diagnosis of partially edentulous patient
DESCRIPTION
Dr. Mostafa Ibrahim FayadLecture of Removable ProthodonticsAl-Azhar UniversityBritish UniversityTRANSCRIPT
Diagnosis of partially
edentulous patientsDr Mostafa Ibrahim Fayad
Lecture of Removable ProthodonticsAl-Azhar UniversityBritish University
Drmostafafayadgmailcom
Indications for a removable partial denture in preference to a fixed partial denture
bull A Edentulous areas too long for a fixed prosthesis bull B Need to restore soft and hard tissue contours bull C Absence of adequate periodontal support bull D Structurally or anatomically compromised abutment
teeth bull 1 Lack of clinical crown height bull 2 Lack of sound tooth structure bull 3 Unfavorable position contour or inclination
bull E Need for cross-arch stabilization bull F Restoration of an extension base bull G Anterior esthetics bull 1 Attitude and desires of patient
Diagnosis
bull It is the determination of the nature location and causes of diseases
To assemble all appropriate information about the patientrsquos medical and dental history and conduct clinical examination including evidence from radiographs and mounted diagnostic casts to achieve good prognosis
Diagnosis of partially edentulous pt includesbull Patient Historybull Clinical examination ( Extraoral and
Intraoral) bull Radiographsbull Mounted Diagnostic Castsbull Occlusal plane analysisbull Surveying of the diagnostic castbull Pre-extraction record
Treatment plan
1 Patient history
ndash Personal and Social history
ndash Chief complaintsndash Medical historyndash Dental historyndash Mental attitudes
Personal and Social history
bull Name - Address - Tel N0
bull Age - Sex
bull Occupation and Socio-economic Class
bull Public speakers and singers
bull Wind instrument players
bull Psychological conditions
Chief complaints
bull Reason for attendance (Patients requests and desires)
Medical history
bull 1048633 Diabetesbull 1048633 Arthritisbull 1048633 Pagetrsquos diseasebull 1048633 Acromegalybull 1048633 Parkinsonrsquos diseasebull 1048633 Pemphigus vulgarisbull 1048633 Epilepsybull 1048633 Cardiovascular diseasesbull 1048633 Cancerbull 1048633 Transmissible diseases
1 Smokinghas been known to be
associated with a variety of oral conditions including Periodontal disease
Bone amp tooth loss
Peri-implantitis Dental implant
failureThe effect of tobacoo is due to1 resistance to inflammation2 resistance to infection3 Impaired wound healing4 Calcium absorption
Patients who are unable to sustain a high level of plaque control eg Parkinsonism
Dental history
bull The cause of teeth lossbull Patient experience during and following
previous partial denture constructionbull Expectation of treatmentbull Chewing habits preferred side for chewing
This will determine the amount of support retention and bracing of the denture on each side
bull Para functional habits clinching and bruxism
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Indications for a removable partial denture in preference to a fixed partial denture
bull A Edentulous areas too long for a fixed prosthesis bull B Need to restore soft and hard tissue contours bull C Absence of adequate periodontal support bull D Structurally or anatomically compromised abutment
teeth bull 1 Lack of clinical crown height bull 2 Lack of sound tooth structure bull 3 Unfavorable position contour or inclination
bull E Need for cross-arch stabilization bull F Restoration of an extension base bull G Anterior esthetics bull 1 Attitude and desires of patient
Diagnosis
bull It is the determination of the nature location and causes of diseases
To assemble all appropriate information about the patientrsquos medical and dental history and conduct clinical examination including evidence from radiographs and mounted diagnostic casts to achieve good prognosis
Diagnosis of partially edentulous pt includesbull Patient Historybull Clinical examination ( Extraoral and
Intraoral) bull Radiographsbull Mounted Diagnostic Castsbull Occlusal plane analysisbull Surveying of the diagnostic castbull Pre-extraction record
Treatment plan
1 Patient history
ndash Personal and Social history
ndash Chief complaintsndash Medical historyndash Dental historyndash Mental attitudes
Personal and Social history
bull Name - Address - Tel N0
bull Age - Sex
bull Occupation and Socio-economic Class
bull Public speakers and singers
bull Wind instrument players
bull Psychological conditions
Chief complaints
bull Reason for attendance (Patients requests and desires)
Medical history
bull 1048633 Diabetesbull 1048633 Arthritisbull 1048633 Pagetrsquos diseasebull 1048633 Acromegalybull 1048633 Parkinsonrsquos diseasebull 1048633 Pemphigus vulgarisbull 1048633 Epilepsybull 1048633 Cardiovascular diseasesbull 1048633 Cancerbull 1048633 Transmissible diseases
1 Smokinghas been known to be
associated with a variety of oral conditions including Periodontal disease
Bone amp tooth loss
Peri-implantitis Dental implant
failureThe effect of tobacoo is due to1 resistance to inflammation2 resistance to infection3 Impaired wound healing4 Calcium absorption
Patients who are unable to sustain a high level of plaque control eg Parkinsonism
Dental history
bull The cause of teeth lossbull Patient experience during and following
previous partial denture constructionbull Expectation of treatmentbull Chewing habits preferred side for chewing
This will determine the amount of support retention and bracing of the denture on each side
bull Para functional habits clinching and bruxism
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Diagnosis
bull It is the determination of the nature location and causes of diseases
To assemble all appropriate information about the patientrsquos medical and dental history and conduct clinical examination including evidence from radiographs and mounted diagnostic casts to achieve good prognosis
Diagnosis of partially edentulous pt includesbull Patient Historybull Clinical examination ( Extraoral and
Intraoral) bull Radiographsbull Mounted Diagnostic Castsbull Occlusal plane analysisbull Surveying of the diagnostic castbull Pre-extraction record
Treatment plan
1 Patient history
ndash Personal and Social history
ndash Chief complaintsndash Medical historyndash Dental historyndash Mental attitudes
Personal and Social history
bull Name - Address - Tel N0
bull Age - Sex
bull Occupation and Socio-economic Class
bull Public speakers and singers
bull Wind instrument players
bull Psychological conditions
Chief complaints
bull Reason for attendance (Patients requests and desires)
Medical history
bull 1048633 Diabetesbull 1048633 Arthritisbull 1048633 Pagetrsquos diseasebull 1048633 Acromegalybull 1048633 Parkinsonrsquos diseasebull 1048633 Pemphigus vulgarisbull 1048633 Epilepsybull 1048633 Cardiovascular diseasesbull 1048633 Cancerbull 1048633 Transmissible diseases
1 Smokinghas been known to be
associated with a variety of oral conditions including Periodontal disease
Bone amp tooth loss
Peri-implantitis Dental implant
failureThe effect of tobacoo is due to1 resistance to inflammation2 resistance to infection3 Impaired wound healing4 Calcium absorption
Patients who are unable to sustain a high level of plaque control eg Parkinsonism
Dental history
bull The cause of teeth lossbull Patient experience during and following
previous partial denture constructionbull Expectation of treatmentbull Chewing habits preferred side for chewing
This will determine the amount of support retention and bracing of the denture on each side
bull Para functional habits clinching and bruxism
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
To assemble all appropriate information about the patientrsquos medical and dental history and conduct clinical examination including evidence from radiographs and mounted diagnostic casts to achieve good prognosis
Diagnosis of partially edentulous pt includesbull Patient Historybull Clinical examination ( Extraoral and
Intraoral) bull Radiographsbull Mounted Diagnostic Castsbull Occlusal plane analysisbull Surveying of the diagnostic castbull Pre-extraction record
Treatment plan
1 Patient history
ndash Personal and Social history
ndash Chief complaintsndash Medical historyndash Dental historyndash Mental attitudes
Personal and Social history
bull Name - Address - Tel N0
bull Age - Sex
bull Occupation and Socio-economic Class
bull Public speakers and singers
bull Wind instrument players
bull Psychological conditions
Chief complaints
bull Reason for attendance (Patients requests and desires)
Medical history
bull 1048633 Diabetesbull 1048633 Arthritisbull 1048633 Pagetrsquos diseasebull 1048633 Acromegalybull 1048633 Parkinsonrsquos diseasebull 1048633 Pemphigus vulgarisbull 1048633 Epilepsybull 1048633 Cardiovascular diseasesbull 1048633 Cancerbull 1048633 Transmissible diseases
1 Smokinghas been known to be
associated with a variety of oral conditions including Periodontal disease
Bone amp tooth loss
Peri-implantitis Dental implant
failureThe effect of tobacoo is due to1 resistance to inflammation2 resistance to infection3 Impaired wound healing4 Calcium absorption
Patients who are unable to sustain a high level of plaque control eg Parkinsonism
Dental history
bull The cause of teeth lossbull Patient experience during and following
previous partial denture constructionbull Expectation of treatmentbull Chewing habits preferred side for chewing
This will determine the amount of support retention and bracing of the denture on each side
bull Para functional habits clinching and bruxism
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Diagnosis of partially edentulous pt includesbull Patient Historybull Clinical examination ( Extraoral and
Intraoral) bull Radiographsbull Mounted Diagnostic Castsbull Occlusal plane analysisbull Surveying of the diagnostic castbull Pre-extraction record
Treatment plan
1 Patient history
ndash Personal and Social history
ndash Chief complaintsndash Medical historyndash Dental historyndash Mental attitudes
Personal and Social history
bull Name - Address - Tel N0
bull Age - Sex
bull Occupation and Socio-economic Class
bull Public speakers and singers
bull Wind instrument players
bull Psychological conditions
Chief complaints
bull Reason for attendance (Patients requests and desires)
Medical history
bull 1048633 Diabetesbull 1048633 Arthritisbull 1048633 Pagetrsquos diseasebull 1048633 Acromegalybull 1048633 Parkinsonrsquos diseasebull 1048633 Pemphigus vulgarisbull 1048633 Epilepsybull 1048633 Cardiovascular diseasesbull 1048633 Cancerbull 1048633 Transmissible diseases
1 Smokinghas been known to be
associated with a variety of oral conditions including Periodontal disease
Bone amp tooth loss
Peri-implantitis Dental implant
failureThe effect of tobacoo is due to1 resistance to inflammation2 resistance to infection3 Impaired wound healing4 Calcium absorption
Patients who are unable to sustain a high level of plaque control eg Parkinsonism
Dental history
bull The cause of teeth lossbull Patient experience during and following
previous partial denture constructionbull Expectation of treatmentbull Chewing habits preferred side for chewing
This will determine the amount of support retention and bracing of the denture on each side
bull Para functional habits clinching and bruxism
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
1 Patient history
ndash Personal and Social history
ndash Chief complaintsndash Medical historyndash Dental historyndash Mental attitudes
Personal and Social history
bull Name - Address - Tel N0
bull Age - Sex
bull Occupation and Socio-economic Class
bull Public speakers and singers
bull Wind instrument players
bull Psychological conditions
Chief complaints
bull Reason for attendance (Patients requests and desires)
Medical history
bull 1048633 Diabetesbull 1048633 Arthritisbull 1048633 Pagetrsquos diseasebull 1048633 Acromegalybull 1048633 Parkinsonrsquos diseasebull 1048633 Pemphigus vulgarisbull 1048633 Epilepsybull 1048633 Cardiovascular diseasesbull 1048633 Cancerbull 1048633 Transmissible diseases
1 Smokinghas been known to be
associated with a variety of oral conditions including Periodontal disease
Bone amp tooth loss
Peri-implantitis Dental implant
failureThe effect of tobacoo is due to1 resistance to inflammation2 resistance to infection3 Impaired wound healing4 Calcium absorption
Patients who are unable to sustain a high level of plaque control eg Parkinsonism
Dental history
bull The cause of teeth lossbull Patient experience during and following
previous partial denture constructionbull Expectation of treatmentbull Chewing habits preferred side for chewing
This will determine the amount of support retention and bracing of the denture on each side
bull Para functional habits clinching and bruxism
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Personal and Social history
bull Name - Address - Tel N0
bull Age - Sex
bull Occupation and Socio-economic Class
bull Public speakers and singers
bull Wind instrument players
bull Psychological conditions
Chief complaints
bull Reason for attendance (Patients requests and desires)
Medical history
bull 1048633 Diabetesbull 1048633 Arthritisbull 1048633 Pagetrsquos diseasebull 1048633 Acromegalybull 1048633 Parkinsonrsquos diseasebull 1048633 Pemphigus vulgarisbull 1048633 Epilepsybull 1048633 Cardiovascular diseasesbull 1048633 Cancerbull 1048633 Transmissible diseases
1 Smokinghas been known to be
associated with a variety of oral conditions including Periodontal disease
Bone amp tooth loss
Peri-implantitis Dental implant
failureThe effect of tobacoo is due to1 resistance to inflammation2 resistance to infection3 Impaired wound healing4 Calcium absorption
Patients who are unable to sustain a high level of plaque control eg Parkinsonism
Dental history
bull The cause of teeth lossbull Patient experience during and following
previous partial denture constructionbull Expectation of treatmentbull Chewing habits preferred side for chewing
This will determine the amount of support retention and bracing of the denture on each side
bull Para functional habits clinching and bruxism
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Chief complaints
bull Reason for attendance (Patients requests and desires)
Medical history
bull 1048633 Diabetesbull 1048633 Arthritisbull 1048633 Pagetrsquos diseasebull 1048633 Acromegalybull 1048633 Parkinsonrsquos diseasebull 1048633 Pemphigus vulgarisbull 1048633 Epilepsybull 1048633 Cardiovascular diseasesbull 1048633 Cancerbull 1048633 Transmissible diseases
1 Smokinghas been known to be
associated with a variety of oral conditions including Periodontal disease
Bone amp tooth loss
Peri-implantitis Dental implant
failureThe effect of tobacoo is due to1 resistance to inflammation2 resistance to infection3 Impaired wound healing4 Calcium absorption
Patients who are unable to sustain a high level of plaque control eg Parkinsonism
Dental history
bull The cause of teeth lossbull Patient experience during and following
previous partial denture constructionbull Expectation of treatmentbull Chewing habits preferred side for chewing
This will determine the amount of support retention and bracing of the denture on each side
bull Para functional habits clinching and bruxism
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Medical history
bull 1048633 Diabetesbull 1048633 Arthritisbull 1048633 Pagetrsquos diseasebull 1048633 Acromegalybull 1048633 Parkinsonrsquos diseasebull 1048633 Pemphigus vulgarisbull 1048633 Epilepsybull 1048633 Cardiovascular diseasesbull 1048633 Cancerbull 1048633 Transmissible diseases
1 Smokinghas been known to be
associated with a variety of oral conditions including Periodontal disease
Bone amp tooth loss
Peri-implantitis Dental implant
failureThe effect of tobacoo is due to1 resistance to inflammation2 resistance to infection3 Impaired wound healing4 Calcium absorption
Patients who are unable to sustain a high level of plaque control eg Parkinsonism
Dental history
bull The cause of teeth lossbull Patient experience during and following
previous partial denture constructionbull Expectation of treatmentbull Chewing habits preferred side for chewing
This will determine the amount of support retention and bracing of the denture on each side
bull Para functional habits clinching and bruxism
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
1 Smokinghas been known to be
associated with a variety of oral conditions including Periodontal disease
Bone amp tooth loss
Peri-implantitis Dental implant
failureThe effect of tobacoo is due to1 resistance to inflammation2 resistance to infection3 Impaired wound healing4 Calcium absorption
Patients who are unable to sustain a high level of plaque control eg Parkinsonism
Dental history
bull The cause of teeth lossbull Patient experience during and following
previous partial denture constructionbull Expectation of treatmentbull Chewing habits preferred side for chewing
This will determine the amount of support retention and bracing of the denture on each side
bull Para functional habits clinching and bruxism
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Patients who are unable to sustain a high level of plaque control eg Parkinsonism
Dental history
bull The cause of teeth lossbull Patient experience during and following
previous partial denture constructionbull Expectation of treatmentbull Chewing habits preferred side for chewing
This will determine the amount of support retention and bracing of the denture on each side
bull Para functional habits clinching and bruxism
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Dental history
bull The cause of teeth lossbull Patient experience during and following
previous partial denture constructionbull Expectation of treatmentbull Chewing habits preferred side for chewing
This will determine the amount of support retention and bracing of the denture on each side
bull Para functional habits clinching and bruxism
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Mental attitudes
ndash Houses Classification Based on patientrsquos mental attitude
bull philosophical patients (Well adjusted and easygoing)
bull Exacting patients (Precise in everything they do)
bull Hysterical patients (Are emotionally unstable and convinced that they will never be able to wear a prosthesis)
bull Indifferent patients (are uncooperative)
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Clinical examination
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Clinical oral examination
What features should be considered in the
examination
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
bull PATIENT EVALUATION
bull EXTRAORAL EXAMINATION
bull INTRAORAL EXAMINATION
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
PATIENT EVALUATION
bull Gait
bull Complexion and Personality
bull Cosmetic Index
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
II-Clinical Examination
Extra oralExtra oral Intra-oralIntra-oral
Facial ExaminationFacial Examination
TMJ ExaminationTMJ Examination
Visual ExaminationVisual Examination
Digital ExaminationDigital Examination
Radiographic ExaminationRadiographic Examination
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Extra oral Examination
Front ViewFront View Profile ViewProfile View
Angle of the mentolabial SulcusAngle of the mentolabial Sulcus
Vertical dimension of old denture wearersVertical dimension of old denture wearers
Size - Form ndash Shape of the faceSize - Form ndash Shape of the face
Juvenile Appearance of the patientJuvenile Appearance of the patient
A- Facial Examination
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Extra oral Examination
Clinical InterpretationClinical Interpretation Radiographic InterpreRadiographic Interpre
DigitalExamDigitalExam
Clicking or Pop sounds on jaw OpeningClicking or Pop sounds on jaw Opening
Panoramic Panoramic
Corrected Cephalometric TomographyCorrected Cephalometric Tomography
B- TMJ Examination
Transcranial RadiographyTranscranial Radiography
Computerized TomographyComputerized TomographyMRIMRI
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
EXTRAORAL EXAMINATION
bull Facial examinationndash Facial Formndash Facial Features
bull Lip Examination
bull TMJ Examination
bull Neuromuscular Examination
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Intra oral exam
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Intra Oral Examination
For Partially Edent ptFor Partially Edent pt
Edentulous Area Edentulous Area
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Colour- Contour-Ridge
Relationship -Tongue Tori-
UndercutndashThroat form-
Saliva- Frena Att
Remainimg Natural TeethRemainimg Natural Teeth
A- Visual Examination
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
N0 - Form-Location-Caries- Existing Restoration-Periodontium-Positions- Occlusion
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Intra Oral Examination
Edentulous Area Edentulous Area
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Firmness -Irregularities-
Tongue- Tuberosities- Slope of
RetromPad- Mylohyoid Ridge-
Lingual Pouch-Painful Areas
Remainimg Natural TeethRemainimg Natural Teeth
B- Digital Examination
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
Vitality test- Percussion ndash
Mobility- pocket
Evaluation
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
The following should be examined
1-Oral Hygiene2-Carious lesions and existing
restorations3-Evaluation of the periodontium4-Tooth mobility5-Sensitivity to percussions6- vitality tests of individual teeth7- Atrition8- Occlusion9 Ridge Morphology10- Arch form 11- Interarch space12-Evaluation of the space for the
mandibular major connector
13 Maxillo-mandibular relationship
14-Para-functional habits15-Mouth opening16- Oral mucosa17- Hard tissue abnormalities18- Soft tissue abnormalities19- Occlusal relationships20- Temporomandibular joint
(TMJ) examination21- Quality and quantity of saliva22-Tounge size and mobility23- Examination of old denture
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
1-Oral hygiene of the patient
The ultimate success of dental
treatment relies on the home care of
the patient as well as the technical
procedures performed by the
dentist
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Oral Hygienebull The patient must
have a high standard of plaque control
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
2-Carious lesions and existing restorations
bull Any caries should be restored prior to PD fabrication
bull Patient with caries index should have the abutment teeth crowned
bull Existing restoration should be examined
o whether rest will be all on amalgam or partly on amalgam and tooth structure
o Amalgam or composit on labial or buccal surface are liable to wear by action of retentive clasp arm
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
3-Evaluation of the periodontiumExamination findings
that indicate the need for PL treatment includes
bull Gingivitisbull Pocket depth in excess
of 3 mmbull Calculous depositsbull Furcation involvementbull Marginal exudate
upon probing or application of digital pressure
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
4-Tooth mobility
Causesbull Trauma from occlusion (usually reversible)bull Inflammation in PL (usually reversible)bull Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is
questionableSo many clinicians prefer to use a
mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion
Possible causes1 Tooth in traumatic occlusion2 Periapical or pulpal abscess3 Periodontitis4 Cracked tooth
The cause must be identified and treated before partial
denture construction
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
6 -vitality tests of individual teeth
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
7-Attrition
Loss of teeth
drifting and migration
deflective occlusal contact
increased muscular response
bruxism and excessive tooth wear
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Types of wear1 Attritional wear (due to rubbing of opposing teeth)2 Wear from erosion Carbonated beverages (Coke-Swishing) Amalgam
restoration will be raised above the eroded surface GERD Most pronounced on the lingual surface of
molars (depends on the patientrsquos sleeping position) Regurgitation (Self induced projectile vomiting )
mostly wear appears in the upper anterior segment Bulemia
3 Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
A popular misconception about severely worn
dentition is that patients have lost their VDO and that
it must be restoredThe VDO is maintained even when rapid abrasive wear occurs As the occlusal
surface of teeth wear the dento alveolar process elongates by
progressive remodeling of the alveolar bone
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Actually loss of VDO occurs in 2 situations
1 Severe bruxism aggressive bruxers can destroy tooth structure at a greater rate than extrusion can compensate for
2 large number of teeth are lost remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces and begin to tip sideways resulting in over-closure of the jaws (collapsed bite)
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
8- OcclusionA situation that looks simple when
the teeth are apart may be complicated when the teeth are
in occlusion
Occlusion is better evaluated on a mounted
diagnostic casts
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
9 Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
10 Arch formbull It is either ovoid tapered or square
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
11-Interarch spacebull For fixed restorations 7
mm in the posterior region and 8-10 in the anterior region
bull For removable restoration at least 12 mm
bull An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Management of inadequate interarch space
Excessive interarch spaceOnlay bone graft may be used before implant
placement to decrease the interarch space if fixed restoration is to be made
Decreased interarch spaceTreatment of the overerrupted opposing teethIf opposing teeth are adequate Osteoplasty
andor soft tissue reduction of the implant region is made
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
12-Evaluation of the space for the mandibular major
connector A minimum of 8 mm
vertical space must be available if a lingual bar major connector is planned
It is measured using a periodontal probe
The space will determine the type of major connector
to be used
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
13 Maxillo-mandibular relationshipbull Arch relationship often concern implant
placement in the anterior regions of the mandible and maxilla
bull In cases of Angle class III cases it is anticipated that maxillary implants are placed more lingual than the original incisal tooth position which will compromise esthetics speech and function
bull This will require overcontouring of the final restoration to place the incisal 23 in an ideal position cantilever force on the implant
bull Management use of additional implants and Increase the anteroposterior distance between implants to compensate for the increased load on the implant specially in mandibular excursion
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
bull In case of angle class II casesManaged by anterior cantilever on
implants in the mandibular arch but this requires
Increase number of implantsIncrease in the anteroposterior
distance between implants
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
14-Para-functional habitsbull Bruxusmbull Clenchingbull Tongue thrust
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Bruxism It is the vertical and horizontal non functional grinding of teeth
Clenching It is the force exerted from one occlusal surface to the other without any movement
Parafunctional tongue thrust Is the unnatural force of the tongue against the teeth during swallowing
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Tongue Position
Normal tongue positions Retracted or awkward
tongue positions
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
23-Examination of old denture
ndash a- the design and quality of construction should be noted
ndash Any associated problems in relation to gingival and mucosal inflammation or to decalcification of contacting tooth surfaces
ndash evaluate whether the denture is still fit accurately against the teeth and under lying mucosa or not
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
4 Radiographic examination
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
1 Caires
Clinical findings must be correlated with radiographic examination to reveal
bull Severity and extent of caires
bull Number of lesions
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
2-Presence of root fragments
If roots are deeply embedded and has no evidence of pathologic changes it is advisable to keep them under observation rather than to remove it to avoid excessive bone removal
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
3 -Root canal filling
An abutment tooth with inadequate root canal filling must be retreatedNot all periapical radiolucencies related to a root canal filling is a pathological condition It may be fibrous healing So it must be correlated with the clinical finding
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
4-Locate areas if infection
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
5-Lamina durabull Resorption of LD occurs where there is
pressure and apposition occurs when there is tension
bull Loss of lamina dura may be due to1 Systemic disorders as hyperparathyrodism
or Pagetrsquos disease2 Excessive pressure on the toothbull Thickening of lamina dura may be due to The tooth is under heavy function and the
patient has high resistance
The cause of change in the lamina dura must be corrected or the abutment will
have poor prognosis
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
6 -The quality of alveolar support
Abutment teeth providing support to a prosthesis will have to withstand greater load specially in a horizontal direction so it must have good bone support If the CR ratio is 11 poor prognosis but still we can use it as an overdenture abutment
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
7-Bone index areas
bull Index areas are those areas of bone that disclose the reactions of bone to additional stresses
bull Bone may respond to abnormal stresses by increase in bone density bone condensation which is a favorable bone response
bull Although it is a favorable bone response the excessive stresses must be relieved because at any time if the patientrsquos resistance is decreased bone resorption may occur
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
bull If the bone responds to extra loading by
increasing bone density the patient is said to have +ve bone factor
and vice versa
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
8-Periodontal ligament space
Thickness of lamina dura with widening of the periodontal ligament space indicates
MobilityOcclusal trauma Heavy function
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces So we predict that this tooth will have a good prognosis as a PD abutment
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
9-Root length size and form
bull Teeth with long multiple and divergent roots will resist stresses better than teeth with fused and conical roots because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone moderate irritation or forces may be destructive
So additional abutment must be used to support the PD
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
11-Third molarbull If its size shape
and position appears favorable it should be retained to avoid a free end saddle condition
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
5-Evalation of the mounted
diagnostic casts
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
The diagnostic casts should be mounted on a semiadjustable articulator with
bull Face bow transferbull Centric relation record
at the correct vertical dimension
bull Protrusive and lateral records
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
1-Interarch distancebull Loss of interarch space is
frequently caused by a large maxillary tuberosity
bull A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane
Surgical correction
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
2 -Diagnostic surveying
To determine1 Parallelism or lack of parallelism
of tooth surface involved 2 Areas of interferences to path of
placement and removal3 Esthetic effects of the selected
path of insertion
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
3-0cclusal plane
Most partially Most partially edentulous pts have edentulous pts have occlusal interferences occlusal interferences due to due to driftingdrifting and and migrationmigration of natural of natural teeth which require teeth which require occlusal equilibrationocclusal equilibration
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Treatment of irregular occlusal planebull Treatment ranges from simple enameloplasty
to extraction of the toothbull If a single tooth is overerupted it may be
treated by1 Simple enameloplasty if overerruption is
within 2 mm2 Reduction and crowning if dentine will be
exposed3 RCT reduction and crowning4 RCT and reduction of the tooth to be used as
an overdenture abutment5 in severe overeruption it may be necessary to
remove the tooth and recontour the surrounding bone
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Treatment of malpositioned occlusal plane
bull Extrusion of an unopposed segment of teeth usually occurs with downward growth of the associated alveolar process causing obvious space problem malposition of the occlusal plane
Orthognathic surgery(Anterior or posterior segment osteotomy(
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Tipped or malposed teeth
May occur if an edentulous space is present mesial to a posterior tooth it may be1 Orthodontically repositioned2 Adjusted with a crown3 Onlay rest
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
5Occlusal equilibriation
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Occlusal equilibration is the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Occlusal interferences is manifested as follows
Clinically1 Wear facets2 Tooth mobility3 Muscle spasm pain and TMDRadiographically1 Widening in the periodontal
membrane space2 Periapical radiolucency3 Bone condensation4 Bone resorption5 Root resorption
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Areas of interferences are detected eitherManually 1 Ribbons2 Marking papers3 Waxes4 Pastes sprays and paint-on
materialsComputer assisted analysisEG T-scan
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
T-scan IIIThe T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Diagnostic equilibriation
bullOcclusal equilibration should be first made on accurately mounted diagnostic cast and all steps should be recorded then duplicated in the patient mouth
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
when do we decide to treat a partially
edentulous patient at centric relation or
maximum intercuspal position
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
The following situations suggest that prosthesis should
be constructed at centric relation
1 Coincidence of CR and CO2 Absence of posterior teeth contact3 When all posterior teeth contact are
to be made by fixed restoration4 Few remaining posterior contacts5 Clinical symptoms of occlusal
trauma (TMJ disorder)
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Examination of the articulated study casts
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Importance of the study castsbull Evaluate several
prosthodontic criteria in the absence of the patient
bull Evaluate the current occlusion
bull The relationship of the edentulous area to the adjacent natural teeth and opposing arch
bull Position of the potential natural abutments parellelism and esthetic considerations
bull Number of missing teeth
bull Inter-arch space analysis
bull -Perform wax up and surgical template
bull -Perform the provisional prosthesis
bull -Ridge mappingbull -Future comparison
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-
Treatment PlanTreatment PlanProper Diagnosis is the Key of Best Prognosis
bullAdjunctive Care - Elimination of infection and pathoses -Surgical improvement of denture support
-Tissue Conditioning -Nutritional CounselingbullProsthodontic Care
- Diagnosis of partially edentulous patients
- Slide 2
- Diagnosis
- Slide 4
- Diagnosis of partially edentulous pt includes
- Patient history
- Personal and Social history
- Chief complaints
- Medical history
- Slide 10
- Slide 11
- Dental history
- Mental attitudes
- Clinical examination
- Clinical oral examination
- Slide 16
- PATIENT EVALUATION
- II-Clinical Examination
- Extra oral Examination
- Slide 20
- EXTRAORAL EXAMINATION
- Intra oral exam
- Intra Oral Examination
- Slide 24
- The following should be examined
- 1-Oral hygiene of the patient
- Oral Hygiene
- 2-Carious lesions and existing restorations
- 3-Evaluation of the periodontium
- 4-Tooth mobility
- 5-Sensitivity to percussions
- 6- vitality tests of individual teeth
- 7-Attrition
- Types of wear
- A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
- Actually loss of VDO occurs in 2 situations
- 8- Occlusion
- 9 Ridge Morphology
- 10 Arch form
- 11-Interarch space
- Management of inadequate interarch space
- 12-Evaluation of the space for the mandibular major connector
- 13 Maxillo-mandibular relationship
- Slide 44
- Slide 45
- 14-Para-functional habits
- Slide 47
- 15-Mouth opening
- Slide 49
- Slide 50
- 4 Radiographic examination
- 1 Caires
- 2-Presence of root fragments
- 3- Root canal filling
- 4-Locate areas if infection
- 5-Lamina dura
- 6- The quality of alveolar support
- 7-Bone index areas
- Slide 59
- 8-Periodontal ligament space
- 9-Root length size and form
- 10-Proximity of roots
- 11-Third molar
- 5-Evalation of the mounted diagnostic casts
- Slide 65
- 1-Interarch distance
- 2- Diagnostic surveying
- 3-0cclusal plane
- Treatment of irregular occlusal plane
- Treatment of malpositioned occlusal plane
- Tipped or malposed teeth
- 5Occlusal equilibriation
- Slide 73
- Occlusal interferences is manifested as follows
- Areas of interferences are detected either
- T-scan III
- Diagnostic equilibriation
- Slide 78
- The following situations suggest that prosthesis should be constructed at centric relation
- Slide 80
- Importance of the study casts
- Slide 82
-