Treatment planing in dental implants/ orthodontic continuing education
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Transcript of Treatment planing in dental implants/ orthodontic continuing education
Treatment planningINDIAN DENTAL ACADEMY
Leader in continuing dental education www.indiandentalacademy.com
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Loss of teeth
•Loss of function•Disuse atrophy of ridge
•Migration of teeth•TMJ
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Sequelae Of Loss Of Teeth
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Occlusal Plane Derangement
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Occlusal Plane Derangement
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Shift Of Masticatory Apparatus
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Treatment plan•Fixed dentures•Implant supported fixed denture
•Removable partials•Make a dental cripple
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Fixed dentures are the most preferred!
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Removable partial dentures may be the
IDEAL
treatment choice
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Solution or the problem?
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Problem continues….
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Indications for a RPD
• Length of edentulous span
• No abutment tooth posterior to the edentulous area
• Need for cross arch stabilization
• Excessive bone loss of the residual ridgewww.indiandentalacademy.com
• Reduced Periodontal support of the remaining teeth
• Patient desires
• Youth
• Physically or emotionally handicappedwww.indiandentalacademy.com
• Abutments with guarded prognosis
• Economic considerations
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Contraindications• Epileptic patient having frequent
and severe attacks, without premonition
• Poor patient attitude
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Treatment plan• Examination• Diagnosis & prognosis• Comprehensive rehabilitation• Pre prosthetic treatment• Revaluation• Prosthetic treatment plan• Treatment phase• Maintenance phasewww.indiandentalacademy.com
Principle of RPD is the DE VAN’s principle.
Broad distribution of forces Least
damage to the abutments
Effective utilization of componentswww.indiandentalacademy.com
THE SOLUTION IS
Keep the end in mind
Plan treatment for a favorable and predictable prognosis
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Treatment planning
• Identification of patients needs
• Correction of existing disease
• Prevention of future disease• Restoration of function• Improvement of appearance
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Evaluation of existing prosthesis
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Treatment of abused tissues
• Inflammed and irritated mucosa
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Steps for successful treatment• Step 1 ascertaining what the patient desires
or wants
• Step 2 finding what he actually needs
• Step 3 developing a treatment plan relevant to the patient’s wants and needs
• Step 4 executing the treatment plan after explaining the plan to the patient
McCracken's Removable Partial Prosthodonticswww.indiandentalacademy.com
Evaluation of occlusion
• Collapsed occlusion• Traumatic occlusion• Deranged occlusal plane
Herbert T. Shillingburgwww.indiandentalacademy.com
• Signs of traumatic occlusion– Excessive wear of teeth– Chipping or fracture– Tooth mobility, migration or discomfort during
occlusal contact– Pain in the T.M.J , muscle spasm or joint
dysfunction• Radiographic
– Widening of periodontal ligament space– Thickening of lamina dura– Root resorption or alveolar resorption
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Signs of collapse of occlusion
• Collapse of vertical dimension of occlusion– Requires extensive treatment
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Treatment Objectives• Restore lost tooth structure• Restore lost VD• Establish new horizontal relation• Develop new engram• Transfer data to articulator• Develop new occlusal relationship
for the established VD&HRwww.indiandentalacademy.com
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Diagnostic wax up
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Modified dentures
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Diagnostic casts
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•Analysis of the existing occlusion»Angulation»inclination» supraeruption» elongation» jaw relation» occlusal plane» occlusal contacts» interference» interocclusal space» proximal tooth contacts» guide planes
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Analysis of existing occlusion
» Angulation» Inclination» Supraeruption» Elongation
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Analysis of existing occlusion» Interocclusal space» Proximal tooth contacts
Type of restoration
Anterior Posterior
Removable 12 mm. 12 mmwww.indiandentalacademy.com
Management of less Interarch space.
1. Surgical reduction of tuberosities.
2. Osteoplasty and /or soft tissue reduction of implant region
3. Selective grinding 4. Prosthodontic restorations5. Endodontic therapy.
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Management of increased Interarch space.
•MMay be decreased by addition of onlay grafts .•AAutogenous and /or membrane grafts.–AAlloplastic grafts
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Analysis of existing occlusion
» Jaw relation» Occlusal plane
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Analysis of existing occlusion
» Occlusal contacts» Interference
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Occlusion
• Occlusal plane
• Occlusal relation
• CO CR discrepancy
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Correction of occlusal plane
• Enameloplasty• Onlay restoration• Intentional RCT & crown• Orthodontics• Extraction• Sinus lift• Increase VD
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Intentional RCT
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Tilted abutment
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• Angulation of abutment
• Tooth contact
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Orthodontic up righting
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Analysis of abutment• Root length• Size• Form• Crown root ratio
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Abutment evaluation
• Dentition and abutment• Caries susceptibility
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Restorations
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Caries susceptibilityrestorative status
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Post-Endodontic Restorations
Presented byDr.T.V.Padmanabhan
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Salvage or Sacrifice
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Periodontal conditions
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Fixed Splinting• Incase of compromised periodontal support
of remaining teeth• Short tapered roots• To improve support for the partial denture
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Convert modification areas to
FPDs, making design simple
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Missing teeth
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Removable splinting• When abutment teeth exhibit a alveolar bone
loss of greater than 50% splinting them by means of fixed splints to adjacent healthy teeth, the adjacent teeth is also subsequently weakened
• Splinting may also be accomplished using properly designed removable partial dentures
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• This is done by means of lingual plating in conjunction with multiple facially positioned clasp arms
• Thus remaining teeth and removable prosthesis functions as a single functional unit
• Forces are distributed over increased number of teeth, increasing the longevity of the remaining teeth
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Existing prosthesis
• Response of teeth and residual ridge to previous stress
• Arch form
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Plan the prosthesis
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1 Knowledge of design2 Incorporation in to present
clinical situation
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Design 1
•Cingulam rest•I-bar clasp•A-P palatal
bar•Proximal plate
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Design 2 Only possible
modification is to incorporate embrasure clasp to manage the space
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Alternative treatment modalities
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Thank you
For more details please visit www.indiandentalacademy.com
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