MULTIDISCIPLIN

ARY APPROACH
IN
PROSTHODONTI
CS

Veena
Pg III year
 CONTENTS:
1. Introduction
2. Prostho- Medicine interrelationship
3. Prostho- Pathology interrelationship
4. Prostho- Surgery interrelationship
5. Prostho- Pedo interrelationship
6. Prostho- Ortho interrelationship
7. Prostho- Perio interrelationship
8. Prostho- Endo interrelationship
9. Prostho- Forensic medicine interrelationship

10. References
 INTRODUCTION

 Advanced dental therapy intends to meet patients demands and

achieve satisfactory results which can’t be met by single specialty
alone.

 That’s where MULTIDISCIPLINARY dental treatment excels. Specialists

work together to ensure both functionality and esthetics

 Multidisciplinary dentistry involves what is known as a “team

approach.”
What is multidisciplinary
approach?
 Benefits of the approach

Clinician Patient
ROLE OF PROSTHODONTIST

• Both simple and complex restorative needs

(crowns , bridges, veneers etc)
• Dental implants and reconstructive
dentistry.
• Rehabilitation of patients with partial or
completely missing teeth
• Advanced cosmetic procedures ( bleaching,
veneers, tooth reshaping, bonding
 CONTRIBUTORS TO THE APPROACH

1. Prostho- Medicine interrelationship

2. Prostho- Pathology interrelationship
3. Prostho- Surgery interrelationship
4. Prostho- Pedo interrelationship
5. Prostho- Ortho interrelationship
6. Prostho- Perio interrelationship
7. Prostho- Endo interrelationship
8. Prostho- Forensic medicine interrelationship
PROSTHO MEDICINE RELATIONSHIP
 The prosthodontic procedures should not be planned until the systemic status of
the patient is evaluated.

CARDIOVASCULAR DISEASES

• ANGINA PECTORIS:

• MYOCARDIAL INFARCTION:

• SUBACUTE BACTERIAL ENDOCARDITIS:

• CONGESTIVE CARDIAC FAILURE:

• HYPERTENSION:
 MANAGEMENT OF ENDOCRINE DISORDERS
IN
PROSTHODONTICS

DIABETES MELLITUS
THYROID DISORDER
ADRENAL GLAND DISORDER
MANAGEMENT OF ENDOCRINE
DISORDERS IN
PROSTHODONTICS

 THYROID DISORDER
 DIABETES MELLITUS
DIABETES MELLITUS

COMPLETE DENTURE-
• Diabetic patients are more
susceptible to infections which
in severe cases may lead to
excessive oral tissue
destructions, such patients may
need obturators
REMOVABLE PARTIAL DENTURE
• If a Diabetic patients given an acrylic
denture is a preferred option, then the
design should incorporate the principles
of ‘Every Denture’
FIXED PARTIAL DENTURE-
• The finish-line of the preparation
should be placed supragingival
and to provide chamfer finish-line
on the facial aspect of prepared
tooth can concentrate stresses on
weakened tooth/ teeth..
•  Ante’s law should be obeyed
 IMPLANT DENTISTRY

• Implant placement must be

accomplished with least trauma
under stress free environment
•  Implant supported prosthesis are
not advised for patients whose
blood sugar level remains
uncontrollable but if conditions are
favorable , then this type of
prosthesis can be planned
 BONE DISEASES

A. OSTEOPOROSIS

B. FIBROUS DYSPLASIA:

C. OSTEITIS DEFORMANS:
NEUROLOGIC AND PSYCHIATRIC CONDITIONS

A. PARKINSON’S DISEASE:

B. BURNING MOUTH SYNDROME:

BURNING MOUTH SYNDROME
 AUTOIMMUNE
DISEASES

A. RHEUMATOID ARTHRITIS:

The temporomandibular joints are frequently affected in this

disease. The problem encountered in the prosthodontic
rehabilitation of patients with Rheumatoid arthritis of TMJ is
a. Changes in occlusion.
b. Jaw relation.

B. SALIVARY DYSFUNCTION
PROSTHO-PATHOLOGY INTERRELATIONSHIP
WHY AND HOW DOES ORAL PROSTHESIS CAUSE MUCOSAL
PATHOLOGIES?
o Lesions of the oral mucosa associated with wearing of removable
dentures may represent acute or chronic reactions to microbial denture
plaque, a reaction to constituents of the denture base material, or a
mechanical denture injury.

o DENTURE STOMATITIS,
o ANGULAR CHEILITIS,
o TRAUMATIC ULCERS,
o DENTURE IRRITATION HYPERPLASIA,
o FLABBY RIDGES, AND
o ORAL CARCINOMAS.
DENTURE STOMATITIS ANGULAR CHEILITIS
 DENTURE IRRITATION
o TRAUMATIC ULCERS HYPERPLASIA
FLABBY RIDGES ORAL CARCINOMAS
PROSTHO-SURGERY
INTERRELATIONSHIP
 It is a branch of dentistry dealing with the surgical treatment or repair
of any problematic or pathological condition of the mouth or jaws.

 The main aim of the preprosthetic surgeries is to provide an ideal

denture bearing area or the foundation area on/in which the
prosthesis gains retention, stability, and harmony with the surrounding
structures.
The pre-prosthetic surgeries are done under the reference/consultation of the
prosthodontist
 Implants:

 Ideal conditions for implant success are residual bone

height more than 10 mm and width more than 6 mm,
normal maxilla-mandibular relation, and healthy peri-
implant soft tissues.

 The use of autogenous bone grafts with osseo-integrated

implants seems to significantly reduce bone resorption.
 Lasers:
• These various wavelengths have made it possible for laser
technology to become a safe, simplified, and effective
component in current oral surgery.

• As the laser has the ability to vaporize soft tissues without

bleeding, the wound heals without scar formation and
without any deformation of the healed site.

• Moreover, there is no need for sutures, which is the most

important effect in the field of preprosthetic surgery, as any
loss in vestibule lengths provoked by the suture is avoided.
PROSTHO PEDO RELATIONSHIP
 CLEFT LIP AND PALATE

 In the cases such as cleft lip and palate conditions, the multidisciplinary
approach by a surgeon, orthodontist, speech therapist, pedodontist, and
prosthodontist is very crucial.
 Dental defects pose a challenge to the pediatric dentist because their
treatment requires a multidisciplinary approach, management of the
child’s behavior, preservation of the other dental and oral structures,
and the achievement of high-performance results in terms of parents
satisfaction.
 REMOVABLE DENTURES

• In cases of hypo and anodontia, there is atrophy of the

alveolar bone and decreased ability to retain removable
constructions. However, partial and complete conventional
dentures are successfully used for the oral rehabilitation of
children.

• An advantage of the use of removable constructions in

children is the possibility for their easy modification and
processing during the periods of growth and development
of the maxillary and mandibular bones
Use of complete dentures in
children

 The need for complete denture prosthesis is most commonly seen in children with
abnormalities in the development of jaws and the formation of dental follicles,
systemic diseases (e.g. ectodermal dysplasia), genetic diseases, traumas, rampant
caries, early childhood caries, etc.

 According to a number of authors, complete denture prosthesis in children aged 3

to 14 years follows the routine clinical steps.
 USE OF CROWN PROSTHESIS IN CHILDREN

• Fixed crown prosthesis is considered to be a safe and successful method of restoring

injured teeth in children.

INDICATIONS FOR THE USE OF CHILDREN’S CROWNS:

• Cases of large, multi-surface carious lesions, high risk of caries, defects in the
development of dental structures, conditions after pulpotomy or pulpectomy, fractured
teeth, discolored teeth, erosions, need for a retainer for a space maintainer, preventative
restorations, and severe bruxism.
• The purpose of the crowns is to preserve the underlying tooth structures, to protect the
dentine-pulp complex from contamination from the surrounding oral environment, to
promote the healing processes and to preserve the vitality of the dental pulp in case of
inflammation.
CLASSIFICATION OF CROWNS ACCORDING TO SAHANAS ET AL:
a) Crowns that are luted to the tooth

1) Resin veneered stainless-steel crown

2) Facial cut out crown
3) Polycarbonate crown
4) Pedo pearls

b) Crowns that are bonded to the tooth

1) Strip crowns
2) Pedo jacket crowns
3) New millennium crowns
4) ART glass crowns
 IMPLANTS IN CHILDREN

INDICATIONS FOR USE OF IMPLANTS

IN CONTRA‑INDICATIONS FOR THE
ADOLESCENTS: USE OF
• Pediatric patients with ectodermal dysplasia () DENTAL IMPLANTS:
• Implants combined with bone grafting in
patients with cleft of the alveolus and palate • Pre-pubertal age group
• Children and adolescents having anodontia, • Individuals with pubertal growth
partial anodontia, congenitally missing teeth,
teeth lost as a result of trauma spurt
• Uncooperative children who find it difficult to • Inadequate mesiodistal space.
adjust to removable appliances.
THE ROLE OF A ORTHODONTIST
Consequences of tooth loss
Space maintenance
 Micro implants

Miniscrews can be used to provide absolute anchorage as in this case

where a miniscrew is being used to retract the maxillary incisors
 ADULT
ORTHODONTICS

• Adult orthodontic tooth movement can be

performed on both healthy and diseased
periodontia with few detrimental effects
(root resorption) provided physiologic light
continuous forces are used,
periodontal inflammation is controlled
and meticulous oral hygiene is
maintained throughout active therapy.
 ROBOT IN PROSTHODONTICS AND ORTHODONTICS

•  Robot in prosthodontics and

orthodontics can realize functions, such
as the manufacturing of complete or
partial denture, dental implantology, and
the bending of archwire.
• Rich experience and technique between
experienced dental specialist and skilled
technician is integrated to the software of
prosthodontics and orthodontics expert
system
PROSTHO PERIO
INTERRELATIONSHIP
• Prosthodontics and Periodontics exhibits strongest and intimate connections
within modern dentistry. Prosthodontic treatment should aim at improving
patient comfort, function, health and esthetics, but at the same time, should
not provoke damage to the periodontal structures.
• Periodontal health plays an important role on the longevity of restoration,
while defective prostheses contributes to periodontal disease progression
1. The Provisional Restoration
2. Marginal Fit
3. The Contour of the Crown
4. Smoothness of the Contacts and Contours
5. Biologic Width and Margin Placement
6. BW and Implants
PONTIC DESIGN
PROSTHO ENDO
RELATIONSHIP
ENDODONTICS
1. In Fixed Prosthodontics’
2. In Tooth-supported Overdenture
THE ROLE OF THE ORAL
RADIOLOGIST
ORAL RADIOLOGY
The intraoral radiology has a limited role in defining
1. Abnormalities in the oral structures
2. . Examining the tuberosities
3. Evaluating the submucosal conditions under denture bearing areas
4. Evaluating the periodontium and bone level at the abutment and pontic levels in
fixed partial dentures (FPDs).
5. Pre-operative, operative, and post-operative imaging for implant therapy helps in
the accurate positioning of the implants.
6. Post-operative imaging after 3–5 years and beyond can be used to assess the bone-
implant interface
7. Marginal peri-implant bone height.
1. Extraoral Radiography
2. Panoramic Radiography
3. Computed Tomography
4. Magnetic Resonance Imaging (MRI)
PUBLIC HEALTH DENTISTRY
• Community dentistry helps in doing the survey among the population
and analyzes the results and to draw the conclusion on the knowledge,
awareness of the population toward prosthetic treatment, percentage
of edentulism.

• The prevalence of edentulous sites pertaining to the classification

systems, and the age group commonly effected by edentulism, the
percentage satisfaction of the patient’s toward prosthetic treatment,
etc.
THE ROLE OF PROSTHODONTIST
 POSTSURGICAL PROSTHODONTIC
REHABILITATION OF ACQUIRED DEFECTS

Intra oral defects Extraoral defects

• Maxillary defects • Auricular defects
• Soft palate defects • Nasal defects
• Mandibular defects
• Tongue defects • Ocular defects
REHABILITATION OF MAXILLARY DEFECTS

• Acquired defects of the palate

• Fluid leakage through the nose, impaired
mastication and hypernasal speech
• WHAT IS AN OBTURATOR?

• It is a disc or plate used to close an unnatural

opening or defect!
SURGICAL
OBTURATOR

• The objective of this obturator is to

separate the nasal cavity from the
oral cavity which facilitates patients
to speech and function.
• This is inserted at completion of
resection
INTERIM/
PROVISIONAL
OBTURATOR
FINAL /DEFINITIVE
OBTURATOR
PROSTHODONTIC MANAGEMENT OF
ECTODERMAL DYSPLASIA
CASE STUDY
 PROSTHODONTIC MANAGEMENT OF
EATING DISORDERS
• Eating disorders (EDs) are increasingly recognized as complex medical
and psychiatric illnesses primarily associated with severe physical and
psychosocial morbidity and significant mortality
• Anorexia Nervosa (AN) AN is a severe mental illness that causes them
to see themselves as overweight even when they are dangerously thin
which can lead to starvation, and eventual death
BULIMIA NERVOSA (BN) BN IS
CONSIDERED A MULTIFACTORIAL
PSYCHIATRIC SYNDROME.
 CONCLUSION

• By working collaboratively, we can hope to answer questions never

addressed before, including those with substantial influence on
society. Clinical and research aspects of prosthodontics have become
more multidisciplinary
• Therefore, prosthodontists need to understand various technical
procedures as well as the underlying physiological, anatomical, and
biological principles.
REFRENCES
1. A Multidisciplinary Outlook in Prosthodontics V Chakradhar1 , B Lakshmana Rao2 , Satyanarayana S V Tammineedi3 , Y S S Sruthi1 , P S
H L Parvathi1 1 Postgraduate Student, Department of Prosthodontics, Lenora Institute of Dental Sciences, Rajahmundry, Andhra
Pradesh, India, 2 Professor and Head, Department of Prosthodontics, Lenora Institute of Dental Sciences, Rajahmundry, Andhra
Pradesh, India, 3 Reader, Department of Prosthodontics, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India
2. Eating Disorders: Diagnosis and Prosthodontic Management Article  in  Open Access Library Journal · December 2017
3. Prosthetic Rehabilitation of Crowded Maxillary Anterior Teeth Emese Rita Markovics1 , Kinga Dörner1 , Orsolya Birta1 , Julia Popa2 1
Department of Removable Prosthetic Dentistry, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureș,
Romania 2 Student, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4. Prosthodontic Management of a Child with Ectodermal Dysplasia: A Case Report Akshay Bhargava • Arun Sharma • Sachet Popli • Renu
Bhargava Received: 13 July 2010 / Accepted: 7 August 2010 / Published online: 8 December 2010 Indian Prosthodontic Society 2010
5. A multidisciplinary approach for the management of hypodontia: case report Accácio Lins do VALLE1 , Fabio C LORENZONI2 ; Leandro
Moura MARTINS3 , Caio Vinícius Martins do VALLE4 , José Fernando Castanha HENRIQUES5 , Ana Lúcia Pompéia Fraga de ALMEIDA1 ,
Luiz Fernando PEGORARO1
6. Eating Disorders: Diagnosis and Prosthodontic Management * Corresponding Author: Esteban D Bonilla, Prosthodontist, Section of
restorative Dentistry, UCLA School of Dentistry, E-mail id: edbonilladds@sbcglobal.net Sub Date: October 24th 2017, Acc Date:
November 25th 2017, Pub Date: December 4th 2017. Citation: Esteban D Bonilla, Carlos L Del Aguila, David Wetzel, Eric M Scott , and
Steven C Bonilla (2017) Eating Disorders: Diagnosis and Prosthodontic Management. BAOJ Dentistry 3: 037. Copyright: © 2017 Esteban
D Bonilla, et al.