Mohamed q orto
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  • 1. 1-Clinical examination of the patient in the clinic of orthopedic dentistry.sequence,practical importance. Subjective examination: 1)complains.2)history of the patient.3)history of the disease. Objective examination: A) extra oral. B)intraoral. A )extra oral: 1- symmetry of the face. 2- color of the skin, mucosa(lips, conjunctive) 3- expression of the face. 4- 3 floors: a)till supra-orbital line. b)till nasal with. c)till chin.(mental) 5- nasal-labial line. 6- angle of mouth. 7- TMJ: a)movable of condoyle. b)open &close mouth. c)crepitating. 8- muscle palpation(maseter& temporal). 9- some pathologic formation. 10- palpation of some points(painful): a)supra-orbital foramen. b)canine fossa. 11- palpation of lymph nodes: a)occipital’s b)auricular’s c)sub-mandible. d)sub-mental. B) Intraoral: 1- correlation of lips& oris vestibule(mucosa):a)degree of mouth’s)situation of the mouth, dental arches(occlusal type).c)situation of mucosal membrane, alveolar& maxillary apophysis(alveolar bone). 2- inspection of teeth from upper right side_ left side_ left lower _right lower. *Dental arches classified: 1- the shape of dental arches, if correct symmetrical. 2- central occlusion_ correlation of dental arch(orthognat, head to head). 3- examination of alveolar apophysis. 4- examination of oral mucosa. 5- transversal monson-vilson + sagital space curve. 6- signs of central occlusion: a)dental. b)TMJ. c)muscle. d)deglutition. 2-Clinical examination of the dental arches,physiological and pathological forms.definition of occlusion, physiological and pathological types.characteristic. When we exam the dental arches , first of all we see the form of arches. Physiological: - upper dental arch has a form of semielips. -lower dental arch has a form of parabola. Pathological: V- shape U-shape M-shape(W) П-shape *presence of trauma or diastema , crowding of the teeth. *functional unity of dental arch is determined by: a)interdentally contacts. b) alveolar process. C )paradontium. d) structural peculiarities of dental arches(teeth location, direction of crowns &roots, number of teeth). *exam every teeth separately :volume, shape, presence of caries ,mobility, implantation. *exam dento -paradontal support. *exam the type of occlusion. OCCLUSION: is a closure of dental rows or group of teeth during different mandible movements. *occlusion can be: lateral, anterior, posterior &co. *occlusion can be: physiological, pathological. Physiological: 1-orthognat:presence of all signs of co. 2- right occlusion:(head to head)cutting edges of frontal upper incisors have contact with cutting edges of frontal lower incisors. 3- biprognat: frontal teeth of upper and lower jaws together with their alveolar processes have vestibular inclination. 4- opistognat: frontal teeth of upper and lower jaws together with their alveolar processes have oral inclination. Pathological: it has many functions: mastication. Phonation. Esthetics. Types: 1)prognaty: forward position of upper teeth, we can find space between upper and lower teeth. 2)progeny: forward position of lower teeth. 3)deep occlusion: deep or big overlap of upper frontal teeth , maybe cause of trauma of gingiva by cutting edges of the teeth.
  • 2. 4)crossed occlusion: vestibular cusps of lateral lower teeth overlap the cusps of lateral upper teeth. 5)open: absence of frontal teeth contact ,sometimes premolars too. 3-Maximal fissures-tubercular contacts between dental arches by korber ,methods of definition. Practical importance. Physiological(natural)mobility: very small natural mobility which the dentist can’t determine. This mobility created by polishing surface during day, between contact points of teeth. Pathological mobility(abnormal): can be determined by palpation& pincer. The pathological mobility can be result of tooth overload . 3 stages of mobility: 1)vestibular-oral. 2)vestibular-oral and medium-distal. 3)vestibular-oral and medium-distal and vertical. 4-Clinical examination of temporal-mandible joint(TMJ).practical importance. *during examination of the TMJ pay attention on: 1) if present asymmetry ,right &left sides. 2) color of the skin. 3)character of opening & closing of the mouth(limited, dislocated from the facial central line, presence of pain…) *palpation: 1) application of the fingers on the skin 2) during palpation can be feel: crepitating ,pushes ,clicks. 3) by palpation can be appreciated the level of amplitude & synchronic movements of condyles during opening &closure of the mouth. *auscultation: can be as a palpation or can be by phenendoscope. 5-Diagnostic model stones studying. methods. practical importance. - information about contacts due to closure of the mouth, we can get during examination of the oral cavity , but we can’t see closure of palate &lingual cusps. -preparation of diagnostic models: 1)the impression from both jaws. 2) manufacturing of models from gypsum. 3)determine co &apply in to articulator. 4)make movements of mandible. *on diagnostic models we can study: 1) the form of dental arches. 2) deformation of dental arches. 3) occlusial contacts of palate & lingual cusps. 4) the level of overlap of frontal lower teeth by upper . 5) character of occlusial curve. 6) deformation of occlusial surface of dental arches. *on diagnostic models can be performed different changes: 1) width of dental arches 2) width of teeth. *after prosthetic treatment, the diagnostic models can be as a control_ if the prosthetic treatment was done successfully. 6-Electroodontometry,thermo-diagnosis.practical importance. *for making special exam (detrmine the situation)we need to make electro-odonto-metric for hard tissue lesion ,pathologic abrasion of teeth, hypoplasia, erosion, prepare the teeth physiognomic crowns, or different teeth traumas :of pulp chamber, sensibility of pulp chamber .E.O.M allow us to determine the level of sensibility of dental nerve system, which indicate us the situation of pulp. Electro-odonto-metry- for determination the degree of electric excitability. In healthy-2-6ma In pulp inflammation-till 40 ma Necrosis of the pulp-till 60ma Pulp +peri-apical tissue-60_90ma Periodontium-100_120ma *thermo-diagnosis _determination of reaction of the tooth on thermal irritation (cold or hot water or cotton ball, moister in cold or hot water) or spry. *E.O.M & thermo-diagnosis_ are auxiliary methods of patient examination, which can help us to determine correct diagnosis & treatment.
  • 3. 7-Static and dynamic methods of chewing efficiency determination. Practical importance. Basic function of ”stomathognat system ” is act of mastication, that’s why the determination of chewing efficiency is very important. during making plane of orthopedic treatment: 1)static method. 2)functional method 1)static: A_khaber:with help of ganato-dinamometer, take in consideration the individual properties of each teeth:volume of chewing surface, number of roots, cusps, implantations. B_mamlok,agapov&oxman: they changed the method. they consider that in norm if the teeth are present, the masticatory efficiency =100.each teeth has coefficient, if one of teeth hasn’t antagonist ,his masticator coefficient=0. C_oxman: take in consideration the functional state of the teeth, which is determined by degree of their mobility (1)masticatory efficiency 100%.(2)50%.(3)0%. Static methods has a disadvantages: a)cant correct determine the role of each teeth during mastication. b)doesn’t take in consideration the type of occlusion, intensively of chewing, force of masticatory pressure, in the fluency of saliva on the food processing. 2)Functional: *krietensen method: the patient should chew a nut after 50 chewing movements the all mass is dried & and collected in thermostat . *gel man method: in norm “stoma. System ”chews 5 gr. of nut during 50 sec. Rubinov method: nut (0.8gr)determine the time from staking of chewing till act of swallowing. In norm it takes 14 sec, it present disturbances. it takes more time till act of swallowing. 8-Odontoparodontography by kurleandsky.changes of functional conditions of the teeth according to the degree of alveolar bone tissue resorption.practical importance. O.P.G:_is a static method that considers functional state of teeth,which can help to doctor to appreciate the masticatory efficiently. O.P.G:_is scheme of dental formulation which filling the data about state of each teeth during clinical examination-ray and investigation data of ganatodynamometr..N-norm, 1/4-atrophy 1st degree 1/2-2nd degree, 3/4-3rd degree. With help of parodontogram, the doctor can appreciate the functional state of teeth on upper and lower jaw, separate functional groups of teeth &the result, which the doctor is received _makes plane of the orthopedic treatment, which can be exclude the over pressure on the support teeth. During chewing of food ,the teeth received a different force :incisors_5-10kg Premolars_13-18kg molars_20-30kg. The healthy parodontium can receive more bigger pressure depend on level of intensively of masticatory muscle force, the paradontium receives just part of pressure(50%)from the all pressure that he can receive. The average between them is receive _for special situations. We need O.P.G_because every tooth have own dental implantation. for determination which tooth takes for support tooth. (Mathematical choosing by Agapov insufficiency) Functional table for support teeth (degree of implantation).it resorption of support teeth, choose the neighboring teeth in additional. 9-Clinical methods of muscles examination. miotonometry.electromyography. One of the methods: manual(palpation)of the muscles, the doctor should palpate the muscles during their constriction and relation. The function of masticatory muscles can be changed due to pathological states, like: 1)losing of teeth. 2)disorders in TMJ. 3)changes in the intra alveolar high. For clinical picture there is important to receive information about the state of masticatory muscles with help of electromyography. Application of electrodes on the skin(muscle),functional state of masticatory muscles check in the state of physiological rest position of mandibul,during closure of teeth in anterior,lateral,during swallowing & due to mastication. Electromyography is used in prosthodontics for checking the function of masticatory muscles in partial or total adentia,anomalies in stomatognat system . Also this method can be used after orthopedic treatment (register the changes of muscle function).
  • 4. Muscle tone is one of the principal parameters of muscle function. myotonometer_instrument for measure the muscle tone. 10-Diagnosis in orthopedic dentistry. examples .general and local indication and contraindications to orthopedic treatment. The diagnosis is based on clinical & para-clinical examination, the diagnosis consist of 3 parts: a)the main disorders of stomatognant system. b)complication of basic disorder. c)secondary disorder(diseases). *the primary disorder passes more pronounced, difficult more danger for the helth, consist of: 1)cause of disease. 2)stage. 3)character of pathological process localization. 4)degree &character of disease. 5)pathogenesis. *If in dynamic of disease appear a complications like: 1)disorders in the bite. 2)pathological erosion. 3)pathological mobility. The doctor makes the second part of diagnosis, the third part: 1)symptomatic disease 2)disease of oral cavity. The general state of organism is very important for determination of plane of treatment, or blocks the treatment temporary. The general state of organism doesn’t include in 3rd part. the doctor should take in consideration the disease like: 1) hypertension. 2) stenosis of the heart. 3) epilepsy. The 3rd part of diagnosis (disease in the oral cavity)the doctor knows during examination: 1)clinical. 2)para-clinical 11-Curative-prophylactic and biological principles of orthopedic treatment. Prophylactic principle: “stoma. System” is a morph-functional unit, one of the elements of whole organism morph functional disturbance(pathological process)negative depends not only on oral cavity, but also on organism in general, prophylactic principle of treatment is divided on local & genera. Local: prevention of disease of other organs , tissues in “stoma system”. General: prophylaxis of other organs, systems &entire organism, which can lead to pathology of “stoma. System” . Creative principle: morph-functional reestablishment of “stoma. System” by orthopedic stomatologic treatment. the goal of orthopedic treatment is a normalization of basic function of stoma .system: mastication, phonetic, swallowing, physiognomic. type of curative treatment depends on character of lesion: 1) partial/total crown lesions. 2) partial/total different of dental row. 3) lesions of the face, jaws. Orthopedic treatment isn’t consider finished with prosthesis fixation need period of adaptation reabilitation. Evrey orthopedic construction has curative & prophylactive direction. Biological principle: is based on natural approach during preparation of prosthetic field to stomatological intervention: 1) preparation of support teeth. 2) resection of crowns. 3) manufactory modern adhesive prosthesis, which doesn’t require preparation of the teeth. Biological principle requires manufactory of the prosthetic work from modern biomaterials, which haven’t toxic action on prosthetic field. 12-Biomechanical principle of orthopedic treatment. Biomechanical principle: creation of some equilibrium between resistance of biological substrate of prosthetic field & forces, which appear during function. For being stable to this forces, the biomaterial of prosthesis should have physical & mechanical properties(stable, elastic, extend and distend).also should take in consideration the level of biological resistance of the prosthetic field, tissue to forces(dento-paradontal complex has a big adaptation possibility to be stable to functional forces, when the mucosa-bony base hasn’t this properties). Absence of this equilibrium _lead to pathological processes. 13-Preparation of the oral cavity to orthopedic treatment. methods of orthopedic treatment. Characteristic.
  • 5. *Preparation of oral cavity to prosthetic treatment: 1)assignation of organism: in general infections, psychotic diseases which can influence on the processes & success of treatment allergy, DM… . 2)assignation of oral cavity: treatment of carries &its complication, lesions of teeth, parodontal &mucosal diseases, extraction of roots by indication, endodontic retreatment, extraction of teeth of 3rd mobility apical resection &etc. 3)general and local prophylaxis: hygienic procedures _prophylaxis of general pathological states of organisms which can lead to equilibrium disturbance of “stoma .system” &explanation to patient the hygienic rules of oral cavity. *Methods of orthopedic treatment: 1)functional method: myo-therapy &mechanic therapy. Use in complex with treatment of lesions, with surgical &therapeutically methods & for preparation of oral cavity to prosthetic treatment (microstomia, contracture of mandible….) 2)mechanical method: the usage of orthopedic devices(instruments)for the treatment of anomalies &deformation of “stoma .system”. for splinting, immobilization can be useful. 3)prosthetic method: the usage of types of prosthesis with the purpose of reestablishment of morphology & function of oral cavities organs ,&for prophylaxis of deformations &lesions of stoma. system & the organism in general. 14- classification of denture by method of fixation ( examples ). , manner of transference of functional forces ( ex ) and modern classification ? By fixation: a- removal ( PRD , complete RD ) b- non removal ( bridges .. soldering , casting mc ma ) By force transmitting : a- physiological: transsmition of force to periodontium of rest teeth . b- non – physiological: transmits force to mucosa of prosthetic field c- semi – physiological : one part transmits to periodontium and the other to mucosa . By betel-man : a- supra-dental prosthesis ( like physiologic ) b- gingival prosthesis ( like non physiologic ) c- dento – gingival ( like semi – physiologic ) By ox-man : a- prosthesis used for restoration coronary lesion . b- restoration of edentulous area in dental row . c- restoration for total adentia d- for dento-maxilla-facial restoration . 15 – impression , definition ,classification , one stage method of impression getting with one or two impression materials ? Impression: is a negative clear image of the prosthetic field . CLASSIFICATION: 1- According to requirements : a- Working ( basic ) impression : taking after specific intervention on teeth or soft tissue of prosthetic field for manufacturing different construction b- Auxillary impression : taking in different stages of prosthesis manufacturing . c- Diagnostic impression : for study on them for preparing the oral cavity for prosthetic treatment . 2- According to condition of adjacent soft tissue : a- Anatomical : taking by standard ( individual ) tray without take it consideration the functional state of soft tissue of prosthetic field for non removal prosthesis . b- Functional : taking only by individual tray usage of specific functional tests for registration the functional state of mucosa of prosthetic field for removal ( total or partial ). 3- According to technique : a- In one stage ( one layer ) . b- In two stages ( double layer ). c- Impression with help of copper ring . d- Occlusal impression . e- Partial total impression . Impression in one stage ( one layer ) : taking with one impression material ( gypsum , algenat , stence ) . This is for : metal simple crown , soldering bridge , PRD . Impression in two stages ( two layers ) : for more clear image of gingival margin . for : acrylic ceramic combine ( mc , ma ) prosthesis . Impression with copper ring : copper ring 0.4 mm is fixed on prepared teeth ( should be space 0.02 – 0.03 mm between the wall and tooth ). Fill with elastic material this copper ring and apply on prepared teeth .after that taking the total impression of dental row with copper ring for: inlay , ceramic crowns Occlusial impression :imege of both dental arches in CO . for : bridges .
  • 6. Partial impression : impression of several teeth . Total impression : image of entire dental arch . 16- Dual ( two stages ) method of impression getting ( two layer impression ), stages of getting impression with standard impression trays ? Dual method : usage of two layers . for : acryl , ceramic , MC ,MA prosthesis . In one stage ( 2 layers a silicone materials ) : one layer is applied on teeth and soft tissue ( by syringe ) , the second ( base ) layer applied on dental arch . Dual ( two stages ) : 1 layer base is applied on dental arch , 2 layer added to 1 layer and apply on dental arch . Stages of getting impression : 1- Choose the impression material . 2- Choose the tray ( for upper or lower jaw ). 3- Preparation of impression material . 4- Application of impression material on tray . 5- Entrance of tray with material into oral cavity and application on dental arch . 6- Margin design of impression . 7- Taking out the impression material from the oral cavity . 8- Appreciation of impression . 17- classification of impression materials by postolachi and Birsa . examples This classification is based on state of impression : 1- ELASTIC : a- reversible hydrocolloid ( helin , dentacol )  ager-agar (jell) b- non – reversible hydrocolloid ( chromopan , elasic )algenat c- synthetic elastomers :  Selycone :sielot , speedex , xantopren , opthosil , dentaflex , z+.  Polysulfat :thiodent , surflex .  Polyether :impregun , polygel . 2- Hard materials : a- Reversible  thermoplastic masses( stence ) . b- Non- reversible crystalic materials ( gypsum ). 18 – classification of dental crown damages by Deshuym – Bului. Dental damage ( lesion ): is disorder ( changes ) of structure , form , color , volume , place of tooth crown . Classification by Burlui 4 classes : 1 CLASS – anomlies of position .volume , shape and direction they are not hard tooth tissue lesions themselves , but they require the same treatment as hard tooth tissue lesions . 2 CLASS –hereditary hard tooth tissue lesion: imperfect amelogenesis , dysplasia kapdepon , opalescent , dentin hodge , imperfect dentinogenesis . 3 CLASS –hard tooth tissue lesion gained before teeth eruption :simle enamel hydroplasia , complex hypoplasia , ionizing radiation ( x-ray ). 4 CLASS –hard tooth tissue lesion gained after teeth eruption, both affected  temporal teeth :  melanodontiumBeltram and Romieux  Caries .  Trauma.  Tooth erising . Permanent teeth   Caries.  Trauma.  Medical dental lesion .  Dental lesion after ionizing radiation ( x- ray) 19 – classification of dental crown damages . clinical examination of the patient with damages of dental crowns . + 20 – extra – oral and intra – oral clinical picture of dental lesion . Clinical picture of dental lesions : are divided into subjective symptoms and objective symptoms . the subjective symptoms : 1- Pain ( intensity depends on length and depth of lesion and degree of tooth loss) . 2- Esthetic changes ( especially in frontal tooth ) and its appears due to  losing of tooth tissue : caries , trauma , shaped defect .
  • 7. changes of tooth tissue : structure , volume , form , color . 3- Changes in mastication : in frontal teeth : responsible for incising food . in lateral teeth : responsible for crushing , grinding food . 4- Phonetically changes : especially in frontal lesion > 5- Nevrosis . Objective symptoms : 1- Changes in color , form , place of teeth . 2- Changes in structure ( rough surface , defect ). 3- Loss of proximal teeth contacts ( defect of teeth on proximal surface ) . 4- Static and dynamic disbalance of stom. System :  Loss of tissue on the cusps  Central contact  Vertical teeth displacement Clinical examination of patient with dental lesions : Extra oral :  More often facial changes are absent .  When defect are deep and localized in frontal teeth, changes in the lips position ( upper lip fall ).  Decrease lower third of the face . Intra oral :  Pay attention on degree of mouth opening .  Mucosa of vestibule ( tumor formation , ulcer )  Exam each tooth separately ( form, color ,position ) .  Special attention on affected teeth ( topography of defect , form , degree of tooth sensibility …..)  Condition of periodontal tissue of each teeth : ( mucosa : color , swelling , hyperplasia , presence of pockets ) .  Degree of teeth mobility .  Vertical percussion : data about apical periodontium condition .  Horizontal percussion : data about marginal paradontium .  Determine correlation between upper and lower dental arches , static and dynamic occlusion , type of occlusion .  Alveolar process,.  TMJ examination .  Muscles examination . 21- para clinical examination of the patient with dental lesion .  Study of diagnostic models .  X – ray ( simple , panoramic ).  Electro –odoto – diagnostic .  Electro – myo – graphy . 22- diagnosis of dental crown lesion examples , method of treatment of dental crown damages characteristic ? Diagnosis of dental lesions is determined on the basis of complexes clinical and paraclinically examination and it must include local and general state .. Local state :state of hard tooth tissue and may be characterized by :  Anatomo- clinical complexes .  Topographical component ( shows us present of teeth and lesion position )  Etiological component : ( caries , trauma )  Functional component : ( functional changes in stom . system ) Complication :of local state ( teeth migration ) Auxiliary disorder : ( ex : chronic local periodontitis in stage of remission . Example of diagnosis : Partial hard tooth tissue lesion 3.6 second class by black , as result of caries : disorders in mastication , vertical migration 2.6 chronic local periodontitis in stage of remission . Treatment of dental crown lesion :
  • 8. Surgical way . Medical way . Restoring way : a- Using of crown reconstruction .in small defect (inlay , onlay , pinlay ) . b- Using of full artificial crowns .( in large defect ) c- Substitution constriction. 23-Indication and contraindications to treatment of dental crowns damages by method of restoration. INDICATIONS: 1- Local: changes of structure , form ,volume, color, and place of tooth crown that cannot treated by conservative method ~use prosthetic treatment. 2- General: changes in the nervous system ,in digestive tract (gastritis) caused by dental lesions . 3- To restore occlusal surface of affected teeth . CONTRAINDICATIONS: 1- temporary teeth (relative). 2- if present big dental lesion . 3- mobility of 3rd degree. 4- if present periodontal disease in acute form (relative). 5- mental disorders. 6- 24~Classification of dental lesions by black , kurilenko. Dental index occlusal surface lesion (DIOSL) by MILICKEVICH and choosing only type according to its significance. Tooth cavity classification by black : 5 classes: 1- caries cavity in fissures and natural pits . 2- c.c. on contact surface of molars and premolars. 3- c.c. on contact surface of frontal teeth without involving the angle and the edge. 4- c.c. on contact surface of frontal teeth with involving the angle and occlusal edge. 5- c.c. on cervical region . Classification of hard tooth tissues lesion by, KURILENKO:(based on making the plastic microprosthesis ). 1- class-hard devital tooth tissue lesion . 2- class - hard vital tooth tissue lesion : 1subclass: lesion localized on 1or 2 proximal surface and occlusal surface of lateral teeth. 2subclass: lesion on contact surface of frontal teeth ~damaging of angle and occlusal edge . 3subclass : all lesions on any surface (except proximal) 4subclass: atypical lesion. The total occlusion surface ~1. The index of destruction is less than 1 and we should remove from 1. (1 ~index of destruction) *application of lamina with coordinates . 1coordinate- 1mm2. *if DIOSL -0,2-0,6mm ~cast inlays. 0,8-0,6mm~artificial core & past. To determine the degree of coronary lesion for classes 1 &2 by black ~using DIOSL . 1. index 0,2~0,3mm~ for metallic inlay . 2. if index 0,4~ 0,5mm ~ inlay stretches & builds on coronary cusps . 3. if index ~0,6mm & more ~ cover the whole occlusal surface of tooth. 25-Dangerous zones for frontal teeth by Gavrilov and Abolmasov and lateral teeth by Gavilove and Kluev. During preparation attention should be paid on topographical relation of hard tissue to pulp .
  • 9. Dangerous zones: are zones ,where the layer at hard tissue is thin . preparation in this regions is very carefully & economic . In non -dangerous zones : preparation can be deep with creation of cavities , for retention points , without a risk of pulp trauma . Upper and lower incisors : Non dangerous : 1- cutting edge . 2- in the region of equator (vestibular, oral surface) 3- in cervical region (vestibular, oral). Dangerous : 1. oral concave surface (between oral tubercular cusp &cutting edge). 2. contact walls in equator & cervical regions. CANINES: Non-dangerous: 1- cutting edge . 2- in equator region (vestibular ,oral, contact). 3-in cervical region (vestibular, oral) for upper canines and distal surface . dangerous : 1. oral concave surface . 2. mesial contact wall in cervical region for lower canines and distal cervical surface. Premolars non dangerous: Upper: 1- on occlusal surface (tops of cusps &mesio distal fissure ) 2- in equator region (vestibular, oral, contacts ~both) 3-in cervical region (oral, vestibular) Lower:+ in cervical region- distal surface too. Dangerous: 1- occlusal surface (oral slop of buccal casp near fissure ) 2-upper ~contact surface in cervical region . 3-lower-mesial cervical surface . Molars non dangerous : contact surface ,central part of occlusal surface . Dangerous: 1- tops of cusps. 2-vestibular &oral cervical regions. 26-stages of cavity preparation for inlays & requirements to them preparation of cavities in case of 1-2 classes by black classification . tooth preparation particularity for inlay : 1- different damage ~different preparation . 2- rules : 3- take account depth & length of lesion . 4- tooth condition & topography . 5- patient age . 6- created cavity can be : - - simple -double -triple -atipre Requirements to a cavity of tooth preparation under lay: 1- cavity prepared not only within the limits of enamel, but also in dentin limits. 2- the vertical walls of cavity should be slightly beveled.(for easy removal of wax lay). 3-bottom of cavity should be equal to the pulp chamber & strictly horizontal . this wall should have sufficient thickness to be able to resist chewing pressure. 4- is obligatory of retentive points for best fixation . 5- the inlay should exact lay adjacent enamel (create bevel in enamel).
  • 10. 6-all surfaces should be smoothed. Preparation in 1 class by black: .bottom is prepared horizontally , lateral wall ~vertically . .the edge of cavity –create bevel 45 degree. .the depth of cavity-1,5~2mm. Preparation in 2 class by black : 1-walls 90 degree. 2-without contacts of antagonist with remain cusps of prepared tooth .to avoid fracture. (removing of antagonist or prepared tooth length on 2~2,5mm). 27. requirements to preparation of the cavities for inlays in damage of III-IV-V classes by black classification. III class: The walls of cavity it to the longitudinal areas of the tooth & with retentrenal elements which are localized in oral surface. The incisive margin of cavity should be lower on 1/3 of crown (for resistance). IV class: For better retention can be added Para-pulpal canals & posts ,depth 1.5-2mm. Preparation is the same in III class. V class: On frontal teeth & upper premolars – physiognomic inlay , on the lateral – metallic. Contour of the cavity is oval. For easy trying and fixation of inlay is recommended , that the form of cavity shouldn’t be straight geometric. 28. receiving of wax reproduction of inlay by direct and indirect methods. Direct method: Clinical : - modeling of wax reproduction of inlay directly in tooth cavity. - application of m – shape posts. - taking out this reproduction from the tooth cavity. -determination of color & send to lab. Laboratory: *change the wax reproduction into acryl / metal. *polishing ,grinding. Indirect method : Clinical *taking 2impression Laboratory *making a model *modeling wax reproduction of inlay in model *change the wax into acryl/metal. *trying on model , polishing ,grinding. 29.testing and fixing inlays .used fixing cements. Testing: *see indirection / direction of applying , shouldn’t be inclination ,should be II. *should be tightly (but not very much) contact between inlay & tooth cavity, to intaduce without force. *to check the occlusion surface (CO) , if inlay doesn’t make over occlusion. Fixation: *First of all drying of the tooth cavity . *Applying of cement in tooth cavity & on inlay. *‫חסר‬ *to check occlusion. *the cement should be liquid consistence . Cement: *fastest cement *Harvart *Fuji *glass-inomer *Zn-phosphate cement.
  • 11. *Resin – based adhesive cement. * polycarboxylate cement . 30. indications to prosthetic treatment of dental crown damages with artificial crown (covering method). Artificial crown are indicated: 1. in damaging of hard tissue , when the filling &inlay are non affective/impossible. 2. in disorder on natural teeth color. 3. for reestablish the esthetic disorders. 4. in presence of big filling material which can lead to fracture of crown. 5. Anomalies of volume ,form & place of teeth. 6. it’s a support element of removable / non removable denture , orthodontic apparatus &o.m.f prosthesis . 7. in trauma of a tooth. 8. as a splint element due to parodontium diseases . 9. in increase or reestablishing the high of occlusion (due to pathological erasing )& for avoiding decreasing of high of occlusion. 10. as a temporary crown. 11. in deformation of occlusion. 31. classification of artificial crowns according to function and constructive peculiarities ,esthetic aspect and technique of manufacturing. I. classification according to function (indication): 1. reestablishment ,restore the anatomical morphology of the tooth. 2. as a support element of different prosthetic. 3. equilibration , transmit ion of masticatory force or all the teeth. 4. as a temporary crown. II. according to constructive peculiarity (covering): 1. cover ¾ of crown on incisors & canine. 2. cover 4/5 of crown on premolar ,molars. 3. equatorial crown . 4. complete crown. III. according to esthetic aspect : 1. non esthetic (metallic) 2. semi esthetic (combine) 3. esthetic (acrylic/ceramic) IV. according to technique of manufacturing: 1. Metallic – stamping , casting ,soldering. 2. Acryl – polymerization. 3. Ceramic-burning. 4. Combine- mixed technique. 32. requirement to artificial crowns .general principles of teeth preparation for covering with artificial crowns. Requirement : 1. A.C should reestablish the morphology ,volume &form of teeth. 2. should reestablish the contact points (proximal). 3. ‫חסר‬ 4. the relief of occlusial surface should to correspond to occlusial surface of antagonist , create the contact points with antagonist. 5. during moving of mandible shouldn’t make contacts before the time, free moving of the mandible. 6. tightlyeves lap the neck of the tooth or posy of the crown (equatorial , partial crowns). 7. shouldn’t reestablish the esthetic aspect . 8. take a count the interrelationship between the crown and the marginal paredontium . Method of preparation : classical :low speed rotation. 1.proximal surface :remove contact points ,with metal separ disc . * parallel walls create with active one side ,active double side . *2 technique : a) progressive grinding of hard tissue (one side disc). b) by layers (double side) . - progressive grinding from occlusial surface to cervical. - by layers :use in narrow cervical area - in tooth mesio distal inclination . *remove 1.0- 1.5 mm thickness .
  • 12. *not create the bevel. 2. vestibular/ oral surface: * to cut (destroy) the anatomical equator . *preparation from mesial to distal (tangentially). *vestibular & oral surface should be II to tooth axis. 3. occlusual surface *presence it’s form (not to change the form). *remove 0.25-0.3 mm of thickness. 4. cusp preparation – smoothing. 5.cervical region – not include bevel creation modern(high speed): using turbine piece (high speed) with permanent cooling with air & water. We can begin preparation from any surface, depending in clinical situation. 33.instruments used for teeth preparation for covering with artificial crown . requirements to them. Preparation of tooth surface is done with abrasive tools of different size , form & d &different speed of rotation ,carborundum or diamond burs with different granules surface. Metallic separating disk for removal proximal contact points with neighbor teeth .has different size and d. Carboround / diamond burs for occlusial surface preparation :  Excavating decay.  Finishing cavity walls.  Finishing restoration surface.  Drilling out old filling.  Finishing crown preparation.  Separating crown & bridge.  Adjusting & correction of acrylic temporary crown. Diamond rotary instruments have a metal base base with flecks of industrial diamonds implanted into the base ,different design:  Round.  Topical cylinder  Flame shape , wheel shape ,disc shape.  Cone , inverted cone .  Pears , taper tissue. 34. indication to artificial metal stamp crown manufacturing 1. considerable damage of tooth when impossible non effective to restore with filling material. 2. as support element for clasp . 3. as support element for bridge. 4. restore the form , structural disorder ,anomalies. 5. to prevent pathological erasing . 6. presence of big filling to avoid fracture of the crown. 7. at trauma of the teeth. 8. as support element at removable prosthesis. 9. as splint element in periodontal disease treatment . 10. at o.m.f prosthesis . 11. at treatment of deformation of tooth rows when it’s necessary to correct vertical or other displacement of the teeth. 35. classic and modern methods of teeth preparation under metal stamp crowns. classical :low speed rotation. 1.proximal surface :remove contact points ,with metal separ disc . * parallel walls create with active one side ,active double side . *2 technique : a) progressive grinding of hard tissue (one side disc). b) by layers (double side) . - progressive grinding from occlusial surface to cervical. - by layers :use in narrow cervical area - in tooth mesio distal inclination . *remove 1.0- 1.5 mm thickness . *not create the bevel. 2. vestibular/ oral surface:
  • 13. * to cut (destroy) the anatomical equator . *preparation from mesial to distal (tangentially). *vestibular & oral surface should be II to tooth axis. 3. occlusual surface *presence it’s form (not to change the form). *remove 0.25-0.3 mm of thickness. 4. cusp preparation – smoothing. 5.cervical region – not include bevel creation modern(high speed): using turbine piece (high speed) with permanent cooling with air & water. We can begin preparation from any surface, depending in clinical situation. Control of preparation quality: 1. Abutment’s cones must be slightly visible (conic form). 2. Vertical surface must be rounded (not plane). 3. Occlusial perimeter (surface) must be less or equal to cervical one. 4. Inter-occlusial space must be equal to the thickness of the future crowns. 36.requirements for tooth prepared under metal stamp. 1. to correspond exactly to the form of restoring tooth. 2. to have a well noticeable equator. 3. closely envelope (overlap) cervical teeth along whole it’s length ,entering in gingival pocket at 0.3 mm. 4. not to interfere in closing the tooth rows in any phases of occlusial movement of the mandible. 5. to restore contacts points with neighboring teeth. 6. occlusial relief must correspond to occlusial , refit of antagonist. 7. to restore physiognomy (esthetic) of the “stoma system”. 37.possible complication in stage of preparation of teeth for metal stamp crowns covering. 1. pain (individual patient sensitivity ). 2. damage of soft tissue (inter-dental papilla, gingiva). 3. opening of the tooth pulp(pulpitis). 4. damaging of neighboring teeth. 5. Fracture of prepared teeth. 6. prepared more than need , not enough preparation. 7. thermal irritation pulpitis (without cooling hand piece). 38.gitting of one stage and two stages impression of prosthetic area for manufacturing metal stamp crowns. For stamp crown use ‫חסר‬ Materials (ypeen , cromax, tropicalgin ,) Getting in 1 stage impression (anatomical): 1. choose of impression tray. 2. Preparation of impression material & apply into tray. 3. introduction of tray into oral cavity and registration of edge of an impression. 4. remove the tray after hardening . 5. analysis of impression. Impression in 2 stages – for more clear image of gingival margin. 93. aspect relations of complete metal stamp crown border with marginal paraodontiom. There are 3 opinions about correlation between margin of crown & gingival sulcus (marginal paradontium) : 1. crown edge must enter into gingival sulcus on 0.2 -0.3 mm, it will not be appear relation space where the rest of food will be present. 2. crown edge must be at the level of gingiva borders , the thickness of crown 0.25-0.3 mm ,if introduce into gingival sulcus lead to trauma ,swelling ,gingival retraction and dento-paradontal pocket formation. 3. crown edge must stop at 1.5 – 2.0 mm to gingival borders .negative influence on marginal parodontium is prevented. *it’s considered that the correlation between artificial edge and marginal gingiva must be determinal individual at each clinical situation. 40.Testing artificial crowns. 1) At firsttesting the crown on the gypsum model
  • 14. In the second step: removing of the crown and see the insertion (direction of application)also the way of inclination. 2) Test the margins and cervical region of the crown. 3) The contact points with the neighboring teeth. 4) Examine of the occlusial surface (central occlusion and dynamic occlusion) 5) Contact points with antagonists. 6) The color of the gingiva in the cervical area . If its paleshould remove from the crown If its pink normally 41.Final testing and fixing artificial crowns. Possible complications and their prophylaxis. Testing: 1. To check if the artificial crown not related to other person. 2. To see the insertion in application. 3. Shouldn’t introduce with a power ,but not to be free also the contact points with neighboring teeth 4. To check the central occlusion and dynamic occlusion (shouldn’t have over occlusion) but should have contact points with the teeth antagonists. 5. To check the color of surrounding gingiva. fixation : 1. To isolate the tooth ,dry the surface and the crown. 2. Application of cementum (glass ionomer) into the crown. 3. Applying the crown on the abutment tooth. Complication after fixation 1.pain 2.pulpitis 3.its introducing very deep local marginal periodontitis between the crown and the gingiva (pocket). 5.over occlusion or infra-occlusion 6.neurosis 7.decementation (applying the cementum in moist surface) Prophylaxis: 1.good &correct preparation/fixation 42.Disadvantages of metal stamp crowns. Indications and contraindications to treatment of dental crowns defects with cast metal crowns. Disadvantages of metal stamp (swage) crowns: 1.can not be used in any age 2.metal crown transform thermical irritations to the pulp &not esthetic (physiognomic) 3. not always cover exact the cervical part of teeth that can cause caries or trauma of marginal periodontium 4.necessity of tooth preparation & as a result of infecting of the pulp ,trauma of marginal periodontium or surrounded soft tissue. Indication to cast metal crowns: 1.damage of the tooth as a result of caries & can’t be restored by filling or inlay 2. as a support element for clasp ,especially if it’s necessary to change their form . 3. as a support element for bridge denture 4. at teeth color ,form, structure disorders ,tooth anomalies. 5. at pathological erasing ,to prevent future erasing present of big filling that can lead to breaking of remaining crown part. 7. at trauma of the teeth 8. as supporting element of removable prosthesis. 9. as splint element in periodontal diseases treatment. 10. at treatment of deformation of tooth rows when its necessary to correct vertical or other Displacement of the teeth/ 11. at maxillary –facial prosthesis. Contra-indications:- Relative: 1. General disorders (infection, CVD system, respiratory system. Etc.) 2. Local disorders (gingivitis ,tumor, mucosal lesions.) Absolute: 1. On healthy teeth if they will not be used as support teeth in bridge denture and other prosthetic denture. 2. At subtotal and total teeth when they remain tooth tissues cannot provide a good fixation. 3. At 3ed degree of pathological tooth mobility if they are not included in immobilization splint. 4. At 2/3 bone of alveolar process resorption and the tooth is not include in immobilization splint. 5. In case of not formatted root apex
  • 15. 43.Peculiarities of teeth preparation under complete metal cast crowns. The preparation must be done without presence , with comma movements. occlusial surface : remove till 0.5 mm vertical walls : 0.35 mm – 0.5 mm the shape of prepared tooth should be a little rounded  Cervical area: 1. Edge margin formation-bevel -shoulders -chamfers. 2. Without edge. 3. Mixed.  During preparation we reduce more tooth tissues than during teeth preparation under swage crowns .  In cervical area the tooth may be prepared (creating or not bevel) or mixed/  Preparation without bevel is effective in tangent or a little excavated plane (inclinator teeth) 44.Peculiarities of getting impressions of prosthetic field at metal cast crowns manufacturing and used materials. 2 stages: (1 layer ”hard putty” + 2 layers)and gingival retraction before the 1st layer Stages: - After preparationapplication of retraction cord 20-30 min. - Application of 1 layer “hard putty” - Application , checking of the impression - Application of 2 layers  (base and catalyst) Retraction: can be: - Chemical retraction (cord) - Surgical retraction. - Mechanical retraction. Chemical retraction: - Application of retracted cord into gingival sulcus ,surrounded the tooth (for tissue and vessels constriction). - Can be: -impregnated (contain astringent-vasoconstrictor) -non-impregnated( does not contain chemicals) Surgically: - Cutting of the excessive gingival tissue - In hypertrophied gingival. - To remove by electrosurgical or knife method. Mechanical:- by pushing the tissue away from the tooth. Materials: silicone-optosil -zeta,plus -speedex Silicone base and catalyst for the 2 layers 45.Clinical-laboratory stages of metal cast crowns manufacturing. Clinically: - patient examination, putting diagnosis , choosing method of treatment , making an anesthesia (if it’s necessary ). Hard tooth preparation ,taking the impressions ,determining and registration of central occlusion , protection of remained hard tooth tissues by covering them with protective lacquer or temporal crown. Laboratory: - making a pattern (gypsum model) and their fixing in an articulator or ocludator ,modeling on a pattern wax reproduction of a future tooth crown . flasking , replacing wax by cast . polymerization ,taking of crown out ciuvetta , its processing , polishing. Clinically: - testing the cast crown in the model after that in the oral cavity . Laboratory: - final processing , polishing and finishing of the cast crowns. Clinically: - final testing and fixing of the crown in the oral cavity . 46. Cast crowns advantages and disadvantages. Using alloys. Advantages: 1-more fightly and clear cover in the cervical area (related to the swage crown ) 2-make a less trauma of the gingival. 3-less or not erase 4-more exact form of crown , then in swage crown. 5-retoration of integrity of dental row. Disadvantages: 1- deeps preparation ,then in swage crown. 2- Needs enough high of natural tooth crown. 3- Can’t use in the fontal area ,non-esthetic. 4- Difficult removing of the crown after fixation (when its necessary). Using alloys for cast crowns:
  • 16. 1- Noble alloyAu900 ,Au916, consists of: 90%-Au ,6% Cu, 4% silver. 2- Half-noble alloysilver palladium 190. 3- Non-nobleCr-Co consists of: Cr 30% , Co 60% Ti Cr-Ni 47.Wound dentine surface protective methods of the teeth prepared for casting metal crowns. Methods of protection divided into: 1- Chemical (impregnation) 2- Mechanical (covering by different protective lacquer or temporary crown) - For impregnation  use of 30% sol. Of silver nitrate. - Lacquers can be “ftorlak” or 5% of celluloid mat. - Temporary crown  stimulates the formation of dentine . they are fixed on the abutments by Zn-oxide eugenol paste , Zn phosphate cement or dentine paste (temporary materials). Temporal crown by scutan (technique): 1- Taking impression before preparation . 2- Preparation of the tooth under cast crown . 3- Plastic material applied in the impression tray after the impression which we took 4- Entering the tray into the oral cavity and establishing it. 5- Acryl (plastic) hardening and processing (preparation) 6- Fixation of temporal crown . Indications and contraindications to using equatorial crowns. Principles of teeth preparation. Partial crowns 3/4 and 4/5. Characteristic. Indications. 49.Metal telescopic crowns. Characteristic. Indications. Telescopic crown: are for effective stabilization of PARD.(acryl/arch) Compose from 2 crowns (one covers the other) 1- Internal fixated by cementation on prepared tooth(abutment) 2- External  (can be swage/cast) fixated on the base of PARD. Manufacturing of internal crown : cylindrical shape before  deep preparation of vertical and occlusial surfaces. deep preparation for: 1- Good anatomical tooth shape 2- To avoid the over occlusion. Indication: 1- The preparation should be straightly. 2- The ways of entrance and exits of internal crowns should be straightly. 3- After fixation of internal crown on the toothgetting impression for manufacturing of the external crown. 4- On the gypsum abutment modeling equator more pronounced then for metallic crowns, but the occlusial surface without modeling. 5- Final external crowns is testing on the internal (the internal is fixed on the tooth). 6- The external one should free cover the internal one and not go till the gingival on 1 mm (1mm above the gingival) . 7- The external crown will be fixed by soldering with PARD. 50.Indications and contraindications to esthetic ceramic and acryl artificial crowns manufacturing. Indications: 1- Tooth crown lesion on the frontal teeth. 2- Changes in the color ,form, shape ,volume ,and position of the tooth . 3- Fluor sis 4- High volumetric (great by volume) tooth crowns. 5- At the present of great by volume filling that can lead breaking of the tooth crown. 6- Necessity of restoring inter-tooth contact points. 7- As a support element of bridge denture ,PRD and orthopedic apparatus . 8- Tooth trauma. 9- As a support element of immobilization apparatus. 10- At deformation of tooth row when its necessary to prepare thick layers of hard tooth tissue at a great inclination or vertical displacement of tooth. Contraindication: 1- Small short tooth crowns. 2- Fragile tooth tissue . 3- In subtotal and frontal tooth lesion. 4- At lll degree of tooth mobility . 5- In the presence of pathological changes in tooth apex (relative) 6- Local pathological process(gingivitis, tumor of bucal mucosa) 7- In stage of root development. 51. Preparation of the tooth for ceramic jacket crown. Favorable forms of finishing line. 1- Depend on morphological particularities of tooth crown (incisors, canines, premolars)
  • 17. 2- Thickness of future vcrowns will be more than 1.5mm 3- Length of prepared crown  should be 2/3 length of clinical crown (for good retention) 4- Cervical part creation of bevel of 90o ,thickness 0.8mm-1.2mm. 5- Partially bevel :- -first upper premolars and lower incisors only the vestibular and oral bevels 6- In some clinical situations only the vestibular bevel . 7- The abutment is slightly have a conic form. Types of bevel :- 1- Bevel in straight angle . 2- Long bevel 3- Short bevel 4- Knife. 5- concave 52. Modern method of impression getting for ceramic crowns manufacturing. 2 layers of impression and retraction cord. - First layer  putty (hard) - Second layer base and catalyst (liquid) 1- preparation. 2- Application of retracted cord for 20-30 min 3- Application of 1 layer (hard) 4- Application ,checking of impression 5- Application of the second layer (liquid) 6- Application, checking of impression . 7- Taking impression from another jaw (antagonist),with alginate material for the central occlusion. 53- clinical- laboratory stages of ceramic crowens manfacturing. Porcelain, components and types. :Clinical 1- patient examination, diagnosis and plan of treatment. 2- preparation, taking impression. Laboratory: 1-making models of prepared tooth or for general working models 2- making a platinum cap (0.025mm in thickness) 3- cover this cap with basic layer 4- first burning 5- covering with dentin layer 6- covering with enamel layer 7- second burning Clinical: -tasting in the oral cavity determination the color of the ceramic with the color of natural teeth. Laboratory: 1- final burning and glazing 2- take out the cap from the crown :Clinical Final tasting and fixation. :*ceramic crowns layers 1-opak or basic layer 2- dentin layer 3- enamel layer 4- glazing layer * ceramic (porcelain) Is a ceramical natural protecting which is produced by burning. Components: 1-field spar without color 2- quartz –silicon dioxide 3-white clay 4- dye –metalo-tetanium oxide Classification (type): 1- ceramic for making without metal details (crown, inlay) 2- ceramic for fusing to metal part .
  • 18. 54- preparation of the teeth for jacket acrylic crowns.description of two known methods. Classical method: 1- proximal: distal_ mesial. 2- disc in direction of cervical area but stop at 0.5mm 3- creation of bevel on vestibular and oral surface 4-preparation of vestibular surface with wheel shaped bur 5- preparation of oral surface with cylindrical burs 6- preparation of occlusal surface 1.5-2mm. 7- the bevel in cervical area 8- eminence preparation Modern method: The same orders of surface preparation but using different forms of burs fixed in turbine – with high speed hand piece and cooling with air and water. 55- impression getting for jacket acryl crowns manufacturing. clinical –laboratory stages of jacket acrylic crowns manufacturing. Acryl and composites used for these type of crowns manufacturing. Impression getting : -with double layer (hard and liquid) -application of retracted cord elastic ( ypeen, cromex, alginate)-seliconic (optozil, z+, speedix) 2-1materials :- laboratory stages:-Clinical Clinical: 1-patient examination, diagnosis, plan of treatment . 2- anesthesia and take impression, determination. Laboratory: 1- making model, fixation in articulator 2- modeling wax reproduction, flasking 3- replacement wax by plastic 4- polymerization 5- taking out of the crown 6- processing and polishing Clinical : 1- tasting of the crown in the oral cavity Laboratory: Final processing and polishing :Clinical Final testing and fixation of the crown in oral cavity . isosit, vita k+b, luchipast, spectrolink.Composite material: Acryl material: etacryl, sinma 74, carbodent for temporal crown 56- method of temporary crowns manufacturing, used acryl. Temporal crown by scutan (material) 1- take impression before preparation 2- preparation of tooth under acryl crown (on ther crown) 3- plastic material material apply on impression 4- enterning the tray into oral cavity establishing 5- acryl (plastic) hardening and processing 6- fixation of temporal crown :Indirect method (by classical technique) 1-take impression 2- manuf' model from gypsum 3- wax reproduction 4- change into acryl 5-processing, grinding, polishing. 6- fixation. Direct method scutan 1- take impression before preparation
  • 19. 2- preparation and apply Vaseline 3- on impression that we took apply self curing (cold) acryl and application into oral cavity 4-polimerization take out and remove excessive material and polishing 5- trying (tasting)in oral cavity and fixation (scutan carbodent)Material for temporally crown 57- combined metal-ceramic crowns. Types. Indication and peculiarities of teeth preparation. ceramic part.-metallic part,2-1Combined m/c crowns consist of : : depend on alloy.Types Noble metallic part (Au, Pt, Ag, Pd)(degudent, degudent universal) Non-noble part :( Ni-Cr, Co-Cr) (wittalium, wiron) Semi-noble part :with small quantity of Au. Indication: 1- in frontal area. 2- Change in color, shape, form, volume, position. 3- fluorosis. 4- high volumetric crowns. 5- present of big filling material which can lead to crown fracture. 6- to restore contact points. 7- in tooth trauma. 8- as support element of BD, PRBD. 9- as elements of immobilization apparatus . 10- as support element of splinting. Peculiarities of tooth preparation : 1- deep preparation (metal part:0.3-0.4mm)(ceramic part: 0.8mm) 2- under anesthesia, turbine high speed preparation . 3- creation of edge (bevel, shoulder ,chamfer)(1-1.2mm) 4- before preparation apply retraction cord (for easy preparation) 5- the prepared tooth should be 2/3 of clinic crown. 6- on vestibular surface – edge will be under the gingiva on 0.5mm - on proximal surface – edge will be on the level of interdental papilla. -on oral surface – edge will be on the level of gingiva. 58- peculiarities of getting impression for ceramic crown manufacturing. Methods of gingival retraction, clinical-laboratory stages of metal- ceramic crowns manufacturing. . Stages of getting an anatomical impression:Getting impression first of all is needed to choose the tray of correct form and size 1- choice of impression tray. 2- preparation of impression material and it's imposing in an impression tray. 3- introduction of a tray in an oral cavity and registration of edges of an impression. 4- removing of the tray with the hardened impression from oral cavity. 5- analysis of an impression. It's disinfection and transfer to laboratory. gypsum, elastic(Ypeen, Cromax, Tropicalgin)–seThe material that we u Methods of gingival retraction: 1- chemical (cord): - application of retracted cord into gingival sulcus surround the tooth. -can be – impregnated (contain astringent ) – non-impregnated (dosen't contain chemicals). 2- surgical: - cut hypertrophied gingival by knife . 3- mechanical: pushing the tissue away from the tooth. laboratory stages-Clinical Clinical: 1-examination, diagnosis, plan of treatment. 2- anesthesia, preparation, taking impression. 3- determination and registration of central occlusion, protection of remained hard tooth tissues. Laboratory: 1- making model (with removal crown) 2- wax reproduction of metallic part 0.3-0.5mm+edges 3- replacement wax into cast crown 4- fixation on the model the cast part (metallic)
  • 20. Clinical : 1-testing in oral cavity the metallic part 2- choosing the color of the crown Laboratory: 1- mechanical cleaning, thermical cleaning (10 min) 2- application of layers (opak, dentin, enamel)and burning after opak layer and enamel layer. 3-testing on model , polishing,CO. final testing and checking if the color is ok.Clinical: glazing and burning.Laboratory: testing and fixation by cementum.Clinical: 59-cmbined metal-acrylic with cast metal portion. Indication, contraindication and peculiarities of teeth preparation. Indication: 1- tooth crown lesion in frontal area as premolars (especially at lesion of incisor edges and tooth angles when it's impossible to restore then with filling or lays). 2- changes in the color, form, shape, volume, position of the tooth 3- high volumetric tooth crown. 4- fluorosis. 5- at the present of great by volume, filling that can lead to breaking of the tooth crown . 6- necessary to restore intertooth contact points. 7- as support element of bridge, PRD orthopedic apparatus. 8-teeth trauma. 9- as element of immobilization apparatus . 10- at deformation of tooth crown when it is necessary to prepare thick layer of hard tooth tissues at a great vertical displacement of tooth. Contraindication: 1- small short crown 2- fragile teeth tissue. 3- healthy teeth if they are not supporting element in prosthetic treatment with bridge. 4- in subtotal and total tooth crown lesions degree of mobility.rdat 3-5 6- in the presence of pathological changes in tooth apex. 7- local pathological process (gingivitis, tumar) 8- on teeth whose roots are still at the stage of developing. Combine M/A crowns can be: - semi-physiognomic(half esthetic) - physiognomic (esthetic). M/A cast crown:Peculiarities of teeth preparation under 1- deep preparation – metal part (0.3-0.4mm) – acryl – (0.8mm) 2- under anesthesia, turbine high speed preparation. 3- creation of bevel width (1.0-1.2mm) 4- before preparation application of retracted cord 5- prepared teeth should be 2/3 clinic crown. 6- upper frontal teeth (prepared 1-1.3mm)and create the edge: -on vestibular surface – level of gingival margin -on proximal surface – level of interdental papilla -on oral surface – level of gingival margin. 60- combined metal-acrylic crowns with stamp metal portion by Belkin,SMFU(I.Postolachi) clinical-laboratory stages. By Belkin: 1- manufa' stamp crown and tasting in oral cavity 2- additional preparation of vestibular surface of tooth on 0.5-1mm for future acryl part 3- vestibular surface of stamp crown – create foramen by spherical bur. 4- inside of crown – introduce soft wax or thermoplastic material. 5- apply on support teeth. 6- remind material (wax exits through the foramen) 7- take impression from whole dental row with the crown on the tooth. 8- making a model (melting of wax, remove the crown, prepared tooth model.
  • 21. 9- enlargement of foramen 1.0-1.5mm and hatchings creation (swallow tail form) for acrylic retention 10- application of crown on model and modeling the vestibular surface by wax 11-flasking in horizontal position and replacement wax by acryl . 12- polymerization and taking out 13- polishing and processing . By Postolachi (SMFU): 1.5mm-prepared tooth with additional vestibular surface on 1–visitstin 1-1 2- manufa' of stamp crown and testing in oral cavity 3- take impression with a crown from whole dental row and making model 4- creation of trapesiform foramen – base direct to inside of crown for acryl retention. 5- application of isolated backer to avoid translucent of a metal 6- modeling from wax the vestibular part and transforming into acryl. postindication and contraindication to treatment of damage of dental crowns with post crowns (substitution construction). Type of-61 big fracture of-wide and total, subtotal damage of dental crown when the therapeutic treatment doesn't helpful. 2in-1Indication:teeth. dental crown (in trauma). 3- big pathological erasing, dental dysplasia erosion, chemical damage in all teeth of upper and lower jaws-restore color, form, volume, shape, on tooth. 6-as a support element of bridge and RD5-.4 short movable carved root.-deep localization of root in alveolar process2-1Contraindication: 3-periapical process, unfilled apex of the root 4- patient with deep occlusion or deep overlap according to material :-IImixed-supporting-restorationaccording to function-Classification of post crown: chnique: casingaccording to manufa' te-Vin two visit-in one visit-according to method of manufacturing:-IIcombin-l acryl/ceramil-meta- combined with ring ,inlay.-simpleAccording to form of post-soldering VI 62- types of preparation of prominent dental root portion for treatment with post teeth. 1- Richmond (ring, protective supraradicular layer-cap drical form from oral and vestibular surface.cylin-Preparation : -from oral surface remain 1.5-2mm of root above the gingiva 2- Iliana-Marcosean wire post, cast, inlay of cuboids form: part of root remove till the gingiva-Preparation: - creation of cavity for inlay, cuboids form 3-4mm straight walls and smooth bottom. 63- preparation and impression getting from root canal. Methods of impression getting. Preparation of root: -Vestibular surface prepared till the gingiva -oral surface prepared a little 1.5-2mm above the gingiva should be remain -proximal surface is gradually transformed enlargement at opening of the root canal :* -taking impression after preparation -taking impression after introducing of the post and protected layer the prepared tooth-post and cap*impression will be taken with -taking impression after fixation of post and cap into root from whole dental row -Preparation of root: from all surfaces remove till the gingiva -Enlargement and creation of the cavity for inlay of root -taking impression of the cavity with wax – direct method of manuf' of inlay. first of all apply wax in cavity then through the wax introduce post into the canal post a little should be hot. then we remove the post together with a wax. 64- post tooth by Ilina – Marcosean. Structure .indication ,clinical-laboratory stages. cast inlay excludes rotation movements tightly closes the canal transmits masticatory pressure-wire post2-1Component : 3- artificial crown(layer of acryl above the cap ) 4- protective lamina (cap, layer). laboratory stages:-Clinical 1- preparation of the root opening (till the gingiva) 2- creation of cavity for inlay 3- enlargement of root canal entrance 4- tasting the post into root canal 5- taking wax impression of cavity for inlay 6- push the wax (soft) into the cavity and root after that enter the wire post 7- casting of inlay
  • 22. 8- trying show the inlay adjacent to root with protective lamina (cap) above the inlay 9- take gypsum impression with a post inside of root – for modeling the crown 10- covering the vestibular part with acryl, polymerization (modeling from wax the vestibular part and replacement by acryl) as a support element of bridge and RD.-absence of crown part of tooth with strong root2-1Indication: 65- crown fixed on artificial core. Indication and clinical-laboratory stages of manufacturing. Crown which fixed on artificial core components: 1-post 2- artificial core 3- artificial crown *indication: 1- subtotal-total lesion of crown part and present of stong root 2- as support element of M/C,M/A bridge RD 3- in erasing teeth, dental dysplasia erosion 4- in big trauma of crown part laboratory stages:–*clinical :Clinical 1- preparation of root opening 2- enlargement of root canal 3- trying on the post 4- modeling from wax the artificial core and send to the lab Laboratory: 1- casting of core :Clinic 1- testing of post together with core 2- taking impression and send to lab Laboratory: 1- modeling from wax the artificial crown 2- replacement by acryl (polymerization )or for ceramic (burning) :Clinic -Final testing and fixation. 66- etiology of partial edentation. characteristic of etiological factors. Partial edentation- absence of 1-13, 15 teeth in 1 dental row. tiological factors:2 groups of e primary partial edentation:–group-1 -absence of dental germ -disorders in eruption (impacted tooth). *adentation can be: -hypodontia (absence of some teeth) -anodontia (complete edentation) during life):-secondary(acquired-group-2 -trauma -dental caries &it's complications -trauma of parodontium -inflammatory process -surgical intervention *other classification: disorders.CNS, endocrine ,GIT-general- bad hygiene ,periodontitis ,trauma ,surgical treatment ,infection).-local- 67-clinical picture of partial edentation.extraoral and intraoral symptoms. : depends on:External symptoms- -type of edentia and topography
  • 23. -time past after losing teeth and type of extraction -age of patient -type of occlusion -previous treatment(success or not) *more changeable part of the face is the inferior part. decrease of inferior part-During p.adentation: -face asymmetry -mandible become smaller pain in remain teeth ,soft tissue ,TMJ ,tongue-:*patient complains -mastication, esthetic and phonetic disorders -CNS & GIT disorders 68-caracteristic of defects of dental arches and of alveolar process. Defects of dental arch: 1)small defect(absence of 1-3 teeth) 2)medium defect(absence of 4-8 teeth) 3)large defect(absence of 9-…) *subtotal edentation : 1-5 teeth are present (treated with PRD) Classification of alveolar process: 1)narrow-till 3 mm. 2)middle- 4-5 mm. 3)wide- more than 6 mm. 69-classification of partial edentation by Kennedy and Kennedy Applegate .practical importance. Kennedy: erminal defects of dental row.bilateral tclass:st1 unilateral terminal defect of dental row.class:ed2 unilateral limit defect of dental row.class:rd3 defect of frontal teeth.class:th4 classes have subclassesrd,3ed,2st1 class DOESN'T have subclass.th4 Applegate:-Kennedy Presence of 2 classes or more(class 5 & 6). : is like class 3 but limit absence of lateral and frontal teeth too (1 or 2)shouldn't be in the middle.Class 5 unilateral limit defect, limited just by posterior teeth.Class 6: :Importance risk ofclass is the most grave or severe state of patient .other classes (2,3,4) become more easy. the severity may increase thest1 complications: -TMJ disorders -mastication insufficiency -teeth migration *In combine defects we use the SMALLER CLASS .ex: class.rdclass,we choose the 3thand the 4rdIf we have the 3 70-sequence of subjective and extra-oral examination of the patients with partial edentation. Complains. Clinical examination: -subjective. -objective. Subjective examination: 1)complains. 2)anamnesis morbi (history of diseases). 3)anamnesis vita(where does the patient live,…). Complains: -pain -alveolar hyperesthesia(pain in mucosa, bone after extraction). -functional disorders(esthetic ,mastication ,phonetic ,during swallowing/ deglutition). -general disorders (respiratory ,CNS,GIT). -very big adentation all stoma .System. oral.-extra-Objective examination: -intra-oral.(question # 71) oral examination:-Extra 1)symmetry of the face. 2)color of the skin and lips. 3)3 parts of the face and limits. 4)some pathological formation. part),we pay attention to:rd*when we exam the inferior part of the face(3 -asymmetry
  • 24. -muscles -TMJ (intra and extra oral) -lymph nodes. 71-intra-oral examination of the patient with partial edentation . diagnosis .examples. oral examination:-Intra 1)color of the lips and vestibular mucosa, If present pathological formation 2)exam every tooth separately: -color ,volume ,shape ,position ,mobility. -if present obturation ,quality &age of obturation & relation with neighboring teeth. -if bridge denture ,quality of the BR. )exam the form of dental arch:3 -lower =parable -upper =semi ellipse :)type of occlusion4 -physiological -pathological 5)curves: -transversal Monson-Vilson -sagital Spee sign of central occlusion:6) -dental -TMJ -muscle -deglutition(swallowing). Dental sign: -form of arch -for all teeth:-central line -antagonist :every tooth has 2 antagonists ,except: last molar(3)&lower central incisor. -for frontal teeth: central line.& cover for 1/3 -for lateral teeth: cusps &key of occlusion :mesio-vestibular cusp. *if the patient hasn't molars ,use canine for correlation. Example for diagnosis: subclass by Kennedy on the lower jaw with masticationstclass 1rdsubclass by Kennedy on upper jaw,3stclass 1edPartial secondary adentia 2 insufficiency 50% by Agapov ,with esthetic &phonetic disorders. 72-Notion"Bridge Denture".components,characteristic of Fix Bridge Denture and Removable Bridge Denture. is an apparatus (engineered structure)for restoring the partial defect of stoma . System.Bridge Denture: Components: 1)support elements(teeth)-retention. 2)pontic. Fix BD: -fixed by cement on support elements -transmit pressure on all dental arch &paradontium by way of support elements. -indicated in small defects (1-3 teeth)or in lower 4 incisors. -restore the integrity of dental row & functions -it has to pass the middle line -indicated in many included defects. ort elements by:fixed on suppRemovable BD: 1)clasp system 2)system inlay? 3)post system 4)telescopic system *saddle form of pontic element-good for transmitting masticatory pressure. *hygiene-patient can remove and clean it. 73-characteristic of Bridge Denture Pontic. classifications according to used materials and relationships with alveolar process. According to used materials, Pontic can be: 1)metal (noble,non-noble) 2)non-metallic (acryl,ceramic) 3)mixed (m/a , m/c) Correlation of pontic to alveolar process: 1)saddle (non-hygienic ,can't be cleaned) 2)half saddle 3)cadge lap type (?) 4)ballet
  • 25. 5)hygienic(has a space ,easy to clean it)*the space in lower jaw till 2mm. *the space in upper jaw till 1mm. 74-classification of Bridge Denture by Kopeikin,according to the relationships of the pontic with alveolar process, according to construction. According to esthetic aspect: 1)non-esthetic 2)half esthetic 3)esthetic According to types of fixation: 1)fixed 2)removable(support teeth-clasps) 3)semi-removable 4)demountable(fixation with post, one is fixed and the other is not) According to technique: 1)soldering BD 2)casting BD 3)polymerization (acryl) 4)burning (ceramic) 5)mixed Construction: 1)soldering BD 2)casting BD 3)console BD 4)acrylic BD 5)ceramic BD 6)m/a m/c BD 7)demountable BD 8)adhesive BD According to number of support teeth: 1)1mesial 1distal 2)2mesial 1distal 3)1mesial 2distal Support elements can be: 1)inlay 2)crowns(partial, equatorial ,full) 3)clasps 4)telescopic crowns. 75-Indications and Contra-indications for treatment of Partial edentation with Bridge Denture. Indications: 1)partial edentation not more than 3-4 absent teeth. 2)when there is present condition to create parallelism between support teeth (during preparation). 3)in multiple included defects. Indications depend on: -size & topography of tooth row defect -functional value of remained teeth -conditions of teeth antagonist -patient age, sex ,.. indications:-Contra Absolute:- a)more than 4 absent teeth degree of teeth mobilityrdb)3 Relative:- a)young patient(age till 18) b)not treated process in apical area of support teeth c)MI (in acute form) d)allergy to some components e)gingivitis f)general diseases 76-biofunctional, biochemical and prophylactic principles of partial edentation treatment with bridge denture. Biochemical principle: Study of forces and movements of mandible, how these forces act on bridge denture.Because bridge denture becomes part of stoma. System which transmit the functional forces on biological tissue (periodontium ,mucosa ,bone tissue) and these biological tissues react depend on volume, duration& direction of these forces. Prophylactic principle:
  • 26. Restore the integrity of dental row, normal contacts with antagonists & neighbor teeth & avoid the deformation, functional overload of periodontium. 77-Bridge Denture biomechanics .Characteristic of forces that act on the bridge denture pontic. during mastication are in different plates. On BD act. The movements of mandiblectionlike constru-BD with partial support elements is a bar many forces like: -force of pressure -extension -horizontal forces Pressure forces act vertical and depend on BD can be compensative for parodontium of support teeth. Pressure act on ponticpontic transmit to support teeth->support teeth to periodontium. Pressure that act on the center of ponticswill be spread equally to support elements. If the food will be near one of the support elements(not in the middle) the pressure will be more on that support element. If the food is on one of support elements,the all pressure will go just to this support element. *under vertical pressure on periodontium: -the inner fibers are constricted -the outer fibers are dilated 78-Including support teeth into Bridge Denture according to reserve forces of paradontium.Odontoparodontogramm. Sum of teeth efficiency, which were include in pontics should be equal or less than sum of support teeth coefficient, in normal use just 50% ,rest is a reserve. But this math method doesn't include the state of parodontium. degree=> require increase thestDisorders of parodontium, elongation of clinical crown, atrophy of dental alveola and pathological mobility 1 number of support element (include the neighbor teeth in BD as additional support element). For example: Absence of tooth number 25 which is = 1.75(in the odontoparadontogramm),and the efficient of neighboring teeth (24 & 26) is: 24=1.75 & 26=3.0 together (1.75+3.0=4.75) The sum of efficient of resistant teeth antagonists = 1.75+1.75+3.0=6.5 And we need just 50% so it is 3.25 . 79-peculiarities of support teeth preparation for treatment of partial edentation with bridge denture? It’s depends on which kinds of incrustation we will choose as a support elements ,its can be: Inlay, crown(partial ,equatorial ,full),clasps ,and telescopic crown. And the technique (solder bridge ,cast bridge) we prepare the teeth as under the artificial crown. If it’s for soldering bridge-we prepare 0.3-0.4mm from the tooth without creation of bevel. If it’s for casting bridge-deeper preparation till 0.5mm and with or without bevel creation… Methods of preparation: it can be by classical and modern methods. 80-one stage impression getting with 1 or 2 impression materials in case of bridge denture manufacturing. complications and their prevention? Impression materials in one stage id for soldering bridge denture ,the materials that we use: Gypsum ,algenat and silicon .elastic materials can be like :cromax,tropicalgin,algenate. If we choose un-correct impression materials or un-correct technique of taking impression can be complication: -mobility of bridge denture, rotation. -over-occlusion or hypo-occlusion -broken bridge denture (because of pressure) -periodontal disease(gingivitis, pockets) -absence of contact points. Prevention: -choose correct impression materials. -choose correct technique of application. -if it’s needed: retracted cord for more clear impression image. 81-three variants of impression receiving in two stages, impression in occlusion ,used for treatments of partial edentia with bridge denture. impression materials? Variant 1: First stage before preparation Second stage after preparation Variant 2: Double silicone impression: First layer –hard Second layer-liquid (base+ catalist)+retracted cord. materials that we use(zeta plus, micronlight, speedex) Variant 3: First stage-application termoplastic materials into ring and apply on prepared tooth Second stage-taking impression form whole dental row. with copper ring, that was applied before Termo-plastic materials (orthocor and dentafole)used for acrylic and temporary denture. *impression in occlusion: takes in central occlusion from both dental rows simultaneously..
  • 27. Material that can be used: -polymer materials(termo-plastic and elastic materials). -wax. -ZOE paste. 82-characteristic of three clinical situations in case of definitions and fixations of centric occlusion or centric relation of jaws for treatment of partial edentia with bridge dentures? Different clinical situations depends on presence of central occlusion (maximal interdental contacts between upper and lower jaw).we have 4 signs: dental, TMJ, muscles and delutation. First clinical situation: Without any devices can put the model in central occlusion, dental rows in such position-not less than 4 pairs teeth antagonists put model in central occlusion without special devices+ high of occlusion(distance between the present teeth). Second clinical situation: -presence signs of central occlusion(4signs) -but high of occlusion(stable and instable) -ask the patient, close the mouth and use special device for special wax occlusal rims will be stable. Third clinical situation: -haven’t signs of occlusion. -haven’t high of occlusion. -using of occlusal rims and registers. Fourth clinical situation: For total edentation. 83-methods of definition of central occlusion height. characteristic? 1-anatomical (not use)not clear determinations 2-antropo-metrical. 3-anatomo-phsiological. 4-functional-cntraction of the muscles during closure of the mouth. *Anatomo-phsiological method: Require usage of occlusal rims,during the life no changes in vertical high of rest physiological position of mandible. in rest physiological position of mandible there is free space between maxilla and mandible (2-4mm) -patient should speak -after finishing of speaking –the mandible will stop in position of physiological rest. -with help of spatula is measured and fixed distance between lower edge of mandible (chin) and edge of anterior nasal ostium. -introduce occlusal rims into the oral cavity and determined the vertical high of occlusion. This vertical high of occlusion should be less than (2-3mm)then previous vertical length of physiological rest position of mandible .if it’s less it’s correct position -after that we should remove from occlusal rim(lower)2-3mm. *antropo-metrical method: The distance from lower edge of the mandible (chin) till anterior nasal ostium should be equal to distance from line of lips till line of inter-pupil. 84-methods of definition of neutral position of mandible for determination of central occlusion.methods by abjean and korbendau? 1-kontorovich method: Press on the chin of the patient during closure of the mouth. this method is rare, because it’s possible to determine the mandible distally from central occlusion.(disadvantage) 2-incline (dislocate) the head and simultaneous close the mouth, due to this method, the suprahyoid group of muscles dislocate the mandible posterior and determine in central occlusion. 3-test of swallowing act: patient will swallow saliva and close the mouth. in this moment the mandible relate to maxilla in central occlusion. 4-betelman method: Index finger ( 2fingers) of the doctor apply on occlusal surfaces of lateral lower teeth, one bigger finger are on the chin of patient, patient should close the jaws and bite the fingers of the doctor. during closure, the fingers go away in oris vestibule, by pressing on the chin with the bigger finger the mandible determined in central occlusion. 85-methods of definitions of central jwas relationships in case of instable occlusion. *interrelation between models making with help of: 1-gypsum,termoplastic,elastic blocks. 2-wax basis with occlusal rims. If present at least one inter-dental occlusal contact ,the high of occlusion doesn’t determine. Occlusion is fixed with the help of hot materials and cold materials. Hot materials: On upper occlusal rims make hotches,lower occlusal rims is desolved (make soft),this method requires the control of vertical length of occlusion. Cold materials: On upper occlusal rims make hotches.on lower occlusal rims apply the soft strip ofwax.
  • 28. Methods: -helps with wax basis+occlusal rims. -helps with gypsum monoblock -helps with pantomographic registration 86-sequences of definition and registration of central jaws relationships in case of absence of occlusion. testing wax occlusal rims on the upper jaws and definition of occlusal plane? 1-adaptation of wax basis with occlusion rims. 2-determination of high of 3 frour of face. 3-determination and fixation of central interrelationships between the jaws. -introduce upper occlusal rims-to work. -introduce lower occlusal rims. -Measured distance-should be less than (2mm),it’s correct position. Remove (2mm)from the lower occlusal rims. -Add wax for blocking between them. 87-soldering dridge denture.chracteristic.indications.clinical-laboratory stages of soldering bridge dentures manufacturing? Soldering bridge denture is a denture or dental restoration made from 2 parts(stamp crown and cast pontic)connected together by soldering. and used to replace missing teeth by joining permanently on support teeth or dental implants. *Indications: Indications for soldering bridge denture are the same as for bridge in general,but this type of denture more often is used in lateral area because of its un-esthetical properties. *clinical-laboratory stages of soldering bridge denture manufacturing: Clinical: Examination of the patient, putting diagnosis ,plan of treatment, anesthesia if it’s necessary ,preparation of hard tooth tissue under stamp crown, by classical or modern methods, determination and registration of central occlusion ,taking impression ,protection of tooth by covering with protective laqure or temporary crown. *laboratory: Manufacturing of gypsum model ,and fix it in articulator. Stamp crown manufacturing. *clinical: Testing stamp crown in the oral cavity, and taking impression with stamp crown fixed on the support teeth. *laboratory: Pontic manufacturing and soldering stamp crown together with the pontic. *clinical: Testing bridge denture on the model, and after this on the oral cavity. Laboratory: Final processing (polishing and finishing of the bridge) *clinical: Final testing and fixing of the soldering bridge denture on the oral cavity .and advice to the patient. 88-cast bridge denture.characteristic.indications.clinical-laboratory stages of cast bridge denture manufacturing? Cast bridge denture have some advantage over the soldering bridge denture ,the absence of soldering gives to cast bridge denture skeleton ,higher durability ,and the possibility of exact modeling the occlusal surfaces of support crown and pontic making them more affective in functional relation. *indication: -this type of denture are used in every clinical situations in case of partial edentation situated in lateral area of dental arches when we have clinical technical conditions for creation parallelism between support teeth fixation and stabilization of the construction of the bridge. *clinical-laboratory stages of cast bridge denture manufacturing: Clinical: Examination of the patient, putting diagnosis, plan of treatment ,anesthesia if it’s necessary ,preparation of hard tooth tissue under cast crown, by classical and modern methods ,determination and registration of central occlusion ,taking impression ,protection of tooth by covering with protective laque or temporary crown. *laboratory: Manufacturing gypsum model and fixing in the articulator. Cast denture manufacturing. *clinical: Testing cast denture in the oral cavity ,and taking impression with the cast crown fixed on the support teeth. *laboratory: Grinding of the cast bridge and testing it on the model. *clinical: Testing bridge denture in the oral cavity. *laboratory: Final processing(polishing and finishing of the bridge denture. *clinically: Final testing and fixing the cast bridge denture on the oral cavity. and advices to the patients.
  • 29. 89-metal-ceramic bridge denture.characteristic.types.indications.clinical-laboratory stages of metal-ceramic bridge manufacturing? *clinical-laboratory stages of metal-ceramic bridge manufacturing: Clinical: Examination of the patient ,putting diagnosis ,plan of treatment ,anesthesia if it’s necessary,preparation of hard tooth tissue under m/c bridge denture, taking double impression ,determination and registration of central occlusion, protection of prepared teeth by protection laque or temporary crown. Laboratory: Making gypsum model, fixing the model in the articulator, modeling from wax the metallic part, casting of metallic part, mechanical processing and testing on the model. Clinical: Testing in the oral cavity. Choosing the color of the future bridge. Laboratory: Mechanical cleaning, processing, thermical cleaning (960) Applications of opak layer (0.2-0.3mm)+burning. Apply dentine +enamel layer+ burning. Testing the model ,polishing ,central occlusion. Clinical: Final testing and, comparison the color with the other teeth. Laboratory: Glazing of the bridge and burning. Clinical: Testing and fixation of the bridge. *indications: -In all area of dental raw(especially in frontal area). -partial adentation not more than 3-4 absence neighboring teeth. -when present condition to create parallelism between support teeth. -in multiple include defect -when present allergy to acryl masses. *the ceramic part can be covered: -all surfaces(vestibular and oral)esthetic -vestibular and half of oral surface. -just vestibular(without oral) *metal part: -noble(AU+PT) -non-noble(ni-cr,co-cr) -semi-noble(AG-PD) 90-metal acryl bridge denture with cast metal skeleton.characteristic.types.indications.clinical laboratory stages of metal acryl bridge denture manufacturing? *Clinical-laboratory stages: Clinical: Examination of the patient, putting diagnosis, plan of treatment, anesthesia if it’s necessary, preparation of hard tooth tissue ,taking impression from both dental arches to occlusal impression .determination and registration of central occlusion, protection of prepared teeth by protective laque. Laboratory: Making gypsum model. Fixation of the model in articulator in central occlusion. Modeling from wax the metallic part with retention elements-notches. Casting of the metal part. Testing the metal part on the model. Clinical: Testing the metal part in the oral cavity. Choosing of the color. Laboratory: Modeling from wax the acrylic part. Replacement to acryl.(polymerization +flasking). Polishing and finishing. Testing on the model in central occlusion. Clinical: Testing in oral cavity in central occlusion and movement of the mandible and fixation. *indication: 1-in all areas of dental rows(specially in frontal area) 2-partial adentation not more than 3-4 absence neighboring teeth. 3-when present condition to create parallelism between support teeth.
  • 30. 4-in multiple include defects. 91-half esthetic metal fused ceramic bridge denture.indications.hypothese of connections of ceramics with metal alloys? Half esthetic metal fused ceramic bridge denture when the ceramic part is covered: 1-vestibular surface and half of oral surface. 2-vestibular surface only(without oral surface) *indications: 1-in case of deep occlusion. 2-in case of pathological abrasion. 3-in neurological problems of muscles constriction-can cause fracture of the ceramic part. *theory (hypotheses)of connections of ceramic with metal alloys: 1-the coefficient of metal and ceramic nearly. 2-theory of chemical reactions-between ceramic and metal is formed connective acid ,which form the strong transitional layer. 3-leakage of ceramic into microspores of metallic surfaces (forces of adhesion). 92_acryle bridge denture . indications. Advantages and disadvantages . particularities of support teeth preparation. Indications: 1-partial adentia in frontal area not more than 1~2 absence neigh..teeth. 2-fluorosis. 3-as a temporal BD. 4-in teeth with healthy periodontium. 5-restablish the functions : mastication and masticatory pressure and efficiency on 85~100%. 6-restablish esthetic aspect. Contraindications; Absolute: 1-in small support teeth. 2-in fragile support teeth. 3-in lateral area. 4-in deep occlusion. 5-in erosing pathology. 6-3ed degree of mobility. Relative: 1-in young patients . 2-in periapical area non treated process. 3-in gingivitis . 4-in general disorder. Advantages: 1-reestablishing of functions (masticatory insufficiency),(articulations of phonation). 2-esthetic aspect. 3-simple technique of manufacturing. 4-cheeper. 5-can be prepared without laboratory(directly). Disadvantages: 1- deep preparation of support elements. 2- fast erasing. 3- extension in oral cavity (high coefficient of thermal extension). 4- changes in color. 5- irritating of marginal periodontium + mucosa . 6- allergic reaction. Particularities of support teeth preparation acryl BD. the bevel should be to marginal gingival 90 degree or less. classical and modern method. Clinical-laboratory stages of acryl BD manufacturing . Clinical: 1- examination of the patient + diagnosis + plan of treatment . 2- anesthesia + preparation of support elements . 3- take impression (double material) + antagonists and determine co + registration. 4- choosing the color . Laboratory: 1- making models + gypsum in occludator in co .
  • 31. 2- modeling the wax ,reproduction of BD . 3- flasking, polymerization , get out from queveta. 4- processing, polishing. 5- tasting on model. Clinical: 1- tasting in oral cavity , check the relationship between jaws. Laboratory: 1- polishing . clinical: 1- final testing + fixation. 93- ceramic BD .indications .particularities of support teeth preparation . clinical laboratory stages of ceramic DB manufacturing . Clinical : 1- examination of the patient + diagnosis + plan of treatment . 2- anesthesia + preparation of support teeth . 3- take impression (double material) + antagonist impression and determination of co + registration . 4- protection of teeth + choosing the color . Laboratory: 1- making models with removable abutments from super-gypsum . 2- gypsing in occludator 3- making platinum cylinders on abutments and covering by ceramic layers + burning. 4- between 2 abutments apply a bar (for supporting) from ceramic (vitadign). 5- stick the bar by wax with abutments and burning . 6- cover by ceramic layers the bar (dentin, enamel)+ burning. Clinical: 1- testing in oral cavity . Laboratory: 1- glazing+ 3burning. Clinical: 1- Final testing and fixation . Particularities of support teeth preparation : 1- the length of prepared teeth should 2/3 from the clinical crown. 2- slightly conical form. types of bevel : - Chamfer - shoulder - knife - concave - long/ short . Indications: 1- partial edentation in frontal area not more than 1~2 absence neigh….teeth. 2- reestablish the functional and esthetic aspects. 3- fluorosis. 4- after extraction …to avoid deformation of dental row. 94-Console BD . indications . biomechanics . advantages and disadvantages. Has support elements and pontic as normal but this support elements area situated only on the 1 side of the pontic (or distal or medial). More often this type of BD indicated when u have absence of 1 tooth in frontal area . + support teeth should have healthy parodontium. Depending on situation , position of pontic the patient can have console BD with distal situation of pontic or medial situation of pontic. Advantages: 1- restoration of dental row integrity and functions : mastication, esthetic ,phonetic... etc. Disadvantages : 1- in some cases ~prepare healthy teeth (as support element). 2- overloading of support teeth . Indications: 1- if absent lateral incisor use as support elements canine and 1 premolar . 2- if absent of 2 premolars use as support elements 1 and 2 molars . 3- if absent central incisor use as support elements lateral incisor and canine and put occlusal rest on neighbor central incisor in oral surface. Contraindications : In absence of canine don’t use console BD.
  • 32. -clinical & laboratory stages depend on type of BD (cast , solder). Preparation of support elements ~ depend on type of BD (cast, solder, plastic…). 95-clinical laboratory stages of removable BD fixed on support teeth with clasps manufacturing . Clinical: 1- examination of the patient + diagnosis + plan of treatment . 2- taking impression +determination and registration of co. Laboratory: 1- making model +gypsing in occludator. 2- application of clasps on the model (modeling of clasp from wax). 3- modeling the pontics from wax + replacement of cast. 4- processing, polishing. 5- trains on the model. Clinical: Tasting in oral cavity , if good or not send to laboratory correction. Advantages of removable BD: 1- can be removed and cleaned not in oral cavity. 2- the pontic has saddle form ? help to receive it self ,masticatory pressure and to transmit to support elements (or transmit little). 96-Demountable BD and Adhesive (with physical - chemical fixing) bridge dentures .characteristic. indications. Clinical ~laboratory stages of adhesive bridge denture manufacturing. Demountable BD is fixed to support teeth by screwing system or pontics fixed to support elements by screwing . Screw not should be placed extern or intern of crown near the defect . After tasting screwing system making pontics. Adhesive BD: Support elements are fixed on support teeth by adhesive materials .for avoiding preparation of tooth .the fixing elements are invisible , that’s why this BD is esthetic . Indication: 1- small including defects . 2- in non deep incisors overlapping . 3- in high crowns (with caries and have healthy periodontium). 97-testing of BD . parameters of occlusal balance and technique of its realization. Fixing bridge denture .indicate cements . 1- testing on the model , Remove BD and see insertion (direction of apply),in the BD site very tightly , patient feels discomfort ,disorders in parallelism of support elements , if present defect in solder parts (dislocation of crowns). 2- test the margin of crown. 3- contact points between neighboring teeth and antagonist . 4- correlation between pontics and alveolar bone . on lower jaw till 0.5 mm (hygienic space). on upper jaw can be long and short (esthetic) 5- exam, the occlusal surface (dynamic and CO. ). If present some disorders . the BD sends to laboratory , if not , fixing by temporary materials (dentin paste)and after couple days /weeks ,if the bridge sits good , replace the temporary materials to permanent cements : - glass- ionomer cement . - Zn phosphate cement.. - Poly-carboxylate cement . - fuji. - 98-final preparation and fixation of bridge denture . - when pontic was testing the BD can be small un-clearance like small points ,that disturbe to occlusion (CO). - the doctor checks the points with spural paper and remove this points with burs - if patient feels small discomfort ,the BD will be fixed by temporary filling material (dentin paste) couple of days /weeks after will be replaced by permanent material: - glass ionomer material. - Zn phosphate cement . - Poly-carboxilate . - fuji. - The DOCTOR apply the cement on support elements (if its crown inside of crown ) . and after applies on dental row + checking of co. - 99-enumerate possible mistakes during and after fixation of bridge denture .preventive steps. 1- absence of contact points with neighboring and antagonists teeth.
  • 33. 2- irritation of the mucosa because un-correct choosing of pointic type. 3- presence of contact points before the time (just in 1 side of dental row on side of BD). 4- permanent pain (pulpitis ) discomfort . 5- if introduce and fixed very deep ~local marginal periodontitis . 6- creation of pockets . 7- dissemination . 8- un-correct form of clasps lead to biting of buccal mucosa. 9- Un-correct choosing of color non esthetic BD. Preventive steps (in clinical and laboratory): 1- choose correct pontic type . 2- good impressions (not just tooth , also alveolar and palatine bone ). 3- creation of parallelism during preparation. 4- during testing and fixing of BD ~ check if the surround mucosa is not pale . 5- in lab ~making correct form of casps. 6- choosing of correct color. 100-methods and technique of removing fixed BD . tools . complications. Preventive steps. 1- with separative disc or burs to cut the crown of support teeth .from cervical ~to occlusal surface 2- after, with spatula or technician scalpel separate the crowns from the teeth. 3- with special instrument~ crown _removing of kop remove the crown . COMPLICATIONS: 1- with burs ,separating disc can damage the hard & soft tissues. 2- irritation of pulp if its not extirpated . destruction of support elements (tooth) problem for future support elements BD