Prosthodontics oCharacterization is very  Continuity and integrity of the

 Head and Neck Examination important lamina dura

 Oral Examination Mounted Diagnostic Cast  Pulpal morphology
 General Oral Assessment 1. Original state of the patient  Previous endodontic treatment with
 Examination of the Teeth 2. Treatment plan for the patient or without post and core
 Occlusal Examination  Presence of apical disease, root
 Periodontal Examination  Essential in the analysis of patient’s reorption, or root fractures
Head and Neck Examination pre-treatment occlusal relationship  Retain root fragment, radioluscent
 Size  Presenting final treatment plan to the areas, calcifications, foreign
 Shape patient bodies, or impacted teeth
 Symmetry  Diagnostic wax up can be done on a  Presence of carious lesions and
Check for facial profile: duplicate cast to give a preview of the proximity of restorations to the
 Normal anticipated occlusal scheme and dental pulp
esthetic form  Proximity of carious lesion and
 Prognothic o As esthetic as possible
 Retrognathic restoration to the alveolar crest
o If esthetics is not improved, do not do
o In Filipinos, we have a condition FPD, but ortho treatment instead.  Calcular deposit
called Bimaxillary Protrusion.  Check for intermaxillary distance  Oral radiographic manifestations of
Check for abnormalities  Re-contouring on enamel only systemic disease
 Skin and Hair Occlusal Examination Bone Area Index
 Lymph Node Enlargement  Classification of Malocclusion  Teeth that are subjected to greater
o SCM – sternocleidomastoid than normal stress and can provide
 Vertical overlap of anterior teeth
 Cutaneous Ulceration and Scars good information on how bone
 Plane of occlusion
 Pigmentations tissue reacts to additional load
 Vertical dimension of occlusion
 Muscles of Mastication o By the use of Willis Method
o Abutment teeth of a fixed or a
 TMJ Function removable partial denture
o Supraerupted teeth, rotated teeth,
 Envelop of Motion and malignant teeth are cases that o Teeth involved in occlusal
need wax up interference
 Opening of the Mouth
o Crepitus – crackling sound  Evidence of Bruxism  Supraerupted teeth
o Natural teeth will wear off o Teeth receiving greater occlusal
Screening of Malignancy stress because of adjacent teeth
 In Prosthodontics, use two Periodontal Examination
 Gingiva should be coral pink Two Reactions of Bone
mouth mirrors to:  Deposition (+) – no trabeculation;
o Check for any discoloration  Periodontal Pockets – 1-3 mm
 Furcation involvement bone is denser
 Leukoplakia – white  Resorption (-) – has large
o Bone has undergone bone resorption
color trabeculation
 Mucogingival Defects
 Eryhtroplakia – red o Exposure of root surface Impacted tooth
color Radiographic Enterpretation  SOP prior to FPD
o Refer to oral
pathologist for  14 periapical radiograph and 4 Root fragments
biopsy bitewing radiograph  needs to be removed
General Oral Assessment  TMJ radiograph is indicated for  from extraction that was a long
 Oral Hygiene patient dysfunction time ago
 Overall caries activities  Pancreatic radiograph is indicated  how would you know if it is
o Females are more prone to caries for patients with asymmetrical or embedded in the bone or not? –
due to menstruation doubtful lesion palpate the area; if the patient
 Periodontal status Panoramic Radiograph reacts to such pressure applied,
 Quality and quantity of saliva  Excellent in determining pathologic the root fragment is not embedded
Gingival hypertrophy due to Dilantin Sodium in the bone, therefore it should be
 Will undergo gingivectomy prior to fixed
conditions but not adequate for
partial denture definitive examination. removed.
Intraoral Radiograph Condition of Existing Restorations
Examination of the Teeth  Remaining bone support  We need to redo or replace the
 Individual teeth  Root number and morphology restoration with a new one, or
o Carries and recurrent caries  Root proximity better, suggest another type of
o Condition of existing  Quality of supporting bone (bone restoration.
restorations index area)  Amalgams are more superior than
o Decalcifications  Width of the periodontal ligament composite because it lasts longer
o Fractures spaces Quality of Bone
o Erosion, abrasion, or attrition  Area of vertical and horizontal  Bone Index Area can be used as a
o Mobility of remaining natural osseous resorption and furcation parameter to determine the
invasion reaction of the bone to additional
teeth
 Axial inclination of the teeth pressure or load.
 Missing Teeth
(degree of non-parallelism)
  Disappointment with the
Level of Alveolar Bone outcome of prosthodontics care
 Important in determining how much are usually a result of poor C. Margin Placement
of the root is embedded on the communication and lack of  G.V. Black’s Extension for
bone understanding of the limitation Precaution
 Answers the question “can it of treatment  Placement of margin in a
withstand additional load?” Systemic and Emotional Health “caries immune” areas is
Root Configuration  Elderly and debilitated patient not universally advocated
 Condition of the root  might not be able to tolerate  All gingival finish lines be
 Vitality of the tooth the long appointment developed are placed
Treatment Planning in FPD routinely required for above the gingival crest
Aims: extensive fixed for a healthier gingiva
 Restoration masticatory function prosthodontics, may be Intraclavicular Margin Placement
 Restoration of normal condition in better served with  This is not a universal solution to
compliance with esthetic  Patients undergoing antibiotic dental caries
requirement therapy  Indications:
 Restoration of ideal phonetics  Maximize treatment  Esthetics
 Restoration of patient’s comfort performed per appointment  Retention requirements
 Restoration of the general health of to minimize dentist-induced  Location of caries or
the patient bacteremia preexisting restoration
Requirements of an Ideal Artificial Crown  Patients under medications  Root sensitivity
 It should:  Can result to xerostomia and  Presence of cervical erosions
o Provide adequate occlusal will unfavorably affect the  Root fracture
contact outcome of the Level of Placement of Gingiva
o Provide proper proximal  Patients with Bruxism a. Supragingiva
contact  May taxes the reparative b. Equigingiva
o Satisfy esthetics capability of the c. Subgingiva
o Protect the teeth against periodontium and the Supragingival Margin
further injury serviceability of the  More susceptible to cement
o Not cause gingival irritation restoration dissolution
o Be retentive  Patient with infectious disease  Shouldn’t be used to patients
o Be properly cemented  May require special with poor oral hygiene
precaution in the dental D. Biological Width
o Have correct fit
operatory and laboratory to  A band of soft tissues
o Not be over or underextended
prevent cross-contamination attachment between the base
Considerations in Treatment Planning Periodontal Factors of the gingival sulcus and the
 Patient’s desires, expectations,  Inflammation alveolar crest
and needs
 Furcation invasions  Composition:
 Systemic and emotional health
 Margin placement  1mm of junctional
 Periodontal factors
 Biological Width epithelium (attachment
 Occlusion A. Inflammation epithelium)
 Esthetics  Periodontal disease is common  1mm of connective tissue
 Endodontic consideration to patients which exhibit multiple fibers
 Abutment selection missing teeth Subgingival Preparation
 Available tooth structure and crown  Our goal:  Prevention of caries formation
morphology  To resolve the inflammation  Maximize retention
 FPD/ RPD  To convert periodontal  Hide unesthetic margins
 TMJ and Muscles of Mastication pocket depths to clinically Contemporary Margin Placement
A. Patient’s Opinion normal sulcular depths  Placement of margins to the
 Know the patient’s needs,  Establish physiologic gingival crevice to avoid
insights, concerns, and gingival architecture encroaching on the biological width
expectations regarding  Provide adequate zone of  Tooth preparation must terminate
treatment outcome attached gingiva at least 2mm coronal to the
 The desire of the patient should  Adequate oral hygiene alveolar crest
take priority; yet the dentist B. Furcation Invasions Conditions that predisposes violation of
should not deliver substandard  Tooth with furcation involvement the Biological Width:
care, claiming “the patient may require special  Presence of Caries
wanted it” consideration  Fractured root surface
 Patient’s expectations should  Tooth with furcation involvement  Previous restoration place apical to
be realistic is not likely a good candidate for the gingival crest
abutment
  Short clinical crown for added placement of a post and core for Tooth with conical roots can be
retention retaining a complete veneer crown used as an abutment for a
short span bridge if all other
Dentogingival Attachment  Sagittal Osteotomy – surgical factors are optimal
 Damaging will result to: procedure where ibabalik mo place  Single rooted teeth with
o Chronic gingival ng occlusion and make putol the evidence of irregular
inflammation ridge and ngipin configuration or with some
o Pocket formation curvature in the apical third of
o Osseous defect formation as Abutment Selection the root are preferable to a
the bone, fibrous connective  Vital tooth – endodontically treated tooth with a nearly perfect
tissues, and epithelium tooth can serve well as abutments taper.
remodels in an attempt to provided there is a good seal and  Labiolingually conical root
reestablish physiologic complete obliteration of the canal (more stable compared to
attachment  Supporting tissues surrounding the circular)
 Alternative Procedures abutment must be reacting and  Apically divergent (apical)
o Elective crown lengthening free from inflammation Bone Support
with controlled osteotomy  Should not exhibit mobility since  Ante’s Law
and apically positioned flaps they will be carrying extra load  “The abutment teeth should
o Elective extraction or root (weight of retainer or crown and have a combined
resection or hemisection varying degrees of masticatory pericemental area equal to
Occlusion force) or greater in pericemental
 FPD affects occlusion. Do no harm  The root and their supporting are than the tooth or teeth to
when restoring occlusal surfaces of tissues should be evaluated for the be replaced.”
the teeth. following: C. Root Surface Area
 Occlusal equilibration should be a) Crown-root ratio  Measurement of periodontal
done to restore the plane of b) Root configuration ligament attachment of the root
occlusion c) Periodontal surface area to the alveolar bone
A. Crown-root Ratio  Larger teeth with a greater
 Rule of BULL (spot grinding):
Buccal Upper  Measurement of the length of surface are will be better
Lingual Lower the clinical crown to the equipped to handle additional
Esthetics alveolar crest of the bone stress
 FPD cases should be restored compared with the length of the Max
Average
Mandi
Average
root embedded in the bone Area Area
aesthetically, if in doubt of its Central Central
aesthetic potential wax up of case,  As the level of the alveolar Incisor
204
Incisor
154
should be done prior to preparation bone moves apically, the lever Lateral Lateral
179 168
of case arm of the portion of the bone Incisor Incisor
Endodontic Consideration increases, and the chances for Canine 273 Canine 268
harmful lateral forces is 1st 1st
 Endodontically treated tooth: 234 180
Premolar Premolar
increased
o Can be used as FPD and 2nd
220
2nd
207
 Acceptable crown-root ratio: Premolar Premolar
RPD abutment provided all
1:1 1st Molar 433 1st Molar 431
remaining tooth structures 2nd Molar 431 2nd Molar 426
can be consolidated and  Ideal crown-root ratio: 1:2
 Realistic optimum crown-root  For maxillary teeth:
protected using crown 1. 1st Molar
restoration ratio: 2:3
B. Root Configuration 2. 2nd Molar
o Extremely short root which 3. Canine
cannot be negotiated to  An important aspect in the
assessment of abutment 4. 1st Premolar
place a post as an abutment 5. 2nd Premolar
to FPD or RPD is suited for suitability from a periodontal
standpoint 6. Central Incisor
overdenture 7. Lateral Incisor
o Pulpless tooth is  Roots that are broader
labiolingually than they are  For mandibular teeth:
contraindicated as abutment 1. 1st Molar
to a cantilever FPD mesiolingually are preferable to
roots which are round in cross- 2. 2nd Molar
Elective Endodontic Therapy 3. Canine
 Usually done on supraerupted or section
 Multi-rooted teeth like the 4. 2nd Premolar
malaligned tooth to improve arch 5. 1st Premolar
relationship with post and core to posterior teeth with widely
separated roots will offer better 6. Lateral Incisor
improve such position and 7. Central Incisor
occlusion periodontal support than roots
with convergent, fuse, or Periodontal Ligament Area
 Tooth that has lost most of the  Nyman and Ericsson doubted on
coronal tooth structure is often conical configuration
the validity of this law
treated endodontically to permit
  Clinically lower surface area of endodontically treated before the
abutment teeth has been equally irritation of fixed prosthesis
supportive provided a good  If unhealthy pulp tissues to be Treatment Modality
periodontal health has been deleterious it will jeopardize the  Extract the third molar and
maintained. prognosis of the given fixed upright the tilted second molar
Span Length prosthesis orthodontically
 Relative deflection  Endodontically treated teeth are  Fixed appliance
 Directly proportional (span more favorable for giving a fixed  Premolars and the
legth)3 prosthesis canine are barded and
 Inversely proportional Pier Abutments lied to a passive
(occlusogingival thickness)3  An edentulous space can occur stabilizing wire
Direction of Forces on both sides of a tooth, creating  A helical uprighting
 The dislodging forces on a FPD a tone, freestanding pier spring inserted into a
retainer tend to act in a mesiodistal abutment tube on the banded
direction, as opposed to the more  There is different faciolingual molar
common faciolingual direction of and intrusive force on different  Activated by hooking it
forces on a single restoration teeth in different arch over the wire on the
 Preparation should be modified  You need to put a stressbreaker anterior segment
accordingly to produce greater  It has potential to produce If orthodontic correction is impossible:
resistance and structural durability unfavorable leverage and an  Modified preparation design
Secondary Abutment unseating effect on the terminal  Proximal half crown: ½
 Overcomes several problems retainers, this may cause crown
 Unfavorable crown-root ratio fracture on the cement seal and  Non-rigid connector on
 Long spans cement washout in a distinct distal aspect of the
 Secondary abutment should be possibility premolar retainer
comparable to primary in terms of:  If a long span fixed prosthesis is compensates for the
a. Root surface area given on this create huge stress inclination of the tilted
b. Favorable crown-root ratio on the terminal abutment and molar
c. Retainers pier abutment, will act as a Telescopic Crown
Arch Curvature fulcrum and failure of prosthesis  Used as a retainer on the distal
 When pontics lie outside the  Different veins regarding: abutment
interabutment axis line – act as a  Rocking of retainer  A full crown preparation with
lever arm, which can produce a  Bending of retainer heavy reduction is made to
torqueing movement  Tension between follow the long axis of the tilted
 Mainly of pointed in the anterior abutment and retainer molar
 Secondary retention (K) must  Intrusion of retainer on  Caner coping is made to fit the
extend a distance from the abutment tooth preparation
primary interabutment axis equal  Two alternatives are there to  The proximal half crown that will
to the distance that the pontic minimize the stress, i.e. serve as the retainer for the fixed
lever arm (P) extends in the a. Non-rigid connector partial denture is fitted over the
opposite direction  Broken stress coping
Health of Periodontium mechanical union of Canine Replacement – Fixed Partial
 Healthy periodontal tissues are a retainer (dovetail Denture
prerequisite for all fixed keyway) and pontics  Difficult – it often lies outside the
restoration (T-shaped key) interabutment axis
 Adequate crown to bone ratio – b. Cantilever (first premolar  Maxillary more difficult than
inadequate periodontal health pontic) mandible due to labially and
turns prognosis to poor in long  Adequate lingually acting force respectively
run where it turns to be worst in periodontal support  No fixed partial denture
case inadequate crown to bone Third Molar Abutments replacing a canine should
ratio  Early loss of a mandibular first replace more then one additional
 Fixed prosthesis has been molar with mesial tilting and tooth
successful even in the presence drifting of the second and third Cantilever – Fixed Partial Denture
of inadequate crown to root ratio molars  FPDs in which only one side of
after periodontal tissues have  Impossible to achieve common the pontic is attached to a
been returned to excellent health path of insertion retainer
and long-term maintenance has  In an attempt to do excessive  Long-term prognosis of the
been ensured preparation has to be done or single abutment cantilever is
Endodontic Consideration mesially tilted third molar will not poor
 Teeth in which pulpal health is allow seating of prosthesis  Vertical – tipping
slightly doubtful also should be
  Horizontal forces – rotation of  If undesirable root proximity is  Phase 4
abutment teeth present, then it is not a good  Construction of FPD
 3 unit FPD, resist forces much candidate for abutment  Reinforcement of
better since the teeth have to be Common Path of Insertion education and motivation
moved bodily rather than merely  Abutment teeth must be of patient
rotated or tipped prepared with common path of  Phase 5
 Essential requirement for insertion for all retainers when a  Post insertion care
abutment teeth: rigid design is employed  Periodic recall (annual)
a. Lengthy roots with a  If the long axis of the tooth is  Reinforcement of
favorable configuration converge or diverge from education and motivation
b. Long clinical crowns parallelism by more than 25 of patient
c. Good crown-root ratio degrees, tooth preparation
d. Healthy periodontium becomes more difficult
Maxillary Lateral Incisor – Cantilever Fixed  A non-rigid connector has been
Partial Dentures suggested as a solution
 No occlusal contact on the  The female component of the
pontic in either centric or lateral non-rigid connector is commonly
excursions placed within the confines of the
 Canine must be used as an normal tooth contours on the
abutment – root configuration of distal surface of the intermediate
a central incisor makes it an abutment
undesirable cantilever abutment Treatment Planning
 Solo abutment – only if it has  Phase 1
long root and good bone support  Collection and evaluation
 Metallic rest on the distal of the of the diagnostic data,
central incisor to prevent rotation including a diagnostic
of the pontic mounting and the analysis
First Premolar – Cantilever Fixed Partial and design of the
Dentures diagnostic cast
 Best if occlusal contact is limited  Immediate treatment to
to the distal fossa control pain and infection
 Full veneer retainers are  Biopsy or referral of
required on both the second patient
premolar and first molar  Development of education
 Excellent bone support and motivation of patient
Molars  Phase 2
 When there is no distal abutment  Removal of deep caries
present and placement of
 Pontics prerequisite temporary restoration
 Possess maximum  Periodontal treatment
occlusogingival height to  Extirpation of inflamed or
ensure a rigid prosthesis necrotic pulp tissues
 Light occlusal contact with (endodontic treatment)
absolutely no contact in  Construction of interim
any excursion prosthesis for function or
 When the pontics loaded esthetics
occlusally, the adjacent  Occlusal equilibrium
abutment tends to act as a  Reinforcement of
frenulum, with a lifting tendency education and motivation
on the farthest retainer of patient
 Minimize the leverage effect,  Phase 3
 The pontic should be kept  Preprosthetic surgical
as small as possible procedure
 More nearly representing  Definitive endodontic
a premolar than a molar procedure
Root Proximities  Definitive restoration of
 Adequate clearance must be teeth
present between the roots of the  FPD
proposed abutments to permit  Reinforcement of
the development of physiologic education and motivation
embrasures of patient