Post insertion adjustment and follow up care

POSTINSERTIONADJUSTMENT

The following may be required aftercementation of the final restoration: -Check the occlusion of the teeth making sure that they are in their correct intercuspation -Remove again all existing premature contacts after the restoration has been seated completely -Make sure the gingiva is not impinged

-Remove excess cements on the surrounding soft tissues to avoid inflammation-Instruct the patient of the proper home care procedures-Regular recall appointments are required to check the health of the tooth/teeth and surrounding structures-Seek the attention of the dentist in cases of pain and discomfort after the final installation of the denture

FOLLOW-UP CARE

Well-organized andefficient follow-up care is thechief mechanism forensuring successful fixedprosthodontics.

A restoration that iscemented, forgotten andignored is likely to fail nomatter how expertly it wasdesigned and executed.

 Restored teeth should require careful plaque removal and maintenance than healthy unrestored teeth. An FPD requires an additional care and attention.

Common Complications associatedafter Completion of the Treatment:(Post Insertion Problems)  dental caries  periodontal failure/disease  endodontic failure  occlusal dysfunction  loose retainers  porcelain fracture  fractured connector  pain

DENTAL CARIES Most common cause of failure of a cast restoration Detection is difficult particularly where complete coverage is used

Undetected caries beneath this FPD

PERIODONTAL DISEASE Often occurs after placement of fixed prostheses especially where the cavosurface margin is placed subgingivally or the prosthesis is over contoured Inflammation is more severe with poorly fitting restorations but even perfect margins have also been associated with periodontitis

 At recall appointments, attention is given to sulcular hemorrhage, furcation involvement and calculus formation as early signs of periodontal disease Improper contoured restoration should be recontoured or replaced

OCCLUSAL DYSFUNCTION An examination of the occlusal surfaces may reveal abnormal wear facets Questions should be asked concerning any parafunctional habits such as BRUXISM Abnormal tooth mobility is investigated and also muscle and joint pain

If a cast restoration is not designed according to neuromuscular and temporomandibular controls, extensive wear can result after a relatively short time.

PULP AND PERIAPICALHEALTH Px may reveal having experienced one or more episodes of pain which indicate the loss of vitality of an abutment tooth/teeth Radiographs provide useful information as to the presence of periapical pathosis Endodontically treated teeth should be examined radiographically every few years

PAIN Should be examined as to its location, character, severity, timing and onset Most oral pain is of pulpal origin

LOOSE RETAINERS Usually a sign of inadequate tooth preparation, poor cementation technique or caries In this case, the tooth/teeth require repreparation and a new prosthesis The best policy is to section the prosthesis rather than attempt to remove it intact

A B C D(A) severe tooth destruction may result when a loose retainer goes undetected(B) looseness of one retainer can occasionally be observed directly (arrow) when force is exerted in an occlusal direction(C) water is then applied to the cervical area, and the diagnosis is confirmed if bubbles appear when pressure is exerted (D)

FRACTURED CONNECTOR Px may complain varying degrees of pain due to extra force transmitted to the abutment teeth Wedges can be used to separate individual components enough to permit the correct diagnosis

Fractured connector

FRACTURED PORCELAIN VENEER Usually related to faulty framework design, improper laboratory procedures, occlusal functions or trauma If porcelain has fractured but not missing on a satisfactory prostheses, repair than remake may be justified with a porcelain repair system utilizing silane coupling agents to promote bonding with acrylic/composite resin

Fractured porcelainRepaired porcelainusing acrylic/composite resin

SEE YOU ALL SOON IN THE CLINIC! GOODLUCK!!! o DR. VIVIAN C. CARLOS Prosthodontics Section

Post insertion adjustment and follow up care

by Emjei Mendoza

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