Post cementation /certified fixed orthodontic courses by Indian dental academy

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

Contents
Introduction
Post cementation instructions
Oral hygiene
Follow up:
 Dental caries
 Periodontal health
 Occlusal dysfunction
 Pulpal Health
 Periapical Health

Emergency Appointments
 Pain
 Fracture of tooth
 Loosening of Retainers
 Fractured Connectors
 Fractured Porcelein
Conclusion
Refrences

Introduction


Post Cementation Instructions
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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 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

Bass Method


Modified Stillmans Method


Charters method


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


Types of Embrasures


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

Floss Holders


Super Floss


Interdental Brushes


Wooden and rubber tips


Oral Irrigating Devices


Disclosing Solutions


Plaque Control Record


Dental Caries
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Pain or sensitivity

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Bad taste

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Bad breath

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Loose restorations

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Fractured teeth

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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 caries1.
Visual
2.
Explorers
3.
Radiographs


LocationOn abutment at the margin of restoration


Caries involving the furcation and root caries


Extensive Caries Requiring Removal
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 Disease
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Looseness of teeth or bridgework
Drifting teeth
Bleeding tissues
Change in colour of the gingiva
Bad taste
Bad breath
Pain
Abscess formation
Poor aesthetics

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.

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.
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Advanced cases of furcation involvement –
treated endodontically and root resected
Absolutely unmaintainable site still persists
–extraction


Gingival facade

Subpontic inflammation
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Pain

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Swelling

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Poor aesthetics

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Poor plaque control


Occlusal dysfunction
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Abnormal tooth
mobility,muscle and
joint pain.
Wear facets on
occlusal surfaces.
Articulated diagnostic
casts must be remade
Correction by
occlusal adjustments,
occlusal devices.

Occlusal adjustment
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Centric relation
position must be
verified
Remove retrusive
prematurities and
eliminate
the
deflective shift from
RCP to ICP.


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


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Test for excessive contact (fremitus) on the
incisor teeth.

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Remove posterior protrusive supracontacts
and establish contacts that are bilateral.

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Remove or lessen mediotrusive (balancing)
interferences


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


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Eliminate gross occlusal disharmonies
include, Extruded Teeth, Plunger Cusp,
Uneven Adjacent Marginal Ridges,
Rotated, Malposed Teeth, Flat Occlusal
Wear.
Recheck tooth contact relationships.

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Polish all rough tooth surfaces.

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Occlusal Device
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Repositioning of condyles
/ articular disk

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Reduction in masticatory
muscle activity

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Modification of harmful
oral behavior

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Used as a night guard in
cases of bruxism


Occlusal wear
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Perforations of
restorations

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Leakage and caries

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If detected earlysealed with amalgam
restoration

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Remaking of
restoration

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


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

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 inlaywww.indiandentalacademy.com
repair.

Emergency Appointments
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Pain
Tooth fracture- coronal or radicular
Causes :
Excessive tooth preparation.
Interfering centric or eccentric contacts .
Unseating of a prosthesis


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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.

Root fractureDue to internally
weakened tooth with
short oversized posts.
Usually extraction
Complicates follow up
treatment.


Loose Abutment Retainer
Percieved as bad taste ,bad odour or sensitivity,
May develop caries.


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

Crown and Bridge Removal Systems

Coronaflex crown remover

Metalift Crown and Bridge
Removal System

Roydent Bridge and Crown
www.indiandentalacademy.com Back Action-Crown Remover
remover

Richwil crown and Bridge Remover

Removal by Sectioning


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.

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.

Fractured porcelain Veneer
Fracture within the porcelain


Mixed porcelain / metal repair


Metal repair

Fabrication of an overcasting

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.

Refrences
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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

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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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Post cementation /certified fixed orthodontic courses by Indian dental academy

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