1

2

The sites should be numbered and graded for pain and discomfort so that, If neuromuscular or TMJ treatment is initiated , the examiner can then re palpate the same sites periodically to asses the response to treatment .

3

LIPS

Visibility during normal and exaggerated

smiling.

This can be critical during FIXED

PROSTHODONTIC TREATMENT

PLANNING

“NEGATIVE SPACE”:- The space between

maxillary and mandibular anteriors during

normal smile.

Missing teeth, diastemas and fractured or

poorly restored teeth affect negative space and

require correction.4

INTRAORAL EXAMINATION Condition of the soft tissues ,

teeth and supporting structures.

This information can be properly

evaluated during treatment

planning only if objective

indices, rather than vague

assessments, are used.

5

PERIODONTAL EXAMINATION

Status of bacterial accumulation

The response of the host tissues and

the degree of irreversible damage.

Long term periodontal health is

essential to successful fixed

prosthodontic treatment.

Existing periodontal disease must be

corrected. 6

DENTAL CHARTING

An accurate charting of the state

of the dentition will reveal

important information about the

condition of the teeth and will

facilitate treatment planning.

7

OCCLUSAL EXAMINATION

The initial clinical examination

starts with the clinician asking the

patient to make a few simple

opening and closing movements

while carefully observing the

opening and closing strokes.

Special attention is given to

Initial tooth contact, Tooth

alignment, and

Eccentric contacts and jaw

maneurability,8

DIAGNOSTIC AIDS

RADIOGRAPHS

VITALITY TEST

DIAGNOSTIC CASTS

PERIODONTAL PROBE.

9

RADIOGRAPHIC EXAMINATION

Provides supplement information to clinical information Extent of bone support Root morphology Peri apical pathology

10

PANOROMIC RADIOGRAPHS

Presence or absence of teeth

Assessing third molars

impactions,

Evaluating the bone before

implant placement.

Screening edentulous arches for

buried root tips.

11

TRANSCRANIAL RADIOGRAPHS

12

For assessement of TMJ disorders, More information can be obtained from• Tomography

•Arthrography

• C T scanning

•Magnetic resonance imaging

VITALITY TEST

Pulpal health must be measured before restorative treatment to

Percussion and

Thermal stimulation

Test cavity-nonvitality without l.A

13

VITALITY TEST asses only afferent Nerve supply.

MISDIAGNOSIS occurs if N S is damaged and blood supply intact .

Careful inspection of radiographs therefore an essential aid in the examination.

14

DIAGNOSIS AND PROGNOSIS

Not all the patients seeking fixed

prosthodontic treatment will present

diagnostic problems.

Nevertheless ,diagnostic errors are possible,

especially when a patient complains if pain

or symptoms of occlusal dysfunction.

A logical and systematic approach to

diagnosis will help avoid mistakes.

15

PROGNOSIS

The prognosis is an estimation of the

likely course of a disease.

It is difficult to make , but its

importance to patient understand

successful treatment planning must

nevertheless be recognised.

The prognosis of dental disorders is

influenced by.

16

GENERAL FACTORS (age of patient, lowered resistance of the oral

environment)

LOCAL FACTORS (Forces applied to a given tooth , access for oral

hygiene measures).

17

DIAGNOSTIC CASTS

A life size reproduction of the parts of the

oral cavity and or facial structures for the

purpose of study and treatment planning.

Diagnostic casts are the integral part of the

diagnostic procedures necessary to give the

dentist as complete a perspective as

possible of the patients dental needs.

18

19

DIAGNOSTIC CASTS

SEMIADJUSTABLE ARTICULATOR with a FACE BOW

TRANSFER.

Articulated diagnostic casts permits a detailed analysis of occlusal

plane and the occlusion for a better diagnosis and treatment plan.

Tooth preparations can be “rehearsed “ on the casts and diagnostic

waxing procedures allow evaluation of the eventual outcome of

proposed treatment .

20

INTEROCCLUSAL RECORDS

CENTRIC RELATION RECORDS are

used to replicate on the articulator.

LATERAL OCCLUSAL RECORDS

are used to the condylar guidance of

the articulator.

Identify the deflective contacts.

A distinction must be made between

mounting for diagnosis and for

treatment.21

The attachment of casts to an articulator for diagnosis will be done

with the condyles in the centric relation position.

For restoration of a significant portion of the occlusion , it may also

be done with the condyles in the centric relation position.

22

MOUTH PREPARATION

Mouth preparation refers to the

dental procedure that need to be

accomplished before fixed

prosthodontics can be properly

undertaken.

As a general plan , the following

sequence of treatment procedures

in advance of fixed prosthodontic

should be adhered to;

23

Relief of symptoms (chief complaint)

Removal of etiological factors (eg; excavation of caries removal of

deposits)

Repair of damage .

Maintainance of dental health.

24

The following list describes the sequence in the treatment of a patient

with extensive dental disease including missing teeth , retained roots ,

caries and defective restorations.

25

Preliminary assessment

Emergency treatment of presenting symptoms

Oral surgery

caries control and replacement of existing restorations

Definitive periodontal treatment

26

Orthodontic treatment

Definitive occlusal treatment

Fixed prosthodontics

Removable prosthodontics

Follow up care . A logical TREATMENT SEQUENCE should be planned before

beginning any fixed prosthodontic intervention. Such planning will

normally multidisciplinary.

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TREATMENT PLANNING OF SINGLE TOOTH RESTORATION

DESTRUCTION OF THE

TOOTH STRUCTURE

ESTHETICS

PLAQUE CONTROL

FINANCIAL

CONSIDERATIONS

RETENTION28

The selection of the material and design of the restoration

depends on several factors:-

DESTRUTION OF THE TOOTH STRUCTURE

The destruction previously suffered by the

tooth has to be restored , such that the

remaining tooth structure must gain strength

and protection from restoration , cast metal or

ceramic is indicated over amalgam or

composite resin .

29

ESTHETICS

PARTIAL VENEER restoration can be used to restore in highly

visible area.

The use of ceramic in some can be used as FULL VENEER.

METAL CERAMIC CROWNS

Single unit anterior

Posterior crowns

Fixed partial denture

30

commonly used on anteriors

posteriors (adequate bulk)

31

ALL CERAMIC CROWNS

PLAQUE CONTROL

Motivated to follow a regime of brushing,

flossing and dietary regulation to control or

eliminate the disease process responsible

for destruction of tooth structure.

If these measures prove to be successful

cast metal, ceramic or metal ceramic

restorations can be fabricated.

32

FINANCIAL CONSIDERATIONS

“SOME ONE”

Government agency

A branch of military

Insurance company

Selection should not be less than

optimum just because the patient

cannot.

Sound alternative to the preferred

treatment plan and not apply

pressure.33

RETENTION

FULLVENEER CROWNS; unquestionably most retentive.

SINGLE TOOTH RESTORATION: not nearly important.

Special concern for ;

Short teeth

Removable partial denture abutment.

34

TWELVE RESTORATION TYPES

PLASTIC and CEMENTED restoration

PLASTIC RESTORATION: Is inserted as soft or plastic mass into

the cavity preparation , where it will harden and be retained by

mechanical undercuts or adhesion.

35

CEMENTED RESTORATION

Made of cast metal ,metal ceramics or ceramic material alone is

fabricated away from the operatory and is luted in or on patients tooth

at a subsequent appointment.

One type can be better suited for a particular application than the

other or their suitabilities may overlap.

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