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Diagnosis and Treatment Planning in Fixed Partial Dentures
Diagnosis and Treatment Planning in Fixed Partial Dentures
Introduction
esthetics.
examination.
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- Treatment planning: It means developing a course of action that
Chief Complaint:
first. This will reveal problems and conditions of which the patient is
often unaware.
History:
concerning the reasons for seeking treatment, along with any personal
details and past medical and dental experiences that are pertinent. A
Medical History:
conditions.
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previous allergic responses to medication or dental materials
should be recorded.
recorded.
Dental History:
treatment, much time can often be saved if minor tooth movement for
3
A history of pain or clicking in the temporomandibular joints or
treatment begins.
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EXTRAORAL EXAMINATION
palpated.
Temporomandibular joints:
tragic while having the patient open and close his lower jaw.
jaw opening less than 40mm indicates jaw restriction, because the
average opening is greater than 50mm. Any deviation from the midline
is about 12mm).
Muscles of mastication
Lips:
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INTRAORAL EXAMINATION
chartered.
can offer some prognosis for new restorations that will be placed.
should be observed.
DIAGNOSTIC CASTS
occlusal surfaces ensuing from air entrapment during the making of the
impression).
position).
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Advantages of diagnostic casts:
dimension.
5) The true inclination of the abutment teeth will also became evident,
anticipated.
location is possible.
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8) Discrepancies in the occlusal plane become very apparent on the
articulated casts.
10) Teeth that have supraerupted into the opposing edentulous spaces
determined.
11) Diagnostic wax-up can be carried out in situations calling for the
use of pontics which are wider or narrower than the teeth that
Full-mouth Radiographs
that have been collected in listening to the patient, examining the mouth
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- The presence of periapical lesions, as well as the existence
noted.
Vitality Testing
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SELECTION OF AN ARTICULATOR
intercuspation.
opening. The distance between the teeth and the axis of rotation
restored.
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2) A semi-adjustable articulator is an instrument whose larger size
axis of rotation and the teeth. If the casts are mounted with a
articulator can be used for the fabrication of most single units and
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(To set the condylar inclinations on a semiadjustable instrument,
record is removed from an arcon articulator, and the teeth are closed
together, the condylar inclination will remain the same. However, when
accuracy and the ease with which they disassemble to facilitate the
occlusal waxing required for cast restorations. This feature makes this
type of articulator (arcon) more difficult for arranging denture teeth. The
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A) The most accurate way to determine the hinge axis is by the “trial
B) Arbitrary face bows can also used. But they must have an
by it falling within 6mm of the true hinge axis. These face bows
RESTORATIONS
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cast metal or ceramic is indicated over amalgam or composite
resin.
from the oral environment, they may in fact be poor risks for
cemented restorations.
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dependent on the strength of the remaining tooth structure for structural
integrity.
a) Glass ionomer:
abrasion.
iv) Very useful for the restoration of root caries in geriatric and
periodontal patients.
b) Composite resin
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c) Simple amalgam
ii) They are best used when more than half of coronal dentin is
intact.
d) Complex amalgam
e) Metal inlay
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ii) Pre-molars should have one intact marginal ridge to preserve
structural integrity.
f) MOD Inlay:
cusp on a molar.
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b) Full metal crown:
c) Metal-ceramic crown
d) All-ceramic crown
e) Ceramic veneer
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TREATMENT PLANNING FOR REPLACEMENT OF MISSING
TEETH
a) Biomechanical factors.
b) Periodontal factors.
c) Esthetics.
d) Financial factors.
e) Patient’s wishes.
Abutment Evaluation
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through the use of a dowel core, or a pin-retained amalgam
The roots and their supporting tissues should be evaluated for 3 factors:
1. Crown-root ratio.
2. Root configuration.
crest of bone compared with the length of the root embedded in the
bone. As the level of the alveolar bone moves apically, the lever arm of
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that portion out of bone increases and the chance for harmful lateral
force is increased.
teeth.
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2) Root configuration
- Larger teeth have greater surface area and are better able
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- Johnston et al in 1971 in their statement designated as
restorations.
that teeth with severe bone loss and marked mobility can
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Biomechanical Considerations
All fixed partial dentures, long or short spanned bend and flex.
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to produce greater resistance and structural durability.
ratios and long span. There are several criteria that must be
partial denture.
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a fixed partial denture. The best way to offset this torque is
interabutment axis.
canine FPD.
SPECIAL PROBLEMS
can make a rigid 5-unit fixed partial denture as a less than ideal plan
of treatment.
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Standlee and Caputo in 1988 has shown that the prosthesis
discovery.
key that is attached to the pontic and a dove tail key way
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A common problem that occurs is the mandibular second molar
abutment that has tilted mesially into the space formerly occupied by the
molar.
that has been rotated 90°. It can be used only if the distal
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- A telescoping crown and coping can also be used as a
its path of insertion parallel with the long axis. A box form
crown.
interabutment axis. The abutments are the lateral incisor, usually the
weakest in the entire arch and the first premolar, the weakest posterior
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the loss of a canine and any 2 contiguous teeth is better restored with a
D) Cantilever FPDs
end only, with the other end of the pontic remaining unattached. This is
a potentially destructive design with the lever arm created by the pontic.
1st premolar with second premolar and 1st molar as abutment. The
premolar pontic.
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- Cantilever FPDs can also be used to replace molars when
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Conclusion
ability, maintain the health and integrity of the dental arches, in many
Bibliography
1977.
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3) Markley M.R. : Broken-stress principle and design in
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