Preparation for RPD /certified fixed orthodontic courses by Indian dental academy


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Preparation for RPD /certified fixed orthodontic courses by Indian dental academy

  2. 2.
  3. 3. DEFINITION Mouth preparations are identified as those procedures that are accomplished to prepare the mouth for reception of prosthesis. RENNER BOUCHER
  4. 4. More specifically they are the procedures that change or modify existing oral structures of conditions to Facilitate placement and removal of prosthesis Facilitate its efficient physiologic function Enhance its long term success
  5. 5. Mouth preparation follows preliminary diagnosis and development of tentative treatment plan.
  6. 6. Classification
  7. 7. Mouth preparation Prosthodontic procedures Non prosthodontic procedures Procedures related to Occlusion  Restorative dentistry (fixed partial dentures)  Preparation of abutment teeth  Oral surgery Orthodontics Periodontics Endodontics 
  8. 8. OBJECTIVES  Establishing state of health in supporting and contiguous tissues  Eliminating interferences or obstructions  Establishing acceptable occlusal plane  Alteration of natural tooth form for requirements of form and function of prosthesis
  9. 9. PLANNING MOUTH PREPARATIONS         Examination of patient Examination of oral structures Complete radiographic survey Mounted diagnostic casts Evaluating diagnostic data Surveying diagnostic cast Designing removable partial denture Recording mouth preparations
  10. 10. RECORDING MOUTH PREPARATIONS  Executed in a red pencil  Teeth to be extracted are marked with X
  11. 11.  Outlining areas of bony ,soft tissues recontouring and alteration of tooth structures with closely spaced parallel lines or shade with a red pencil
  13. 13. ADVANTAGES OF CHARTING MOUTH PREPARATIONS      Ensures completeness Serves as quick and convenient record of mouth preparations to be accomplished to prepare patient for reception of removable partial denture Serves as a road map when properly prepared Serves as a legal record Ensures execution of procedures in proper sequence
  14. 14. TERM          ABBREVATION Survey line Guiding plane Interference Occlusal rest Incisal rest Incisal hook rest Cingulum rest Facial Lingual SL GP INT OR IR IHR CR F L
  15. 15. TERM        ABBREVATION Mesial Distal Line angle Raise survey line Lower survey line Reduce cusp tip Selectively grind M D LA RSL LSL RCT SG
  16. 16. TIME INTERVAL   Endodontic surgery ,periodontal surgery and oral surgery should be planned so that they can be completed during same time frame Longer the interval more complete the healing and more stable denture bearing area
  17. 17. SEQUENCE OF PROCEDURES TO BE FOLLOWED DURING MOUTH PREPARATIONS       Oral surgical preparation Periodontal preparation Orthodontic considerations Endodontic therapy Restorative dentistry Preparation of abutment teeth
  18. 18. ORAL SURGICAL PREPARATION  Extraction of teeth that may be detrimental to design of partial denture
  19. 19. RETAINED ROOTS   Located adjacent to abutment teeth contributes to progression of periodontal disease Removal is considered when associated with pathologic finding
  20. 20. IMPACTED TEETH  Removal is considered when associated with pathologic condition
  21. 21. TISSUE REACTIONS TO WEARING OF PROSTHESIS PALATAL PAPILLARY HYPER PLASIA  Poorly fitting prosthesis worn for prolonged periods  Inadequate oral hygiene  Inadequate prosthesis hygiene TREATMENT  Tissue rest  Tissue conditioners  surgery
  22. 22. EPULIS FISSURATUM     Ill fitting prosthesis TREATMENT Removal of irritation Tissue conditioners surgery
  23. 23. DENTURE STOMATITIS       Trauma from occlusion Ill fitting prosthesis Poor oral hygiene Continuous wearing of prosthesis TREATMENT Tissue rest Tissue conditioning
  24. 24. CYSTS AND ODONTOGENIC TUMOURS    Panoramic radiographs are recommended Periapical radiographs are recommended for suspicious area to confirm diagnosis Biopsy for microscopic study
  25. 25. EXOSTOSIS AND UNDERCUTS  Prevents proper extension of denture  Undercuts are minimized by changing path of insertion  Surgical correction
  26. 26. TORI  Surgical removal is considered when it is so large interfering with design of prosthesis  Mucosa over tori is thin
  27. 27. FRENA      Maxillary labial frenum Problems while replacing anterior teeth Mandibular frenum Compromise rigidity and placement of major connectors frenectomy
  28. 28. WHITE, RED AND ULCERATIVE LESIONS Biopsy for Microscopic study 
  29. 29. PERIODONTAL PREPARATION    Thorough examination of periodontium Complete periodontal charting Radiographs to evaluate periodontal destruction
  30. 30. PERIODONTAL DISEASES THAT REQUIRE TREATMENT      Pocket depths in excess of 3mm Furcation involvement Gingivitis Potential abutment teeth with less than 2mm of attached gingiva Pulling of frena on attached gingiva
  32. 32. INITIAL DISEASE CONTROL THERAPY       Oral hygiene instructions Scaling and root planing Elimination of local irritating factors other than calculus Elimination of gross occlusal interferences Splinting Use of night guard
  33. 33. ELIMINATION OF GROSS OCCLUSAL INTERFERENCES    Selective grinding is indicated when associated with pathologic condition Deflective contacts in centric path of closure are removed Balancing or nonchewing side interferences should be removed
  34. 34.  Occlusal equilibriation done priorly on diagnostic cast serves as a blueprint for selective grinding in mouth
  35. 35. SPLINTING     Short length Periodontally weakened teeth Excessive taper of single root Unfavourable crown root ratio
  36. 36. REMOVABLE SPLINTING  Indicated in patients in fourth ,fifth and sixth decades of life having major medical problems
  37. 37. FIXED SPLINTING  Indicated when an individual teeth or two adjoining teeth may have lost some periodontal support as a result of local conditions  Accomplished with full or partial coverage crowns
  38. 38. NIGHT GUARD     Removable acrylic resin splint Eliminates deleterious effects of nocturnal clenching and grinding Act as a temporary splint Used when abutment teeth has been unopposed for an extended period
  39. 39. DEFINITIVE PERIODONTAL SURGERY GINGIVECTOMY   Eliminates supra bony pockets Pocket depth confined to band of attached gingiva
  40. 40. PERIODONTAL FLAP SURGERY    To perform osseous recontouring for Pocket elimination Crown lengthening
  41. 41.
  42. 42.
  43. 43. MUCOGINGIVAL SURGICAL PROCEDURES  Indicated when abutment teeth for removable partial denture lacks adequate attached gingiva  Abutment teeth requires root coverage to facilitate partial denture construction and maintenance
  44. 44.
  45. 45. RECALL MAINTAINENCE  Patients with previous moderate to severe periodontitis 3 to 4 months
  46. 46. ORTHODONTIC CONSIDERATIONS  Extrusion  Mesial drifting  Rotated teeth
  47. 47.
  48. 48. CORRECTION OF OCCLUSAL PLANE  DISCREPENCIES IN OCCLUSAL PLANE IS DUE TO  Super erupted teeth  Infra erupted teeth
  49. 49.  Tipped molars  Mesially drifted teeth
  50. 50.  Malrelationship of jaws
  51. 51. TREATMENT  Enameloplasty  Onlay  crowns
  52. 52.  Coping  Surgical repositioning of one or both jaws to correct malrelationship
  53. 53. ENDODONTIC THERAPY  Tooth with pulpal involvement and root end pathology are candidates for endodontic therapy
  54. 54. Treated Pulpless Teeth Criteria to be followed to use them as abutment    Canals have been filled to apex with what appears radio graphically to be well condensed filling material No radioluscency at apex Tooth has been clinically asymptomatic since therapy was accomplished
  55. 55. ABUTMENT TOOTH WITH PULPITIS ENDODONTIC TREATMENT SHOULD BE CONSIDERED     Abutment tooth healthy from standpoint Favorable crown root ratio Prosthesis itself is satisfactory When mouth is in state of good health
  56. 56. RESTORATIVE DENTISTRY       Integrated with endodontic treatment Crowns Inlays Onlays Restoration of carious lesions Replacement of defective restorations
  57. 57. PREPARATION OF ABUTMENT TEETH OBJECTIVES     Directs stress along long axis of tooth Eliminating interference by recon touring of teeth Creating retention by simple alteration procedures Allows placement and removal of prosthesis without having it transmitting wedging types of stress against teeth with which it comes in contact
  58. 58. CLASSIFICATION OF ABUTMENT TEETH    Abutment teeth that require only minor modifications to their coronal portions Abutment teeth that are to have restorations other than complete coverage crowns Abutment teeth that are to have crowns
  59. 59. SEQUENCE    Preparation of guiding planes Modification of tooth contours Rest seat preparation
  60. 60. PREPARATION OF GUIDING PLANES   Diagnostic cast mounted on surveying table at the tilt at which design of removable denture was drawn should be placed on table in front of patient Hand piece with appropriate diamond instrument in place positioned over cast to visualize relationship of hand piece and diamond instrument and can be duplicated in patients mouth
  61. 61.  Cylindrical diamond point is used for guide plane preparation  Gentle light sweeping stroke from buccal line angle to lingual line angle
  62. 62.  Flat surface created should be 2-4mm in occluso gingival height  Reduction should follow curvature of proximal surface
  63. 63.  All prepared tooth surfaces must be polished with carborandum impregnated rubber wheel or points
  64. 64. ABUTMENT TOOTH ADJACENT TO DISTAL EXTENSION EDENTULOUS SPACES    Occluso gingival height reduced to 1.5-2mm Permits partial denture to Rotate Slightly around distal occlusal rest as downward force occurs on artificial teeth Avoids torquing forces on abutment teeth
  65. 65. LINGUAL SURFACES  Provides maximum resistance to lateral stresses  Occlusogingival height should be 2-4mm
  66. 66. ANTERIOR ABUTMENT TEETH  Provides parallelism, ensures stabilization  Minimize wedging action between teeth  Increase retention through frictional resistance  Decrease undesirable space between denture and abutment teeth
  67. 67. ENAMELOPLASTY TO CHANGE HEIGHT OF CONTOUR  Height of contour is changed to provide better positions for clasp arms or lingual plating Retentive clasp arm   Located at junction of gingival and middle third Enhances esthetic quality of clasps and provides mechanical advantage
  68. 68.     In maxillary arch molars and premolars if unsupported tend to tip buccally Height of contour will be near occlusal surface on facial side Amount of correction depends upon thickness of enamel If dentin is exposed placement of restoration is considered
  69. 69.
  70. 70.  In mandibular arch premolars and molars unsupported tip lingually  Problem with positioning of reciprocal clasps and lingual plating
  71. 71.
  72. 72. ENAMELOPLASTY TO MODIFY RETENTIVE UNDERCUTS  Successful only when buccal and lingual surfaces of tooth are nearly vertical  created in form of gentle depression  dimpling
  73. 73.  Prepared by using a small round end tapered diamond stone  End of stone is moved in an antero posterior direction near line angle of tooth  Depression should be 4mm in mesio distal length and 2mm in occluso gingival height
  74. 74. PREPARATION OF REST SEAT OCCLUSAL REST   Outline form of occlusal rest is triangular with base of triangle at marginal ridge and apex towards centre of tooth Apex of triangle and external margins of preparation should be rounded
  75. 75.    Extension of rest seat preparation should vary from 1/3 to ½ the mesiodistal diameter of tooth Buccolingual extent should be half the distance between buccal and lingual cusp tips Floor must be spoon shaped
  76. 76.   Angle formed by inclination of floor of rest and vertical projection of proximal surface of tooth must be less than 90 degrees PREPARATION First channel of correct depth and desired outline of preparation is created by small round diamond stone
  77. 77.    Lower the marginal ridge at either buccal or lingual extent of rest seat to continue inward towards centre of tooth and to return to marginal ridge Island of enamel remains with in outline form can be removed and shaped Deepest portion of rest seat is towards centre of tooth preparation raises gradually towards marginal ridge
  78. 78.
  79. 79.      Adequacy of occlusal rest seats can be checked before impression of master cast is made by Visual inspection Direct tactile contact By making imprints in red utility wax By making impression to create a diagnostic cast
  80. 80.
  81. 81. IN NEW GOLD RESTORATION  Placed in wax pattern after establishment of guiding planes  Depression is added in prepared tooth to accommodate depth of occlusal rest
  82. 82. IN AMALGAM RESTORATIONS    Less desirable as amalgam alloy tends to flow under constant pressure Rest seats are prepared using no.4 round bur Care must be taken not to weaken proximal portion of amalgam restoration
  83. 83. REST SEAT PREPARATION FOR EMBRASSURE CLASP    Preparation extends over occlusal embrasure of two approximating posterior teeth from mesial fossa of one tooth to distal fossa of other tooth Small round diamond stone is used to establish out line form for normal occlusal rest in each of approximating fossa contact point between teeth should not be broken
  84. 84.   Same round diamond stone is used to carry buccal and lingual extension of occlusal rests over buccal and lingual embrasures Cylindrical diamond stone is held horizontally from buccal surfaces of teeth pointing towards lingual surface
  85. 85.   Stone is held against distal incline of buccal cusp of one tooth and mesial incline of buccal cusp of other tooth to create occlusal clearance Preparation should be 1.5-2mm wide and 11.5mm deep as it passes over buccal and lingual embrasures
  86. 86. LINGUAL REST SEAT  Outline form is half-moon shaped  Forms a smooth curve from one marginal ridge to other crossing centre of tooth incisally to cingulum Rest seat is v shaped 
  87. 87.   Labial incline of lingual surface of tooth forms one wall of v shaped notch other starts from top of cingulum and inclines linguo gingivally towards centre of tooth to meet other wall of preparation Lingual rest is prepared in enamel of surface of anterior tooth if it is sound and with prominent cingulum
  88. 88.  Mandibular canines are poor candidates for placing lingual rests preparation   Using cylinder diamond cut should be made low on one marginal ridge pass over cingulum and pass gingivally to contact opposite marginal ridge Rest seat must be gingival to contact level of opposing tooth
  89. 89. INCISAL REST SEAT  Least desirable rests on anterior teeth  Used only on enamel surface  Usually placed near incisal angles of canine
  90. 90. PREPARATION   Small safe side diamond disk is held parallel to path of insertion First cut is made vertically 1.5-2mm deep in form of notch and 23mm inside proximal angle of tooth
  91. 91.   Small flame shaped diamond point is used to complete preparation Enamel wall created by disk towards centre of tooth must be rounded  Base of notch is also rounded  Groove that results after notch has been completely rounded must be carried slightly onto labial surface and partway down to lingual surface as an indentation
  92. 92. ABUTMENT TEETH PREPARATIONS USING CONSERVATIVE RESTORATIONS   When inlay is restoration of choice proximal and occlusal surface that support minor connectors and occlusal rests require modification in restoration Buccal and lingual proximal margins must be extended well beyond line angles of tooth
  93. 93.   Axial wall is carved to confirm with external proximal curvature of tooth Gingival seat should be placed where it can be easily accessed to maintain good oral hygiene
  94. 94. ABUTMENT PREPARATIONS USING CROWNS Crowns may be in the form of     Three quarter crowns Complete coverage cast crowns Porcelain veneer crowns Ideal restoration for partial denture abutment is complete coverage crown
  96. 96.
  99. 99.
  100. 100. SHAPING VENEER CROWNS  If veneer is porcelain shaping must precede glazing  If veneer is resin it must precede final polishing
  101. 101. Leader in continuing dental education