Fixed & removable prosthetics

• treat perio disease prior to restorative dentistry
• why would advanced restorative procedures initially involve monitoring pt OH?

  if a pt can't maintain good oh, they shouldn't be considered for advanced restorations
• diagnosis and tx planning?

  • comprehensive study
  • examination
  • mounted study casts
  • tx plan
  • competent to perfom procedures
• flexible tx planning?


  if pt unwilling/unable to maintain high levels of OH - consider denture over bridge
• prognosis perio affected teeth?

  • maintain good oh
  • age
  • diagnosis
  • boneloss
  • MH
  • root morphology/furcation
  • smokers?
  • biological response
• why restore?

  • aesthetic
  • function
• dental restorations and impact on gingival margin?

  • supra gingival margins ideal however subgingival may occur to follow caries
  • JE won't attach to restorative materials
  • plaque retentive even if good contour
  • poor margins can lead to pocket formation
  • pts can forget to clean restorations
• occlusal relations to restorations:

  • occlusal trauma may occur if balance occlusion not achieved
  • pattern of bone loss
  • excerbating factor for perio
  • treat perio problems initially and consider relieving any occlusal interference
• partial dentures and fixed bridgework?

  • more teeth lost greater force applied to remaining teeth
  • perio tx first
  • perio disease reduces support of teeth
• gingival recession

  • cavities management - remove cause, restore?
  • care with margins - PRF
• cast restorations?

  • Advanced restorative procedure.
  • Gain added retention and achieving a supra gingival margin.
  • If no pocketing then will require soft tissue and bone removal.
  • Often need to remove more bone than at first appears necessary.
  • At least 6 weeks healing prior to crown placement.
• endodontic treated before perio
• implants must be avoided in perio disease
• restorative options of missing teeth

  1. Nothing!
  2. Acid etch retained bridge.
  3. Fixed bridge.
  4. Fixed moveable bridge.
  5. Removable prosthesis.
  6. Implant.
• Periodontally ideal bridge:

  • high standard of plaque control
  • Free of periodontal disease
  • Abutment teeth adequate bone support
  • Patient instructed in bridge hygiene
  • Supra gingival margins
  • Easy to clean
  • Adequate embrasures
  • Convex fitting surface to pontic
  • Pontic just touching or free of mucosa
  • Balanced occlusion
• perio ideal denture

  • high standard of plaque control.
  • Free of periodontal disease.
  • Design free of gingival margins.
  • Patient instructed in denture hygiene.
  • Tooth borne. (+/- mucosal)
  • Easy to clean.
• aesthetic consideration with perio pt ?

  • perio disease, drifting anteriors, occlusal/soft tissue dysfunction
  • recession following perio tx