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Module: Prosthodontics




Faculty Teaching Guide for Dental Materials



Module - Prosthodontics




                    ...
Faculty Teaching Guide for Dental Materials




Faculty Teaching Guide for Dental Materials

Module: Prosthodontics
Review...
Module: Prosthodontics



Materials and Procedures for Today’s Dental Assistant, by Ellen Dietz, Delmar Learning, 2004. IS...
Faculty Teaching Guide for Dental Materials



Knowledge                                                                  ...
Module: Prosthodontics




Part A: Types of Fixed Prosthetics
Overview
This part examines the various permanent fixed pros...
Faculty Teaching Guide for Dental Materials




[Insert In-Class Act icon]   In-Class Activities
   Porcelain Veneer Set ...
Module: Prosthodontics




          DM – Stands for Dental              Module: Prosthodontics

          Materials. The ...
Faculty Teaching Guide for Dental Materials




                                                  towards making an inform...
Module: Prosthodontics




                                  Explain that the tooth being replaced is called a pontic,

  ...
Faculty Teaching Guide for Dental Materials




                                                   Explain that core build...
Module: Prosthodontics




Slide 12   [Insert DM 3-12]    The Dental Laboratory

                               Explain th...
Faculty Teaching Guide for Dental Materials




Part B: Fixed Prosthesis Procedures
Overview
Chairside procedures preparin...
Module: Prosthodontics




[Insert In-Class Act icon]   In-Class Activities
   Crown Preparation (Part B, Objectives 2-5)...
Faculty Teaching Guide for Dental Materials



        end of Chapter ____ (Phinney & Halstead).




Ideas for learners st...
Module: Prosthodontics




                               existing dentition as closely as possible.

                    ...
Faculty Teaching Guide for Dental Materials




                                                   the patient’s mouth whi...
Module: Prosthodontics




                                ensure it fits properly and that the occlusion is accurate. It
...
Faculty Teaching Guide for Dental Materials




Section 2: Removable Prosthodontics
Section Overview
Removable prosthodont...
Module: Prosthodontics




Learning Activities
These learning activities directly address the Learning Objectives and Comp...
Faculty Teaching Guide for Dental Materials




Part A: Removable Partial Dentures
Overview
A removable partial denture re...
Module: Prosthodontics




[Insert In-Class Act icon]   In-Class Activities
   Partial Denture Final Impressions (Part A,...
Faculty Teaching Guide for Dental Materials



    Use Homework Wisely. Encourage learners to focus on their homework as ...
Module: Prosthodontics



                            prosthesis.

                            Explain that these preparat...
Faculty Teaching Guide for Dental Materials



                                                   Describe how the connect...
Module: Prosthodontics



                                                   Ensure learners understand that an accurate f...
Faculty Teaching Guide for Dental Materials




Initial Questions and Activities
     1. Why would extracting teeth and re...
Module: Prosthodontics



    steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain c...
Faculty Teaching Guide for Dental Materials




     Ideas for learners who are ahead and want to learn more…
    Web Res...
Module: Prosthodontics




                            must help hold it in place, during mastication as well as

        ...
Faculty Teaching Guide for Dental Materials




Slide       [Insert DM 3-37]                       Final Impressions

37  ...
Module: Prosthodontics



                            they look, and how well they will function, before they are

       ...
Faculty Teaching Guide for Dental Materials




                                                   must be kept moist to a...
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  1. 1. Module: Prosthodontics Faculty Teaching Guide for Dental Materials Module - Prosthodontics -1- 1
  2. 2. Faculty Teaching Guide for Dental Materials Faculty Teaching Guide for Dental Materials Module: Prosthodontics Review of Previous Module Review topics from the previous module to confirm understanding prior to presenting new material. Module Overview Prosthodontics is the specialty concerned with replacement of teeth and missing or deformed oral structures. The accuracy of crowns, inlays, bridges, or dentures, and therefore the dental health of the patient, depends on the physical properties of the materials involved. The success of these prosthesis also rests with dental personnel who manipulate the materials and equipment during the process of creating the prosthesis. Dental laboratory technicians are partners with dental office personnel in the endeavor for maximum service for the patient. Strict attention to detail, and knowledge of materials used, are essential for dental assistants in order to aid in this process of fabricating oral structures. The Big Picture Faculty Teaching Guide for Dental Materials Module: Prosthodontics Section 1: Section 2: Fixed Removable Prosthodontics Prosthodontics Part A: Types of Fixed Part A: Removable Prosthetics Partial Dentures Part B: Fixed Part B: Removable Prostheses Procedures Complete Dentures Resources This module utilizes the following learner resources: Textbooks: Dental Assisting, A Comprehensive Approach, 2nd edition, by Donna J. Phinney and Judy Halstead. Delmar Learning, 2004. ISBN 1-4018-3480-9. 2
  3. 3. Module: Prosthodontics Materials and Procedures for Today’s Dental Assistant, by Ellen Dietz, Delmar Learning, 2004. ISBN 1-4018-3733-6. Workbook: Workbook to Accompany Dental Assisting, A Comprehensive Approach, 2nd edition, by Donna J. Phinney and Judy Halstead, prepared by Karen L. Waide, Delmar Learning, 2004. ISBN 1-4018-3483-3. Instructor’s Manual: Instructor’s Manual to Accompany Delmar’s Dental Assisting, A Comprehensive Approach, 2nd edition, by Donna J. Phinney and Judy Halstead. Delmar Learning, 2004. ISBN 1-4018-3482-5. Electronic CD-ROM: Delmar’s Dental Assisting Interactive Skills and Procedures CD-ROM, ISBN 1-4018-3485- X. Faculty CD-ROM: The faculty CD-ROM includes this Faculty Guide the PowerPoint Presentation for Dental Materials. Additional Resources Safety Standards and Infection Control for Dental Assistants, by Ellen Dietz. Delmar Learning, 2002. ISBN 0-7668-2659-7. Electronic Classroom Manager to Accompany Delamr’s Dental Assisting, A Comprehensive Approach, 2nd edition, by Donna J. Phinney and Judy Halstead. Delmar Learning, 2004. ISBN: 1-4018-3484-1. Section 1: Fixed Prosthodontics Section Overview A fixed prosthesis is cemented permanently in place in the patient’s mouth, and if cared for properly by the patient, is designed to last a lifetime. It is a restoration that replaces missing tooth structure, improves mastication, prevents drifting of teeth, and promotes better oral health. The dental assistant’s meticulous responsibilities at each phase of the procedure contribute to the success of the final product. There are many steps involved and each one is vital to the ideal end result. Outline of Section 1 Part A: Types of Fixed Prosthetics Part B: Fixed Prostheses Procedures Learning Objectives and Competencies These learning activities directly address the Learning Objectives and competencies as stated. -3- 3
  4. 4. Faculty Teaching Guide for Dental Materials Knowledge Teaching Tip 1. Define the Key Terms. Be sure to explain each learning objective and Comprehension demonstrate how obtaining this learning 2. Describe various types of fixed prostheses and their functions. will increase their success in the 3. Describe dental material used in fixed prostheses. workplace. Spend time on learning objectives 4. Explain the role of the dental assistant in fixed prosthodontic treatment. before diving into the content. Application 5. Demonstrate the knowledge and ability to assist during a crown preparation appointment. 6. Demonstrate the knowledge and ability to assist during a crown cementation appointment. Learning Activities These learning activities directly address the Learning Objectives and Competencies as stated. [Insert Homework Assignment icon] Key Term Glossary (Part A, All Objectives) [Insert In-Class Activity icon] Porcelain Veneer Set Up (Part A, Objectives 2-5) [Insert Homework Assignment icon] Textbook Assignment (Part A, All Objectives) [Insert In-Class Activity icon] Crown Preparation (Part B, Objectives 2-5) [Insert In-Class Activity icon] Crown Cementation (Part B, Objectives 2-4, and 6) [Insert Homework Assignment icon] Interactive Skills and Procedures CD-ROM (Part B, Objective 5-6) [Insert Homework Assignment icon] Workbook Assignment (Part B, All Objectives) [Insert Homework Assignment icon] End of Chapter Activities (Part B, All Objectives) 4
  5. 5. Module: Prosthodontics Part A: Types of Fixed Prosthetics Overview This part examines the various permanent fixed prostheses and materials used to restore missing tooth structure. Each requires a certain amount of tooth reduction by the dentist, and is an investment for the patient in their oral health. They are designed to provide maximum chewing efficiency and a lifetime of service. These restorations are prepared outside of the patient’s mouth, in a dental lab, and therefore are called indirect prosthetics. Dental assistants need to understand the various types of fixed prostheses and how they are fabricated, in order to support the dentist, as well as to be able to educate the patient regarding choices to improve the patient’s dentition. The Adult Learner…. has strong feelings Initial Questions and Activities about his/her 1. Is there anyone here who has a permanent crown or bridge? If not, what do you educational experiences. think a patient might experience if they were to have a permanent crown or Remember to provide him/ with the best bridge? experience possible. You might have to overcome previous There will be various answers depending on learners’ experiences. bad experiences. Ask what they remember about having impressions done and wearing a temporary restoration while the permanent prosthesis was being made. Remind learners that relating to the patient’s experience will help them be more caring dental assistants. Key Concepts References and Activities Slides Introduction to Module Slides 1-2 Introduction to Section 1 Slides 3-4 Key Terms [Insert Home Ass icon] Key Term Glossary Slide 5 Types of Fixed Prosthetics Chapter ___, pgs. ____ (Phinney & Halstead) Slides 6-15 [Insert Group Activity icon] Porcelain Veneer Set Up [Insert Home Ass icon] Textbook Assignment [ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Act [ ] Evaluation -5- 5
  6. 6. Faculty Teaching Guide for Dental Materials [Insert In-Class Act icon] In-Class Activities  Porcelain Veneer Set Up (Part A, Objectives 2-5). Goal: To have learners set up for and understand Porcelain Veneer procedures. Instructor should ensure enough materials and supplies are available for learners and place them into teams. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized. Depending on supplies available, grading may include verbal explanation of certain steps, by the learners to the evaluator. Instructor should allow enough time for learners to practice steps before evaluating. The instructor should be the operator during testing and grading of this procedure. Teaching Tip [Insert In-Class Dis Ques icon] In-Class Discussion Pay attention to each 1. Describe a good impression of a patient’s arch? learner individually. How do they do in group activities? How effective 1 A good impression is an accurate negative reproduction of a persons or independent are they in lab activities? Can you teeth and surrounding tissues. make any suggestions to assist in learning? 2. What would happen if not enough material is used for the impression? Instead of looking at your entire class as a whole, assess each The impression may not acquire enough of all oral structures learner as an independent member of necessary, if there isn’t enough material mixed, loaded into the tray, the group. and then placed properly in the patient’s mouth. 3. What could happen if too much material is used for an impression? This could cause the patient to gag. [Insert Home Ass icon] Homework Assignments Key Term Glossary. Learners will define key terms listed in the PowerPoint presentation. They are to enter this glossary on disk, in a dedicated notebook or in a designated part of a notebook. They are expected to augment information from text or lecture with other resources including any available in the school or public libraries or on the Internet and will be graded at the end of the module on completeness and presentation. Textbook Assignment. Learners are to read Chapter ____ (Phinney & Halstead). Presentation Tools Note: If you change Objectives or Assignments, don’t forget to change the slides accordingly. Slide 1 [Insert DM 3-1] Power Point Presentation for Dental Materials 6
  7. 7. Module: Prosthodontics DM – Stands for Dental Module: Prosthodontics Materials. The 1st number “3” Prior to introducing this module. Ask learners if any questions remain from the previous module. If questions indicates the Module called remain review the material as needed. Prosthodontics. The 2nd Introduce this Module. number indicates the slide number. Slide 2 [Insert DM 3-2] Module: Prosthodontics Introduce the sections and each part. Slide 3 [Insert DM 3-3] Section 1: Fixed Prosthodontics Discuss each objective in detail. Learners need to know what they will be learning and why. Try to relate it back to their careers as dental assistants. Slide 4 [Insert DM 3-4] Section 1: Fixed Prosthodontics (cont.) Continue to discuss each objective in detail. Slide 5 [Insert DM 3-5] Key Terms (cont.) Continue to review each key term and discuss. Homework Assignment: Stop here and go over the Key Term Glossary assignment. Slide 6 [Insert DM 3-6] Part A: Types of Fixed Prosthodontics Review the definition of prosthodontics and introduce the functions of these types of restorations. Inform learners that these are the ideal replacements for lost tooth structure. Slide 7 [Insert DM 3-7] Contraindications for a Fixed Prosthesis Explain the reasons why the dentist and patient may decide against a fixed prosthesis. Review the vital role DAs have in educating their patients -7- 7
  8. 8. Faculty Teaching Guide for Dental Materials towards making an informed decision regarding their dental health. Explain that if a mouth shows habitual lack of care, and the patient does not respond to counsel for improvement, the effort, time, and expense may be wasted; or if the patient is unable to follow strict oral hygiene, due to a physical handicap, a fixed prosthesis is contraindicated. Slide 8 [Insert DM 3-8] Cosmetic Dentistry Explain how advances in technology and materials are continually expanding in this field of dentistry. Discuss how rewarding it is to give patients an improved smile which often results in a boost of confidence and self esteem. Review each procedure on the slide, explaining the meaning of each. Point out that esthetics may also be spelled aesthetics. Slide 9 [Insert DM 3-9] Types of Fixed Prostheses Explain how full cast crowns, partial crowns, inlays, and onlays are made in the dental lab from elastomeric impressions taken of the patient in the dental chair. Explain that the dental lab technician will construct a restoration that is an exact replica of the tooth, and made with precision to fit on or into the shape of the tooth preparation. Point out that a full cast crown covers the entire coronal portion of a tooth and a partial crown covers the coronal surface but leaves the natural facial surface intact. Describe the difference between an inlay and an onlay. 8
  9. 9. Module: Prosthodontics Explain that the tooth being replaced is called a pontic, and the tooth used to support or stabilize a bridge is called an abutment. Describe a Maryland bridge as a resin-retained fixed bridge that replaces only one tooth. Ensure learners understand that each tooth of a crown or a bridge is called a unit, and that is how insurance companies code the procedure, how the office will charge the patient, and how the lab will charge the doctor – per unit. Explain that veneers improve the appearance of the patient by using a conservative preparation on the facial surface of the tooth and placing a thin layer of tooth- colored material. Address the difference between direct and indirect veneers, as well as porcelain veneers. Describe the reasons for these types of restorations. Slide 10 [Insert DM 3-10] Materials Used for Fixed Prostheses Discuss how pure gold would be too soft and that a precious metal alloy is a stronger material. Explain that porcelain may be attached to the metal alloy, which adds strength to the ceramic material, or used alone where the forces of mastication shouldn’t fracture the restoration. Point out that recent composite resin techniques are becoming popular due to continuous improvement in technology and materials. Slide 11 [Insert DM 3-11] Retention of Restorations -9- 9
  10. 10. Faculty Teaching Guide for Dental Materials Explain that core buildups and retention pins are used to help retain the filling material on badly broken down teeth, when not much tooth structure is left to restore. Describe how pins are screwed into the dentin so the amalgam, composite, or the silver alloy/glass ionomer material has something to adhere to. Point out that a post, placed inside of the root canal is necessary to strengthen a tooth following endodontic treatment. Refer to the figure in Chapter ___ (Phinney & Halstead) which illustrates a post and core with a pin. Explain that dental implants are surgically inserted into the bone, and following the healing process, provide support for prostheses. Point out that implants prevent resorption of the patient’s alveolar ridge, and must be routinely cleaned to remove plaque. Discuss the use of devices used to clean under and around implants as well as fixed bridges, such as bridge threaders, proxi-floss, dental tape, and interproximal brushes. Explain that dental hygienists will scale implants with plastic coated instruments so the precious metal won’t become scratched. Refer to the figure in Chapter _____ (Phinney & Halstead) which illustrates the screw-retained implant prosthesis and the cement-retained implant prosthesis. 10
  11. 11. Module: Prosthodontics Slide 12 [Insert DM 3-12] The Dental Laboratory Explain that the dental lab technician uses the impression and bite registration taken on the patient, and follows the dentist’s written instructions on the lab prescription in order to fabricate a prosthetic restoration. Describe how the lab tech pours the elastomeric impression with die stone, and constructs an exact replica of the normal tooth in wax on the die. Explain that this wax pattern is then invested and cast into a metal alloy duplicating normal tooth form, just as jewelers cast metal for jewelry. Point out that this is called a precision cast restoration because each step requires absolute accuracy. Ensure learners understand that the lab can only work with what is sent to them and that errors such as distorted or inaccurate impressions will affect the final prosthesis, and may not fit the patient’s tooth preparation. Slide 13 [Insert DM 3-13] Dental Assistant Responsibilities Explain that the DA has many responsibilities during fixed prosthetic procedures, and that these duties vary depending on the dentist as well as state regulations. Point out that DAs, highly skilled in restorative procedures, are always in demand. In-Class Activity: Stop here for the Porcelain Veneer Set Up activity. Homework Assignment: Stop here to assign and discuss the homework. - 11 - 11
  12. 12. Faculty Teaching Guide for Dental Materials Part B: Fixed Prosthesis Procedures Overview Chairside procedures preparing for fixed prosthetics must be detailed and Teaching Tip accurate in order for the lab to create a quality product. The dental assistant’s Pay close attention to learners who don’t role is to set up for the procedure, assist the dentist, explain the process and oral participate in initial discussions. Try to hygiene instructions to the patient, and to coordinate scheduling with the dental determine the reasons for their lack of lab. These tasks may be expanded depending on the dental office. Knowledge participation and address it. of the many materials and equipment used are mandatory during each step. Initial Questions and Activities 1. How can the dental assistant help a patient feel more comfortable during a long crown preparation procedure? The dental assistant should ensure all materials and supplies needed for the procedure are prepared and ready, help the dentist work quickly and efficiently, and continue to ask the patient how they are doing throughout the procedure, when appropriate. Ask the patient if they need a break. Key Concepts References and Activities Slides Fixed Prosthesis Procedures Chapter ___, pgs. ___ (Phinney & Halstead) Slides 14-22 Assessment Questions [Insert Group Activity icon] Crown Preparation Slide 23 [Insert Group Activity icon] Crown Cementation [Insert Homework Ass icon] Interactive Skills Procedures CD-ROM [Insert Home Ass icon] Workbook Assignment [Insert Home Ass icon] End of Chapter Activities [ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Activity [ ] Evaluation 12
  13. 13. Module: Prosthodontics [Insert In-Class Act icon] In-Class Activities  Crown Preparation (Part B, Objectives 2-5). Goal: For learners to have the opportunity to practice chairside assisting skills during a crown preparation procedure. Place learners into teams. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized. The instructor should allow enough time for learners to practice all steps before evaluating and should perform as the operator during testing and grading of this procedure. The more actual materials and supplies used, and hands-on practice learners are allowed, the better quality training they will acquire. If possible this should be practiced on a live patient as much as possible, at least for the elastomeric impression and bite registration.  Crown Cementation (Part B, Objectives 4-5). Goal: For learners to practice assisting during a crown cementation procedure. Instructor should ensure enough materials are available for learners. Place learners into teams. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized. The instructor should allow enough time for learners to practice all steps before evaluating and should perform as the operator during testing and grading of this procedure. The more actual materials and supplies used, and hands-on practice learners are allowed, the better quality training they will acquire. [Insert In-Class Dis Ques icon] In-Class Discussion 1. What were some problems found when manipulating elastomeric impression materials and bite registration? Discuss problems learners had with these materials. Explain proper techniques regarding mixing or using an extruding gun, loading the tray, and placing it in a patient’s mouth. [Insert Home Ass icon] Homework Assignments Interactive Skills and Procedures CD-ROM. Learners should use the CD-ROM to practice the Crown Preparation and Cementation Prosthodontic procedures. Workbook Assignment. Learners are to complete the workbook Chapter ___questions. Learners should be prepared to review these in class. End of Chapter Activities. Have learners complete the Review Questions and Critical Thinking Questions at the - 13 - 13
  14. 14. Faculty Teaching Guide for Dental Materials end of Chapter ____ (Phinney & Halstead). Ideas for learners struggling with this material …  Group Participation. Ask learners if they are a good participator in group activities? Encourage them to ask themselves if they add to the group or inhibit its effectiveness? Suggest they conduct a short assessment on their group participation, both in class discussion and in small groups. Tell them they should make a plan of action if they see areas where they can improve. Ideas for learners who are ahead and want to learn more …  Web Research. Have learners go to http://www.ada.org to research more information on cosmetic dentistry. Have them prepare a short paper on their findings to present to the class. Presentation Tools Note: If you change Objectives or Assignments, don’t forget to change the slides accordingly. Slide 14 [Insert DM 3-14] Part B: Fixed Prosthesis Procedures Review Part A. Review the homework and make sure any remaining questions are answered. Introduce Part B. Inform learners that the crown preparation procedure is fairly complicated as it has many steps to remember and that they will have the opportunity to practice this procedure following this part. Point out that diligence by the DA during each step contributes to the quality of the final prosthetic restoration. Explain that the DA will need to retract the patient’s cheek or tongue while the dentist prepares the tooth with the handpiece. Slide 15 [Insert DM 3-15] Selecting a Tooth Shade Explain how important a proper shade is in order to match 14
  15. 15. Module: Prosthodontics existing dentition as closely as possible. Point out that just as during the composite restoration procedure, the shade should be taken before the tooth is prepared, the shade guide moistened, and compared to the natural teeth under natural light. Ensure learners understand that the shade chosen must be recorded in the patient’s chart as well as on the lab prescription form. Slide 16 [Insert DM 3-16] Margin Preparations. Describe that where the cast restoration meets the tooth is called the margin, and that the dentist will design the margin carefully, with meticulous attention to detail. Slide 17 [Insert DM 3-17] Tissue Retraction Explain how necessary tissue retraction is in order to obtain an accurate impression of the gingival margin. Point out that the retraction cord is placed around the tooth and into the gingival sulcus. Explain that the cord may be impregnated with a chemical, or dipped in a hemostatic solution which will control bleeding and cause the gingiva to temporarily shrink in order for the impression material to flow around the margin of the preparation. Slide 18 [Insert DM 3-18] Elastomeric Impressions Ensure learners understand how important the impression is, and that if there is an air bubble, or other distortion detected in the impression, the dentist will want to retake it. Explain that latex glove powder can interfere with the setting of elastomeric materials, the impression can shift in - 15 - 15
  16. 16. Faculty Teaching Guide for Dental Materials the patient’s mouth while it is setting, or the tray may not fit properly. Describe the various ways to obtain impressions. Address how the lab tech will need an accurate occlusal relationship from a bite registration in order to fabricate a restoration that fits properly. Slide 19 [Insert DM 3-19] Provisional Restorations Explain that the temporary crown or bridge will provide temporary coverage for the tooth or teeth while the dental lab makes the permanent prosthesis. Ensure learners understand that the provisional restoration protects the tooth, while providing esthetics and comfort for the patient. Point out how important the provisional is for stabilizing the contacts between the teeth as well as the occlusion. Explain how the prosthesis may not fit if the temporary restoration is not made correctly, or if the patient loses it. Discuss how it must fit snugly at the gingival margin to prevent plaque and debris away from the tooth. Address the various types of provisional restorations. Slide 20 [Insert IDA 3-20] The Laboratory Prescription Explain that the lab prescription gives detailed instructions to the lab technician regarding the prosthesis, including the date the permanent crown or bridge is expected to be in the dental office. Slide 21 [Insert IDA 3-21] Crown Cementation Explain that the temporary crown is removed from the patient’s tooth, then the permanent restoration is tried on to 16
  17. 17. Module: Prosthodontics ensure it fits properly and that the occlusion is accurate. It is then adjusted if necessary and permanently cemented into place in the patient’s mouth. Describe how the DA mixes the cement when the dentist is ready, and places it in a thin layer within the dried permanent prosthesis. Point out that after the cement sets, the excess is removed with instruments and dental floss. Slide 22 [Insert IDA 3-22] Fixed Prostheses Maintenance Ensure learners understand that the DA will be educating the patient on how to care for the new investment in their oral health. Explain how each oral hygiene aid on this slide will be used by the patient to keep the new prosthesis clean. Discuss how to use a floss-threader to remove plaque from under bridges. Slide 23 [Insert IDA 3-23] Assessment Questions Short Activity: Stop here and have learners answer the questions on the slide. Review material as needed to enhance understanding. Short Activity: Stop here to discuss the case study in Chapter ____ (Phinney & Halstead). In-Class Activity: Stop here for the Crown Preparation and Crown Cementation activities. Homework Assignment: Stop here to assign and discuss the homework. - 17 - 17
  18. 18. Faculty Teaching Guide for Dental Materials Section 2: Removable Prosthodontics Section Overview Removable prosthodontics is the art and science of dentistry that provides the replacement of lost dental tissues and their components. This replacement for missing teeth is divided into two categories: removable partial dentures and removable complete dentures. Intraoral factors such as muscular function, the shape of the alveolar ridge, and the mucosa covering the residual ridge will be considered by the dentist when deciding whether a partial denture, or a complete denture would be best for the patient. Extra oral factors to be considered are the patient’s age, mental and physical health, as well as the attitude toward improved oral hygiene and retention of natural teeth. In many instances a removable prosthesis must be used for a portion, or all of the replacement dentition. Outline of Section 2 Part A: Removable Partial Dentures Part B: Removable Complete Dentures Learning Objectives and Competencies Teaching Tip These learning activities directly address the Learning Objectives and Walk around during lab Competencies as stated. activities and give feedback to each individual Knowledge learner. Encourage them to help each other and to 7. Define the Key Terms. write down exactly where they get stuck in a 8. List the components of a partial denture. procedure or exactly what they do not understand. Participate fully in lab Comprehension activities and monitor each learner closely. 9. Explain the reasons for removable prostheses. 10. Describe the consultation appointment for a removable prosthesis. 11. Explain the difference between a removable partial and a complete denture. 12. List and discuss the appointment steps for a partial denture and a complete denture. 13. Explain denture reline, repair, and adjustment procedures. Application 14. Demonstrate partial denture final impressions and delivery. 15. Demonstrate setting up and assisting during a jaw relationship and a denture relining procedure. 18
  19. 19. Module: Prosthodontics Learning Activities These learning activities directly address the Learning Objectives and Competencies as stated. [Insert Homework Assignment icon] Key Term Glossary (Part A, Objectives 7-9) [Insert In-Class Activity icon] Partial Denture Final Impressions (Part A, Objective 14) [Insert In-Class Activity icon] Delivery of a Partial Denture (Part A, Objective 14) [Insert Homework Assignment icon] Textbook Assignment (Part A, All Objectives) [Insert In-Class Activity icon] Field Trip (Part B, All Objectives) [Insert In-Class Activity icon] Jaw Relationship Appointment (Part B, Objective 15) [Insert In-Class Activity icon] Denture Reline (Part B, Objective 15) [Insert Homework Assignment icon] Workbook Assignment (Part B, All Objectives) [Insert Homework Assignment icon] End of Chapter Activities (Part B, All Objectives) - 19 - 19
  20. 20. Faculty Teaching Guide for Dental Materials Part A: Removable Partial Dentures Overview A removable partial denture restores a large span of lost dentition. A fixed bridge is the ideal replacement for missing teeth, but may not be feasible due to existing conditions in the patient’s mouth. Each patient’s individual oral conditions must be evaluated, such as the extent of caries, the quality and quantity of remaining supporting tissue, and tooth contours. Esthetics, mastication, phonetics, and comfort should be restored, while at the same time preserving teeth, the alveolar process, gingival tissue, tooth position, occlusion, and oral as well as overall systemic health. The DA will prepare diagnostic casts, radiographs, and visual aids for the denture consultation appointment. Assisting the dentist during each phase of the process to ensure a quality partial will be part of DAs responsibility as will patient education regarding how to care for the new appliance. Teaching Tip Initial Question and Activities For good learner retention, keep an eye on both the 1. Why do you think a partial denture would be needed rather than a fixed struggling learners and the best in the class. Address prosthesis? each learner in appropriate ways to ensure that they are getting the most from A fixed prosthesis is the ideal restoration, but if there are too many the class and are not in danger of leaving because teeth missing already, especially on both sides of an arch, a partial they are bored or struggling. Address any problems immediately. denture will restore function to both sides of the mouth. Key Concepts References and Activities Slides Introduction to Section 2 Slides 24-25 Key Terms [Insert Homeword Ass icon] Key Term Slide 26 Glossary Removable Partial Dentures Chapter ____, pgs. ____ (Phinney & Halstead) Slides 27-32 [Insert Group Activity icon] Partial Denture Final Impressions [Insert Group Activity icon] Delivery of a Partial Denture [Insert Home Ass icon] Textbook Assignment [ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Activity [ ] Evaluation 20
  21. 21. Module: Prosthodontics [Insert In-Class Act icon] In-Class Activities  Partial Denture Final Impressions (Part A, Objective 14). Goal: For learners to practice setting up and assisting during Final Impressions for a Partial Denture. Instructor should ensure there are enough materials and supplies for the class and separate learners into teams. Instructor should be the operator for this procedure. If possible this should be practiced on a live patient as much as possible, at least for the elastomeric impression and bite registration. Some of the steps may be simulated and procedures verbalized so the instructor knows the learner being evaluated understands the procedure. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.  Delivery of a Partial Denture (Part A, Objective 14). Goal: For learners to practice setting up and assisting during Delivery of a Partial Denture. Instructor should ensure there are enough materials and supplies for the class and separate learners into teams. Instructor should be the operator for this procedure. Some of the steps may be simulated and procedures verbalized so the instructor knows the learner being evaluated understands the procedure. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized. [Insert In-Class Dis Ques icon] In-Class Discussion 1. What type of gypsum material is used by the lab technician for fabricating Teaching Tip Participate fully in lab crowns and bridges? activities. Watch learners carefully to Die stone is used because it is stronger than plaster or lab stone. Die see that they are understanding the stone is also used for partial denture modes because it is stronger and information and keeping on track. Lab sections should be as shouldn’t be fractured by insertion and removal of the clasps. informative as lecture sections [Insert Home Ass icon] Homework Assignments Key Term Glossary. Learners will define key terms listed in the PowerPoint presentation. They are to enter this glossary on disk, in a dedicated notebook or in a designated part of a notebook. They are expected to augment information from text or lecture with other resources including any available in the school or public libraries or on the Internet and will be graded at the end of the module on completeness and presentation. Textbook Assignment. Learners are to read Chapter ____ (Phinney & Halstead). Ideas for learners struggling with this material … - 21 - 21
  22. 22. Faculty Teaching Guide for Dental Materials  Use Homework Wisely. Encourage learners to focus on their homework as a learning aid rather than one more task to do to pass the course. Remind them their goal is to learn the information so they will be successful in their new career and that studying more than necessary will enable them to excel and be proud of their accomplishments. Ideas for learners who are ahead and want to learn more …  Web Research. Have learners go to http://www.nadl.org and find out if there is an accredited dental laboratory education program in the area. Have them prepare a short report to share with the class regarding their findings. Presentation Tools Note: If you change Objectives or Assignments, don’t forget to change the slides accordingly. Slide [Insert DM 3-24] Section 2: Removable Prosthodontics 24 Discuss each objective in detail. Learners need to know what they will be learning and why. Relate it back to their careers as dental assistants. Slide [Insert DM 3-25] Section 2: Removable Prosthodontics (cont.) 25 Continue to discuss each objective in detail. Slide [Insert DM 3-26] Key Terms Review each key term and discuss the importance of 26 knowing the definition of each. Homework Assignment: Stop here to remind learners about the importance of completing the Key Term Glossary assignment. Slide [Insert DM 3-27] Part A: Removable Partial Dentures Explain the purpose of a partial denture and what may 27 take placed during a consultation appointment. Point out that the most important step in achieving a quality partial denture is adequate preparation of the mouth by the dentist before construction of the 22
  23. 23. Module: Prosthodontics prosthesis. Explain that these preparations enable a mouth to accept and support a partial denture for the maximum period of time, and with minimal adverse reaction on the remaining natural teeth and supporting tissues. Inform learners that photographs of the patient may be taken in order to provide before and after treatment documents, and visual aids used to explain how the prosthesis is inserted, removed, and maintained. Explain how the DA will take alginate impressions of the partially edentulous mouth and pour plaster study models on which the dentist will draw the design for the partial and decide locations for the partial framework components. Slide [Insert DM 3-28] Advantages of a Removable Partial Discuss advantages of a removable partial denture. 28 Slide [Insert DM 3-29] Contraindications for a Partial Discuss how important a sound foundation is in order for 29 a partial denture to be successful, and the reasons why it may not be the best choice for the patient. Slide [Insert DM 3-30] Components of a Partial Denture Explain each component of a partial denture to the 30 learners. Point out that the framework is the skeleton that provides the basic support for all other components. Explain that the rests are metal projections, on or near the clasps, and are designed to lie in a prepared recess on the occlusal, lingual, or incisal surface of the tooth crown. - 23 - 23
  24. 24. Faculty Teaching Guide for Dental Materials Describe how the connectors may be a lingual or palatal bar, and that the retainer is the clasp that provides stability and enables the partial to be removed and inserted easily by the patient. Explain that the denture base or saddle is gingival- colored acrylic that lies over the alveolar ridge and holds the artificial teeth which teeth may be constructed of either porcelain or acrylic. Note to Instructor: Having a visual aid when describing parts of a partial would be helpful. Slide [Insert DM 3-31] Metal Frameworks Point out that the framework of a partial denture is 31 constructed in wax by a dental lab technician, according to the dentist’s precise design, and then cast from precious metals. Explain that the framework may be tried in the patient’s mouth before teeth are added to ensure proper positioning of the clasps and the path of insertion. Slide [Insert DM 3-32] Appointments for a Partial Denture Discuss the various types of appointments necessary for 32 a partial denture. Explain that rest preparations are made by the dentist, on the abutment teeth, with a high speed handpiece, and that these recessed areas are prepared to receive the extension of the rests on the clasps of the framework. Point out that the patient doesn’t usually need anesthetic as this is minor re-contouring of teeth to be used for retention and support of the prosthesis, and to provide enough depth for proper occlusion. 24
  25. 25. Module: Prosthodontics Ensure learners understand that an accurate final elastomeric impression will be taken following the rest preparations and sent to the lab. Explain that it is the DA’s job to teach the patient proper home care of the removable prosthesis during the delivery appointment. Point out that the DA will need to describe to the patient how plaque accumulates and how the acid present in plaque decalcifies enamel, making such areas soft and readily abraded during removal and insertion of the partial denture. Discuss how the DA should instruct the patient to remove the partial after eating, to remove debris from the clasps, rests, and saddle, to vigorously brush the abutment teeth to remove plaque, and when the partial is not worn, to keep it moist in order to avoid warping. In-Class Activity: Stop here for the Partial Denture Final Impressions activity and the Delivery of a Partial Denture activity. Homework Assignment: Stop here to assign and discuss the homework. Part B: Removable Complete Denture Overview Removable complete dentures, as with partial dentures require many exta oral procedures to be performed by the dental assistant. These include coordinating appointments for the patient and communicating with the dental lab. The dental assistant will also teach the patient how to care for their prosthesis and assist the dentist during chairside, lab, and other associated procedures. It is often traumatic to lose teeth and learn how to use facial muscles to control a prosthesis during chewing and speaking. The patient may need reassurance that they are making the correct decision regarding their health. - 25 - 25
  26. 26. Faculty Teaching Guide for Dental Materials Initial Questions and Activities 1. Why would extracting teeth and replacing them with a denture always be the last option considered? Anytime a tooth is removed, bone loss occurs. Keeping teeth, as Teaching Tip well as the bone surrounding them, is the healthiest result for us Remind learners that homework activities are not busy work and that all. they will get out of them as much learning as they 2. How do you think a denture stays in place in the mouth during mastication? put into them. Encourage learners to The denture will fit the alveolar ridge and sit on top of it. The mucosa will excel in their homework. become tough over time, but the patient will struggle when first losing their teeth, both physically and mentally. The dental assistant can reassure the patient during this period of adjustment. Key Concepts References and Activities Slides Removable Complete Dentures Chapter ___, pgs. ____ (Phinney & Halstead) Slides 33-43 [Insert Group Activity] Field Trip Assessment Questions [Insert Group Activity icon] Jaw Relationship Slide 44 Appointment [Insert Group Activity icon] Denture Reline Summary of Module [Insert Home Ass icon] Workbook Assignment Slide 45 [Insert Home Ass icon] End of Chapter Activities [ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Activity [ ] Evaluation [Insert In-Class Act icon] In-Class Activities  Field Trip (Part B, All Objectives). Goal: For learners to see a working dental laboratory. Instructor should call a dental laboratory and set up a time for the dental assisting learners to tour as a group. During the tour, learners should write down what they see. They then should prepare a report to present and discuss in class.  Jaw Relationship Appointment (Part B, Objective 15). Goal: For learners to practice setting up and assisting during a Jaw Relationship Appointment. Instructor should ensure there are enough materials and supplies for the class and separate learners into teams. Instructor should be the operator for this procedure. Some of the steps may be simulated and procedures verbalized. Learners should be graded on the procedure 26
  27. 27. Module: Prosthodontics steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.  Denture Reline (Part B, Objective 15). Goal: For learners to practice setting up and assisting during a Denture Reline. Instructor should ensure there are enough materials and supplies for the class and separate learners into teams. Instructor should be the operator for this procedure. Some of the steps may be simulated and procedures verbalized. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized. [Insert In-Class Dis Ques icon] In-Class Discussion 1. What is rest preparation for a partial denture? Teaching Tip Remind learners that The dentist prepares the teeth so there are recessed areas on the there are opportunities to meet with you occlusal, lingual, or incisal edge, in order for enough depth for individually to help clear up those fuzzy proper occlusion after the partial is seated in place. learning points. 2. Why would the dental assistant construct a custom tray for impressions rather than to use a stock tray? A custom tray will fit just one patient’s dentition for a more accurate impression. [Insert Home Ass icon] Homework Assignments Workbook Assignment. Learners are to complete the workbook Chapter ___ questions. Learners should be prepared to review these in class. End of Chapter Activities. Have learners complete the Review Questions and Critical Thinking Questions at the end of Chapter ____ (Phinney & Halstead). Ideas for learners struggling with this material …  Review Learning Objectives. Suggest that learners continue to refer back to the learning objectives and check them off when they are confident that they have achieved the objective. Tell them that they should review these often to ensure that they have retained the information in their long term memory and to realize how much they have retained. - 27 - 27
  28. 28. Faculty Teaching Guide for Dental Materials Ideas for learners who are ahead and want to learn more…  Web Research: Have learners go to http://www.ada.org, oral health care topics, and under “dentures” find questions patients frequently ask about removable dentures. Have them write a short report of their findings to present to the class. Presentation Tools Note: If you change Objectives or Assignments, don’t forget to change the slides accordingly. Slide [Insert DM 3-33] Part B: Removable Complete Denture 33 Review Part A and make sure that any remaining questions are answered. Review the homework and address questions as needed. In-Class Activity: Prior to beginning Part B, complete the Field Trip activity. Introduce Part B. Explain that complete dentures are for patients without teeth, or who will be having teeth extracted, and will become edentulous. Slide [Insert DM 3-34] Indications for a Complete Denture 34 Discuss the reasons a patient may need a complete denture. Ensure learners understand that this treatment is a last resort and that if there is any possibility of preserving some teeth, and therefore bone, it should be considered and communicated to the patient. Slide [Insert DM 3-35] Components of a Complete Denture 35 Point out that there are fewer components in a complete denture than there are for a partial denture. Explain that the denture base must sit on the mucosa, which must support it, and that the patient’s facial muscles 28
  29. 29. Module: Prosthodontics must help hold it in place, during mastication as well as when speaking. Describe the flange as the part of the acrylic base that extends to the areas of retention on the natural landmarks of the alveolar ridge. Explain that the flange extends to the retromolar area, the oblique ridge, and the mylohyoid ridge on the mandible. Point out that on the maxillary arch, the flange conforms to the curvature of the residual ridge, and fits into the vestibule. Slide [Insert DM 3-36] Appointments for a Complete Denture 36 Discuss the appointments necessary for construction of a complete denture and the procedures that will take place at each. Explain that photographs of the patient, before they lost teeth, may be used in order to evaluate the mold, or shape, of the original dentition, or to provide before and after treatment documents. Point out that the posterior teeth may be removed, and that the mouth allowed to heal before the final impression appointment, or all the teeth may be extracted at one time, and the immediate denture delivered then. Explain that the immediate denture will act as a bandage over the surgical area and that the patient will need to return to the office in a few days so that the dentist can make any adjustments to the denture. Any sutures placed during the extraction appointment would also be removed at this time. - 29 - 29
  30. 30. Faculty Teaching Guide for Dental Materials Slide [Insert DM 3-37] Final Impressions 37 Discuss how important the final impression is to a quality final prosthesis. Explain that the impression compound will be added onto the custom tray and used to acquire an accurate impression of the periphery. Ensure learners understand that the periphery is the outermost part of the patient’s mucosa, where the denture must fit, including fitting properly onto the frenum muscle attachments in the vestibule of the mouth. Slide [Insert DM 3-38] Construction of Complete Dentures 38 Explain that the baseplate is a preformed shape made of shellac, or acrylic resin that temporarily represents the base of the denture, and that the wax bite rims are built to represent vertical dimension. Discuss vertical dimension as the space provided by the normal teeth. Slide [Insert DM 3-39] Jaw Relationship Set-Up 39 Inform learners that the base plate-bite rim assembly is tried into the patient’s mouth and vertical and centric relationships recorded by the dentist. Explain that the patient will be asked to move their jaw forward, backward and from side-to-side. Discuss how the tooth shade is taken and recorded, as well as the mold, or shape of the teeth. Slide [Insert DM 3-40] Try-in Appointment 40 Explain that if the patient is edentulous, the teeth may be set in wax and tried in the patient’s mouth to evaluate how 30
  31. 31. Module: Prosthodontics they look, and how well they will function, before they are finished in the dental lab. Slide [Insert DM 3-41] Delivery Appointment 41 Discuss the procedures completed during the delivery of the complete denture. Ensure learners know that the DA will explain to the patient how to care for removable prostheses. Refer to the home care instructions illustration found in Chapter ___ (Phinney & Halstead). Slide [Insert DM 3-42] Denture Relines, Adjustments, and Repairs 42 Explain the importance of denture relines, and the difference between a tissue conditioner, temporary reline, and a permanent reline. Ensure they understand that the bone will shrink, or resorb, following tooth extractions, and that the prosthesis will no longer fit. Point out that the patient may come to the office for several soft relines, before the tissue has resorbed to a point when the dental lab will permanently reline the denture. Explain that as the bone and other tissues change, the patient may develop sore areas that must be adjusted. The dentist, or dental assistant, will use an acrylic bur to relieve the sore areas, and the patient instructed to return if more sores occur. Discuss how some repairs to dentures can be done in the office whereas other repairs may require the denture to be sent to the lab. Ensure learners understand that removable prostheses - 31 - 31
  32. 32. Faculty Teaching Guide for Dental Materials must be kept moist to avoid distortion. Slide [Insert DM 3-43] Implants and Overdentures 43 Discuss with learners how important it is to keep the alveolar bone from resorbing. Explain that teeth can be treated with endodontics and restorative procedures, or implants may placed in the alveolar ridge, and therefore used to stabilize a prosthesis. Explain to learners that the patient will need to clean the retained teeth at home, and schedule regular recall visits to the dental office. Slide [Insert DM 3-44] Assessment Questions Short Activity: Ask the group to answer these questions to 44 assess their comprehension of the material recently presented. Review any material that does not seem clear. Short Activity: Stop here to discuss the case study in Chapter ____(Phinney & Halstead). In-Class Activity: Stop here to complete the Jaw Relationship Appointment activity and the Denture Reline activity. Slide [Insert DM 3-45] Summary of Module 45 Review with learners all they learned during this module, from fixed to removable prosthodontics, and the diverse intra oral and extra oral procedures performed in the dental office, as well as and those completed in conjunction with the dental laboratory. Homework: Stop here to assign and discuss the homework assignment. 32

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