Removal partial denture considerations in maxillofacial prosthetics discusses interim, definitive, and surgical considerations for prosthetics following maxillofacial defects. Interim prosthetics aim to separate oral and nasal cavities and improve swallowing/speech. Definitive prosthetics restore function after tissue healing. Surgical preservation of teeth and tissues benefits prosthetics by providing support and retention. Mandibular reconstruction challenges include soft tissue bulk and bone placement impacting function.
The document discusses overdentures, which are removable partial or complete dentures that cover and rest on one or more remaining natural teeth, tooth roots, or dental implants. Key points include:
- Retaining natural teeth can preserve alveolar bone and periodontal receptors important for function.
- Abutment teeth are prepared with short copings or left uncovered, and attachments may be added to improve retention.
- Overdentures can improve retention, stability, support and proprioception compared to conventional dentures.
- Proper case selection and maintenance are important for long term success.
The document discusses various techniques for making impressions for implant prostheses. It describes the materials needed and outlines implant level and abutment level impression methods, including open tray, closed tray, direct, and indirect techniques. Splinting multiple implants is recommended to improve accuracy. The importance of minimizing errors in impression making is discussed to ensure proper seating of components and interfaces between impressions posts and analogues. A literature review found that implant and abutment level impression techniques did not have significantly different effects on marginal discrepancy. Precise impressions are important to decrease prosthetic failures and ensure proper fit and function of dental implants.
Digital impressions in prosthodontics are emerging as an alternative to traditional elastomeric impressions. Various digital impression systems like CEREC, E4D, iTero, and Lava COS use intraoral scanners with blue or red lasers to optically capture 3D images of the teeth and produce digital models. This eliminates the need for physical impressions and allows for viewing of the occlusion digitally. The digital files can be used to directly mill restorations chairside or be sent to a lab for fabrication. Benefits include accuracy, reduced errors and cross-contamination control compared to conventional impressions. However, the equipment has high costs and requires trained personnel. Overall, digital impressions are expected to become more common
The document discusses different types of partial veneer crowns, including maxillary and mandibular posterior three-quarter crowns. It describes the tooth preparation steps for each type in detail, including occlusal and axial reduction, placement of grooves and bevels, and finishing. The advantages of partial crowns include preserving more tooth structure while still providing adequate restoration of function. Key factors in the preparation like extent of reduction, groove placement and size, and bevel design help ensure strength and longevity of the restoration.
Gingival retraction is the deflection of the gingiva away from the tooth to provide adequate access and an accurate impression of prepared tooth margins. Traditional methods include mechanical retraction using copper bands or temporary crowns filled with material, as well as chemomechanical retraction using cords impregnated with chemicals like aluminum chloride. Retraction cords are commonly used in single or double cord techniques to displace tissue laterally or vertically. Recent advances include gingival displacement foams and gels that are applied to the sulcus to control bleeding and allow for cord placement. Lasers can also be used to incise and cauterize tissue for retraction. The goal is effective retraction while minimizing trauma to the ging
This document provides an overview of implant supported overdentures, including definitions, history, indications, contraindications, advantages, disadvantages, treatment options, and procedures. Key points discussed include:
- Overdentures are removable prostheses that cover natural tooth roots, implants, or both for support.
- Implant supported overdentures have better outcomes than conventional dentures or overdentures supported only by natural tooth roots.
- Treatment options depend on factors like jaw, bone quality, number of implants, and can involve bar-retained or independent attachments.
- Procedures involve medical evaluation, treatment planning, transitional dentures, surgical placement, attachment connection, and definitive prosthesis fabrication
This document discusses residual ridge resorption, which is the process of bone loss in the jaw after tooth extraction. It defines residual ridge resorption and classifies it in various ways. It describes the cells involved in bone remodeling and the mechanisms, causes, and implications of excessive residual ridge resorption, including ill-fitting dentures and increased challenges for prosthodontic treatment. Pathologically, imbalances between bone formation and resorption can lead to more bone being lost over time, ultimately decreasing jaw structure and function.
This document discusses terminology and techniques for dental implant impressions. It defines terms like cover screws, healing caps, transfer copings, and implant analogues. It explains that impressions are needed to capture the implant position, depth, axis, and soft tissue contour. The document outlines two main impression techniques - open tray (using pick-up copings) and closed tray (using transfer copings). It notes the advantages and disadvantages of each technique. Abutment level impressions are also discussed for customization and laboratory abutment selection. Gingival simulation is described as a technique to simulate the soft tissue around implants.
The document discusses overdentures, which are removable partial or complete dentures that cover and rest on one or more remaining natural teeth, tooth roots, or dental implants. Key points include:
- Retaining natural teeth can preserve alveolar bone and periodontal receptors important for function.
- Abutment teeth are prepared with short copings or left uncovered, and attachments may be added to improve retention.
- Overdentures can improve retention, stability, support and proprioception compared to conventional dentures.
- Proper case selection and maintenance are important for long term success.
The document discusses various techniques for making impressions for implant prostheses. It describes the materials needed and outlines implant level and abutment level impression methods, including open tray, closed tray, direct, and indirect techniques. Splinting multiple implants is recommended to improve accuracy. The importance of minimizing errors in impression making is discussed to ensure proper seating of components and interfaces between impressions posts and analogues. A literature review found that implant and abutment level impression techniques did not have significantly different effects on marginal discrepancy. Precise impressions are important to decrease prosthetic failures and ensure proper fit and function of dental implants.
Digital impressions in prosthodontics are emerging as an alternative to traditional elastomeric impressions. Various digital impression systems like CEREC, E4D, iTero, and Lava COS use intraoral scanners with blue or red lasers to optically capture 3D images of the teeth and produce digital models. This eliminates the need for physical impressions and allows for viewing of the occlusion digitally. The digital files can be used to directly mill restorations chairside or be sent to a lab for fabrication. Benefits include accuracy, reduced errors and cross-contamination control compared to conventional impressions. However, the equipment has high costs and requires trained personnel. Overall, digital impressions are expected to become more common
The document discusses different types of partial veneer crowns, including maxillary and mandibular posterior three-quarter crowns. It describes the tooth preparation steps for each type in detail, including occlusal and axial reduction, placement of grooves and bevels, and finishing. The advantages of partial crowns include preserving more tooth structure while still providing adequate restoration of function. Key factors in the preparation like extent of reduction, groove placement and size, and bevel design help ensure strength and longevity of the restoration.
Gingival retraction is the deflection of the gingiva away from the tooth to provide adequate access and an accurate impression of prepared tooth margins. Traditional methods include mechanical retraction using copper bands or temporary crowns filled with material, as well as chemomechanical retraction using cords impregnated with chemicals like aluminum chloride. Retraction cords are commonly used in single or double cord techniques to displace tissue laterally or vertically. Recent advances include gingival displacement foams and gels that are applied to the sulcus to control bleeding and allow for cord placement. Lasers can also be used to incise and cauterize tissue for retraction. The goal is effective retraction while minimizing trauma to the ging
This document provides an overview of implant supported overdentures, including definitions, history, indications, contraindications, advantages, disadvantages, treatment options, and procedures. Key points discussed include:
- Overdentures are removable prostheses that cover natural tooth roots, implants, or both for support.
- Implant supported overdentures have better outcomes than conventional dentures or overdentures supported only by natural tooth roots.
- Treatment options depend on factors like jaw, bone quality, number of implants, and can involve bar-retained or independent attachments.
- Procedures involve medical evaluation, treatment planning, transitional dentures, surgical placement, attachment connection, and definitive prosthesis fabrication
This document discusses residual ridge resorption, which is the process of bone loss in the jaw after tooth extraction. It defines residual ridge resorption and classifies it in various ways. It describes the cells involved in bone remodeling and the mechanisms, causes, and implications of excessive residual ridge resorption, including ill-fitting dentures and increased challenges for prosthodontic treatment. Pathologically, imbalances between bone formation and resorption can lead to more bone being lost over time, ultimately decreasing jaw structure and function.
This document discusses terminology and techniques for dental implant impressions. It defines terms like cover screws, healing caps, transfer copings, and implant analogues. It explains that impressions are needed to capture the implant position, depth, axis, and soft tissue contour. The document outlines two main impression techniques - open tray (using pick-up copings) and closed tray (using transfer copings). It notes the advantages and disadvantages of each technique. Abutment level impressions are also discussed for customization and laboratory abutment selection. Gingival simulation is described as a technique to simulate the soft tissue around implants.
This document discusses preparations for partial veneer crowns. It covers indications, contraindications, advantages, disadvantages, and preparations for both posterior and anterior teeth. For posterior teeth, it describes preparations for maxillary premolar and molar three-quarter and seven-eighth crowns, as well as mandibular premolar modified three-quarter crowns. For anterior teeth, it discusses maxillary canine three-quarter crowns and pinledge preparations for maxillary central incisors. The goal of partial veneer crowns is to preserve tooth structure while providing retention, resistance, and rigidity. Proper preparation design and metal coverage are important for successful partial crowns.
This document provides information on partial veneer crowns, including definitions, types, indications, contraindications, advantages, disadvantages, and principles of tooth preparation. Partial veneer crowns restore all but one surface of a tooth, usually not covering the facial surface. They are indicated for teeth with moderate tooth structure loss where the buccal wall is intact. Preparation involves preserving tooth structure, creating retention forms, and maintaining marginal integrity. Proper groove placement and clearance from adjacent teeth are important.
A dental implant is a surgical component that interfaces with the jawbone to support dental prosthetics like crowns, bridges, dentures, or act as an orthodontic anchor. Modern implants bond directly to bone through osseointegration, where titanium implants form a bond with bone. A variable healing time is required for osseointegration before attaching a prosthetic. Dental implants can replace single or multiple missing teeth and involve placement of a fixture into the jawbone followed by attachment of components like abutments and prosthetics.
This document discusses relining and rebasing procedures for complete dentures. It defines relining as adding material to the denture base to improve fit, while rebasing involves replacing the entire denture base. Relining is indicated when dentures lose adaptation due to ridge resorption. Closed mouth techniques take impressions with the teeth in occlusion, while open mouth techniques record a new bite relationship. Impression materials and lab procedures are also outlined. The goal of relining is to prolong the useful life of dentures by improving fit as the ridges change.
There are several protocols for loading dental implants after surgery based on bone density and healing time requirements. Protocols include Brånemark's loading protocol, progressive loading, and immediate/early loading. The density of the bone where the implant is placed determines the appropriate loading protocol, as less dense bone requires more healing time before loading to allow for sufficient bone mineralization and strength. Progressive loading gradually increases stress on the implant over time to allow the bone to adapt, reducing risks of failure. It is particularly important for lower density bone which is weaker.
Impression procedures for compromised ridges/cosmetic dentistry coursesIndian dental academy
The document discusses the history and techniques of impression making for compromised dental ridges. It begins with defining an impression and providing a brief history of impression materials from wax and gutta percha in the 1700s-1800s to alginate and silicones in the 1940s-1950s. It then describes various impression techniques such as open vs closed mouth, mucodisplasive, mucostatic, and selective pressure. Special impression procedures are discussed for minimally displacive, controlled pressure, functional, and external/denture space impressions. Border molding and principles of impression making like support, retention and stability are also summarized.
Tissue conditioners and denture liners are used to improve the fit and comfort of removable dentures. They can be classified based on their curing method, composition, durability, consistency and other properties. Tissue conditioners are temporary soft liners that help condition traumatized tissue, while hard and soft denture liners provide a more permanent resilient layer. Relining or rebasing dentures helps maintain proper fit as ridges resorb over time. Selection of the appropriate liner depends on the clinical situation and needs of the patient.
This document discusses principles of removable partial denture design. It covers different types of partial denture support, including tooth-supported and tooth/tissue-supported designs. Key factors in partial denture design include distributing forces, controlling movement, selecting appropriate components, and considering the individual patient's anatomy and needs. Design elements like survey lines, clasps, connectors, and occlusal rests are discussed in terms of their effects on support and stress distribution. The document contrasts the biomechanical considerations between total tooth-supported versus distal extension partial dentures.
The document discusses various concepts related to complete denture occlusion including:
- The history of dental occlusion in mammals and its development.
- Andrews' six keys to normal occlusion which are seen in natural dentition.
- Differences between natural tooth occlusion and artificial denture occlusion.
- Various occlusal schemes for complete dentures including balanced, lingualized, and monoplane occlusion.
- Requirements for incisive, working, and balancing units in occlusal schemes.
Failures in Fixed Partial Denture
(Prosthodontics FPD- Dental science)
Various types of failures in the fabrication of fixed partial denture
Dr.Sachin Sunny Otta
St.Gregorios Dental College,Kothamangalam,Ernakulam
The presentation gives you an overview of the digital impression as well as intraoral scanners. Trios 3 of 3Shape was specifically discussed in the presentation.
This document discusses progressive bone loading for dental implants. It begins with an introduction and table of contents. Then it discusses concepts like bone density classifications, rationale for progressive loading based on studies showing bone adapts to stress over time. It outlines elements of progressive loading protocols including extended healing times based on bone density, use of provisional restorations to gradually load bone, and diet restrictions. Studies supporting progressive loading show less crestal bone loss and increased bone density around loaded implants. The conclusion is that progressive loading aims to strengthen bone and reduce risk of implant failure.
This document discusses various methods for remounting dentures, including direct correction in the mouth, laboratory remounting, and clinical remounting. Laboratory remounting involves fabricating remount casts of the dentures and mounting them on an articulator to eliminate deflective contacts through selective grinding. Clinical remounting techniques include split cast mounting, which involves constructing the maxillary cast in two parts to allow for easy removal and replacement of the casts. The modified split cast technique is also described as a timesaving clinical remount method. Remounting aims to improve denture occlusion and patient comfort by correcting errors that occurred during the fabrication process.
1. The functionally generated pathway technique involves recording the paths of tooth movement during excursive jaw motions using wax or other materials.
2. This recording is used to develop the occlusal morphology for dental restorations like crowns, ensuring optimal occlusion during all jaw motions.
3. Studies have found that the functionally generated pathway technique results in restorations with better functional articulation compared to conventional single casting techniques, with less adjustment needed and higher patient satisfaction.
This document discusses clinical and laboratory remounting in complete dentures. It begins by introducing complete dentures and the importance of proper occlusion. Errors can occur during the fabrication process that affect occlusion. Remounting procedures, including laboratory and clinical remounting, are recommended to identify and correct occlusal errors. Laboratory remounting involves using a split-cast mounting technique to remount the dentures on an articulator after processing. Clinical remounting takes new interocclusal records in the patient's mouth and mounts the dentures on an articulator to correct errors made during the initial records. Selective grinding is then used to refine the occlusion based on the remount records.
Wax patterns fabrication for fixed partial denturesShebin Abraham
This document provides information on the principles and techniques for fabricating wax patterns for crowns and fixed dental prostheses using the lost wax technique. It discusses the prerequisites for wax patterns including correcting defects on dies, providing cement space, and marking margins. Details are given on materials used for wax patterns and different waxing techniques. The sequence of wax pattern fabrication is outlined including coping formation, evaluation, shaping proximal, axial, and occlusal surfaces, and finishing margins. Occlusal schemes and developing cusp-fossa and cusp-marginal ridge relationships during waxing are also described. The goal is to produce highly accurate wax patterns to result in well-fitting cast restorations.
The document discusses immediate dentures, which are dentures fabricated and inserted immediately following tooth extraction. It describes the different types of immediate dentures, including conventional/classic immediate dentures, interim immediate dentures, labial flange dentures, partial flange dentures, and flangeless/socketed dentures. The advantages of immediate dentures include maintaining a patient's appearance without teeth, providing a bandage effect to extraction sites, and allowing easier adaptation to dentures during healing. However, immediate dentures also present challenges like reduced retention from undercuts caused by remaining posterior teeth.
Abutment & Its Selection In Fixed Partial DentureSelf employed
This document discusses factors to consider when selecting abutment teeth for fixed partial dentures (FPDs). It defines an abutment tooth and outlines how to assess potential abutments, including taking radiographs and evaluating crown morphology, root configuration, crown-to-root ratio, and other anatomical features. Good abutment teeth are vital with adequate bone and root support and crown structure to withstand forces from the FPD. Location, occlusion, tooth structure and root health must be optimized for successful force distribution from the prosthesis.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
This document discusses factors affecting denture retention, including classification, interfacial forces, adhesion, cohesion, oral and facial musculature, atmospheric pressure, undercuts, parallel walls, and gravity. It defines retention as the resistance of a denture to forces that attempt to displace it from its basal seat. Primary retention comes from physical and mechanical means like surface area, adaptation, viscosity and secondary retention from surrounding musculature. Denture adhesives are discussed as a way to augment existing retention mechanisms by increasing adhesion, cohesion and viscosity between the denture and mucosa.
A removable partial denture is made by taking an impression of the patient's mouth, preparing a model, designing a metal framework with clasps to hold the denture in place, adding artificial teeth, curing it in a flask, and finishing/polishing. The process takes 3-6 weeks and involves multiple appointments for impressions, fittings, and adjustments.
This document discusses maxillofacial prosthetics, which are artificial devices used to replace missing facial or oral structures. It describes various types of maxillofacial defects including cleft lip and palate, acquired defects from surgery or trauma, and extraoral defects. The goals of maxillofacial prosthetics are to preserve remaining structures, reconstruct function, and improve aesthetics. Common materials used include silicone, acrylic, and metals.
This document discusses preparations for partial veneer crowns. It covers indications, contraindications, advantages, disadvantages, and preparations for both posterior and anterior teeth. For posterior teeth, it describes preparations for maxillary premolar and molar three-quarter and seven-eighth crowns, as well as mandibular premolar modified three-quarter crowns. For anterior teeth, it discusses maxillary canine three-quarter crowns and pinledge preparations for maxillary central incisors. The goal of partial veneer crowns is to preserve tooth structure while providing retention, resistance, and rigidity. Proper preparation design and metal coverage are important for successful partial crowns.
This document provides information on partial veneer crowns, including definitions, types, indications, contraindications, advantages, disadvantages, and principles of tooth preparation. Partial veneer crowns restore all but one surface of a tooth, usually not covering the facial surface. They are indicated for teeth with moderate tooth structure loss where the buccal wall is intact. Preparation involves preserving tooth structure, creating retention forms, and maintaining marginal integrity. Proper groove placement and clearance from adjacent teeth are important.
A dental implant is a surgical component that interfaces with the jawbone to support dental prosthetics like crowns, bridges, dentures, or act as an orthodontic anchor. Modern implants bond directly to bone through osseointegration, where titanium implants form a bond with bone. A variable healing time is required for osseointegration before attaching a prosthetic. Dental implants can replace single or multiple missing teeth and involve placement of a fixture into the jawbone followed by attachment of components like abutments and prosthetics.
This document discusses relining and rebasing procedures for complete dentures. It defines relining as adding material to the denture base to improve fit, while rebasing involves replacing the entire denture base. Relining is indicated when dentures lose adaptation due to ridge resorption. Closed mouth techniques take impressions with the teeth in occlusion, while open mouth techniques record a new bite relationship. Impression materials and lab procedures are also outlined. The goal of relining is to prolong the useful life of dentures by improving fit as the ridges change.
There are several protocols for loading dental implants after surgery based on bone density and healing time requirements. Protocols include Brånemark's loading protocol, progressive loading, and immediate/early loading. The density of the bone where the implant is placed determines the appropriate loading protocol, as less dense bone requires more healing time before loading to allow for sufficient bone mineralization and strength. Progressive loading gradually increases stress on the implant over time to allow the bone to adapt, reducing risks of failure. It is particularly important for lower density bone which is weaker.
Impression procedures for compromised ridges/cosmetic dentistry coursesIndian dental academy
The document discusses the history and techniques of impression making for compromised dental ridges. It begins with defining an impression and providing a brief history of impression materials from wax and gutta percha in the 1700s-1800s to alginate and silicones in the 1940s-1950s. It then describes various impression techniques such as open vs closed mouth, mucodisplasive, mucostatic, and selective pressure. Special impression procedures are discussed for minimally displacive, controlled pressure, functional, and external/denture space impressions. Border molding and principles of impression making like support, retention and stability are also summarized.
Tissue conditioners and denture liners are used to improve the fit and comfort of removable dentures. They can be classified based on their curing method, composition, durability, consistency and other properties. Tissue conditioners are temporary soft liners that help condition traumatized tissue, while hard and soft denture liners provide a more permanent resilient layer. Relining or rebasing dentures helps maintain proper fit as ridges resorb over time. Selection of the appropriate liner depends on the clinical situation and needs of the patient.
This document discusses principles of removable partial denture design. It covers different types of partial denture support, including tooth-supported and tooth/tissue-supported designs. Key factors in partial denture design include distributing forces, controlling movement, selecting appropriate components, and considering the individual patient's anatomy and needs. Design elements like survey lines, clasps, connectors, and occlusal rests are discussed in terms of their effects on support and stress distribution. The document contrasts the biomechanical considerations between total tooth-supported versus distal extension partial dentures.
The document discusses various concepts related to complete denture occlusion including:
- The history of dental occlusion in mammals and its development.
- Andrews' six keys to normal occlusion which are seen in natural dentition.
- Differences between natural tooth occlusion and artificial denture occlusion.
- Various occlusal schemes for complete dentures including balanced, lingualized, and monoplane occlusion.
- Requirements for incisive, working, and balancing units in occlusal schemes.
Failures in Fixed Partial Denture
(Prosthodontics FPD- Dental science)
Various types of failures in the fabrication of fixed partial denture
Dr.Sachin Sunny Otta
St.Gregorios Dental College,Kothamangalam,Ernakulam
The presentation gives you an overview of the digital impression as well as intraoral scanners. Trios 3 of 3Shape was specifically discussed in the presentation.
This document discusses progressive bone loading for dental implants. It begins with an introduction and table of contents. Then it discusses concepts like bone density classifications, rationale for progressive loading based on studies showing bone adapts to stress over time. It outlines elements of progressive loading protocols including extended healing times based on bone density, use of provisional restorations to gradually load bone, and diet restrictions. Studies supporting progressive loading show less crestal bone loss and increased bone density around loaded implants. The conclusion is that progressive loading aims to strengthen bone and reduce risk of implant failure.
This document discusses various methods for remounting dentures, including direct correction in the mouth, laboratory remounting, and clinical remounting. Laboratory remounting involves fabricating remount casts of the dentures and mounting them on an articulator to eliminate deflective contacts through selective grinding. Clinical remounting techniques include split cast mounting, which involves constructing the maxillary cast in two parts to allow for easy removal and replacement of the casts. The modified split cast technique is also described as a timesaving clinical remount method. Remounting aims to improve denture occlusion and patient comfort by correcting errors that occurred during the fabrication process.
1. The functionally generated pathway technique involves recording the paths of tooth movement during excursive jaw motions using wax or other materials.
2. This recording is used to develop the occlusal morphology for dental restorations like crowns, ensuring optimal occlusion during all jaw motions.
3. Studies have found that the functionally generated pathway technique results in restorations with better functional articulation compared to conventional single casting techniques, with less adjustment needed and higher patient satisfaction.
This document discusses clinical and laboratory remounting in complete dentures. It begins by introducing complete dentures and the importance of proper occlusion. Errors can occur during the fabrication process that affect occlusion. Remounting procedures, including laboratory and clinical remounting, are recommended to identify and correct occlusal errors. Laboratory remounting involves using a split-cast mounting technique to remount the dentures on an articulator after processing. Clinical remounting takes new interocclusal records in the patient's mouth and mounts the dentures on an articulator to correct errors made during the initial records. Selective grinding is then used to refine the occlusion based on the remount records.
Wax patterns fabrication for fixed partial denturesShebin Abraham
This document provides information on the principles and techniques for fabricating wax patterns for crowns and fixed dental prostheses using the lost wax technique. It discusses the prerequisites for wax patterns including correcting defects on dies, providing cement space, and marking margins. Details are given on materials used for wax patterns and different waxing techniques. The sequence of wax pattern fabrication is outlined including coping formation, evaluation, shaping proximal, axial, and occlusal surfaces, and finishing margins. Occlusal schemes and developing cusp-fossa and cusp-marginal ridge relationships during waxing are also described. The goal is to produce highly accurate wax patterns to result in well-fitting cast restorations.
The document discusses immediate dentures, which are dentures fabricated and inserted immediately following tooth extraction. It describes the different types of immediate dentures, including conventional/classic immediate dentures, interim immediate dentures, labial flange dentures, partial flange dentures, and flangeless/socketed dentures. The advantages of immediate dentures include maintaining a patient's appearance without teeth, providing a bandage effect to extraction sites, and allowing easier adaptation to dentures during healing. However, immediate dentures also present challenges like reduced retention from undercuts caused by remaining posterior teeth.
Abutment & Its Selection In Fixed Partial DentureSelf employed
This document discusses factors to consider when selecting abutment teeth for fixed partial dentures (FPDs). It defines an abutment tooth and outlines how to assess potential abutments, including taking radiographs and evaluating crown morphology, root configuration, crown-to-root ratio, and other anatomical features. Good abutment teeth are vital with adequate bone and root support and crown structure to withstand forces from the FPD. Location, occlusion, tooth structure and root health must be optimized for successful force distribution from the prosthesis.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
This document discusses factors affecting denture retention, including classification, interfacial forces, adhesion, cohesion, oral and facial musculature, atmospheric pressure, undercuts, parallel walls, and gravity. It defines retention as the resistance of a denture to forces that attempt to displace it from its basal seat. Primary retention comes from physical and mechanical means like surface area, adaptation, viscosity and secondary retention from surrounding musculature. Denture adhesives are discussed as a way to augment existing retention mechanisms by increasing adhesion, cohesion and viscosity between the denture and mucosa.
A removable partial denture is made by taking an impression of the patient's mouth, preparing a model, designing a metal framework with clasps to hold the denture in place, adding artificial teeth, curing it in a flask, and finishing/polishing. The process takes 3-6 weeks and involves multiple appointments for impressions, fittings, and adjustments.
This document discusses maxillofacial prosthetics, which are artificial devices used to replace missing facial or oral structures. It describes various types of maxillofacial defects including cleft lip and palate, acquired defects from surgery or trauma, and extraoral defects. The goals of maxillofacial prosthetics are to preserve remaining structures, reconstruct function, and improve aesthetics. Common materials used include silicone, acrylic, and metals.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help boost feelings of calmness, happiness and focus.
This document provides an overview of maxillofacial prosthetics. It discusses the history of artificial facial reconstruction and the establishment of maxillofacial prosthetics as a branch of dentistry. Maxillofacial prosthetics aims to restore function and esthetics after trauma, surgery, or congenital defects. Prostheses can be intraoral or extraoral and may be immediate, transitional, or definitive depending on the healing process. The document outlines various prosthetic options and techniques for reconstructing parts of the maxilla, mandible, ear, nose, and orbit. It emphasizes a multidisciplinary team approach including surgeons, prosthodontists, and other specialists to optimize patient rehabilitation.
The document discusses surgical and prosthetic techniques for maxillofacial rehabilitation following cancer resection, noting that the goal is to restore both function and cosmesis through a combination of surgery, such as skin grafting, and prosthetics like obturators and implants to replace missing structures of the face, jaw, and oral cavity.
Introduction & classification of removable partial dentureAbhinav Mudaliar
This document provides an introduction and overview of removable partial dentures (RPDs). It defines prosthodontics and discusses the different branches including removable prosthodontics. Removable prosthodontics involves replacing missing teeth and tissues with dentures that can be removed by the wearer. The document then examines various RPD classifications including Cummer's, Kennedy's, Applegate's modification, and Beckett and Wilson's classifications. It also outlines indications for RPDs and common terminology used in RPDs such as abutment, retainer, and temporary denture.
Components of removable partial denture prosthesis /certified fixed orthodont...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses the design considerations for different classes of removable partial dentures. It covers key aspects like location of retention, types of direct and indirect retainers, major connectors, bases, and how to avoid undesirable movements. The classes covered are maxillary and mandibular Class I-IV removable partial dentures. Design features are tailored based on tooth support and location of tooth loss for each class.
This document discusses removable partial dentures (RPDs). It describes the objectives of prosthodontic treatment, consequences of tooth loss, components and classification of RPDs, principles of design including support, retention and stability, and types of major connectors and retainers. The Kennedy classification system and Applegate's rules for applying it are also summarized.
Cleft lip and palate abnormalities occur when certain facial structures fail to fuse properly during embryonic development between the fifth and seventh weeks. This can result in openings in the lip and roof of the mouth. Clefts may involve just the lip, just the palate, or both. They can range from mild to severe. Early surgery is aimed at restoring normal anatomy, but long-term management may also include hearing, speech, dental, and orthodontic care.
Prosthetic management of glossectomy/ orthodontic continuing educationIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The document discusses creating effective websites for conservation groups. It provides tips on getting started with website design and hosting. Key points covered include choosing do-it-yourself design or hiring a professional, using content management systems, planning content and navigation, optimizing for search engines, and examples of low-cost hosting providers in New Zealand. The author also shares details about his conservation group's website, which cost less than $200 per year to create and maintain.
This document discusses obturators, which are prostheses used to close congenital or acquired openings in the hard palate. It covers the definition, history, classifications, design considerations, materials used, and objectives of obturators. Key points include that obturators aim to restore functions like speech, swallowing and chewing. They provide support, retention and stability. Design depends on the class of defect based on an established classification system. Common materials are acrylics and silicones. Proper pre-operative dental care and temporary obturators aid in postoperative healing and function.
Wound Ballistics and Body Armor Paper PresentationSam Spurlin
Wound ballistics provided the scientific basis for the development of body armor. However, other factors like weight, comfort, cost of production, and bureaucracy became more important over time in influencing the development of body armor. Key developments included Kocher's studies of gunshot wounds in the 1870s, WWII casualty surveys which showed the potential for body armor, and armor designs from the Civil War through Vietnam which struggled with issues of weight and ballistic effectiveness.
Prosthetic management of mandibulectomy and glossectomy pati/ orthodontic pra...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses various types of clasps used for removable partial dentures and their design considerations. It describes intracoronal and extracoronal attachments as well as different clasp designs like Akers clasps, circumferential clasps, and back action clasps. Factors that influence clasp retention like undercut depth and shape are covered. Design principles for survey lines and preventing torquing forces on teeth with free-end saddles are also summarized.
An interim removable partial denture is a short-term denture used prior to a definitive denture. It is made of acrylic with a major connector and wrought wire clasps. It can be used when teeth have large pulps preventing bridges, when clinical crowns are too short or there are no undercuts. It provides temporary space maintenance for issues like caries, trauma, or missing teeth. It can also be used as a transitional or treatment denture before a final denture. The fabrication involves impressions, design of clasps and rests, and articulation of casts. Adjustments may be needed to proximal extensions, where the clasp exits the resin, or tissue undercuts.
Prosthodontic principles of obturator design.ppt/ dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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1. Maxillofacial prosthetics involves reconstructing areas of the face that are missing or defective due to surgery, trauma, disease, or birth defects using non-living substitutes. Prostheses can be extra-oral, intra-oral, interim, or definitive depending on the situation.
2. For acquired oral defects, the timing of prosthetic treatment involves preoperative planning, interim care following surgery, and definitive care once healing is complete. Interim care focuses on improving functions like swallowing and speech. Potential complications include tissue trauma, inadequate retention, and incomplete sealing of the defect.
3. Surgical preservation of structures like teeth can greatly benefit prosthetic treatment by providing support, stability, and
This document discusses the prosthodontic management of patients who have undergone mandibulectomy surgery. It covers classification of mandibular defects, factors affecting treatment, and different types of prostheses used. Key points include that the location and extent of the defect, remaining teeth/implants, mandibular deviation, mouth opening, and tongue function all impact treatment. Marginal defects have the best prognosis while anterior discontinuity defects are most debilitating. Soft tissue grafts are used for marginal defects while microvascular flaps can reconstruct larger defects.
Prosthodontic management /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
PROSTHODONTIC MANAGEMENT OF MAXILLECTOMY AND MANDIBULECTOMY PART 1NAMITHA ANAND
The document discusses the role of prosthodontists in rehabilitating patients who have undergone maxillectomy or mandibulectomy for cancer treatment. It covers classification systems for maxillary and mandibular defects, pre-surgical and post-surgical prosthodontic interventions, types of prostheses used, and recent advances in materials. The goal of prosthetic rehabilitation is to restore functions like mastication, swallowing, speech and facial esthetics following surgical resection of tissues in the head and neck region.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Rpd consideration in maxillofacial prostheticshamide norouzi
This document discusses considerations for removable partial dentures in patients with maxillofacial defects. It describes different types of maxillofacial defects including acquired, congenital, and developmental. For acquired defects, it discusses preoperative planning, interim prosthetics, potential complications, defect hygiene, and definitive care. It also describes different classifications of maxillary and mandibular defects and prosthetic options for each, including obturator, speech aid, palatal lift, and palatal augmentation prostheses. Framework designs and retention strategies are discussed for different types of mandibular resections.
Diagnosis and treatment planning in removable partial dentureVinay Kadavakolanu
The document discusses the process of treatment planning for removable partial dentures (RPDs). It begins by outlining the steps of patient interview, clinical examination, and treatment planning. Key aspects of the clinical examination are described, including medical history, oral examination, and diagnostic models and radiographs. Factors considered in treatment planning include classification of the edentulism, abutment conditions, occlusion, and residual ridge. Treatment options and their indications are also summarized. The treatment planning process aims to address the patient's unique dental needs and desires through shared decision making.
Complete denture theory and practice 2011.Mostafa Fayad
COMPLETE DENTURE THEORY AND PRACTICE
1 introduction
2 Anatomy and Physiology in Complete Denture
3 diagnosis
4 Impression Trays and techniques
5 Relief Areas and post dam
6 Record Base and occlusion rim
7 JAW RELATION
8 Occlusion & articulators
9 SELECTION , arrangement of artificial teeth and WAXING-UP
10 try in
11 Processing Dentures
12 Denture insertion
13 Complaints
14 SEQUALAE OF WEARING CD
15 PREPARATION OF THE MOUTH
16 Management of Problematic patients
17 FAILURE OF C. D
18 Nausea & gagging
19 SINGLE COMPLETE DENTURE
20 Combination syndrome
21 TEETH supported OVERDENTURE
22 Implant Overdentures
23 Geriatric Edentulous Patient
24 Duplication
25 Relining and rebasing
26 Repair
27 Biomechanics
28 Neutral Zone
29 Esthetics in Complete Denture
30 phonetics in Complete Denture
31 masticatory function
This document discusses the interrelationship between prosthodontics and periodontics in achieving success in fixed partial denture treatment. It emphasizes the importance of proper diagnosis, treatment planning, and preparation of the periodontium prior to prosthetic treatment. This includes management of periodontal disease, gingival problems, occlusal issues, and bone or soft tissue defects. Factors like margin placement, splinting, and impressions are also addressed to minimize risk of damaging the periodontal attachment.
This document discusses preprosthetic surgery, which involves surgical procedures done prior to the construction of dentures to improve the denture foundation and ensure successful denture therapy. Some reasons for preprosthetic surgery include removing retained teeth/roots, smoothing uneven ridges, reducing tori or exostoses that could interfere with denture placement, and adjusting the mental foramen if resorption has caused sharp edges that could cause pain. Both non-surgical and surgical methods are discussed, including alveoloplasty to reshape ridges and remove undercuts or projections, as well as the importance of a thorough examination and developing a treatment plan with the patient.
Management of mandibulectomy / /certified fixed orthodontic courses by Indian...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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A presentation describing relationship between peridontics and prosthodontics and their implications. Helpful for dental graduates and perio and prostho post graduate students.
An overdenture is a removable partial or complete denture that covers and rests on one or more remaining natural teeth, dental implants, or dental abutments. This document discusses definitions, types, indications, contraindications, advantages, and disadvantages of overdentures. It also covers factors to consider when selecting teeth for overdentures such as periodontal health, endodontic needs, tooth position and number. The document outlines the treatment planning process and protocols for laboratory and clinical procedures for overdentures.
This document provides information on overdentures, including definitions, types, indications, advantages, and disadvantages. An overdenture is a removable dental prosthesis that covers and rests on remaining natural teeth, roots, and/or dental implants. Key advantages discussed are the preservation of remaining teeth and alveolar bone, enhanced support, stability, and retention, improved patient acceptance, and the ability to perform conventional dental procedures. Potential disadvantages include increased risk of caries and periodontal disease of abutment teeth, requiring more interarch space, and being more expensive and time consuming. Factors like adequate bone support, endodontic health, and adequate spacing of teeth are discussed in selecting teeth for overdentures.
This document discusses major surgical procedures for correcting orofacial abnormalities, including orthognathic surgeries to correct jaw discrepancies. The key steps in orthognathic surgery are outlined, beginning with clinical diagnosis and evaluation to determine the nature and severity of skeletal problems. This is followed by presurgical orthodontics to position teeth in preparation for surgery. A surgical treatment objective is then developed using prediction tracings to plan the procedure and simulate it on models. The actual surgery is then performed followed by postoperative orthodontics and retention.
Congenital absence of maxillary lateral incisors is a frequent clinical challenge which must be solved by a multidisciplinary approach in order to obtain an
esthetic and functional restorative treatment. . Fixed prosthodontic and removable prostheses, resin bonded retainers, orthodontic movement of maxillary
canine to the lateral incisor site and single tooth implants represent the available treatment modalities to replace congenitally missing teeth. This case report
demonstrates the team approach in prosthetic and surgical considerations and techniques for managing the lack of lateral incisors. The aims of this case
report of replacement of bilaterally congenitally missing maxillary lateral incisors with dental implants.
obturators / prosthodontic management of maxillectomy - part 1NAMITHA ANAND
This document provides an overview of maxillofacial prosthodontics. It discusses the role of the prosthodontist in rehabilitating patients who have undergone maxillectomy or mandibulectomy surgery. It describes various classification systems for maxillary and mandibular defects. It also outlines pre-surgical and post-surgical prosthodontic procedures like interim and definitive obturator prostheses. Historical developments and recent advances in materials used for maxillofacial prostheses are also summarized.
This document discusses periodontal considerations for surgically exposing impacted canines. It notes that impacted canines require multidisciplinary management by orthodontists and periodontists. The aim is to guide eruption while respecting gingival tissues to avoid periodontal damage. Forced eruption alone is not sufficient; the tooth must achieve a stable, healthy position. Techniques discussed include gingivectomy, apically repositioned flap, closed eruption, and tunnel approach. Location of the impacted tooth influences technique choice to best preserve periodontal tissues and bone. Short-term studies found greater periodontal problems for treated teeth versus controls, though closed-flap techniques showed less attachment loss.
Prosthodontic rehabilitation of maxillary defect in a patientNishu Priya
Restoration of maxillectomy defects demand varied modifications in prosthesis fabrication, to make them lighter and well-tolerated by the patient.
Literature suggests the use of various retentive aids for the construction of conventional obturator to improve retention and oral function.
Orthognathic surgery is the art and science of diagnosis , treatment planning and execution of treatment by combining both orthodontics and oral and maxillofacial surge
Similar to Removal partial denture considerations in maxillofacial prosthetics (20)
The document discusses the properties and uses of metals in dentistry. It defines metals and describes their classification into ferrous and non-ferrous groups. Metals solidify through the formation of crystal nuclei that grow into dendritic structures within grains. Smaller grain size improves properties. Dental alloys like cobalt-chromium, titanium, and nickel-chromium are used for implants, crowns, and dentures due to their strength, corrosion resistance, and biocompatibility. Precious metals are also used for restorations.
Restorative resins have evolved from early silicate-based materials to modern resin composites. Resin composites are composed of a resin matrix reinforced with inorganic filler particles. They are classified based on filler size and curing mechanism. Developments include microfilled, small particle, and hybrid composites, as well as flowable and packable composites. Resin composites are used for anterior and posterior restorations. Successful use requires acid etching of enamel, dentin bonding agents, and incremental placement techniques to reduce polymerization stresses.
This document discusses prosthetic options for implant dentistry. It outlines 5 prosthetic options (FP-1 to FP-3 and RP-4 to RP-5) and describes the amount of support and number of implants required for each. The key steps are to first plan the desired prosthesis, then determine the ideal abutment positions and amount of support needed before placing implants and designing the final restoration. Removable prostheses offer advantages like fewer implants and reduced costs but have higher risks of bone resorption over time.
The document discusses desirable occlusal contact relationships and methods for establishing occlusion for removable partial dentures. It describes five methods for establishing occlusal relationships using casts, interocclusal records, or occlusion rims. It also discusses arranging artificial teeth, establishing jaw relations when opposing a complete denture, and the importance of balanced occlusion for retention of the prosthesis.
Minor connectors are components that connect parts of a removable partial denture like clasps, retainers, and rests to the major connector or denture base. There are 4 types that connect different components. They distribute forces to prevent excessive stress on any one tooth or ridge area. Minor connectors are usually located in interdental embrasures and have sufficient bulk and rigidity. They come in different designs like latticework, mesh, or beads to securely attach the denture base. Proper form, location, finish lines, and attachment to the major connector are important considerations for minor connectors.
This document provides an overview of the history and classification of dental implants. It discusses the various types of implants including endosteal, subperiosteal, and transosteal implants. The key implant materials discussed are metals like titanium alloys, cobalt-chromium alloys, and stainless steel, as well as ceramics and polymers. Titanium and its alloys are highlighted as the most commonly used and biocompatible implant materials. The document also reviews factors involved in selecting implant materials and ensuring clinical success.
The document discusses diagnosis and treatment planning for patients requiring removable partial dentures. It outlines the importance of a thorough patient interview and clinical examination, including diagnostic casts and jaw relation records, to understand the patient's needs and dental condition. A comprehensive analysis of all diagnostic findings is necessary to develop an appropriate treatment plan that meets the objectives of eliminating disease, preserving oral tissues, and restoring function and esthetics. The treatment plan for an edentulous patient is simple, but a complex case requires assembling all diagnostic criteria to ensure success.
This document provides an overview of various classification systems for partially edentulous arches. It discusses the American College of Prosthodontists (ACP) classification system and the Index of Clinical and Keratinized (ICK) classification system in particular. The ACP system offers benefits like improved consistency, communication, education/research, and diagnosis. It classifies partially edentulous cases based on criteria like the location and extent of edentulous areas, condition of abutment teeth, occlusal scheme, and residual ridge.
The document discusses the definition, requirements, functions, and types of denture bases. It describes the different methods used for attaching denture bases and artificial teeth. Key types discussed are plastic acrylic and metal bases like gold or cobalt-chromium. The functions of denture bases in supporting teeth and absorbing forces are also summarized.
Impression materials are used to make negative reproductions or imprints of teeth and surrounding structures. They are classified based on their rigidity, setting mechanism, viscosity, interaction with water, and chemical composition. Desirable qualities include accuracy, elasticity, and dimensional stability. Common impression materials include alginate (hydrocolloid), impression plaster, impression compound, zinc oxide eugenol paste, polysulfides, condensation silicones, addition silicones, polyethers, and light-cured polyethers. Tissue conditioners provide temporary soft lining for irritated denture-bearing tissues.
2. Index 1. Maxilofacial prosthetics Definition Classification 2. Timing of dental and maxillofacial prosthetic care for acquired defects Post operative and intraoperative care Interim care Potential complications Defect and oral hygiene Definitive care
3. Index Intraoral prostheses design considerations. 4. Surgical preservation for prostheses benefit Maxillary defects Mandibular defects Mandibular reconstruction-bone grafts
4. Maxillofacial Prosthetics “the art and science of anatomic, functional, or cosmetic reconstruction by means of nonliving substitutes of those regions in the maxilla, mandible, and face that are missing or defective because of surgical intervention, trauma, pathology, or developmental or congenital malformations”
6. Classification Type of prostheisis under consideration- Extra-oral (cranial or facial replacement) Intra-oral (oral cavity) Interim (short periods) Definitive (more permanent) Treatment prosthesis (splint or stent)
7. Major distinguishing feature-tooth supported or tooth and tissue supported. Maxillofacial patient can experience unique alterations in normal oral/craniofacial environment which are the results of surgical resections. (maxillofacial trauma,congenitaldefects,developmental anomalies or neuromuscular disease.) Not only tooth and tissue support considerations-design.
8. Timing of dental and maxillofacial prosthetic care for acquired defects Preoperative and intrao-perative care Interim care Definitive care
9. Preoperative and intraoperative care Planning of prosthetic treatment for acquired oral defects-before surgery. Pt-head and neck surgery-dental needs. Dental objectives-preoperative and intraoperative care stage-potential dental postoperative complications-subsequent prosthetic Rx.
10. Preoperative and intraoperative care Preoperative consultation-pt clinician relationship-surgery. Benefit from a prosthesis standpoint view-strategically important teeth-interim or definitive prosthesis use-discussed surigical team-rx plan –preservation.
11. Preoperative and intraoperative care Immediate postoperative period-challenging. Large carious lesion-endodontic therapy. Acute periodontal disease – treated-post pain. Nonrestorable tooth-interim care-removed-before/at time of surgical resection.
12. Preoperative and intraoperative care Impressions –max and mand arches-immediate or interim prostheses. To assess need for both immediate and delayed modification of teeth or adjacent structures to optimize prosthetic care. Planning-definitive prosthesis.
13. Interim care Major empahasis-surgical mangementneed of pt. When discontinuity defects in mandible results-interim prosthetic care-not indicated. Typical maxillary acquired defect results in oral communication with the nose/max sinus.
14. Interim care Creates physiological and functional deficiencies in mastication,degluttition and speech. Such defects-psychological. Major deficiency addressed by prosthetic management-interim care time-degluttition and speech.
15. Interim care An initial focus on improvement in swallowing and speech with the interim prosthesis can help boost the rehabilitation process significantly. Objective of interim obturator prosthesis-separate-oral and nasal cavities-obturating communication. Such obturatorprostheis commonly refers – obturation of hard palatal defects-same for soft palate.
16. Interim care To artificially block free transfer of speech sounds and food/liquids b/w oral and nasal cavities. Prosthesis-surgery. Surgical obturatorprostheis-control-surgical access closure and split thickness skin graft-postsurgical period.
17. Interim care Such prostheis-stabilized-wiring-teeth-alveolar bone. Teeth-wires in prostheis-undercuts Immediate placement of prostheis-pts acceptance of surgical defect.
18. Interim care Preferable-stabilize surgical dressing-suturing sponge bolster-split thickness graft. Following primary healing-interim prostheis placed.
19. Interim care Interim prostheis-wire retained resin prosthesis-no teeth-modified-addition of teeth.
20. Interim care Total maxillectomy-prosthesis support stability and retention –not satisfactory-extension of defect. Teeth present-impact of defect lessened. Few unilateral teeth-stability-prosthesis is less.
21. Potential complications Duration for interim phase-3-4 months. Primary objective-surgical-observation phase. Common interim prosthetic complications :- Tissue trauma and associated discomfort. Inadequate retention of max prostheisis. Incomleteobturation with leakage of air,food and liquid around obturator portion-prostheis. Tissue effects of chemotherapy and radiation therapy.
22. Potential complications Common interim prosthetic complications :- Tissue trauma and associated discomfort. Inadequate retention. Incomplete obturation (leakage of air,food and liquid). Tissue effects of chemotherapy&radiation therapy.
23. Discomfort related to use of interim prosthesis- Surgical wound healing dynamics. Defect conditions. Mucosal effects of adjunctive Rx/prosthetic fit. Common areas of surgical wound pain include junctions of lip/cheek mucosa-maxillectomy pts. Lateral scar band-skin grafts heals-discomfort. Alveolar bone cuts not rounded-perforate-oral mucosa-discomfort. Most common in mandibular resection-lower and labial contour.
24. Potential complications Prosthesis movt-dependent on quality of supporting structures. When teeth present-retention-clasps. For edentulous pts-denture adhesives.
25. Potential complications When max resection leaves cheek unsupported by bone-prosthesis-support-wound maturation. During immediate postoperative healing stage-surgical defect-change in dimension-fit and seal. Adjustments-temporary resilient denture lining materials. Pts instructed not to swallow large quantities-head horizontal-swallowing-water tight seal.
26. Potential complications Midline soft palate resection-difficult-retain prostheis-water tight seal. When combination Rx (chemotherapy,physiotherapy) – post surgical phase. Major intraoral complication-mucositis. Long term effects of radiation therapy-radiation induced xerostomia and capillary bed changes-within mandible-dentition-osteoradionecrosis. During interim prosthesis stage-xerostomic effects.
27. Defect and oral hygiene Surgical pack removal-defect site mature with time. Initial loss of incompletely consolidated skin graft,mucous secretions mixed with blood and residual food debris –common. Pts instructed to clean defect of food debris and mucous secretions routinely.
28. Defect and oral hygiene Defect hygiene-timelier healing-improve-fit of prosthesis. Common defect hygiene practices-rinsing of defect-bulb syringe,sponge handled cleaning aid. Teeth-oral hygiene. Xerostomia-fluoride.
29. Definitive care Initiated-completion of active Rx phase-defect tissue matured sufficiently-to tolerate aggressive manipulation and obturation. Primary emphasis-prosthetic management. Design of prostheis differ-interim prosthesis.
30. Definitive care For some pts definitive prostheis delayed-general health concerns,questionable tumor prognosis and improper hygiene. For control of maxillofacial prostheses-large skilled performance of pt required.(oral and defect structures important for success.)
31. Definitive care Understanding of impact of post surgical characteristics and soft tissue reconstruction on MFPmanagement :- Opportunity for max prosthetic benefit-necessitates surgical site characteresticsthat are separate from classic tumor approaches. Ability of pt to biomechanically control large removable prostheis following surgery-hindered-surgical closure/reconstruction options.
32. Intraoral prostheses design considerations For maxilofacialreconstruction with RPD-well supported stable,retentive prosthesis-min movt-preserving-max amt-supporting tissue. Max coverage-edentulous ridge-remaining teeth. Normal resistance-functional load-P.attachment-natural dentition. Partial edentulous-support,stability-teeth.
33. Intraoral prostheses design considerations Several post teeth-support-teeth and mucosa. No teeth-support-mucosa-residual ridges. Tumor-loss-tooth & supporting structures-support-combination-teeth/ridge. For both partial & complete tissue supported-functional load support-mucosa-unsuited.
34. Surgical preservation for prosthesis benefit Maxillary defects – Surgical outcomes that impact prosthetic success-amt of max structures removed/that impacts the surgical integrity and quality of the defect. For hard/soft palate-restoration of physical separation of oral and nasal cavities-mastication ,deglutition,speech & facial contour.
35. Surgical preservation for prosthesis benefit Typical prostheis-obturatorprostheisis,speech aid prosthesis. Obturator prosthesis-that restore palatopharyngeal function for defects of the soft palate. Speech prostheis-palatopharyngeal function.-soft palate.
36. Surgical preservation for prosthesis benefit Tooth preservation-greatest impact-stabilizing effect. Classical midline max defect-preservation of premax accomplished-inclusion of ant premaxilla-individual decision-tumor control and resection technique. Resection of pt with teeth-tooth adjacent to defect-force-prostheismovt. Surgical alveolar osteotomy cut-resection-xn site –adjacent tooth-prognosis-supportive tooth.
37. Surgical preservation for prosthesis benefit Midline of hard palate-common-prosthesis pressure. To provide best surgical resection-hard palate resected. Vertical surface of bone cut-advancement flap-palatal mucosa-resilient mucosal covering-prostheis-fulcrum.
38. Surgical preservation for prosthesis benefit To serve as a guide-decision-surgery-if resection leaves less than 1/3rd of soft palate-entire palate removed. Exception-edentulous pt-radical maxillectomy. Without teeth to provide retention-pt benefits-prostheis-above posterior soft tissue band-retention.
39. Surgical preservation for prosthesis benefit Preparation of max surgical site-split thickness graft. If pterygoidplate,ant temporal bone-support-skin graft. Extension into defect-greater-edentulous-than pt-teeth. However all pts-lateral-post region-seal defect.
40. Surgical preservation for prosthesis benefit Surgical defects 3cm or less-reconstructed to normal contours-tissue function-surgical management-appropriate. Larger defects-difficult-incapable-prostheis. Soft palate reconstructions-difficult-functional tissue replacement-compromising-palatal function. In light of this unpredicability,the predictable prosthetic management of such defects is most often the Rx of choice.
41. Mandibular defects Functions of mastication,deglutition,speech and saliva control are possible through coordinated efforts of separate anatomic regions which include:- Oral sphincter. Alveolingual and buccalsulci. Alveolar ridges,floor of mouth. Tongue,tonsillar pillars. Soft palate,hard palate. Buccal mucosa. More regions involved-surgical procedure-greater demand –surgical reconstruction.
42. Mandibular defects When mand involved-complexity-reconstruction-location and amt of mand -resection. Primary prosthetic objectives-restore mastication and cosmesis-replacement-teeth.
44. Mandibular defects Common mandresection-lateral,ant,hemimandibular. Debilitating defects:- Cosmetic deformity-lower third of face, Dec masticatory function, Compromised coordination of tongue and teeth, Altered speech ability, impaired degluttition.
45. Mandibular defects Masticatory rehabilitation-resection-with mand discontinuity-unpredictable. For pts with teeth-altered mand position-functional and cosmetic handicap. Reconstruction plate failure. Cosmetic deformity improved-reconstruction plates. Preserves bilateral nature of mandmovt. Prosthetic replacement of teeth-cannot-regions superior-recontruction bar-mucosal perforation,bar exposure.
46. Mandibular reconstruction-Bone grafts Ideal prosthetic characteristics of replacement mandible-stable union-proximal&distal segments, restoration of contour to lower 3rd of face,rounded ridge contour-attached mucosa 2-3mm. Regardless–prosthesis-bone-vital-functional use. For optimal chance of prosthetic function-implants.
47. Mandibular reconstruction-Bone grafts Major determining factor-soft tissue reconstruction. Major complication-bulk of soft tissue-lack of tongue mobility. Another complication-bone placement and size. Fibula–mand replacement.
48. Mandibular reconstruction-Bone grafts Bcos of straight nature of bone it is easy to err in both the horizontal and vertical positioning-midline. Post inability to recreate natural ascending curve posteriorly-teeth-restoring occlusion-resected side. Mismatch-height-ant junction of graft. Implant supported prosthesis-implant hygiene. For removable prostheses-irritation-fulcrum like action-movt.
49. References Carr A B, Mc Givney G P, Brown D T, McCraken’s Removable partial Prothodontics. 11thed, stlouis: Mosby; 2008. Stewart K L, Rudd K D, Kuebker W A, Stewart’s Clinical Removable Partial Prosthodontics. 2nd edition 2004. Miller E L, Grasso J E, Removable Partial Prosthodontics. 2nd ed, Baltimore: Williams & Wilkins.