Post cementation/ orthodontic continuing education

Post CementationPost Cementation
Instructions ,Home Care andInstructions ,Home Care and
Follow Up of Fixed PartialFollow Up of Fixed Partial
DenturesDentures
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

ContentsContents
IntroductionIntroduction
Post cementation instructionsPost cementation instructions
Oral hygieneOral hygiene
Follow up:Follow up:
• Dental caries
• Periodontal health
• Occlusal dysfunction
• Pulpal Health
• Periapical Health

Emergency AppointmentsEmergency Appointments
• Pain
• Fracture of tooth
• Loosening of Retainers
• Fractured Connectors
• Fractured Porcelain
ConclusionConclusion
ReferencesReferences

IntroductionIntroduction

Post Cementation InstructionsPost 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

Home careHome care
Core of the home care program is plaqueCore of the home care program is plaque
control.control.
Use of a manual or a powered toothbrushUse of a manual or a powered toothbrush
Short flat headed brush with medium softShort flat headed brush with medium soft
bristlesbristles
Thoroughness rather than technique.Thoroughness rather than technique.
Most popular is theMost popular is the sulcus cleansingsulcus cleansing
techniquetechnique or theor the BASSBASS methodmethod

Bass MethodBass Method

Modified Stillmans MethodModified Stillmans Method

Charters methodCharters method

INTERDENTAL CLEANINGINTERDENTAL CLEANING
AIDSAIDS
Purpose
To remove plaque, not to dislodge
fibrous threads of food wedged
between teeth.

Types of EmbrasuresTypes of Embrasures

Dental flossDental floss
Multifilament nylon
yarn
Twisted and non
twisted
Bonded and non
bonded
Waxed and non
waxed
Thick or thin
Monofilament and
multifilament

Floss HoldersFloss Holders

Interdental BrushesInterdental Brushes

Wooden and rubber tipsWooden and rubber tips

Oral Irrigating DevicesOral Irrigating Devices

Disclosing SolutionsDisclosing Solutions

Plaque Control RecordPlaque Control Record

Follow upFollow up
• Dental Caries
• Pain or sensitivity
• Bad taste
• Bad breath
• Loose restorations
• Fractured teeth
• Discoloured teeth

Most common cause of failure of cast
restorations as reported by Schwartz et al
in 1970--- accounting for 36% of failure.
Detection of caries-
1. Visual
2. Explorers
3. Radiographs

Location-
On abutment at the margin of restoration

Caries involving the furcation and root cariesCaries involving the furcation and root caries

Extensive Caries RequiringExtensive Caries Requiring
Removal Of the RetainerRemoval Of the Retainer

Daily rinse of sodium flouride (0.05%) and a
Flouridated dentifrice containing 1,100 ppm
of flouride as sodium flouride
Flouride varnishes.

Periodontal DiseasePeriodontal Disease
• Looseness of teeth or bridgeworkLooseness of teeth or bridgework
• Drifting teethDrifting teeth
• Bleeding tissuesBleeding tissues
• Change in colour of the gingivaChange in colour of the gingiva
• Bad tasteBad taste
• Bad breathBad breath
• PainPain
• Abscess formationAbscess formation
• Poor aestheticsPoor aesthetics

thoroughthorough assessmentassessment of periodontalof periodontal
condition.condition.
1.1. Evaluating patients plaque controlEvaluating patients plaque control
efficiencyefficiency
2.2. bleeding on probing, estimatingbleeding on probing, estimating
pocket depthpocket depth
3.3. Checking for mobilityChecking for mobility
4.4. Radiographic evaluation.Radiographic evaluation.

• Acute conditionsAcute conditions : abscess- incision and: abscess- incision and
drainage.drainage.
• Advanced periodontitisAdvanced periodontitis: around abutments: around abutments
or in case of furcation involvement.or in case of furcation involvement.
Debridement and removal of the soft tissueDebridement and removal of the soft tissue
pocket.pocket.
Subgingival irrigation with 1% chlorhexidineSubgingival irrigation with 1% chlorhexidine
gel.gel.
Elevation of flap ,debridementElevation of flap ,debridement

Recontouring the tooth to provide accessRecontouring the tooth to provide access
for maintenancefor maintenance
Remaking of single crowns if possibleRemaking of single crowns if possible
Antibiotic therapy- doxycycline 200mg onAntibiotic therapy- doxycycline 200mg on
day one followed by 100mg per day for 3day one followed by 100mg per day for 3
weeks.weeks.
Advanced cases of furcation involvement –Advanced cases of furcation involvement –
treated endodontically and root resectedtreated endodontically and root resected
Absolutely unmaintainable site still persistsAbsolutely unmaintainable site still persists
–extraction–extraction

Gingival facadeGingival facade

Subpontic inflammationSubpontic inflammation
• PainPain
• SwellingSwelling
• Poor aestheticsPoor aesthetics
• Poor plaquePoor plaque
controlcontrol

Occlusal dysfunctionOcclusal dysfunction
• Abnormal toothAbnormal tooth
mobility, muscle andmobility, muscle and
joint pain.joint pain.
• Wear facets onWear facets on
occlusal surfaces.occlusal surfaces.
• Articulated diagnosticArticulated diagnostic
casts must be remadecasts must be remade
• Correction by occlusalCorrection by occlusal
adjustments, occlusaladjustments, occlusal
devices.devices.

Occlusal adjustmentOcclusal adjustment
• Centric relationCentric relation
position must beposition must be
verifiedverified
• Remove retrusiveRemove retrusive
prematurities andprematurities and
eliminate theeliminate the
deflective shiftdeflective shift
from RCP to ICP.from RCP to ICP.

• Adjust ICP toAdjust ICP to
achieve stable,achieve stable,
simultaneous,simultaneous,
multipointed,multipointed,
widely distributedwidely distributed
contacts.contacts.

• Test for excessive contact (fremitus) on theTest for excessive contact (fremitus) on the
incisor teeth.incisor teeth.
• Remove posterior protrusive supracontactsRemove posterior protrusive supracontacts
and establish contacts that are bilateral.and establish contacts that are bilateral.
• Remove or lessen mediotrusive (balancing)Remove or lessen mediotrusive (balancing)
interferencesinterferences

• Reduce excessive cusp steepness on theReduce excessive cusp steepness on the
laterotrusive (working) contacts.laterotrusive (working) contacts.

• Eliminate gross occlusal disharmoniesEliminate gross occlusal disharmonies
include, Extruded Teeth, Plunger Cusp,include, Extruded Teeth, Plunger Cusp,
Uneven Adjacent Marginal Ridges,Uneven Adjacent Marginal Ridges,
Rotated, Malposed Teeth, Flat OcclusalRotated, Malposed Teeth, Flat Occlusal
Wear.Wear.
• Recheck tooth contact relationships.Recheck tooth contact relationships.
• Polish all rough tooth surfaces.Polish all rough tooth surfaces.

Occlusal DeviceOcclusal Device
• Repositioning ofRepositioning of
condyles / articularcondyles / articular
diskdisk
• Reduction inReduction in
masticatory musclemasticatory muscle
activityactivity
• Modification ofModification of
harmful oral behaviorharmful oral behavior
• Used as a night guardUsed as a night guard
in cases of bruxismin cases of bruxism

Occlusal wearOcclusal wear
• Perforations ofPerforations of
restorationsrestorations
• Leakage and cariesLeakage and caries
• If detected early-If detected early-
sealed withsealed with
amalgamamalgam
restorationrestoration

Pulpal and Periapical healthPulpal and Periapical health
PainPain : spontaneous or related to hot: spontaneous or related to hot
,cold or sweet stimuli,cold or sweet stimuli
Exacerbated on lying downExacerbated on lying down
Vitality of the tooth assessed – electricVitality of the tooth assessed – electric
pulp testing, thermalpulp testing, thermal

Periapical painPeriapical pain manifests as:manifests as:
Pain on bitingPain on biting
SwellingSwelling
Previous pain that subsidedPrevious pain that subsided
Radiographs provide the most usefulRadiographs provide the most useful
information. Assessed every few years.information. Assessed every few years.
Contradictory evidence where some studiesContradictory evidence where some studies
show high incidence of periapical disease ofshow high incidence of periapical disease of
teeth restored with fixed prostheses othersteeth restored with fixed prostheses others
show opposite results.show opposite results.
Teeth with pulpal or periapical problemsTeeth with pulpal or periapical problems
must be endontically treatedmust be endontically treated

Access opening is made through the crownAccess opening is made through the crown
After the Biomechanical preparation and obturation is doneAfter the Biomechanical preparation and obturation is done
The access opening is sealed with either an amalgamThe access opening is sealed with either an amalgam
restoration or inlay repair.restoration or inlay repair.

Emergency AppointmentsEmergency Appointments
• PainPain
• Tooth fracture- coronal or radicularTooth fracture- coronal or radicular
• Causes :Causes :
Excessive tooth preparation.Excessive tooth preparation.
Interfering centric or eccentricInterfering centric or eccentric
contacts .contacts .
Unseating of a prosthesisUnseating of a prosthesis

• Small fractures-Small fractures- amalgam or resinamalgam or resin
• Large fractures around partial coverage crowns-Large fractures around partial coverage crowns-
full coverage restorations orfull coverage restorations or
core and crown fabricationcore and crown fabrication
if pulpal exposure occurs –endodontic therapyif pulpal exposure occurs –endodontic therapy
,post and core and crown,post and core and crown
• Fracture under a full coverage restoration-Fracture under a full coverage restoration-
horizontal at finish line- endodontic therapy ,posthorizontal at finish line- endodontic therapy ,post
and core followed by a crownand core followed by a crown
Little coronal structure with intact finish line. UseLittle coronal structure with intact finish line. Use
of existing crown .post and core fabricated to fitof existing crown .post and core fabricated to fit
restoration and prepared tooth.restoration and prepared tooth.

Root fracture-Root fracture-
Due to internallyDue to internally
weakened tooth withweakened tooth with
short oversized posts.short oversized posts.
Usually extractionUsually extraction
Complicates follow upComplicates follow up
treatment.treatment.

LooseLoose Abutment RetainerAbutment Retainer
Percieved as bad taste ,bad odour orPercieved as bad taste ,bad odour or
sensitivity,sensitivity,
May develop caries.May develop caries.

Prosthesis must be removedProsthesis must be removed
Abutment evaluatedAbutment evaluated
RecementationRecementation
Intact removal difficultIntact removal difficult
HemostatsHemostats
Ultrasonic scalersUltrasonic scalers
Crown and bridge removal systemsCrown and bridge removal systems
Adhesive resin-richwil systemAdhesive resin-richwil system
Sectioning of prosthesisSectioning of prosthesis

Crown and Bridge RemovalCrown and Bridge Removal
SystemsSystems
Coronaflex crown remover Metalift Crown and Bridge
Removal System
Roydent Bridge and Crown
remover Back Action-Crown Remover

Richwil crown and Bridge Remover
Removal by Sectioning

Fractured connectorFractured connector
Fracture due to occlusal forcesFracture due to occlusal forces
Failure of the cast or solderedFailure of the cast or soldered
connection due to internal porosity.connection due to internal porosity.
Perceived as painPerceived as pain
Repair :Repair :
Stabilization of the parts in theStabilization of the parts in the
mouth, making an impressionmouth, making an impression
,Removal from mouth and,Removal from mouth and
reassembling it on the casts,reassembling it on the casts,
soldering and recementation.soldering and recementation.

Dovetails are prepared to a depth of 2mm onDovetails are prepared to a depth of 2mm on
either side of the fractured connector ,an inlay likeeither side of the fractured connector ,an inlay like
casting is fabricated and then cemented.casting is fabricated and then cemented.
Prosthesis must be removed and remade.Prosthesis must be removed and remade.

Fractured porcelain VeneerFractured porcelain Veneer
Fracture within the porcelainFracture within the porcelain

Mixed porcelain / metal repairMixed porcelain / metal repair

Metal repairMetal repair
Fabrication of an overcastingFabrication of an overcasting

ConclusionConclusion
The responsibility of a dentist does not endThe responsibility of a dentist does not end
with the cementation of the prosthesis .with the cementation of the prosthesis .
TheThe success and longevitysuccess and longevity of the prosthesisof the prosthesis
depends upondepends upon
1.1. carefullycarefully structured sequence of poststructured sequence of post
operative appointments, designedoperative appointments, designed toto
monitor the patients dental health,monitor the patients dental health,
2.2. stimulate and motivatestimulate and motivate the patient tothe patient to
maintain meticulous plaque control.maintain meticulous plaque control.
3.3. IdentifyIdentify any incipient disease andany incipient disease and
introduce anyintroduce any corrective treatmentcorrective treatment beforebefore
irreversible damage occurs.irreversible damage occurs.

RefrencesRefrences
• 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

• 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

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