Prosthetics Revision Clinical Steps Dr Charles Scola July 2004.
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Transcript of Prosthetics Revision Clinical Steps Dr Charles Scola July 2004.
Prosthetics RevisionProsthetics RevisionClinical StepsClinical Steps
Dr Charles Scola
July 2004
Prosthetics RevisionProsthetics Revision
Last two weeks we studied:Last two weeks we studied:Dentist / Patient expectationsDentist / Patient expectationsThe value of an old dentureThe value of an old dentureA written denture treatment planA written denture treatment planRVD = OVD + FSRVD = OVD + FSCopy Denture TechniqueCopy Denture TechniqueF/F Clinical techniquesF/F Clinical techniquesOverdenturesOverdentures
Meeting their needs & expectationsMeeting their needs & expectations
What sort of patient are they?What sort of patient are they?
Easy going or up-tightEasy going or up-tight Adaptable or preciseAdaptable or precise Accepting or demandingAccepting or demanding Cooperative or difficultCooperative or difficult
Asses their attitude & personality, Asses their attitude & personality, This is very important in denture toleranceThis is very important in denture tolerance NEVER promise what you cannot deliver !NEVER promise what you cannot deliver !
Your Denture Treatment PlanYour Denture Treatment Plan
This is your written prescription or recipeThis is your written prescription or recipe Without it you will get lost !Without it you will get lost !
It applies to new or old denture usersIt applies to new or old denture users Must be agreed with the patientMust be agreed with the patient Keeps you on the right trackKeeps you on the right track Is your record and defense, in case of later Is your record and defense, in case of later
problems or complaintsproblems or complaints
At every stage of treatmentAt every stage of treatment
Check your treatment planCheck your treatment plan Remind your patient of the planRemind your patient of the plan Explain what you are doing todayExplain what you are doing today Measure RVD & OVDMeasure RVD & OVD Look at the old dentures & compareLook at the old dentures & compare Observe the patient as they talk & smileObserve the patient as they talk & smile Remind the patient of the limitationsRemind the patient of the limitations
Vertical DimensionVertical Dimension
RVD is RVD is alwaysalways > OVD > OVD RVD should remain constantRVD should remain constant
whether dentures are worn or notwhether dentures are worn or notWhatever treatment you doWhatever treatment you do
OVD may be changed by OVD may be changed by youyou
All patients need FS, 2 – 5mmAll patients need FS, 2 – 5mm
Vertical DimensionVertical Dimension
RVD Freeway space
Vertical DimensionVertical Dimension
0VD
Prosthetics RevisionProsthetics Revision
Today we are going to Today we are going to consider:consider:
Partial Denture planning & Partial Denture planning & designdesign
The clinical stages of partial The clinical stages of partial denture constructiondenture construction
Please read Dr Ulpee Darbar’s notes, these are very good !
Partial dentures often Partial dentures often grow up into full dentures- why ?grow up into full dentures- why ?
Partial dentures often grow up into Partial dentures often grow up into full dentures- why ?full dentures- why ?
Plaque Caries, perio disease
Trauma Abrasion, forced gingival recession, tissue
hyperplasia
Excessive forces Worsens perio disease, bone loss, mobility
Partial dentures – yes or no ?Partial dentures – yes or no ? So before we rush to make a partial So before we rush to make a partial
denture, ask yourself:denture, ask yourself: Will it do more harm than goodWill it do more harm than good Are there ‘safer’ alternativesAre there ‘safer’ alternatives Have you explained all the ‘pros and Have you explained all the ‘pros and
cons’ to your patient cons’ to your patient Partial dentures need plenty of Partial dentures need plenty of
maintenance, by you and the patientmaintenance, by you and the patient
Partial Dentures - BenefitsPartial Dentures - Benefits
AppearanceAppearance Face, lips, smile, sexyFace, lips, smile, sexy
FunctionFunction Chewing, biting, gripping, tearing, kissingChewing, biting, gripping, tearing, kissing
? Helps remaining teeth? Helps remaining teeth Spreads load, prevents tilting, over-eruption Spreads load, prevents tilting, over-eruption
? Prepares pt for full dentures ? Prepares pt for full dentures (Is this rather defeatist)(Is this rather defeatist)
Partial Dentures - designPartial Dentures - design
Must minimize plaque build up and allow pt to Must minimize plaque build up and allow pt to maintain good oral hygienemaintain good oral hygiene
Needs to avoid soft tissue traumaNeeds to avoid soft tissue trauma Should support and stabilize the remaining teeth Should support and stabilize the remaining teeth
without producing excessive occlusal or tipping without producing excessive occlusal or tipping forcesforces
Avoid your partial denture becoming:Avoid your partial denture becoming:1.1. a ‘gum stripper’ a ‘gum stripper’ 2.2. an orthodontic appliance !an orthodontic appliance !
Partial Dentures - designPartial Dentures - design RetentionRetention
Stops the denture falling outStops the denture falling out Suction, friction, muscular, mechanical (clasps etc)Suction, friction, muscular, mechanical (clasps etc)
Resistance or SupportResistance or Support Stops the denture being pushed in (gum stripper)Stops the denture being pushed in (gum stripper) Tissue or tooth borne ?Tissue or tooth borne ?
ConnectorsConnectors Joins the teeth, aids resistance & retentionJoins the teeth, aids resistance & retention Make it as patient-friendly as possibleMake it as patient-friendly as possible
Refer Dr Ulpee’s notes on clasps/ rest seats
Resistance or SupportResistance or Support
Stops the denture being pushed inStops the denture being pushed in A major cause of trauma to tissues !A major cause of trauma to tissues !
Tissue or tooth borne - Which is better?Tissue or tooth borne - Which is better? Teeth are made to take occlusal loadTeeth are made to take occlusal load Soft tissues are not !Soft tissues are not !
The effects of ‘sinking’ are:The effects of ‘sinking’ are: Trauma to gingivae and forced recessionTrauma to gingivae and forced recession Damage to mucosa by flanges and connectorsDamage to mucosa by flanges and connectors Denture teeth start to look too shortDenture teeth start to look too short Natural teeth may be tilted, intruded or loosenedNatural teeth may be tilted, intruded or loosened
Providing Resistance or SupportProviding Resistance or Support Bring the acrylic up over the cingulum of Bring the acrylic up over the cingulum of
anterior teeth,...if the bite allows it !anterior teeth,...if the bite allows it !
✖✔
Providing Resistance or SupportProviding Resistance or Support Bring the acrylic up over the bulbosity Bring the acrylic up over the bulbosity
of molars, ....if the bite allows it !of molars, ....if the bite allows it !
✔ ✖
Providing Resistance or SupportProviding Resistance or Support
You may need to cut a rest seat
Providing Resistance or SupportProviding Resistance or Support
Provide metal occlusal restsProvide metal occlusal rests With premolars & molars you cannot easily With premolars & molars you cannot easily
bring the acrylic over the occlusal bring the acrylic over the occlusal surface, ..but you can fit a metal occlusal surface, ..but you can fit a metal occlusal restrest
Your denture will ‘hang’ off the teeth
Providing Resistance or SupportProviding Resistance or Support
Occlusal rests;Occlusal rests; Make the denture ‘tooth borne’Make the denture ‘tooth borne’ Should be used wherever possibleShould be used wherever possible Are used on ‘strong’ teethAre used on ‘strong’ teeth Need to be positioned carefullyNeed to be positioned carefully Can be formed from stiff wire and inserted Can be formed from stiff wire and inserted
into the arylicinto the arylic
Providing Resistance or SupportProviding Resistance or Support
You may need to cut a rest seat
Providing Resistance or SupportProviding Resistance or Support
You may need to cut a channel for a clasp
This will also provide support
ConnectorsConnectors
Do not ‘pinch’ the gingivaeDo not ‘pinch’ the gingivae Keep 4mm awayKeep 4mm away
Do not cause food trapsDo not cause food traps Cross the gingival margins mid-tooth onlyCross the gingival margins mid-tooth only Keep the design simpleKeep the design simple Avoid cutting across rugae in palateAvoid cutting across rugae in palate
Follow them insteadFollow them instead Follow anatomical lines if possibleFollow anatomical lines if possible
Partial Dentures - planningPartial Dentures - planning As soon as you have your study models, and As soon as you have your study models, and
BEFORE you take your 2’ impressions:BEFORE you take your 2’ impressions:
Plan your design, considering all the pros & cons, Plan your design, considering all the pros & cons, and your patient’s wishesand your patient’s wishes
You may need to consider:You may need to consider: More extractionsMore extractions
Hopeless prognosis, deep undercutsHopeless prognosis, deep undercuts ConservationConservation
Reshape opposing teeth, Reshape opposing teeth, Cut rest seats, channels for clasps, guide planes Cut rest seats, channels for clasps, guide planes Remove undercuts, create undercutsRemove undercuts, create undercuts
Guide Planes & Occlusal RestsGuide Planes & Occlusal Rests
Partial DenturesPartial DenturesLets try to design a fewLets try to design a few
Follow these principles:Follow these principles:
Which teeth are to be replacedWhich teeth are to be replaced Design Design connectorsconnectors and outlines and outlines
Avoid palatine papilla if possibleAvoid palatine papilla if possible Consider undercuts & path of insertionConsider undercuts & path of insertion
Provide resistance & retentionProvide resistance & retention Do any teeth need cutting, reshaping, or exoDo any teeth need cutting, reshaping, or exo Draw on your model & write your treatment planDraw on your model & write your treatment plan
Partial Dentures, 2’ ImpsPartial Dentures, 2’ Imps
Check your treatment planCheck your treatment plan Cut or reshape any teeth as needed, ?undercutsCut or reshape any teeth as needed, ?undercuts Check your special tray covers all areas that are Check your special tray covers all areas that are
crucial to your designcrucial to your design Take good alginate impressions, use your fingerTake good alginate impressions, use your finger Take your shadeTake your shade Check the occlusion, ? take a wax bite, you may Check the occlusion, ? take a wax bite, you may
not need to take MMR using bite blocksnot need to take MMR using bite blocks
Partial Dentures, MMRPartial Dentures, MMR
Will only be needed if:Will only be needed if:
Many teeth are missingMany teeth are missing There are free end saddlesThere are free end saddles There is no tooth to tooth contactThere is no tooth to tooth contact The existing occlusion needs to be raised, The existing occlusion needs to be raised,
or changed in some way (rare)or changed in some way (rare)
Partial Dentures, MMRPartial Dentures, MMR
Check fit and stability of wax blocksCheck fit and stability of wax blocks Trim occlusal levels to follow natural teethTrim occlusal levels to follow natural teeth If there is tooth to tooth contact, use this If there is tooth to tooth contact, use this
occlusion unless there is a specific reason occlusion unless there is a specific reason to change itto change it
Record bite blocks in centric occlusionRecord bite blocks in centric occlusion Mark centre linesMark centre lines
Partial Dentures, Try - InPartial Dentures, Try - In
Confirm smile lines and levelsConfirm smile lines and levels Agree aesthetics with the patientAgree aesthetics with the patient Similar steps to F/F try in:Similar steps to F/F try in: Assess accuracy of the occlusionAssess accuracy of the occlusion
But also:But also: Check resistance – Check resistance – is occlusion affectedis occlusion affected Check retention - Check retention - will clasps showwill clasps show Hygiene – Hygiene – are there food trapsare there food traps Soft Tissues – Soft Tissues – any risk of traumaany risk of trauma
Partial Dentures, FittingPartial Dentures, Fitting
Try them in gently, never force themTry them in gently, never force them Adjust carefully to ensure a snug fitAdjust carefully to ensure a snug fit Check occlusion, ? Tooth to tooth contactCheck occlusion, ? Tooth to tooth contact Check aesthetics, ? Objectives achievedCheck aesthetics, ? Objectives achieved Ensure comfort, no traumaEnsure comfort, no trauma Teach patient how to fit and remove themTeach patient how to fit and remove them
Don’t use clasps as ‘handles’Don’t use clasps as ‘handles’ Give full cleaning & maintenance instructionsGive full cleaning & maintenance instructions
Don’t wear them 24 / 7, give your mouth a restDon’t wear them 24 / 7, give your mouth a rest
Prosthetics RevisionProsthetics Revision
Today we have reviewed: Today we have reviewed:
Partial Denture planning & Partial Denture planning & designdesign
The clinical stages of partial The clinical stages of partial denture construction denture construction