REVIEW OF DIAGNOSIS
• Case history SINGLE TOOTH RESTORATION
• tmj and occlusal evaluation
• extraoral examination
• diagnostic cast
• full mouth radiograph
SEQUELAE OF TOOTH LOSS
• Resorption of residual alveolar ridges
• Occlusal disharmony
• Tilting of teeth - leaning toward the edentulous
space
• Drifting of teeth - Movement toward the
edentulous space
PROGNOSIS
• The prognosis is an estimation of the likely
course of a disease.
• It is difficult to make,but its importance to
patient understand successful treatment planning
must nevertheless be recognized.
• The prognosis of dental disorders is influenced
by:
o GENERAL FACTORS (age of patient,
lowered resistance of the oral
environment)
o LOCAL FACTORS (Forces applied to
a given tooth, access for oral hygiene
measures).
MOUTH PREPARATION
• Mouth preparation refers to the dental procedure
that needs to be accomplished before fixed
prosthodontics can be properly undertaken.
Examples:
• Completion of Required Surgical Procedures
• Correction of Occlusal Plane Discrepancies
• Correction of Malalignment
• Provision of Support for Periodontally
Weakened
• Re-establishment of Arch Continuity
• Preparation of the abutment teeth
SEQUENCE OF TREATMENT PROCEDURES
1. Relief of symptoms (chief complaint)
2. Removal of etiological factors (eg; excavation of
caries removal of deposits)
3. Repair of damage.
4. Maintenance of dental health.
TREATMENT PLANNING OF A
The selection of the material and design of the
restoration depends on several factors:
• Destruction of the tooth structure
• Esthetics
• Plaque control
• Financial considerations
• Retention
DESTRUCTION OF TOOTH STRUCTURE
• The destruction previously suffered by the tooth
has to be restored, such that the remaining tooth
structure must gain strength and protection from
restoration,
• Cast metal or ceramic is indicated over amalgam
or composite resin.
ESTHETICS
• PARTIAL VENEER restoration can be used to
restore in highly visible area.
• Ceramic in some cases can be used as FULL
VENEER.
• METAL CERAMIC CROWNS
o Single unit anterior
o Posterior crowns
o Fixed partial denture
• ALL CERAMIC CROWNS
o commonly used on anteriors
o posteriors (adequate bulk)
PLAQUE CONTROL
• Motivated to follow a regime of brushing,
flossing and dietary regulation to control or
eliminate the disease process responsible for
destruction of tooth structure.
• If these measures prove to be successful cast
metal, ceramic or metal ceramic restorations can
be fabricated.
FINANCIAL CONSIDERATION
• Selection should not be less than optimum just
because the patient cannot afford.
• Sound alternative to the preferred treatment plan
and not apply pressure.
RETENTION
• FULL VENEER CROWNS; unquestionably
most retentive.
• SINGLE TOOTH RESTORATION: not
nearly important.
• Special concern for:
o Short teeth
o Removable partial
o denture abutment.
TREATMENT PLANNING FOR THE
REPLACEMENT OF MISSING TOOTH
• Selection of the type of the prosthesis
o a removal partial denture.
o a tooth supported fixed partial denture
or
o An implant supported fixed partial
denture.
• BIOMECHANICAL
• PERIODONTAL ESTHETIC
• FINANCIAL and
• PATIENTS WISHES.
➢ It is not uncommon to combine two types in the
same arch.
REMOVABLE PARTIAL DENTURE
• Edentulous spaces greater than two
posterior teeth.
• Anterior space greater than four Incisors.
• Edentulous space with no distal abutment.
• Multiple edentulous spaces.
• Tipped teeth adjoining edentulous spaces
and prospective abutments with divergent
alignment.
• Periodontally weakened.
• Teeth with short clinical crowns.
• Insufficient number of abutments.
• If there has been a severe loss of tissues in
the edentulous ridge.
• Patients of advanced age who are on fixed
incomes or have systemic problems.
CONVENTIONALLY TOOTH-SUPPORTED
FIXED PARTIAL DENTURE
• Abutment teeth are periodontally sound.
• Edentulous span is short and straight.
• Expected to provide a long life of function for
the patient.
• No gross soft tissue defect in the edentulous
ridge.
• Reserved for patients who are both highly
motivated and able to afford.
RESIN BONDED TOOTH SUPPORTED FIXED
PARTIAL DENTURE
• Defect-free abutments where single missing
tooth.
• A single molar (muscles are not well developed).
• Mesial and distal abutment are present.
• Moderate resorption and no gross soft tissue
defects on edentulous ridges.
• Younger patients whose immature teeth with
large pulps are poor risks for endodontic-free
abutment preparation.
• Tilted tooth can be accommodated only if there
enough tooth structure to allow a change in the
normal alignment of axial reduction.
• Periodontal splints
IMPLANT-SUPPORTED FIXED PARTIAL
DENTURE
• Insufficient number of abutments.
• Partial attitude and or a combination of intra oral
factors make a removable partial denture or FPD
a poor choice.
• No distal abutment.
• Alveolar bone with satisfactory density and
thickness in broad, flat ridges.
• Configuration that permit implant placement.
• Single tooth where defect free adjacent teeth.
• A span length of two or six teeth can be replaced
by multiple implants.
• Pier in an edentulous span (three or more teeth
long).
DURING CASE PRESENTATION
• In cases where the choice between a fixed partial
denture and a removable partial denture is not
clear cut, two or more treatment options should
be presented to the patients along with their
advantages and disadvantages.
• The prosthodontist is the best person to evaluate
the physical and biological factors present ,
while the patients feelings should carry
considerable weight on matters of esthetics &
finances.
ABUTMENT EVALUATION HOW DO WE MINIMIZE?
• Greater occlusogingival dimension
• Crown root ratio
• Nickel chromium
• Root configuration
• Double abutment
• Periodontal ligament area
• Multiple grooves
I. CROWN ROOT RATIO • Arch curvature (minimize additional retention
from opposite arch)
• Optimum – 2:3
• Minimum – 1:1 (acceptable) SPECIAL SITUATIONS
II. ROOT CONFIGURATION I. PIER ABUTMENTS
• Broader LABIOLINGUALY than • Non rigid connector
MESIODISTALLY. • Restrict to short span FPD
• Multirooted posterior teeth with widely • key way distal contours of pier a abutment
separated roots. • key-mesial side of the distal pontic
• Conical roots can be used -for short span.
• A single rooted tooth with evidence of irregular II. THIRD MOLAR ABUTMENTS
configuration or with some curvature in the
• Tited-upright the tooth/partial veneer or
tooth that has a nearly taper.
telescoping crown.
III. PERIODONTAL LIGAMENT AREA
III. CANINE REPLACEMENT FIXED PARTIAL
• Larger teeth have a greater surface area and DENTURE
better able to bear added stress.
• Edentulous spaces created by the loss of canine
• ANTE’S LAW
and any contiguous teeth is best restored with
o "the abutment teeth should have a
Implants.
combined pericemental area equal to or
greater in pericemental area than the IV. CANTILEVER FIXED PARTIAL DENTURE
tooth or teeth to be replaced"
• Length roots with favorable con figuration.
Maxillary Ave. Mandibular Ave. • Long clinical crowns
Area Area • Good crown root ratios and healthy
C.I 204 C.I 154 periodontium.
L.I. 179 L.I. 168 • Pontic should possess maximum occlusogingival
height to ensure a rigid prosthesis
Canine 273 Canine 268
TREATMENT PLANNING PHASES
1st PM 234 1st PM 180
Phase 1
2nd PM 220 2nd PM 207
• Collection and evaluation of the diagnostic data,
1ST MOLAR 433 1ST MOLAR 431
including a diagnostic mounting and the analysis
2ND MOLAR 431 2ND MOLAR 426 and design of the diagnostic cast
• Immediate treatment to control pain and
infection
BIOMECHANICAL CONSIDERATION • Biopsy or referral of patient
• Development of treatment plan
• In addition to the increased load placed on the • Initiation of education and motivation of patient
pal by a long span FPD.
• Longer spans are less rigid.
• Bending or deflection varies directly with the
cube of the length and inversely with cube of the
occlusogingivally thickness of the pontic.
Phase 2
• Removal of deep caries and placement of
temporary restoration
• Periodontal treatment
• Extirpation of inflammed or necrotic pulp tissues
(Endodontic treatment)
• Construction of interim prosthesis for function
or esthetics
• Occlusal equilibration
• Reinforcement of education and motivation of
patient
Phase 3
• Preprosthetic surgical procedures
• Definitive endodontic procedures
• Definitive restoration of teeth
• FPD
• Reinforcement of education and motivation of
patient
Phase 4
• Construction of RPD
• Reinforcement of education and motivation of
• patient
Phase 5
• Postinsertion care
• Periodic recall
• Reinforcement of education and motivation of
patient