Post cementation /certified fixed orthodontic courses by Indian dental academy


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Post cementation /certified fixed orthodontic courses by Indian dental academy

  1. 1. Post Cementation Instructions ,Home Care and Follow Up of Fixed Partial Dentures INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Contents Introduction Post cementation instructions Oral hygiene Follow up:  Dental caries  Periodontal health  Occlusal dysfunction  Pulpal Health  Periapical Health
  3. 3. Emergency Appointments  Pain  Fracture of tooth  Loosening of Retainers  Fractured Connectors  Fractured Porcelein Conclusion Refrences
  4. 4. Introduction
  5. 5. Post Cementation Instructions       Avoid loading or biting on the restoration for the first 24 hours Exercise all oral functions Avoid sudden impact forces Maintenance and oral hygiene procedures Regular recall Report immediately if there is pain
  6. 6. Home care Core of the home care program is plaque control. Use of a manual or a powered toothbrush Short flat headed brush with medium soft bristles Thoroughness rather than technique. Most popular is the sulcus cleansing technique or the BASS method
  7. 7.
  8. 8. Bass Method
  9. 9.
  10. 10.
  11. 11.
  12. 12. Modified Stillmans Method
  13. 13. Charters method
  14. 14. INTERDENTAL CLEANING AIDS Purpose To remove plaque, not to dislodge fibrous threads of food wedged between teeth.
  15. 15. Types of Embrasures
  16. 16. Dental floss Multifilament nylon yarn Twisted and non twisted Bonded and non bonded Waxed and non waxed Thick or thin Monofilament and multifilament
  17. 17.
  18. 18. Floss Holders
  19. 19. Super Floss
  20. 20.
  21. 21. Interdental Brushes
  22. 22. Wooden and rubber tips
  23. 23. Oral Irrigating Devices
  24. 24. Disclosing Solutions
  25. 25. Plaque Control Record
  26. 26. Dental Caries  Pain or sensitivity  Bad taste  Bad breath  Loose restorations  Fractured teeth  Discoloured teeth
  27. 27. Most common cause of failure of cast restorations as reported by Schwartz et al in 1970--- accounting for 36% of failure. Detection of caries1. Visual 2. Explorers 3. Radiographs
  28. 28. LocationOn abutment at the margin of restoration
  29. 29. Caries involving the furcation and root caries
  30. 30. Extensive Caries Requiring Removal Of the Retainer
  31. 31. Daily rinse of sodium flouride (0.05%) and a Flouridated dentifrice containing 1,100 ppm of flouride as sodium flouride Flouride varnishes.
  32. 32. Periodontal Disease          Looseness of teeth or bridgework Drifting teeth Bleeding tissues Change in colour of the gingiva Bad taste Bad breath Pain Abscess formation Poor aesthetics
  33. 33. thorough assessment of periodontal condition. 1. Evaluating patients plaque control efficiency 2. bleeding on probing, estimating pocket depth 3. Checking for mobility 4. Radiographic evaluation.
  34. 34. Acute conditions : abscess- incision and drainage.  Advanced periodontitis: around abutments or in case of furcation involvement. Debridement and removal of the soft tissue pocket. Subgingival irrigation with 1% chlorhexidine gel. Elevation of flap ,debridement Recontouring the tooth to provide access for maintenance Remaking of single crowns if possible Antibiotic therapy- doxycycline 200mg on day one followed by 100mg per day for 3 weeks. 
  35. 35. Advanced cases of furcation involvement – treated endodontically and root resected Absolutely unmaintainable site still persists –extraction
  36. 36.
  37. 37. Gingival facade
  38. 38. Subpontic inflammation  Pain  Swelling  Poor aesthetics  Poor plaque control
  39. 39. Occlusal dysfunction     Abnormal tooth mobility,muscle and joint pain. Wear facets on occlusal surfaces. Articulated diagnostic casts must be remade Correction by occlusal adjustments, occlusal devices.
  40. 40. Occlusal adjustment   Centric relation position must be verified Remove retrusive prematurities and eliminate the deflective shift from RCP to ICP.
  41. 41.  Adjust ICP to achieve stable, simultaneous, multipointed, widely distributed contacts.
  42. 42.  Test for excessive contact (fremitus) on the incisor teeth.  Remove posterior protrusive supracontacts and establish contacts that are bilateral.  Remove or lessen mediotrusive (balancing) interferences
  43. 43. • Reduce excessive cusp steepness on the laterotrusive (working) contacts.
  44. 44.  Eliminate gross occlusal disharmonies include, Extruded Teeth, Plunger Cusp, Uneven Adjacent Marginal Ridges, Rotated, Malposed Teeth, Flat Occlusal Wear. Recheck tooth contact relationships.  Polish all rough tooth surfaces. 
  45. 45. Occlusal Device  Repositioning of condyles / articular disk  Reduction in masticatory muscle activity  Modification of harmful oral behavior  Used as a night guard in cases of bruxism
  46. 46. Occlusal wear  Perforations of restorations  Leakage and caries  If detected earlysealed with amalgam restoration  Remaking of restoration
  47. 47. Pulpal and Periapical health Pain : spontaneous or related to hot ,cold or sweet stimuli Exacerbated on lying down Vitality of the tooth assessed – electric pulp testing, thermal
  48. 48. Periapical pain manifests as: Pain on biting Swelling Previous pain that subsided Radiographs provide the most useful information. Assessed every few years. Contradictary evidence where some studies show high incidence of periapical disease of teeth restored with fixed prostheses others show opposite results. Teeth with pulpal or periapical problems must be endontically treated
  49. 49. Access opening is made through the crown After the Biomechanical preparation and obturation is done The access opening is sealed with either an amalgam restoration or repair.
  50. 50. Emergency Appointments    Pain Tooth fracture- coronal or radicular Causes : Excessive tooth preparation. Interfering centric or eccentric contacts . Unseating of a prosthesis
  51. 51.    Small fractures- amalgam or resin Large fractures around partial coverage crownsfull coverage restorations or core and crown fabrication if pulpal exposure occurs –endodontic therapy ,post and core and crown Fracture under a full coverage restorationhorizontal at finish line- endodontic therapy ,post and core followed by a crown Little coronal structure with intact finish line. Use of existing crown .post and core fabricated to fit restoration and prepared tooth.
  52. 52. Root fractureDue to internally weakened tooth with short oversized posts. Usually extraction Complicates follow up treatment.
  53. 53. Loose Abutment Retainer Percieved as bad taste ,bad odour or sensitivity, May develop caries.
  54. 54. Prosthesis must be removed Abutment evaluated Recementation Intact removal difficult Hemostats Ultrasonic scalers Crown and bridge removal systems Adhesive resin-richwil system Sectioning of prosthesis
  55. 55. Crown and Bridge Removal Systems Coronaflex crown remover Metalift Crown and Bridge Removal System Roydent Bridge and Crown Back Action-Crown Remover remover
  56. 56. Richwil crown and Bridge Remover Removal by Sectioning
  57. 57. Fractured connector Fracture due to occlusal forces Failure of the cast or soldered connection due to internal porosity. Perceived as pain Repair : Stabilisation of the parts in the mouth,making an impression ,Removal from mouth and reassembling it on the casts, soldering and recementation.
  58. 58. Dovetails are prepared to a depth of 2mm on either side of the fractured connector ,an inlay like casting is fabricated and then cemented. Prosthesis must be removed and remade.
  59. 59. Fractured porcelain Veneer Fracture within the porcelain
  60. 60. Mixed porcelain / metal repair
  61. 61.
  62. 62. Metal repair Fabrication of an overcasting
  63. 63. Conclusion The responsibility of a dentist does not end with the cementation of the prosthesis . The success and longevity of the prosthesis depends upon 1. carefully structured sequence of post operative appointments, designed to monitor the patients dental health, 2. stimulate and motivate the patient to maintain meticulous plaque control. 3. Identify any incipient disease and introduce any corrective treatment before irreversible damage occurs.
  64. 64. Refrences     Carranza Newman:Clinical Periodontology, ed 8,1996, W B Saunders company Dykema-Goodacre –Philips: johnston’s modern practice in fixed prosthodontics, ed 4,1986,W.B. Saunders company. Micheal D. Wise: Failure in the restored dentition: management and treatment, 1995, Quintessence Publishing co. ltd. Rosenstiel-Land-Fujimoto: contemporary fixed prosthodontics, ed 3,2001,C V Mosby
  65. 65.      The Dental Clinics of North America: periodontal restorative interrelationships; apr 1980 Comprehensive fixed Prosthodontics:The Dental Clinics of North America, jul 1992 Antonio Carlos Cardoso. Clinical and Laboratory Techniquesfor Repair of Fractured Porcelein in fixed Prosthesis: A case Report. Quintessence int,1994;25:835-38 J W robbins. Intraoral Repair of Fractured Porcelein Restortion . Operative dentistry,1998;23:203-207 Karson A. Kupiec, Karen M. Wuertz. Evaluation of porcelein surface treatments and agents for composite –to –porcelein repair.Journal of Prosthetic Dentistry; 1996; 76:119-24
  66. 66. Thank you For more details please visit