2. Mouth Preparation
One of the greatest challenges
facing the dentist to achieve a
successful fixed prosthodontic
restoration.
To ensure this success, the hard
and soft tissues must be in an
acceptable biologic state.
3. The main aims for preprosthetic
mouth preparation are :
1- Relief of chief complaint.
2- Remove of etiologic factors.
3- Repair of damage.
4- maintainance of dental health.
5. Oral surgery
• The purpose of surgical intervention:
“Surgery performed to make the
remaining oral tissues(soft & hard) to best
support a prosthesis”
6. A) Soft tissue surgery include:
1- Alteration of muscle attachment.
2- Removal of soft tissue wedge.
3- Increase vestibular depth.
4- Modification of edentulous area.
7. B) Hard tissue surgery:
• Simple tooth removal.
• Tuberosity reduction.
• Mandibular and maxillary tori excision.
• Removal of impacted or unerupted
supernumerary teeth.
9. Caries and old restorations:
• Replace of any existing restoration.
• Foundation restoration:
a) To build a damaged tooth to ideal
anatomic form.
b) Provide the patient with adequate
function ,contoured and finished to
fasilitate oral hygien.
10. The replacement of a foundation
restoration depends on:
The extent of damage to the tooth:
a) Class I , III , V (cement, glass ionemer,
composite)
b) Class II (amalgam)
c) Deep class II (pin retained amalgam)
d) Post and core (in multilated endodotically
teeth)
11. preprosthetic Endodontic treatment:
1. Vitality test by :
- Electric pulp tester
- Heated gutta percha
2. Percussion
3. Any abnormal sensetivity
4. Soft tissue swelling
5. Fistulous tract
6. Disclored tooth
7. Acute pain or chronic abscess
8. Radiographic examination
12. preprosthetic Endodontic treatment:
• Conventional endodotic treatment make
us to avoid apicectomy as possible that
affects C/R ratio .
• Hopeless tooth should be extracted.
• For post and core restoration the
endodontically treatad tooth 3-5 mm of
apical seal should retained.
13. Preprosthetic priodontal treatment:
• In the fabrication of any fixed
prosthesis, the practitioner must maintain
the periodontal status of the involved
abutment teeth , Because periodontal
disease is a major cause of tooth loss in
adults.
14. Preprosthetic priodontal treatment:
• When discussing a diseased state, it is
imperative to understand the normal
relationship of the tooth to the supporting
structure.
• Understanding the deviation structure.
• A normal relationship of the gingival
margin to the tooth, the epithelial
attachment, and the fibers attached from
the cementum to the gingiva.
15. • THE GINGIVA CONSISTS OF THREE
PARTS;
1- Free (marginal ) gingiva: extending from
the most coronal aspect of the gingiva to
the epithelial attachment with the tooth.
2- Attached gingiva: extending from the level
of theAttached gingiva to the junction
between the gingiva and the alveolar
mucosa
3- Interdental papillae: triangular projections
of gingiva , the area between adjacent
16. • The Periodontium :is a connective tissue
structure attached to the periosteum that
anchors the teeth in the mandubular and
maxillary alveolar processes.
• It provides attachment and support,
nutrition.
• The main element of the periodotium is the
periodontal ligament
17. Etiology
• Most gingival and periodontal
diseases result from microbial plaque
which causes inflammation and its
subsequent pathologic processes
• Other contributors to inflammation include
calculus pellicle, materia alba, and food
debris.
• Periodontal disease must be recognized
and treated before fixed prosthodontics .
18. The most common periodotal
diseases that affect Fpd :
• 1- Periodontitis :
• When a loss of connective tissue
attachment occurs, the lesion transforms
from gingivitis into periodontitis, The extent
to which the lesion progresses before it is
treated will determine the amount of bone
and connective tissue attachment loss that
occurs
19. • 2- periodontal pocket:
• is defined as a diseased periodontal attachment
• It is caused by the apical migration of the epithelial
attachment with the loss of connective tissue
attachment
• The clinical significance of a pocket is that if it
extends beyond 3 to 4 mm , the patient has
increasing difficulty maintaining normal brushing
and flossing techniques
• The ideal situation is for the entire mouth to be
free of pockets.
20. EXAMINATION
• 1- Inspection :
• color, consistency, texture, and shape of
the gingival unit.
• 2- Probing :
• The dentist should probe six areas around
the tooth including bifurcation and
trifurcation
• During the probing procedure check for
bleeding , exudation or ulceration
21. • 3- Mobility
• can be determined with the handle end of the
mirror, placed on the buccal and lingual
surfaces and applying pressure to the tooth .
Mobility can be classified in to :
• Class 1: less than 1 mm of movement in any
direction.
• :Class 2: A tooth moves 1 mm from any
direction
• :Class 3: A tooth moves more than 2 mm in
any direction
22. • 4- Radiographs :
• The areas to be reviewed on the
radiographs
• 1.Alveolar crest resorption
• 2.Intergrity of thickness of the lamina dura
• 3. Widened periodontal ligament space
• 4. Size and shape of the roots compared
to the crown to determine crown-to-root
ratio
23. • 5- HABITS:
• The major habit to consider is bruxism
Visual examination of oclusal surface wear
and x-ray interpretation of thickened
lamina dura and widened periodontal
lamina
24. TREATMENT PLANNING:
• 1- Control of microbial plaque
• 2- Tooth brushing
• 3- Flossing
• 4- Scaling and polishing
• 5- Correction of defective and overhanging
restorations
• 6- Root planning
• 7- Removal of hopeless tooth
• 8- Stabilization of mobile teeth
• 9- Evaluation of Initial Therapy
Initial therapy
25. • 1) soft tissue therapy :
• A) Gingivectomy : is the removal of diseased
or hypertrophied gingiva , and it may be
applied to the treatment of suprabony
pockets.
• However, it is unsuitable for the treatment of
infrabony defects
• B) Open debridement (Modified Widman
Procedure)
Open debridement or curettage is a surgical
procedure designed to gain better access to
root surfaces for complete debridement and
root planning.
Surgical therapy:
26. • 2) Hard tissue therapy:
• A- OSSEOUS RESECTION WITH
APICALLY POSITIONED FLAPs
• Chronic inflammatory periodontitis results
in the loss of osseous tissue destruction of
osseous architecture, and creation of an
intrabony lesion.
• The result is intended to be a sound
osseous base for gingival attachment and
the elimination of pockets and excessive
Sulcular depth.
27. • B-crown lengthening :
• Clinical crown lengthening procedures (CCLP) are used to
enhance aesthetics and/or provide adequate tooth structure
for placement and retention of a restoration
• Factors affecting crown lengthening :
• 1- Esthatics
• 2- Root length with in the bone
Periapical Radiographs are needed to ensure sufficient root
length is available.
• 3- Effect of adjacent teeth
• 4- Root furcation involvement in posterior teeth
• 5- Mobility
• 6- Extent of the defect
• 7- Root perforation
28. • C- TREATMENT OF FURCATION
INVOLVEMENT
• FurcationFurcation involvements can be
classified as Class for Grade) I, II, III, and
IV.
• Class I : If vertical loss of periodontal
support is less than 3mm and There is no
gross or or radiographic evidence of bone
loss.
29. • Class II : If vertical loss is greater than 3 mm
but the total horizontal width of the furcation
is not involved but osseous loss is evident on
radiographs.
• Class III : A horizontal through – and –
through lesion that is occluded by
gingiva but allows passage of an instrument
from busccal, lingual, or palatal
The degree of osseous loss is grossly
evident on radiographs
30. • Class IV : A horizontal through – and –
thorugh lesion that is not occluded by
gingiva
• Class I can be treated by reflecting the soft
tissue in the furcation area and
recontouring both the tooth structure and
the supporting . Pocket elemination
provide best results .
31. • Class II and Class III : can be treated by a
procedure known as
1- Tunneling
2- Root amputation
32. EVALUATION OF SURGICAL THERAPY
• The prognosis for a treated tooth depends
on:
1- The manner in which the tooth is to be
used in the restorative plan as an
abutment for a partial denture or as a
single crown.
2- The amount of residual osseous
structure to support the remaining tooth
