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Diagnosis and treatment planning in fixed partial denture

Preeti Kalia 2nd Year P.G. Department of Prosthodontics AECS Maaruti Dental College

Planning is bringing the future into the present so that you can do something about it now

Special problems

Treatment sequence

Definitive diagnosis Identification of the patients needs Treatment planning for single tooth restoration

Cantilever fixed partial denture Canine replacement

Diagnosis and treatment planning in fixed partial dentue Treatment planning for multiple missing teeth

Abutment evaluation

Definition
Diagnosis: Determination of the nature of the disease

Diagnostic casts

Radiographic interpretation

Definitive diagnosis

Periodontal health Occlusal relationships TMJ function Condition of edentulous areas Anatomic abnormalities ,servicibility of the existing prostheses Status of the remaining dentition including previous dental treatment Dental caries,defective restorations and pulpal disease

ACP Classification
Class I -Ideal or minimally compromised
The edentulous span is confined to a single arch and 1 of the following*Any anterior maxillary edentulous area that does not exceed 2 incisors. *Any anterior mandibular edentulous area that does not exceed 4 incisors. *Any posterior maxillary or mandibular edentulous area that does not exceed 2 premolars, or 1 premolar and 1 molar.

Class I

Abutment conditions No preprosthetic therapy is indicated. Occlusal characteristics- Class I molar and jaw relationships are seen. Residual bone height of 21 mm

Class II- Moderately compromised


Edentulous area Both arches Abutment- Abutments in 1 or 2 sextants Occlusion- Localized adjunctive therapy . Class I molar and jaw relationships are seen. Residual bone height of 16 to 20 mm

Class III Substantially compromised

Any posterior maxillary or mandibular edentulous area greater than 3 teeth or 2 molars.
Abutments in 3 sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations. Entire occlusion must be reestablished.Class II molar and jaw relationships are seen. Residual alveolar bone height of 11 to 15 mm

Class IV Severely compromised

Any edentulous area or combination of edentulous areas requiring a high level of patient compliance Abutments in 4 or more sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations. Entire occlusion must be reestablished, including changes in the occlusal vertical dimension.Class II division 2 and Class III molar and jaw relationships are seen. Residual vertical bone height of 10 mm measured at the least vertical height of the mandible on a panoramic radiograph

Definition
Treatment plan: Sequence of procedures planned for a patient after diagnosis

Identification of patients needs

An attempt to conform the patient to the ideal treatment plan rather than have treatment plan conform to patients needs will not lead to success

Objectives of treatment
Objectives Correcting an existing disease

Prevention of disease

Restoration of function

Improvement of appearance

Correcting an existing disease

Prevention of future disease

Restoration of function

Improvement of appearance

Why do we need to replace missing teeth?

Parts of fixed partial denture

Selection of abutment teeth

splinted abutment

Ideal abutment

Treatment planning for single tooth


Treatment planning for single tooth

Intracoronal

Extracoronal

Intracoronal restorations
Glass ionomer restoration

Composite resin restoration

Simple amalgam restoration

Complex amalgam restoration

Metal inlay

MOD Onaly

Ceramic inlay

Extracoronal restoration
Resin veneer crowns

Partial veneer crown

Full metal crown

Metal ceramic crown

All ceramic crown

Ceramic veneer crown

Treatment planning for replacement of missing teeth


Replacement of missing teeth

Removable partial denture

Tooth supported fixed partial denture

Implant supported fixed partial denture

Resin bonded bridges

Conventional

Removable partial denture

Conventional fixed partial denture

Resin bonded bridge

Implant supported fixed partial denture

No treatment
Long standing edentulous ridge No drifting or elongation of adjacent teeth Patients wish

Abutment evaluation

Forces that would normally be absorbed by the missing tooth are transmitted through the pontic,connectors and retainers to the abutments. Vital tooth Endodontically treated teeth Dowel core Pulp capped teeth

Crown to root ratio

Root configuration

Periodontal ligament area

Support calculation

Maxillary

1,2 .. 1 3,4,5 .. 1.5 6,7 .. 2.5 1,2 .. 1 3 ......... 1.5 4,5.. 1.2 6,7 2.8

Mandibular

Biomechanical considerations
1) Span length Bending or deflection varies directly with the cube of the bridge length

2)Double abutment

Double abutments are sometimes used as a means of overcoming problems created by unfavorable crown-root ratios and long spans A secondary abutment must have at least as much root surface area and as favorable a crown-root ratio as the primary

3) Arch curvature

Replacement of a single missing tooth


Canine replacement FPD
Canine is outside interabutment axis Maxillary canine - more stresses than a mandibular canine

Cantilever fixed partial denture

Assessment of the abutment teeth


Radiographs ,pulpal health Endodontically treated abutments

Unrestored abutments

Assessment of the abutment teeth


Mesially tilted second molar

Corrective measures of mesially tilted second molar

orthodontic treatment

Proximal half crown

Corrective measures of mesially tilted second molar

Telescoping crown and coping

Corrective measures of mesially tilted second molar

Non rigid connector

Span length Replacing 3 posterior teeth with FPD unfavorable- implant supported FPD Long span FPD pontics and connectors should be made bulky

Replacing multiple anterior teeth

Special problems
Pier abutments

Non rigid connector

Simple fixed partial denture (One tooth)

Replace central incisor Abutments are central incisor and lateral incisor Abutment pontic- root ratio
Maxilla- 1.9 Mandible 2.1

Simple fixed partial denture (two teeth)

Replace maxillary central incisor and lateral incisor Abutment Central incisor and canine Abutment pontic root ratio 1.2

Complex fixed partial denture (two teeth)

Replace mandibular central incisor and lateral incisor Abutments- Central incisor, lateral incisor and canine Abutment- pontic root ratio- 1.8

Complex fixed partial denture (more than two teeth)

Replace maxillary central incisors and one lateral incisor Abutments- Both canines and the remaining lateral incisor Abutment-pontic root ratio- 1.3

Complex fixed partial denture (pier abutment)

Replace maxillary central incisor and opposite side lateral incisor Abutments- Lateral incisor, central incisor and canine Abutment- pontic root ratio- 1.7

Phase I : Symptomatic treatment

Phase II Stabilization phase

Phase III: Definitive treatment


Oral surgery
Periodontal surgery Endodontic treatment

Orthodontic treatment

Phase III: Definitive treatment

Fixed prosthodontics
Occlusal

adjustments Anterior teeth restored first Restoring opposing posterior segments

Phase IV: follow up

References

Malone W.F.P., Koth D.L., Cavazos E. : Tylmans theory of practice of fixed prosthodontics. 8 th edition,1977, lshiyaku publications, St.Louis,1-24 Rosenstiel R.F., Land M.F., Fujimoto J.: Contemporary fixed prosthodontics. 4th edition,1988, Mosby Publications, India, 42-109 Shillingburg H.T., Hobo S., Whisett L.D., Jacobi R., Brackett S.E. Fundamentals of fixed prosthodontics, 3 Ed., Quintessence Publication,2007,India ,73-104.

References

D.J Jacobs, J.G Steele, R.W Wassell,Considerations when planning treatment, British Dental Journal 2002;192,5:257-267 D.J Jacobs, J.G Steele, R.W Wassell,Changing patterns and the need for quality, British Dental Journal 2002;192,3: 144-148 D.J Jacobs, J.G Steele, R.W Wassell,Material selection, British Dental Journal 2002;192,4: 199-211

References

Thomas J . Mc Garry ,Classification system for partial edentulism , J Prosthodont 2002; 11,3:181-193
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