Interocclusal record Fixed prosthodontic Dentistry Fourth year Al Azhar University Gaza Dr. Mohammed Miqdad crown and bridge department

1. FIXED PROSTHODONTIC III
Department of Fixed Prostodontics

2. DIAGNOSIS RELATED TO FIXED
PROSTHODONTICS

3. Diagnosis:
Diagnosis is simply defined as the procedure of
collecting data and informations through different
channels so that a proper line of treatment could
be proposed.

4. Elements of proper diagnosis:
I. History (Medical-Dental(
II. T.M.J and occlusal evaluation
III. Intra-oral examination
IV. Diagnostic cast analysis
V. Radiographic Examination

5. I. History (Medical history(:
1.To determine any special precautions to be taken before the
start of the treatment.
2.Any selective treatment which might be postponed or
eliminated because of the patient’s psychological or physical
health
3.Any necessary pre-medication

6. I. History (Medical history(:
1.Allergic reactions (drugs, local anesthetics(
2.Hypertension and coronary heart diseases
3.Rheumatic fever and valvular dysfunction, a history of previous
bacterial endocarditis, congential heart malformations or mitral
valve prolapse should be pre-medicated with amoxicillin or
clindamycin in cases of allergy to amoxicillin.
4.Patients receiving anti-coagulants should be asked for their
physicians consultation before starting any treatment that will
cause even minor bleeding

7. 5.Diabetic patients should be well controlled before receiving
routine dental treatment.
6.Epileptic patients should not be treated unless precautionary
measures are taken to minimize seizure (ex.: anxiety should be
avoided, no long fatiguing appointments(
7.Infectious diseases should be known for protective measures
(ex.: HIV, hepatitis(
N.B. The patient’s physician should be consulted before beginning
the treatment.

8. I. History (Dental history(:
-Patient’s chief complaint
-Previous treatment and patient’s attitude
-Patient’s expectations from treatment

9. Patient’s chief complaint:
-Comfort (pain, sensitivity, swelling(
-Function (difficulty in speech, or mastication(
-Social (bad odor or taste(
-Appearance or esthetics (fractured or unattractive
teeth, or discoloration(

10. Previous treatment and patient’s attitude:
This gives an insight into the patient’s level of dental awareness
and the expected patient’s cooperation
Patient’s expectation from treatment:
Special attention should be given to the esthetic effect anticipated
by the patient. Conflicts in this area with sound restorative
procedures should be noted, and the option of not providing
treatment should be considered.

11. II. T.M.J and occlusal evaluation:
A. Temporomandibular joints:
-TMJ should be healthy with no evidence of clicking, crepitations
or limiting of movement on opening or closing or lateral shifting.
-Maximum opening of the jaw less than 40mm is an indication of
jaw restriction (average opening more than 50mm(
B. Muscles of mastication:
-Muscle pain is usually associated with parafunctional jaw activity
related to stress or faulty occlusion.
-Evidence of pain in either muscles or TMJ should be properly
evaluated before starting treatment
C. Occlusal evaluation:

12. III. Intra-oral examination:
This should be carried in a systematic manner to include
the following:
-Oral hygiene and caries index
-Abnormal habits
-Edentulous ridge
-Occlusion
-Prospective abutment

13. III. Intra-oral examination:
Oral hygiene and caries index:
The first thing to be observed intra-orally is the patient’s oral
hygiene, amount and areas of plaque, as well as the general
periodontal condition.
It should be noted that because of the long-term periodontal
health is necessary to successful fixed prosthodontics, existing
periodontal disease must be treated before any definitive
prosthodontic treatment is undertaken.

14. III. Intra-oral examination:
Abnormal habits:
Examination for any abnormal oral habits should be identified (ex.:
pipe smokers, pencil biting, bruxism…..(. This would affect the
prosthesis type, retainer and bridge design.
Edentulous ridge:
The relationship of edentulous spans if more than one should be
recorded. Examine the form and texture and color of ridge
mucosa. Dimensions of edentulous span is a critical deciding
factor in the treatment planning.

15. III. Intra-oral examination:
Occlusion:
Occlusal evaluation should be carried out for:
-Wear facets (localized, or wide spread(
-Presence of any premature contacts
-Existence of cuspal interference in eecenrtic movements.

16. III. Intra-oral examination:
Clinical evaluation of the proposed abutments:
Carious lesions:
Condition of the pulp (vitality(:
Mobility:
Periodontal condition:
Coronal defects:

17. III. Intra-oral examination:
Clinical evaluation of the proposed abutments:
Coronal defects: Examined for:
-Color variations (extrinsic or intrinsic(
-Areas of (attrition, erosion, abrasion(
-Crown morphology (long, short, malformed(
-Axial inclination
-Supra and infra eruptions

20. IV. Diagnostic Cast Analysis:
It is an important adjunct of the diagnostic procedures:
Criteria of good diagnostic cast:
-Accurate reproduction of both arches
-No bubbles or nodules on the occlusal surface
-Mounted in centric occlusion on a semi-adjustable articulator by
means of a face bow and occlusal wax records

21. Diagnostic casts reveal:
1.Distribution and dimensions of edentulous
span:
Diagnostic casts allow an easy unobstructed view of
edentulous spans from these aspects;
-Mesio-distal length ( to assess liability to flexibility(
-Occluso-gingival dimension ( for pontic design(
-Arch curvature ( to assess liabiliy to flexibility(
-Arch curvature ( to assess whether the pontic (s( will act as a
lever arm on the abutments(.
-Distribution and extent of edentulous areas could be properly,
evaluated as to whether construct RPD, or FP

22. Diagnostic casts reveal:
2.Type of bite and occlusal prematurities:
The type of bite whether being anterior or posterior
cross bite, deep over bite or over-jet could be properly
assessed. Occlusal prematurities as well as wear
facets, their number size and location, could be
properly evaluated.

23. Diagnostic casts reveal:
3.Occlusal discrepancies and the need to
establish a new occlusal plane:
With the aid of radiographs, over-erupted teeth can be
easily spotted and evaluated and the amount of
reduction needed could be determined.

24. Diagnostic casts reveal:
4.Changes in teeth axial inclination for a
common path of insertion:
Problems anticipated to attain a certain path of
insertion could be evaluated with the aid of dental
surveyor. Together with radiographic evaluation, the
amount of reduction needed without endangering the
pulp could be properly gauged. Accordingly the type of
bridge and retainer could be decided.

25. Diagnostic casts reveal:
5.Abutment teeth form, size and mal-position:
Considering the necessary retentive means the length
of abutment can be properly assessed to determine the
type of retainer and the retentive features needed.
6.Planning the suitable bridge design:
This could be easily proposed on the cast.

26. Diagnostic casts reveal:
7.Trial tooth preparation and waxing prior to
initiating the treatment:
This is a very useful diagnostic technique for those
cases to be restored with fixed partial dentures.
Apractitioner could rehearse a proposed treatment plan
on a stone cast, this enables him to visualize the
possible problems to be encountered in the clinical
treatment, also through daignostic wax-up the final
shape and form of the prosthesis could be properly
assessed.

27. V. Radiographic Examination:
Radiographic Examination of the Teeth and Investing
Structures:
1.Coronal portion:
2.Pulp portion
3.Root portion
4.Periapical area
5.Thickness of periodontal membrane

28. V. Radiographic Examination:
Radiographic Examination of the Teeth and Investing
Structures:
1.Coronal portion: Together with clinical
examination:
-Any carious lesions both on the unrestored proximal
surfaces and recurring around previous restorations.
-Any local formative defects ( ex. Hypoplastic pits,
amelogenesis imperfecta(

29. V. Radiographic Examination:
Radiographic Examination of the Teeth and Investing
Structures:
2.Pulp portion:
-Size of pulp chamber (necessary in cases of over
eruption, mesial tilting(
-In non-vital teeth, whether endodontically treated or
not, and to evaluate the perfection of endo-treated teeth.
-The size, direction and number of RC to determine its
suitability for endodontic treatment
N.B.: If a non-vital tooth not suitable for endodontic
therapy, so extraction is the treatment choice

30. V. Radiographic Examination:
Radiographic Examination of the Teeth and Investing
Structures:
3.Root portion: Radiographic evaluation of the root
and supporting tissue for:
Crown: root ratio:
Root configuration:
Periodontal surface area:

31. Crown: root ratio:
“It is a ratio between the linear length of that part of
tooth above the level of alveolar crest of bone to that
part of root embedded in the bone, optimally 2:3”.
N.B.: More details are discussed in treatment planning
section.
Root configuration:
“Abutment roots are evaluated for their configuration
and direction:
-Broader roots labio-lingual are preferable than those
rounded cross section.
-Multi rooted widely separated roots provide better
support than converging fusing roots.

32. Periodontal surface area: