothe 01 occ and 0pposing rsadjusted inserti0n.thesecusps Grind only is ifthere a balancing interfererce. using it is criticalm0unt casts the hinge (face t0 the 0n true axls b0w). grind Acomm0n where is preferableto case it selectively AFIERflxed a bridge RPD in 0r is place when FPD RPD t0beconstructeda space which opposing is a 0r is for 0ver the tooth plane has extruded The slightly.CTIVIGRltloltlG thereduction occlusal of interlences ustally done BEF0RE patient PREVET{I ctinga fixed hridge denture a 0r for to duplicating deflective the grindingto remove in lusal c0nlactsthefinal restoration.

l!'lMltLARY ANltRIoteeth setFACIALt0the fofphonetics esthetics. cups should paralleltheposterior 0ftheincisive tips be t0 border I. placed theocclusal following lines ihe 0n rims. extracted a teeth close of teeth. I\4ANDIBUI-AR teeth placed thecrest theresidual lVMl PoSTERIoR are 0ver 0f ridge. Incisalenbrasureprogressively from centraiincis0r. with axis (middle thelace). become LARGTRthe lateral. mandibular lnyounger maxillary incisors more are while incis0rs a more visible age. though 0n side even the are similarsize. themouth iherati0 1. relaiives. and paiients. are the the the .0 0. PHI NUMBER SUM THE NUMBERS lSTHE 0t M0 PRECEEDING ll The tl. you Incisal paaients embrasures in younger hec0me smal point disappearing teeth sometimes t0the 0f asthe vvear. t0themidlile 0l Frpendicular . There should slight be iregularitieseithe. in P0STERIoR functi0nal are cusps placed thefossae mandibularteeth. ofthemidline.6l8t) EACH progressively asyou proceed theback 0{the front teeth sh0uld become smaller toward in of t0 t0 = Pro[ortion.IANDlB ANTIRIOR are base themaxillarv 0n anteriorteeth. in shape. prominent.6 1. lmm same CURVEDwith incisal 0flateral . diagn0stic radiographs. teeth set 14 . casts. Rlles Setting for Teeth: .6 Golden inclined theLINGUAL. Long 0fposteriorteeth axis are toward Long 0fmaxillary cr0wns axis incisor CoNVERGE slightlytoward themidline. with patients: pre-edraction Guides selecting for artificial denture foredentul0us teeth rec0rd photographs. . R are ridge and Canin papilla. alignment. Incisal central incis0rs cusp 0f canines 0nthe and edges maxillary 0f tips lie tlNE the edges incis0rs abovethe line.t{0TEs DEl{TURE SELECTIllN TEEIH SMIIE (ltlClSAL tlllE CURVE) c0mposed incisal oi maxillary 0nthe edges anteriors a parallels inner the curvaiurethelower Parallel theinteFpipillary 0f lip. Interproximal 0fthemaxillary progressively contacts anteri0r are teeth situated closer gingiva more distalthey from midline. .locanin (themore posterior g0).canben 0f and farther the than tacial vestibule.

during bolus f00d 0n. and line most the surface central sh0uld -8mm ofthe inclsor be Datients. BL ihe width narrowedreiation themssifgnaturalt0oth. Drolile should should wth Convex faces a similarconvex abialsurface0f anteriorteeth. B-l-width. form is identified. paiient's logicaluse least to the compllcated that lsthe approachfulfi needs.0ccluso-gingivallength. to the outline0fanteli0rteeth harmonize theJacef0rm. als0 VDO affects lipsupport. smiling compositl0n. reducing B Lwidth the increases space. Broaderc0ntact areas 0fteeih more look ural dentufes they more 0n as are c0mpatible aglng. Shade: shade is selectedharm0ntze theanterior oosteriortooth o1 usuallv t0 wtth teeth. t ls Thus. and r changes be can judiciouslytocreate used a natural appearance. ilaterials: bonds t0 resin. t0ngue 4. lrpping. 6. plastic well acryllc Thus.{sTEs ST important l0r esthetics. have accufate adaptation border andadequate 0f themaxillary 0f the seal bulk facial for esthetics.labial anterior tothe papilla. placement themidline.role0l AilTERI0R 0na denture ESTHETICS. M-B width. lab0incisal of maxillary 0ftheincisive The l/3 central incisors should support lower when teeth rnocclusion. anterior denture should placed teeth be ANIERI0R ridge. lip the are needs llcTl0tlAt overshadow needs selectins esthelic when Pl]STtRl{lR TEETH. is in t0 Reducing thearea theocclusal decreases transleredthedenture 0f table stress to suDDod area penetfat Als0.l\40STimp0rtantfactort0determineposteri0rt00thlengthis ayailable inter-arch s0ace. plastic are teeth retained better porcelain Primary than teeth. reason using for PUSTIC ina denturebecause teeth is plastic areretained inacrylic teeth well resin. p00r most contributet0 denture that often esthetics isplacing maxillary anleriorteeth ctlyover edentulous Maxillary the ridge. extraction records extremely are valuable. ifg anteri0r t00far lingually facially satisf] teeth or t0 esthetic c0ncerns NoT sh0uld be When selecting pre teeih. pport. Settins maxillarv aid anteriff dibular teeth they s0 contact CR in prodrces unsatisfactory an arrangement 0f icialteeth com0lete l0r dentures. with best esthetics. lt isimportant ridge Also. rotation. TEETH is Spaces. nge g00d the |||axillary central incisors the are l. total[4D the space available poster]0r is determined fof teeth bymeasuring from disial the the 0f lower t0the canine p0int the whete mandibular ridge res dual beginsslope to upward.00 not mandihular over ascending 0f themandibleocclusaJ inthe m0lars the area as forces d slodge mandlbular the derture. Maxillary and bular anterior should contact centric teeth l{0T in relation. primarily theamount useful 0l P0STERIoR for a RPtis determined TEETH hy 0l 0rt00th space characterislics denture-supporting Other and 0flhe tissues. Settirg 0rteeth anter directly overthe causes esthetics. ne ef tR ne \R 75 . maxillary anteriorteeth complete ina dent!re arranged are FACIALT0 THE p00r 8E. factors posterl0r teeth ude: evant selecting t0 RPD inc l. llcclusalsurface n0superioft00th 0rarrangement lormr 5. teeth Their c0ntrols speaking ip I ne.

Sfproduced bymaxillary mand incisors {CH. 76 "S"Sound: mandibular edges be with ncisal shouldeven 0rjust lingualthe maxillaryteeih inc saledges. . edges saying Incisal 0lmandjbular are antel0r lingual when edges incisorsimm afd t0maxillary edges making soun0 "S" incisal when SIBIAilTS J. . tjpEiting causedreduced by rnuscletone large and/ora anteriorriz nal0verla (overbiie). whenthetip0ftheirtongueappr0achestheanteriofpalat Formed and ljngual surfacesmaxillary These 0f teeth. byRESET 0f Treat CANINES & pREI!10LARS. Inadequate Treat relining VD0. Establishing plane an the occlusal by arbitraryon face. 2. Failure t0make poift caninesturning 0fihe the arch. bring and cl0se "S"sounds thespeech are sounds hringthe that mandible closeso themaxilla. Tongue Eiting-caused poster byhaving 0rteeih t00farlingually. between and occluding resi the Incisal of mandib!lar arc edges incisors established byOcclusal with contact maxillary incisors bytheirposltion behlfd and lmrn and llingual) 1mm bel0w maxillary the incisal "S". L0wer 0fa patient's appeaF short there aDlarent 0fthe 1/3 lace too afd s loss vermilion border thelips. lfapatient complalrs he/shet when est0makean"s"sound. by dent!resthe at corrccted CR VDo.the effective as i0the 0lthe Note: most ti totestlorphonetics thetime thewax is at 0f (usually try-in thetrialdenture of the 4rhappointment). Posterior setedge-to-edge. Seiting mandibuiarpremolars t0the first buccal cantfes. a new . Faulty palatal c0nlours correctedtrialand are by errOr wax increase Add to contou and remOvet0improve wax airiculati0n 0fs0unds.ruSTFS C0mm0n Made Arranging Errors When Denture Teeth: .th probable m0st causes either maxillary is the incisors set farpalatally. sounds usualproduced 0f and alrnost These y are positi0n. Not rotating 0rteeth anter erough give adequately to an narrower effect. Generalized difliculty complete speech with dentures is!suaycausedfaulty by p0sition tooth and/or palatal faulty contours. . PHl)ENETICS Palients years edentulous many tor often have more distorled s0eech 0atients thafl edentulous short due a loss tonus thetongue fora time t0 0t 0f musculalure. and labricate dent!re.itsoundslike. line the . palate are i00 0rthe is rnade thicktoo W0rds thesihilant (hissing with sound sounds) pr0nounced ywith ifclsal are corrcc the edgesmaxillary mandibular touching. sounds themandible maxilla logether. Biling corners themouth. Speech problems tolaulty position avoidedplacing denture due t00th are by the asclose p0ssible position naturalt€eth. . Potential Problems llew with Dentures: 1. and bular appr0xinating each othet Palate tongue ing and control valve.. Yertical dimension Errors occlusion checked accurately REII|0U Gthedentures the in are most by Tl on articulat0r remount and inteFocclusal using casts new records.th". Cheek iscaused Biting byl . rernount. . Seitlng mandibular anteriorteeth forward the too far t0meet maxiliaryteeth. byreducing teeth Treat BUCCAL 0fmandibutar CUSPS proper molarscreate t0 horizontal overlap. . procedure 0f The indicatedcorrect sit!ation increasinq t0 ihis is 0cclusal (VD0). set 4. h0 0 t ! 3. .

tfort joinvneur0muscular & prevents migrati0n. (POSTERI0R PAIAIAL)Droduced tonsue 1(" & "G" VETAR S0UllDS tll{GUAL when posterior palate. freshly dentin.0cclusalfuncti0n. 7. nd ilke lf theteeth set FAR s "d". provjde cosmeUc ls0r it must a good tesult. affect seal llps blilduppressure. bone N4argins be p0lished. should well An pr0visional y res!lt a oVERHANG from prclormed 0rresin can metal mprope contoured.thetemporary'sabijlrytofuncti0nocclusallyaidsinpatjentcor.prevent i00th and imbalance. cause it can thermaL irritati0n acute and nflammation. nds afJectedanteri0r are by. Pulpal restoration be must fabrlcated a naterial prevent from t0 conductifg temperature extremes. loss. VEUTR palatal 0ra constricted can paiate cause vault high whisiling sounds. A patient thef ike who pron0uncifgletter due "t" ts complete dentures is having difliculty trouble the to positioningthemarillary 0f incisors. l\4ade tip 0l longLe hing. shell !Ir lua EI |at€ ls2.lf teeth notsetcorrectly. 0f incorrcct and VDo. 0. PARTIAT DENTURES FIXED (PR|)VISI()IIAT) REST(lRATIl)IIS IEMPl)RARY MUST PRl)VIDI: protection: l. a CllsT0ltl while PRoVISI0NAL horizontal can cause overhang if improperly trimmed. teeth this fulade by t0ngue max b/t and ibular (1/8 (3mm) 0fiofgue teeth inch tlp sh0uldvisible be NNTFC " & "V"LABl0DEl{TAL lormedincisal ofthemaxillary S0lJllDS by edses incison afd lip(incisaledges jusit0uch wevdry ofthe lip).FII & PR|)TECISTHT CR(IWIIS BECAUSE BETIIR PUIP (as when is placed because p0ly(methyl-methacrylate). gifgival 5. B P& posteri0r positionteeth. 4. Positional stability: tooth the sh0uld extrudedrift lITERPR0XIilAt not 0r s0 C|)NiACTS IHIS.lade pressure the by behind are it can this 0f t0 lps. ll0n-lmpinging ilargins:isVERY it impodant the that temporary's margins d0 gingival t0prevent not impinge 0n the tissues inflam{ration cause that can gingival hypertrophy. 'P" & "8" [ABlAt t0ially l\. 'T" & "0" (Al{lERl0R "t" tlNGUAlPAIATAL S0UtlDS) lfteeth set FAR are t00 LINGUAL. "d"sounds "t". Easily cleaned:temp0rary bemade a materardcont0!r the the musi 0l al that patjent xeep can ctean. (overbite). custonl Can make provisionalsovef using imperssions. Esthetics: tem ifthe porary ananteriortooth. (outside rnouth the tAB)F|)R CUST(]I{ INDInECT iECHlll0UE the in MAI(l{c P0RARY TE ISPRETFERED ITISIII()REACCURATT. should the line lower to 6d S0Ull0Sare formed bythelips.protrude (2-4mm) S0UllD t0ngue sh0uld 'IH" tlNGU0DEllIAL slightly between maxillary putting mandibular anteriof t0 form sound. recession. ora thin crown. set-up ches T00th 0l)ES0I AFFECT S0UNDS.hpaniFrio' by lou. area ient vertical 0verlap ercessive [oriz0ntal 0verlap 0rthe is atalt0 incisorsimpr0perly the contoured. labial llange ickness. should adapted en0ughprevent lvargjns be well t0 saliva leakage. Slrength & retention: temporary withstand forcesissubjected must the it towithout breaking orcoming off. in a direct on cut pulpal technique). PR||VIDE 3. lvhistling durirg (complete ihatreplaces incsors) becaused either h withdentures 0rRPD the can by (overjet). are too LABIAL. ced lary rsal lua ach 11 . templates. 2.

by two vertical . Palladium-Silver oble)' alloys oncasting).e. G0tD = max. isthe This BESTUSE. oftooth inclination each 0n opposing axialwall). lium. RESISTAIICE. (boxes grooves .5-3. AIL-CERAMIC = 2mm pleprations. Greaier ihegreater retention and surface 0fa preparation. purp0sea buccai lingual & path isIN4PRoVE RETEilTI0N. . Chrom Nickel-Chromium-Bery Chr0mium. Retention. Tooth (as prepafation is kept a minimum rctenlion taper taper to toenhance retentlof decreases. RETE prevents removal0f tesioration thepath irsertion lofg the along of or ll0lI axis lhe of preparation. palladium lrace These alloys d.5mm cusps. Crown1.5mm fon-functional. elemefts metal licon. .0" F0R is preparation taFer more 3-6'. than walls a crown in should no PRtPARATl0ll PR0VIDEResistance t0 PIACED THE lN CR0WN GUlDll{G GR00VES groove the liAlN 0f 0r rotaiion. (i. feature mpoirant metal This is ina substrate d0not 0n nterface byadding trace so oxidatr0n metalp0rcelain iscontrolled that atthe (s T0 ndium. increases). iridlrm). 0n Crowns clearance provdes BEVEIspace adequate of netalandprevents for bulk Awide FUNCTI0 CUSP A! perforatl0r metal t0hea!ry due occlusal cortact. mafd).ffnTr5 cR0wl{s preparati0na c0mplete for crown: Principles 0fto0th form: L RelentiolResistance & .5-2mm . High Noble all0ys: t0fabricate used (with gold. PtM = nonJLnciionalcusps. for lmm clearance functi0nal (lingual buccal cusps Crown1. area increase area. tuial IDEAI TAPER ACR0W 5-6"(2. platinum. sudace . Cobalt Nickel um. noble (g0 platinu palladium) 0xidize casting. DISLoDGEIVIENT prevenis by directed apical 0ftherestorationf0rces que prevents rnoveflent rcstoration occlusal any 0fthe under 0robl and (vedjcal)foices. 2. G0ld ( palladium 50-60% + 30-40% (n0t noble silver a 2. ltickel-Chromium (Base all0ys): all0ys p0rcelain-to-metal interlace readily and create hase metalalloys oxidlze can problems. 0fthe PFM Coping Alloys: (PFVls) of metal-ceramic restoraiions c0nsist98 1. Platinum-Palladiumr Gold-Palladium Pallad Silver. 78 . t0the . CR0W ina slngle preparation crowJl impodant features provide t0 adequate ol bulk CI-EARAIICE 0f the mOst is one |)CC[USA[ meialand strength. Achieved 0pposlng surfaces buccal & lingual walls). Structuraldurability 3_ arginalintegrity Preservation structure. metal. forseating crowr. & elements). oxldizes th!s metal 70-80% + 15% nickel chrcmium. lvlaximum path is when is retenti0rachieved there 0flyone 0fdraw . . . 3. lunctional 1-1. Gold um. PINS length and INCREASI RETENTI0N by increasing internallyapically (not externally).

of thethinwax. Unlike PF[4 the restorati0n accepts marginal lbevel.lllain reason lorcelaif crowns allceramic isESTHETICS. a J0llllis lacket provides required. l0ir Base (can asthin 0. . rnarglnal preparationtheAt[-ceramic orporcelain tooth for crown crown BE SH0ULIER.Features: Coping 1. lacial margin design (ideal lmm). minimalt00th and with gingivalfinish Preferred tine forveneer restorations. shoulder). to!se crowns inthe anteri0r where csiscritical. Combinesadvantage easily the ol an delinahle margin the 0n preparation. Sh0ulder resistance t0 0cclusall0rcesminimizes and !0rcelain stresses. These cr0wfs flrimic 0ptical can the 0fa tooth. relat tendency Their ve t0 fracture a minimum at deformation. Extens 0ftheareas be 0n to veneered porcelain l0r 4 . Radial Shoulder ed 0fa shoulder ona lceramic that a modif form used cr0wns combinesmum max s!ppOdthe 0l ceramic.7mm is MARGIIIS. Shoulder (Butt argin lointffinishing 0fchoice ALtCERAMIC line l0r crowns Edge {porcelain crown).ereproduced margin. 2. All-Ceramic margin gn s I TERIIAILY Crown des R0Ull0ED SH0Ut0tR. load under iead propagati0n eventua lailure. must a higher strengih metal be yield as and have and meltrrg temperature). Microscolic surlace detects. may t0 pattern.5mn Nob e ihickness). Piacement olocclusal proximal and contacts. ir praciice difficultread the it is l0 0n impression and ead inaccurate and die. a s0has IEAST lt the MAREIIIAI STREII0TH casting. can used cr0\{rs n0t as Abevel beadded metal can for restorat ors. . The joint resultant casting sufficient has l/vh marginal sircngth e allowing sliding at its the perlphery t0minimizegap the between the tooth preparati0n. regi0n esthet . the guidelines preparaii0n critica more forusage. fiUST A iacket . subsequent asa fesuit ertension dislortionthewax and ol and casting. 0f SHoUtDER (butt |||ARolil iojflt) theP00REST tine is finish used with metal cast restorations. metal(0. Bevel lllargin-the linishing best {Feather-Edge) margin CAST G0LD for FUIL restorations allowing burnishing adaptati0fthe tothe and 0l gold tooth. acute tothe An edge/angle a nearby 0fmeta the0ptim!m with bulk is margin a casting for because it iseasilv burnlshed to mDr0ve ft.largin{he PREFERRTD tlt{E casl FltllSflltlc for lullgold restorations.3-0. t0 crack and llyl0 ru&TE5 7g . The is read and Main disadvantage is any inaccuracies crown a. 3. . H0wevef. Thickness 0fmetaland ngporcelain.2mm. . 0LUTE UM Mlll|l P0RCELAlil THICI0IESS is 0. margin easily 0ntheimpression die. All-ceramic are crowns known fortheir FIEXURAI.0TH inability L(lW STRE (th's t0 llexisthemai0r weakness 0fall-ceramic cr0wns). impression die. and reducing thus the cement thickness. a stfess wiih reducing rounded g ngioaxialangle. ast00th such are more and compl than PFIII cated fOr restorat lt isadvisable allceramtc 0nlV ons. sirengthporcelaln tlrus BUn of is low. t0use and iacket crOwns properties naiural However. crown Chamfer l\. which afy design chamier. melal 3. Heavy Chanfer be 0nallceramic (but asg00d a shoulder). inlhe lit atthe causing increased lhicknesscement.

asa matrix thehighits lt acts for a glassy material. 0cclusal and and is facialfinish 0f PFIV line restorations gingival !|ihere estheticsnotcritical. case. supragingival however. a skeleton theothef for materialslusearound. t the a constant perf0rmed tofinal pteparation.displaymetal seen. aslhelinish 0ntheproxiFal Useo bor meta. labial (subgingival). beused little 0f is Can for inthegingival crevice (PflV)!1. a & metallic l)Et{TAt proper t0theporcelain. & prcservati0n structure. lncisal notch: structural durability. 3. oft00th 5. margins often pOssible t0 esthetics are not due Il a mud be caries. used of and Als0 forthe inlays 0nlays.. PRoFltE theaxialc0ntourlhat flom base thesulcus. Chamfer: marginal integrity perl0dontal retention resistancestructural and and durability. oxides to impart used shade which porcelaintranslucency. 4. and 2. Dental Porcelain's compressive strengthGRTATERil'stensile shear is than 0r porcelain plastic ol delormation. The common iscreating most eror a bulge excessive 0r convexity. because itlacililates PR{|FltE)IHE G(]ALWHE (to0thbrush can inlo oRAL HYGIEilE bristles reach lhesulcrs). STRAIGIIT ACCESS A tlllE PR0flLE ihe gingival 0f theaxial ACCESS G F0R lS T)( REST0RI GIEEIH. (main P()RCEl"Alll mifilre0l FEIDSPAR c0nstituent). extendsthetooth's lt t0 (EI{ERGEII in 1/3 surface. heallhier crown when marsins AB0VE Gll{GIVAI are TllE Periodontium remains (SUPRAGIilGIVAL).h liFe mplalc0llars. margin preparati0n thet00th concern il|]l f0 EXTElll) h the into subgingivally. Wing: retention resistance. Sh0ulderwith a Bevelthis allowssliding t0occur themargin. lf these are crowns. PFM. axiareduction. to fusing which forms refractory then strengths. restorationsBRITTTEarenotcapablemuch are and MEIAMERISMphenomenon causes a that teeth/p0rcelain t0 appear matched c0lor (appears very under an0ther source light under lightsource. margin lfthe extends intothe biologic wi atlachment apparatus hiologic gingjval 0ccurs ultimatelythe will Inthis irritant and crown fail. proximal 0finlays occlusal box and sh0ulderthemandibular 0f may used the be 0n (metal mafgins plac 0r margins PFIV 0l cr0wns ceramic).NtlTES margin a lit at thus 4. the margins be placed so must subgingivally. feldspar When undergoes itfoms fusion. FEATURES Al{iERl0R 0t THE periodontal preservati0n and structural durabillUL Radial shoulder: preservaiion. appear different one but in the diflerent lights). and Pl]RCELAIl{ SELECTI()N SHADE qUARTZ. propertylmp0dant matching shade a PFIV This is 01 differenl under crowna naturalt00tht0 80 .malor lhe (invade width). . th extends the of EMERGEIICE Dast height coniour produce of t0 a STRAICHT Ll frcegingival margin. cerdmic shoulder0nlays %crowns. gives quartz. PRIoR crown sh0uld crown have lengthening TENGTHENING done surgically theALVE0LAR 3mm may be t0 move CREST apical CR0WN periodon pr0p0sed line{margin) ensure hiologic width prevent and lhe finish to pathology.

convenient contoufs hyg and esthetlc. p0rcelains-used p0rcelain crowns. rugTES ONTIC DESIGN & lrtt - ro64 . Hue-the colols families) red. (intensity c0lod. c0mfort. ircrease & YELLoW inRE0 3. Aluminum agent oxide p0rcelains rtsmanufacture added l0w t0 fusing during toincrease resislance its t0 "slunping down" during firing.l) p0rcelains-used 3. ye0w. basic like blue.most c0lor's The critical characteristic ismatched that lirsl. but ir & place ruhber 0nbefore ll0T the dan selecting shade. Pontic should touch 0nly AfiACllE0 KEnATltllZED t0 prevent Gll{GIVA ulcers. esthetics. be juncti0n past Pontic should extend themucogingival t0 prevent tip not ulceration. sodium d!oxide. Staining a porcelain rcstoratr0n a c0mplementary reduce orusing color will the value. Value-a brightness. 0fcleaning. tissue is factor lai 0f p0ntic Area contact 0f between & ridge should small thepart be and touching ridge the shouldCoNVEX. Drastic changes 0f (color shade) often hue or are impossible. Iight sources inthedental used olfice: 1. Low-lusing f0rmetal-ceramic cr0wns. and distal. stain m0st 0range is often t0 change used thehue. Ghroma. single important inshade 0fthe The mOst factor matching is that successiully by increased stains. Incandescent but lacks blue. gingival pontic lvlesial. is almost lt impossible t0 increase value. the A old compared 25year patient most t0have with c0l0r is lower t0a old is likely teeth a that invalue higherchroma. and in 2. High-tusing used DENTIJRE TEETI. (PFi. be Propef is more design important t0cleanaband tissue than ch0ice ity good health s 0f matefla s. 3. Fluorescent-decrcase increaseBLUEGREEN. oxide.! I E0l a ceramic crown matched based thecolols is first 0n value. ilediumJusing forall-ceramic and lackel ph0sphate llledium porcelains fusing also contain oflithium. fOr ene.d ha E'I PfI llTlC-the suspended rnembera fixed 0f brldge replaces that a missing thatIIUST t00th depatieni comfort. 2. in red. 0l c0l0r idicates degree color's 0r Aspect that the 0l SATURATI0 hue. !sing (c0l0r green.value a dentufe dependsiherelative the 0f t0oth on whiteness 0rblackness 0fitsc0l0r. Natural 2. !m and Oxide). the ease and mairtenance patient by the 0fhealthvtissuesedentul0us on the ridse. 8l . and (inadditiOn t0silicone alumlnum potass oxide. hue. are therct0 and drft pontic Success 0rlailure a hridge 0l depends 0nthe m0stly design isdiciated which by patiert functi0n. oxides magnesium. placed P0ntics inthenon-appearancezone restorefunctionprevent fg. lingual embrasure of the should open easy for be cleangaccess. TYoesDental of Porcelains: porcelains t0 manufacture l. Chroma-a strengthsaturation.60-year patient. should clean Teeth the be and ake-up removed thepatient' from sface. then 1. Excessive contacta major inthe ure FPDS. Valuetherelative is amountlightness 0f 0rdarkness color ina oi a In esthetics.

a broad. t0theridge slightly be iacial crest. Added inthe decredses lorhe slress conrecl0 diminished s wilh burk connectors inthe centerwith g0ld less used. RIDGE it theappearance it is giving with FLAT that 0F isa concem. of . . Pontic contact theridge with should compact. P0 TIC CH0lCt a BR0AD. an E)(TRACiI0t{ SIIE P0llllC 82 . P0NTIC CH0ICE ATHlllMAllolBUuR ina non-appearance RIoGE zone. with 0verlaps facial lingual the and aspectstheridge. Formslarge a C0IICAVE C0ilTACT lheridge. . inall . D0ES C0NTACT RIDGE. wider atthe lVl-D {acial. . debris results.E {RIl)GE PI)IITIC IAP}. P0ntic choice ihe"APPERAilCE formaxillarymandibular FPDS. HAS C0llvEx SURFACES FOR CLEAlllllG EASY & PREVEIII ll{PACTl0ll. Floss passes smooth surfaces easily it does surfaces round more than {lat w over snarp angres. UtlCtEAtlUilCtEAl{ABLE TISSUE S0D0 & & GAUSTS lllFtAMMAT|0ll ll0TUSE! p0[Trc (sAil|TARY 'FtsH Pl)Ttc): BELLY" ltyctErc . 1'r 0F ltl . P0ntic a concave has archway and ll4-D c0nvex underside (HYPERB0LIC F-L PARABOLOID). 0cclusogingival must at IEAST with thickness be 3mm adequate under space it lor cleaning. gives illusion heing the 0l a a lap ridge but .IPP|)IITIG: RID6E . 0F F0R . SADOI. . . . Restores occlusal function stabilizes and adjacent opposing and teeth (prevenis drifting). F000 Att . ljses ridge forminimal contact. P(lIITIC: . Ridge (CR[ST) linguallythanmidline 0fthe contact cannot extend farther the ridge. C0ntact thetissue (t not ihe line with sh0uld falljustal0ng gingivofacial angle nospace between thecresi. 0f in Z0 E" & .TES I.angular flat it large embrasure that spaces collect OVATE PI}IITIC: . "Arc-Fixed 0enture" Pontic)anesthetic (Perel = modification 0fthe Partial (occlusal p0ntic visible 0f with hygienic thaiveneers parts thep0ntic porcelain pontic's half lacialsurface isallolthis which surface 0cclusal ofthe and facialsurface).When used f00d. lt is bluntiy (round-ended that into ridge design lits a depression) where rounded ridge concavity. exiendini0 s0cket % the contacts tissue isset a the and into Can atter extracti0n. it and a trap sh0uld be .lncreased lorcleanin access deflection pontic's COIIIGAI. P0llTlG Cll0lCE All0il-APPERAIICE(replaces Z0tlE mandibularmolars). R0UNDED & CLEANABLE tip is small butthe relative its 0verall t0 size. MODIFIEO I. GRoWNG THE FRoIV RIDGE. CoNVEX areas L & M D) easy (F for cleaning. where Used esthetics Drimary . NOT THE IDENIUL0US .ilt. ridge creates tr. edentulous . narr0wer lingual and atthe aspect.

I'ISSIIIG MAXITT. a . s) a |ed ing 9reii €t PIER ABUTMENTS Atraditional SoLDERED bridge NoT rigid 5 unit is desirable because physi0l0gical 0f t00th 0f and capacitytheretainers.ARY CENTRAL ISNTVERABUTI!]ENT IATERAT. 3. . at lt0TEs tcATt0 s: IIIUST A VERY HAVE STRONG ABUT]IITNT & IIIINIIIAL NO OR OCCLUSAL ON THE CONTACT PONIIC. theretentive arch need STRESS-BREAKER. C0NNECT0R a NoN RIGID to prevent "PIER the ABUTI!4ENT" from asa FULCRU[] orLEVER.TITEVER BRIDGES VER BRIDGE abutments0NLY ENo a oontic has at 0NE and attached the0iherend. BOTJ1 PREIIIOLARSBE NIUST ABUTI!]ENTS PONTIC RESEIV]BLE & THE IIIUST A (not PREIV0LAR molar) decreaselength thelever and a t0 the 0f arn mririmize stress pfemolar on the abutments. should inc0ntactcentric be: in occlusion. Apier abutment n0trequire d connector(i. by the . Be non-porous. contact slde andshould bein contact ronworking NoT ir side movements. actlng PIER ABUTMENI freesta ingabutment ed lous nd with entu spaces each on sidethat requires a NoN RIGIDC0NNECT0R. m0vement. Be narrowertheexpense llngual at 0fthe aspecttheridge. 0cclusion beinthe[40SI (1"' must DISTAL 0F P0NTIC prenro b/c F0SSATHE ar) sn0tter evet .r if full a€ 0n and molar abutmentsP0ntic replace lvl0lltR avold l'r can to UNILATERAL PREVENT RPD 0R SUPRA-ERUPTIoN. tiltss c MAD|BUITRPRtM|)tARl 1. .e. Pontic replacemissing can MAXIIIARY a IAIERAI. 2"d prem0lar 1" molar theabutmenis must lullcovefage and are and have cruwns 0n Inem. T() USE SRIDGE: I SITUATIOI{S CAIITITEVIR 1. . . Be0nasstraight lineaspossible a between retarners the t0 prevent torquing any 0f retainers orabutments. FPD. Pontic replace can l{lsslliG M0LARavoid ld to UllltAltRAt 0RPREVEI{I RPD SUPRA-EIUPTI().you of S0. 83 . . smooth. INCISOR AN INA preparedtheDISTAL central CANTILEVER UNLESS seai BRIDGE a rest is 0n 0fthe {inlay 0rmetallic AND rest) l\4ES|AL P0NTICPREVTNT 0F THE T0 R0TAI|0N. Pontic rcplaceFIRST can a PREI{0LllR cr0wns used the2'dprem0lar 1. does a rig s0lderj0int) is way to the and 0f which thePREFERREDconnect abutments pontlc a bridge. lvlake passive pinp0int c0ntact thegingiva wlth tissue. theCANINE bethe but l\4lJST abutment. positi0nabutments. l{0thec0ncayetwo in directi0ns. 2. ldeal the m0lar fullcoveragethe when l" needs and canine isvirgin full and (cosmetic isf0t coverage desirable concern).r . ormay ben may n0t Ina posterior a pontic ln working movements. wilh polished surface. 0f . Be readily cleanable patient.

Pre0arati0ns additional RESISTANCE well demand deiects soft . s t I t 3 0 I u FPD) BRIDGE MARYLAND (RESII{-BllI{DED that metal retainers prosthesis) solid (etched-material wiih restoration A c0nseryative The for its REIEilTll) 0f in innet relies theetched surface theenamel theretainers 0n F0RM give RESISTAIICE grooves increase space t0the . OF TORQUING M-D T(PIER)t0 tt MlIl ABUTiIE 0 THE DtE !s . tro0ves a resin-bonded(Maryland Provide l0r 0ncrowns RETENTIoN can pr0vide The B-L bvpreventingrotation. th I!. gro0ves als0 a I T I T I I 84 . OB()IIE. NON. inthe cannot Nl-D . USED Il)RASHI)RI-SPAII REPIACIIIG ABUTIIIENTS ai FORCES DISPI. I|) . Requires MESIAL anabutment & DISTAL edentul0us pulps are (uselul children large who at with in preparati0n inenamel . IIIINIIMIZES ABUTI!4ENTS. DO USE HAVE NOT IFABUTMENTS COIIIIECT()NS. IRAIISFTRS STRTSS SHTAR ltl SUPPONTI }Il)T IHE INDEPENDENTLY k THEI!] IIIOVE BUT ALLOWS TO . mesial during unseat would side' placed themesial thekey 0n were lfthe solidlv. keyway movements.NI]TES (abutment) &p0ntic 0fa mechanicalunionretainer hroken C0I{NECI0R-a stress ill) -RlGlD R TI)OTH' |)IIT (lIITY BRIDGE . SllE on is . Both inclinaiion difference be> 15'wiihn0diflerence abut$ents F-1. inclination abutment's grooves vialong' defined . Stress-brcaking ina fiveuniiFPD PIACE0 device H tPD toRCE T0THE SEGI!'IENTWHERE oNtY THE bv and a lever fulcrum ISoLATING eliminate ITISPI-ACED. path SHAPED The 0f inseii0n thekeyint0thekewayis patalleli0 Pathway wit[ is not 0ltheretainerthat involved thekeyway.IOBILITY SIGNIFICANT .ACING ON NEUIRALIZE . mosi 0lSTAt . is key The c0mmon design aTP0llTlC. KEY placed thet{tslAt 0FTllE 0n is the 0l KEY. Can noderate with rcsorotion n0gross tissue be . Abutment are left teeth basical!y intact Fl)R RISISTAilCE mainly Bridge) FPD . o0VEIAIL of the KEYWAY connectorplaced the0lSTAt 0l thepierabutmenl t0 when TILT 98% (middle because 0Jposteriorteeth IVESIALLY subjected abutrnenit00th) more the into movemseats key thekeyway forces. Requires a shall0w riskforex!osure). mesialtooth ent vertical occlusal Thus.RIGID DECREAST CONNECTORS OR R THE ABUTI\4ENI ON PIER AFULCRUIV BY ETIMINATING EFFECT (PERIODONTALLY COIlIPROMISED).

Should encompass 180'(guide atleast surfaces/planes interproxinalard0nt0the extend facial achieve t0 a faclal lingual Want extefd faraspossible lock). N{lTES ra db tll ic tl4 Features: Pre0atation . margins minimal preparati0r. moderate of overbite. oisadvantages ol lilaryland Bridges: I . (10% Rellace GTE P0STERI0R T00T{ higher 0ffailuremore I p0ntic). Grooves increase RESISIAIICE T0DISPI"ACEMEIIT 0llAtlTERl0R PREPARATI0IIS. t0 as t0 provide maxrmum area bonding. 85 . Can replace i{ childs molars masticatory are well muscles not devel0ped. . .patients DEEP 0vERlAP). proxinal.e. icaries Replace MAXII|ARY ltlClS0RS if patient anopen end has bite. (mandat0ry). N0 (lf porcelaln beadded iill space correcti0nlVl-D isverywide. .5mm clearance is neededvery teeth 0n few for lormaxillary incisors). IRREVERSIBLE longevity and uncertain . rebonding sLpragingival t00th and ispossible if the wings not are bentorsprung. occlusal preparedabutments is needed (. s0much width 0nly can t0 the embrasure space) . & incisal areas).0pposing exists RPD resultsless which in occlusalstress. (vERTlCAt C0tlTRAlllDlCATl0llS with VERTICAI 0vERBlTt . Al)VAIITAGESMARYtAll0 0F SRIDGESreduced cosi. sEt{srTrvmf. SI risk if than Not Jor > 3 units used FPDS unless mitigatingtx-plan a consideration (i. . ofiEilstvE &l cKEt cARtts.n0 anesthesia requlred. surface for . used a PER|0D0tllAt (but as SPLlllT abutment m0bilitv cause can fallurc).PRAGIilGIVAL thelength throughout t0 minimize deleterious t0the effects peri0donti!m. Difficulttemporize makeprovision (cannot a to FPD). M0BruTy. Light (1mm) chamler linish is placed line SI. to-end.nI lr !E tcATt0ils: RISI0RATI0N 0FCH0ICEreplace missing t0 l-2 luAil0lBUIAR lilclS0RS abutments when are unblemished free). N0 (cann0t aLignment due not alignment c0rrection corrcct 0fteeth t0 restoring lacial. Vertical areplaced allpreparations stops 0n l0r RESISTAIICE & RlGlDmf.

SIIIGIE TOOTH AN ROOT WITH IRREGULAR CONflGURAIION OR CURVATUREAPICAL INITS THiRD IS PREFFERED WTH PERFECT IOAROOT A ]APER. ar0undrnonths. if isimpossible. than Any greate. llon-Rigid Fu Conneclor. 86 . 3 (a%rotated the 2. ex preparati0n a box placed thedistal the 4. configuration. premolar. Telescoping and cr0wn coping. r00t Crown-to ratio al0ne NoT is adequate forevaluating criieda a abutmef orosoective t tooth. s f facial/ll. TIS ab 1:listhe IMUM MI acceptable abutmeft formalc !fder rcumstances. PRoXIMAL !sed orth0dortics %crown.t ISTHE ABUTMETIT. helps minate defects the and e bony al0ng root's nesial Takes surface. greaterthan AI{TE'S the IAW combined abutmeftteeth root surface must equal0r area be ihe edentL space c space). R(ll)T THE C()I{FIGURATI{IT{ WIDEST DIIIIEIISIl)II BEST WITH F. a lateralNOTg00d while is a ch0icea secondary t0a can as abltnent ne. a proxima axis an nner and coping the fits and fits the Al0ws coverage c0mpensat the full whe ng l0r discrepafcy the betweenpaths 0f insertion abutmenis. TO ROOTS ARE BIVERGTIIT ARE Rl)OTS BETTER ABUTMEIITS TUSED/CI}IICIAT THAII ROl}TS. is C0ntraindicated ifthere is a severe marginal height ridge discrepafcy the betweendista 0lthe2dm0larand mesial3'd 0f molar t0the dLe tiping preparation theiipped 3. (secondary Secondary Retention abutments double abutment)to overc()me uffavofable crown:root and spans. I crown with in ol (ke!r. odhodontics h the 0FCH0ICE a mesially tilted abutment.cr0wn over copifg. canine a g00d A is secondary abutment a lrst vs.periodontalsurface and area. f a post-core amalgam on premolar 0rD0 ex sts ihe abutmert. R()OTS ARE THAT BR|)AI)ERTHAN DARE FL IV] PREFERRED THAT ROUND. il the 0nlv !sed distal caries-free. Abutment evaluated 3 fact0rs with is fOr nt crown:r00t r0ol ratio. 1sr M0UR THE ABIJT & CAtllNt THE BEST lS BtST EIIT lS 2n0 ABUTI{EIIT BECAUSE THEY HAVI TARGEST SURFACE THE R()()T AREA. prep. secondary ratios long The abltment have east much MUST at as (abutment r00t surface and favorable area as a crownrroot astheprimary ratio abutment neJd theedentulous t0 space).FlsTES BRIDGE ABUTMENTS B IDEAI is VITAI ABUTiIEI{T TEETH ll0 lu0Bltl . FPD distriblte forces. p0 I)PTIMUM CR|)WI{-R(]I)T Fl)R T()()TH BE RATIO A T() USED ATPD AS ABUTME 2:3.full crown A follows molars l0 tia y. FPD oLs Any replacing morcthan teeth highsk./ay) uselLr thern0lar marked prem0lar Ii40st when lras lingual mesial and ljsed inclination. a ratio 2:3is more Th]s a thus 0f realistic fac A l:1 ratio theminimum is acceptable fora pr0spective under ratio abutment norma circumstances.rgual rest0rati0ns tilted e*rensive on the molar sts. two is {pont TIITED M0LAR ABUTMEI{TS urit bridge notseat thedistaabutment will if . ngprov the 0fthe The c0p des marginal adaptation. long abutmenis converge must n0more 25-30'. Indicated . mesial req!ires tilt either: (uprighting) TREATIVIEIT to better position 1. 90's0 dista sudace is!ncovered). PT Cr0wn-t0-r001 l:2 is thell)EAL ratio: cr0wn{0-r00t 0f anabirlment Jor rati0 t00th a y bridge ABUTI4ENl high ratios fare achieved.A3 iftrldes mes 0f the ineof draw98% posteri0r TILT ally) 0f teeth I4ESIALLY subiected when ltilts t0 occlusal The axsofFPD forces.

BRIDGES
(solder the C0I{I{ECII)R joints) PREFERREDconrect abutments RIGID !1/ay to the and (FPD). cornector pontica bridge A rigid 0f distributes load evenly a pier occlusal more than (n0n-rigid abrtment c0nnecior), is PREFFEnED TEETH thus F0R WITH DECREASEI) (PtRt0D0ltTAttY CASIS). ATTACHT{! PERr0D0r{TAr T [{V0wED that a Fixed 0esign, tactors Determine gridgework peri0d0ntal 1. R00t c0nfigurati0n: important assessing when anabutments suitability. preferred round cross-section. R00ts broader than Dare FL ltl t0r00ts in . lviulti-rooted posteriorteethwide with separated provide periodontal r00ts better support r00ts c0nverge, 0rare than that fuse, conical. . Single-rootedwith ifiegular teeth an configuration curvature Toot's 0rs0me inthe perfect apical are 1/3 better abutments teeth a nearly than with tapel . R00t surface ona !rosDectrve arca abutment also evaluated. sh0uld be 2. Cr0wn-t0-r00t l:2 isthe rati0: idealcr0wn-t0-r00t0fa tooth beused a ratio t0 as bridge ABUTMENI a ratio rarely This high is achieved, rati0 ismore but a ol2:3 realistic.l:l ratio theminimum A is acceplable fora prospective ratio abutment. Cr0wn root alone NoT t0 fati0 is adequate toevaluate a prospectlve abutment tooth. parallelismabutment is BEST prep 3. tuialalignmenl teelh, 0l of determined L0NG bythe MJS iheorcDarations. of 4 . tenglh Lever (Span). 0l Arm REPI-ACING lSTHE 3 TEETH lllAllMllll,l! absolute The llAxlilUil number p0sterior that besalely 0f teeth can replaced a lixed with bridge isTHREE, 0nly and under condltions. bridge ideal Any replacing than teeth more iwo ishigh risk. . Anedentulous involving space 4 adjacent other l0urincisofsusually teeth than is best treated a RPo. more 0ne with lf than edentul0us exists the soace in same arch. even thouglr 0fthem each could individually with bridge,may be restored a lt be desirable t0restore with RPD, ihem a if the especially spaces bilatera each ate and space involves 0rmore two missing teeth. . 3dm0lars rarely used abutments they display can he as since often ncomplete eruption, short-lused and marked inclination absence 2"d r00ts, a mesial inthe 0fa molar.!sea 3'd T0 m0lar, it must c0mpletely peri0dontally longbe erupted, sound, separated (multirooted), display ornomesial roots and must little inclinaiion. . Asinple bridge replaces teeth, a complex replaces more 1-2 while bridge 2 0r teeth. . Edentul0us involving more areas 4 or missing (except teeth 4 inclsors), be sh0Lld restored anRPD. wiih Fixed Bridge Contraindications: . P00f hygiene, caries high rate,0r multiple inthe 0rteeth 0ral spaces arch likelyt0lost be inthe future. near . Space detrimental maintenance stabilitydental not t0the 0farch 0r health. . Unacceptable 0rbruxism. occlusi0n . Afteriorfixed isc0ntraindicated when bridge conslderable residualridge exists. resorpti0n Use RPD. an

N{1TES

87

t{0IES

that small retracti0n passes method anacceptable 0fgingivaliissue ETECTR0SURGERY (sc0rch). usually gingivalt issues,causing cellst0 desiccate 0f c currentsele t ricityi hr0ughthe g00d but clot ofthe of because lack proper formation, isvery delayed healing in resulis some electrode in current anelectrosurgical is Too low hemorrhage. 0f anelecirical at stopping drag. by tissue detected margins' access . Electrosurgery hemostasis' t0 cav0surface coagulation, 0biectives, ol a thin sulcus wall kem0ving layer crevicular theinner 0l thegingival andreduce gingivaltissue). lndications, or into gingival wherehas . Remove it proliferatedpreparations hyperplasiic tissue margins. ovef crown gingivapresent is attached .ln place gingival substantial c0rd retraction where 0f crown . Crown-lengthening pri0rt0 pr0cedures fabricating a prcvisional gingiva,underlying dehiscence because 0r ofthinattached areas Contraindications: PACEiIAKEnS' CARDIAC after gingival areas electrosurgery. occur recession inthese (t120), ltl|)vlilG' d0 AGtllTS KttPTHtEIECTR0DE and Ftll{l{ABtE |l'tETAL lllSIRUEllTS, t00th, bone. 0r a n0tt0uchmetalrest, t0 seri0us damage thePIlt and due i0 during electrosurgery potenlial care Great is used of in h0ne, surrounding resultingl0ss attachment. WAVEFl)RI{S. EI.ECTROSURGENY peaks rapidly. diminishes Causes recurring 0l powerthat Dampened: 1. lJnreclified, hem0stasis healing, g00d but slow, and dehydrati0nnecrosis, painful G00d half occurs damping inthe2'd 0fthecycle 0amlened, Rectified, 2. Partially healingdeepertissu in greatertissue with destructi0n slow heat lateral penetraiion, coagulation. Good hemostasis. and Good fl0w continuous 0fenergy. cutting some Rectified: 3. Fully tissue cutting ofenergy Excellent withless flow continuous Rectilied Filtered: {. Fully healing. injury grcater and

(I!(]WELS) & GI)RES POSIS
Postscores: &
core up orcomposiie build isindicated. anamalgam isdestroyed, clinicalcrown lf 50% 0fthe cores, they than mjcr0leakageamalgam and alenotas c0res greater Comp0site have stable. dimensionally (wiih 0ranother pins and retentive feature) notiust t0the Acore beanch0red t00th must placedfillthe void. to Placing a post anteiorteeth posts a Not allendodonticallvtreated requlre and fullcrown. it. tooth weakens ina conservativelytreated (atleast with occlusalcoverage anonlay) RESTRoATIoN must a Posteriorteeth have CAST RPDS for extemion as sh0uld serve abutments distal ll0T treated Endodontically teeth RCI teeth). (4x greaterlailure than rate non-abutment n0t They than fail Pulpless abutments 2xmore vitalabutments should beabutrnents FPD l Pontic. longerthan with span a (antir0talion place to or GRl)oVEprevent cast-p0st-c0re, a KEYIVAY Fora custom (pot butNoT PINS. holes, channels), Anti-rotaii0nalleatures slots, deyice). rotational l\4ust diametertheCEJ. bea minimum at must Post's diameter notbe> 1/3theroot's and atthemid-r00t beyond iooth structurc 0flmm lhickness 0rrem0ved. l4flust sh0dened Allcuspslhinnerthanbe provide for A retention a core They roots Posts not d0 strengthen it'sa myth! simply premature oftheroot post failure poorly fitted willcause 0r designed

88

(retain core). function Post t0 PR0V|DtPIATFoRM THE 0f is A Fl}R CR0Wil Primary the (esthetic bondable).post becoming pass6. material bemeial Posi can 0rfiber and Cast is . Carb0n &Glass Posts:flexible, and Fiher absorbs disslpates acting f0rces againstthet00th. . Ceramic are rigid, pr0vide flexure. P0sls: morc s0 more Resistancet0 remaining radicular tooth structure. . Post Shaoes: . Tapered: requires LEAST usually the internal dentinal structure corresponds and tothe shape rema root. ofthe ining . Parallel: beiust conservative within minimum diameter can as if selected the canal .2'dStage, both have parallel tapered and sections. WIDIH should P0ST involve mnimum the amountdeniin of removal,provide but sone (non-contact)0!tef passive pedpheryofthe inner space. post engagemefi 0fthe and canal tEl{GTl| nocleatformula fordetermintheidealdepth post PoST exists ng ofthe prcparation. LENGTH be4 5mm theapex. post beAT from Post musi The must LEASTlong theclinical as as post (whichever The should equalthe c.0wn length 2/3ther00llength crown. 0r isgreater). perchaattheapicalend0lihecanal. llere must atleast ofgutta be 4mm P0SIDESIGI{ active passive. because has vs. Just a posi ihead does nean is fg, not it diameter preparation postdiameter 0fthe drilland aciive.The determine postisactive. ilthe Post Color: . ldeal lsthat DENIIN c restOrations). (ceram coi0r of . Translucent, t0bemasked dentrn-colored may need with core material. . Carbon-fiber are posts black used a PFM crown a comp opaque and with 0r with etely
su0sItucIUte.

t{{]TES

(apica])to EFFECT preparation (finish [,luST at beyond the margin line) extend fERRUtE thecore intoS0UND and T00TH STRUCTURE. is the1.5-2nm0r s0ol sound Feffule r00t apical that of structure to thecore themargins thecrown should engage PR0TECT t0 post-retained R00T AGAIIIST FRACTURE. A ferrule makes full-coverage restorati0ns more and strengthensto0th resist significantly retentive dramatically the t0 fracture. lt holdingtogether themetal surnunds circunference t00th, the 0fthe it like bands around ihe head a wooden of mallet. . Preparation post sh0uld preserve tooth lora c0re s0id structu.e. margin Ihe should be APICAL dowel-c0re t0 enable crown girdle t00th hrace margin l0 the the t0 the and it erternally. . lf thetooth flush thegingiva, is with fabricating a post-core crown thout rcling and w efc the tooth struciurethecrown can by walls cause FRACTIJRE. R00T

8g

0n tooth orteeth less with lavorable configurations. 0l using & . Prlmary reason choosing cr0yvn a full cast for a 94 ovel crown T00TH is STRUCTIJRE h ISSPARED. Post core made frcm The is and s separate thelifalrcstoration. lmprove contoLr peg-shaped incisors). adaptation olthe and fit restoration isindependent lit 0lthe 0n the . c0re be amalgam Pt|RCELAIl{ VEl{EERS Indications. like (i. can be inthe if with0ut the and .portion the a 0f eflamelun-veneered is & accessible.atleast 0fthe du With 4. be treatedanindependent as . Porcelain Veneer 1. staining. Reduclng incases 0rth0dont inappropriate. discolorationloss after of 2. less 0lthe decrcasifg the chafce periodontal 0f irritation. Post core beused teeth little n0clinical & can for with 0r crown. s! n Af ho ftl h sl sl (3/4 Restorations& 7/8crowns). ll it isever necessary anelectric test t0do 0n tooth. not il s necessary treated is t0 lrlcdn p lf wiln lire makaer00. is candidates forpartia veneer crowns. Nlarginal post.patient tooih and A 0cclusa c0ntacis.thu margin 3. spaces when csare mbricationteeth.t{0T85 ratherihanpost a crown restoring when RCTtreated teeth: Advantages a post core. part completelyngcementation. disturbing post core. insufficient structure enamel. complete 0fa partial crownmore verified seating veneer is easiy by vision. lf theendodontlcally tooth t0serve a bridge as abutment. incisal 3. Agreat dealolthe margin inanarea is accessrblet0the is f0r f inishing and dent i t0 patient cleaning.crown labricated and just cemented ihecore asa restoration over is placed a preparation 0ntooih over d0ne SITUCIUTC- h HY . Restoration replaced flture needed. l\4asking disc0l0red like teeth teiracycline vita tooth ty. prFpardparallel the 0tdraw otherdparations caqal i0n 0t abutment). Coverlng sudace labial delects eramel like hypoplasia. Advantages 0l PartialVeneer $ l. posterior withlessextensive For ieeth adequate length. laieral 4.e. therestoration 0fch0lcea fullPFI\4 crown. t00th 5. witha h gh caries index. a plnreiaifed 0rcompositecan used. P0RCEUtll{ VEIIEER C0l{TRAll{DlCAI|0tls severe 0f traumatic un{avorable morphology. F 2. Repa r structural damage fractured edges. minimal and horizortal arenot overlap Rather. the fof It restorati0n is fcloseproximrytothegingivalcrevice.and root desiruct ofcoronal structure. rJith but r00ts wilh straightness. clinica sh0rt crown. I sll u I h n s0 . Can more be easily seated margin visible. direct pllp (EPT) the 5. bulk.

Seat posterior 0fthe first.then anteior the t0 a ginate being frOm squeezed0fthe out tray backtoward patient's Always the throat. iOlerant. Sol)IUM PHoSPHAIEcomponent inalgfatepowder c0ntrols SETTT a found that the G llME alginate. fragl may unstable. rnbibition theimpresst0f absorb and When occurs. can stock easl and to .25 D0 not the irch) (espec occlusal mlnimumginate remaln allcrilical 0la should 0ver stfttctures ally sudaces). their . N0 custom isrequired. y mixed. . e. ll. cal t0 . Agar impression s afddental rtaterja compounds inv0lve d0nOt a chem reactionset. Shrinkage inalginale occurs imFressions when = eyen placed 100% under relative humidity (0ccurs exudate drcpletstheliqu medium ontheimoression SY|IERESIS when like ol d fOfms (causes sudace). shr Since fkage undesirable d stortion is ofimpessions). lhe seat ol porUonhelp prevent trayfirst. lrreyersible Hydr0c0ll0idsATEfan ]apression elastic materialwith {A[Gl limited dimensional stahility.placethe alg nate lf you impressions 0fwaterl0ra n a bowl few preventthem dryifg before ngthe pour hours tryand t0 ffom up casts. Reversible hydrocoli0ids are composed water. when water . 0f85% 12. alginate impressi0ns stored briefly a m0ist paper can he only in towel. is no t0nger accuTaIe. Advantages. injurious patiertn0t if handled Very limited dimensional stability. 0f potasslum & sodium s! fate. in must be im]]ted finish is cult weak a deep sulcus. tetraborate. blt have we very limited dimefsl0nal hecause are stabillry they composed water. Seat patienlanupright positi0n. impressions a ginate (causes sh0uld beleft in water not expansion) 0r exposed air (causes t0 shrinkage).use tray. Disadvantages: poured ately. Disadvantages. ol Aftertaking impressions. irexpersive. immediate When s possibie. agar. line diff toread. rusTc$ t z s1 . & pleasant tray lvoisture clean with acceDjablaexcAllenI-lile. easy pour. Decrease me take iflpressi0n have patient the t0 t an afd the breathe thr0ugh nose. mixing requlred a hydr0c0lloid Easyt0 n0 is c0nditi0nunit ng lbut isrequired). the impression. Decreasing (affects cous water-t0-powder ralio causes alginatesellaster t0 mix stency as mix much ihe is thicker less lsused).15% traces borax. Techniques preyent t0 help 0AGGlt{G taking while alginate impressions: . lmpressions bepoured should immed t0 ensure pouring not ately accuracy. setting luandibular alginate impressi0n is taken FIRST gagglngmore t0 occur since is likely while posteior portion the taking maxillary the lmpress For fiaxilary 0n. yery 2.IMPRESSI{1N MATERIATS HYDR0C0tt()lDS theadvaniage have ofWETI|t{c tltTRA0RAt SURfACIS. pOtentlally tothe and pruperly. musi and be poured immediately. overseat tray(0. exponsive. rhel ir . of85% (AgaFAgar)-af L Reversihle Hydrocolloid impression wh0se material physicalstate is changed a GEt byapplying and reversed hyremoving lrom S0L HEAT is back heat. affect casi the surlace. . Advantagesi pour. 0d0r. the in .lBlBlTl0l{ 0cc[r can (the impressions water expands). xing algifaie part the tray Nl the rapidly it toset causes more raDidlv. remove alginate impressi0ns quick inone moyement permaflent with snap help a t0 decrease del0rmation. D0t{0T cold use water mix alginate t0 the because it retards alginate's time.

low fast recovery deformation. Easyto easyt0 mix. Thi0kol) base l. When alginate taking impressi0nRPD. poor tear lowest rise. PVS he lv0st can poured to I week impression and stable most after making are in up solutions. Wettability gypsum p00r and Has isp00r. (Addili0nal 2. fr0m and moderatelytear high strength. high strength. seats guide sh0uld cove.?{OT€S When taklng alginate an impression. Elastomersll0ll-A0El)US are ru[ber impression materials good with elasticity. and from seat qualities forcrown EIAST0MERS impression materials eiastic ruhherlike with 0r used & bridge. have polymerizaiion They less shrinkage.RAIE elastic impression materials.isbest apply alginate 0n fora it to s0me directlythe teeth eliminate t0 bubbles saliva therest 0rcoarations. areas buccalto maxil{arytuberositie Critical are planes retr0mylohyoid Rest and space. . fxcellent very permanent dimensi0nalstability l0w and deformation. impressions but can distort fron where undercuts Polysulfidesa l0ng when removed areas deep exist. . . flexibility. Poof strength. acceleratOr is usually dioxide. Polysullides g00d pr0perties. temperaturevery stiffness. . Addition s.n not when mixing siloxanes because sullur inthelatex retards setting addition the 0l silicone materials. t0lerance is . . an18month with and shelf-life. lt4oderate time 4 min). these pastes mixed. lvToisture inthemouih acceptable. .ed alginate he with and and any sofl olher lisrue urdercu15.advised the beplacedthemouth it is that tray in after with the allcritical are areas wiped alginate. p0lymer-based ElastomeE a chemical set via reaction. use steady (asnap not t0 minimize deformation.liconestemperature are sensitive intemperaiure shortef working & setting times). have low They a resistance t0deformati0n. and Up0n gr0ups there anadditionsilane is 0f hydrogen across d0!ble vinyl bonds does and not form by-products. P0lyvinyl 0r Polysiloranes)-one Siloxanes Silic0nesVinyl tube c0ntains silicone terminal H+groups aninert The tube a vinyl with silane and filler other is with vinyL chlor0platinic acid silic0ne terminal gr0ups. catalyst. acceptable and 0dor and taste. it has taste 0d0r. ina very resulting dimensi0nally matedal. gl0ves inhibit sening polyyinylsiloxane. have fl0w high and tear Polysulfides thestrongest have resislance t0tearing. Atrayl0rpolysulfide impressionlacks a rubber that occlusalstopsrcsult may in aninaccurate linalimpressi0n 0fperflranent during because distorti0n polymerizaiion. . which add discomf0rt. tatex gloves polyvinyl should bewo. polymer are lead When two are the chains lengthened linked and cross through thiolgroups a rubber material. secondary impresslons fordentures. Sets 1214minutes longest (the in setting time). PolysulJide polymerizati0n 0fisexothermicaccelerated increase and byan in temperature orhumidiiy. Polysulfides Base. can poured stable PVS be uoto I week. time 45 working (2 moderate time setting (6-8 min). inlays/onlays. Polyvinyl (PVS) the siloxanes are il0ST Wl0EtY & 0ST USED ACCI. oxidized t0form like . (Ruhber ilercaptan. inferric Sulfur and polymerization Some a uminum sulfate reactionuiion also s0 may inhibit 0fPVS. mixing. removing and When elastomeric permanent force is required) impressions.distortion. stedlizins 32 . the c0ntains a liquid p0lysLlfide (mercaptan nixed anlnert The polymer polymer) with filler. latex might the 0f . clean-up. . have working and tjme relatively polymerization may t0patient long time. [4ixing (30 sec). high very wettability (increases bygypsum. filler.

. r€moval cast. taste y stable more one is poured. Tearing 0lMaterial: by causedinadequatem0ist!re buk. All impressi0n C0IITRACT durirg maierials elast0meric SLIGHIIY settlng (they not do expand). Grainy Material causedimproper by 0rprolonged undLre mixing. tlme minutesSetting 6-7 . & less at sets n stable. the Has hrghest temperaiure highest r se and stiflress. movement dLring oftray 5. tray be with material. For results eastomer with c impressi0n material. on 3.To 0ll) reaction. Cust0n are impoltant ofrubber impression part Trays an base techniques since elast0mers m0re are accurateuniform layers are2-4mm With in thin that thick. Comparcd t0hydr0c0lloids. dimensional (when clean. .verysticky. lrregularly Voids. by c earing excess premalure ofthe water inthe left irfpression. impression f0tpoured mmediatey. was inthe removal the 0rtray held m0uth ong t00 (only certain with brands) 93 r! . tlrne 30-45 lt4 xing is sec0nds easily). easily tear tears may to high (dimensionaly inthe water absorpti0n unstable presence 0fm0isiure). gelation. The accelerator cortalnscToss a linking (ar0matic agent sulfolic acid pr0duces poiymer When ester) which cross-linking bycati0nic 2ati0n. rcmova1 the lr0m mouth. contamination. mixed. resistant materials are easierto more t0tearing removal. eaving cast the the in manip! 0f impression orimproper ation stone. elastomeric impfessi0n pTepare. a rubber polymerization process. a cust0m sh0uldfabricated a plastic allelast0mers. rigid/slitf material). . Polyether impressi0n t0lerates fiaterial m0isture than better any other elastomer. adhereteeth. 100 long. and fine margifs break. I't0TES ZltlooXIDE-EUGEtl0L-an paste settingtime impression whose isacceleratsd by ADDltlc 0f t0 retard setting Z0E. low 0rt00 a waiecpowder ratio. prepared sh0uld best the t00th be free surface of m0isture. messy tlssreirfitant. i0 moisture Shaped due 4. gelati0n.(lmpregnum/Premier (Caulk) two 3. ng ls 2-3 minutes. Distorti0n. Advantages: can record softtrssle rest. f0rms a catl0nic by . rubber includes base a polyether with imine silica and plasticizer. are hydr0philic resultssLperior be up and truly which in wettabiliU bygypsum. 0cclusal t0avoid have stops distortion during and coated anadhesive sh0uld completely takjng be with that dry before the impressl0n t0preveft impression from ling the material pL away. during mixing. Advantages.have upon and a mensional stablliiv. suDerd or . rigid. elastic. P0lyethers & Polygel are c0mponent materials. Disadvantages: dilficult themost materialremove thern0uth most t0 from {the (p00r strength). premature 2. ordebristissue. n0t recommended patients. for lmpression Problems: 1. even FAST G.prolonged 0T mixing. inert (olive mineral lhe ol add 0lls 0r a drop water themir. filler. R0ughChalky Castr or Stone causedinadequate ofthempression. SETTI dimensiona il than cast stable if poured afteftaking (very 24hrs af imp|essiOn pernanent l0w deformation) asit can pouredt0I week. hard 5 mlnutes. indisadvantage t0other ma the 0fusing polyether elastomeric impressi0n materials aremuch isthey stitfer. excellent stability dry). may Compared materials. . premature 0rimproper lr0m moLrth. be should permanent polymerization. sets a chemical Zl)E via . pleasant & 0d0r. Disadvantages: to mix. The p0lymer ethylene groups. Polyethers theSHllRTEST & StTTlllc have W0RKIIIG TllylES elastomerlc 0lthe (mixes Work time impressi0n materials. not dilfcultto gagging manipulate. e xpensive polysulf than ides.

used for luting metal Ons as as It rsa high-strcngth base. liquid. especially 0nly where a thirlayer dentin betweencement the of exists the and pulp.N$TES jnterocclusal should a Bite Registration Material t0 make accurate used an record ofler MlillllUM RESISTAiICE patiert's closure haye ft0w at miring. ALWAYS cement b0th rest0ration thetooth. $owns bonded c0rnposite after are with rcsin eiching internal 0fthe the sLrface cr0wn. 0rwhen the preparatiOnraises concerr depth some pulp rcgarding vitality. l0rcrown bridge.000 itshigh isa problem stfength psi). g00d compressive (14.000-16. pr0cess pr0duces and porous This pR00UCT. apply t0 the and l. 'lll i se D wa m rt s4 .ritalion. Als0. operatlve and & and CEMEIITS do . 2. Zinc 0rZ0Elhese bi0l0gically compatible cements used are 0n teeth preparatiOns wrth with adeqLat€ and ength retentive featurcs. have and superiof compaiibility biol0gic than phosDhate zinc cements.Composite Resin-the materialchoicecement llting 0l t0 a cefamic and crown caf provide STR0NGESTCeramic the BoND. p0lycarborylate Zinc and adhere GIC t0calcif denta ed tissue. pH but because two Iayers yarnish beapplied pr0tect putp. polycarboxylate 3. . l: used Type used make ll: t0 (orthod0ntics). shaped less and p0rous Heating gypsuma 30% in solution calcium produces strength 0l (impoved) chloride high die p0r0us strongest es. Pnd!ces least partic the ard Type used maklrg "dies" lV: (reproducti0ns with when stone ojteeth prepafed cavities) used (inlays 0nlays). t0 the afld L0vir Recenfly.lhese cements exhibit better resistance t0s0lubility zinc than phosphate cement. process Th s unif0rm padicles. stone. Type rarely tOday. plastertheIVEAKISI iregularly shaped Dental ls GypSUM Type used preparing 0l an alginate lll: for casts impressi0n which upon dentures are processed. cr0wn At00th must WtpE0 before be DRy cr0wn cementatiOn. odel casts when sirength notimportant is Dental (Type heating gypsum an open Plaster ll) in kettle. is0ne the 0f must t0 the ZpC 0f oldest and widely cements pelmanent restorat and a used a base. Also. DentalStone lll)-producedHEATINC under (Type by GYPSUII4 pressure watervapor with in produces ana0toclave. are and shownbe t0 betterbonding if strength other than materials. Zinc-Phosphate Cement-rnay used cement porcelain lt ltas also be t0 crowns. padicles. law additi0n-reacti0n impression silic0ne materials d0ninated inlerocclusal have the rec0rd (l0R) market these slfce mater have t(lw Fl0W als VERY when mixed bec0me and rigid after setting. t0itslow Due initial it may pulpal cause i. asopposeddrying t00th alcohol warm to dectease t0 the with and aif the possibilitypulp 01 damage.cements NOT increase retention. GYPSUM plasters stonesCalcium [4ain c0nst]tuent 0fdental afd is Sulfate Hemihydrate. cement mixed zinc0xide powder phosphoric lrom and acid pH.

bi0c0mpatibility structure soft and tot00th and tissues. bond As they chemically hard todental tissues release for relatively peri0d and fluoridea long modern applications day 0fGlCs properties i0r0mer glass have expanded. should anapp0iniment have specifically t0 check occlusron crowns bridges. lll V lesions). occlusi0n resl0rati0ns checked The 0l isbest with stwER PtrsTtG sToGK.a s5 . seE- .materials based thereaction These are on 0f glass silicate powder p0lyalkenoic These colored and acid. resin like Prolonged sensitivity t0 heat. pressu.cemeniable allceramic like crowns PR0CERA 0rcemeniable composite restorationGRADIA. For indirect metal-free restoration rec0nmend reinforced that a resin / resir-m0dified glass iof0merlinal for cementation reinforced . inlays 0flays. sH[{ H{)TE$ r dE te rF lt. and cold.ua r|ot j !a tbl rnd aae r tn (8lC)-a 4. DC Ptllsisa resin glass Fuji reinforced i0nomer cement luting designedllnal l0r cementation porcelaif-fused-to-meial 0fmetai. the 0nall and Excursive movements als0 sh0uld be patients (this evaluated. ler f. c0efficient 0f thermal expansi0n. t00th materials were (Darticuiarlv lntroduced foruse restorative in1972 as materialsanteriorteeth l0r for eroded Classand carious areas. lf CR is complain cold 0f sefsitivity pain biting and on down Alipatients hard.li chemically and bonds and mechanicallyt0toothand all structuret0 placement produces typescore 0f material. occlusion high. bridges. cayitiesprinary in teeth. 0tten since c0mplair pain chewing foods indicates 0f 0n soft g0ld impr0per balancing orworking c0ntacts). ltssimple technique significantly higher g ass bond strengihs conventional than i0n0mer cementse maintaining whi the favorable characteristics ionomers-fluoride low ofglass release. and metalfree crowns.e cementing after a cr0wn fired 0r bridge patient is usually related 0CCLUSAI to TRAUMA. Glass lonomer Cement dental restorative used dentistry matedal in for rest0ring and ieeth lutifg cements.des The rable 0f cements them make uselul materials restoration inthe 0fcarious lesions low-stress such sm0othin areas as pr0ximal surface small and anterio. .