Prosthodontics I

• Fixed Partial Dentures


  Dental prostheses that replace one or more missing teeth and are permanently attached to the remaining natural teeth or dental implants
• Diagnosis


  Examination of the physical state, evaluation of the mental or psychological makeup and understanding the needs of each patient to ensure a predictable result
• Treatment planning


  Developing a course of action that encompasses the ramifications and sequelae of treatment to serve the patient's needs
• Diagnosis in fixed partial denture

  • Chief complaints
  • History taking of the patient
  • Examination
  • Making of diagnostic casts
  • Full mouth radiographs
• Chief complaints


  • Comfort (pain, sensitivity, swelling)
  • Function (difficulty in mastication or speech)
  • Social (bad taste or odour)
  • Appearance (fractured or discoloured tooth)
• Pain


  Location, character, severity and frequency of the pain should be noted as well as the first time it occurred and the factors increasing pain (e.g. hot or cold things), and any changes in its character
• Swelling


  The location, size, consistency, colour change during inflammation, duration, and frequency of the swelling need to be noted
• Difficulty in chewing


  Can be due to a fractured cusp or generalized malocclusion
• Speech difficulty


  May be due to local cause or systemic problems
• Appearance issues


  • Missing or crowded teeth
  • Fractured tooth or restoration
  • Malpositioned or discoloured teeth
  • Congenital anomalies of dentition
• History taking


  • Personal details
  • Medical history
  • Drug history
  • Dental history
• Medical history


  Any cardiac ailments, requiring antibiotic premedication before treatment, CNS disorders or other systemic diseases affecting treatment method. Hypertensive patients and coronary disease patients should not be given epinephrine. Any previous radiation therapy, blood disorders, terminal illness affecting treatment plan. Systemic conditions with oral manifestations. Infective diseases as AIDS, hepatitis and syphilis need to be evaluated.
• Drug history


  Previous medication history, drug allergies and if patient is taking any medicines routinely should be noted
• Dental history


  • Periodontal history
  • Restorative history
  • Endodontic history
  • Orthodontic history
  • Removable prosthodontic history
  • Oral surgical history
  • Radiographic history
  • TMJ dysfunction history
• Periodontal history


  Oral hygiene status, any previous oral hygiene prophylaxis or any previous periodontal surgery is noted
• Restorative history


  All restorations of amalgam and tooth coloured restoration along with time of these restorations are noted
• Endodontic history


  If the endodontically restored tooth is a prospective abutment tooth then a radiographic evaluation of the periapical health is noted
• Orthodontic history


  If radiographic evaluation shows root resorption, it can be due to previous orthodontic treatment. Occlusal adjustment with minor tooth movement can promote long-term positional stability of the teeth and reduce, or eliminate, parafunctional activity
• Removable prosthodontic history


  Previous removable prostheses must be carefully evaluated and the duration of wear needs to be noted
• Oral surgical history


  Missing teeth and period of edentulousness should be noted
• Radiographic history


  Previous radiographs and current diagnostic radiographic series aids to assess the progress of the disease. It also aids in locating impacted tooth, root tips and cyst and tumours
• TMJ dysfunction history


  • Pain or clicking in the temporomandibular joints
  • Tenderness to palpation
  • Difficulty in opening the mouth
  • Deviation while opening
  • The above symptoms with any treatment done earlier for the dysfunction as occlusal appliances, medications, or exercises should be noted
• Examination


  • General examination
  • Temporomandibular joint examination
  • Extraoral examination
  • Intraoral examination
  • Occlusal examination
  • Abutment tooth evaluation
• General examination


  General appearance, gait, weight, skin colour (anemia or jaundice). Vital signs, such as respiration, pulse, temperature, and blood pressure are measured and recorded
• Temporomandibular joint examination


  Bilateral palpation anterior to the auricular tragi while the patient opens and closes the mouth, can locate disorder in the posterior attachment of the disk. Tenderness clicking, or pain is noted. Jaw opening of less than 40 mm indicates restriction. Deviation from midline is also recorded. Maximum lateral movement can then be measured (normal is about 12 mm). Masseter and temporal muscles are palpated for signs of tenderness and classified as mild, moderate, or severe
• Extraoral examination


  • Facial asymmetry
  • Cervical lymph node palpation
  • TMJs and the muscles of mastication
  • Lips: Smile line, negative space between the maxillary and mandibular teeth when the patient laughs, missing teeth, diastemae, and fractured or poorly restored teeth are noted
• Intraoral examination


  • Soft tissues, teeth and supporting structures as the tongue, floor of the mouth, vestibule, cheeks and hard and soft palates are examined and findings noted
• Periodontal examination


  • Oral hygiene status assessment
  • Examination of gingiva, periodontium and the response to the host tissues
• Examination of teeth


  • Absence of teeth, dental caries, any restorations, wear facets, fractures, abrasions, malformations and erosions are noted
  • Pocket depths (usually six tooth) are recorded on a periodontal chart
• Occlusal examination


  • General alignment
  • Lateral and protrusive contacts
  • Centric relation
  • Jaw manoeuverability
• General alignment


  The teeth can be evaluated for crowding, rotation, over eruption, spacing, malocclusion and vertical and horizontal overlap
• Lateral and protrusive contacts

  The presence or absence of tooth contact in eccentric movements is verified with a thin Mylar strip. Tooth movement (fremitus) should be identified by palpation
• Centric relation


  The relationship of teeth in both centric and intercuspal position is assessed. If a slide from CR to IP is present, its horizontal and vertical components can be estimated and a note made of any lateral deviation
• Jaw manoeuverability


  The ability and ease with which the patient moves the jaw and the guiding movements should be assessed
• Abutment tooth evaluation


  • Crown root ratio
  • Root configuration
  • Periodontal surface area
  • Vitality testing
• Crown-root ratio


  An abutment teeth should have a combined peri-cemental area equal to or greater in peri-cemental area than the tooth or teeth to be replaced (Antes law). Favourable crown root ratio is 1:1
• Root configuration


  Root shape: Short conical roots give less support. Divergent multiple roots give good support. Periodontal surface area: Root surface area: Larger teeth will have greater surface area and will handle stress better
• Vitality testing


  Prior to any restorative treatment, pulpal health must be assessed by measuring the response to percussion as well as thermal and electrical stimulation
• Diagnostic casts


  Articulated diagnostic casts aid in planning treatment procedures, provide information about static and dynamic relationships of the teeth and help to view several aspects of the occlusion not detectable within the confines of the mouth
• Advantages of diagnostic cast

  • Changing the arch relationship before orthognathic procedures
  • Changing the tooth position prior to orthodontic procedures
  • Modifying the occlusal scheme before attempting any selective occlusal adjustment
  • Trial tooth preparation and waxing can be done before fixed restorative procedures
  • Selection of an optimum path of withdrawal of a fixed partial denture can be assessed