Prosthodontic Diagnosis

5/21/2018 Prosthodontic Diagnosis

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Section 02 - Prosthodontic Diagnosis

Handout

Abstracts

001. Koper, A.The initial interview with complete denture patients !ts structure and strateg". #

Prosthet Dent 2$%&0-%&', 1&'0.

002. (ouse, ). ). *elationship o+ oral eamination to dental diagnosis. # Prosthet Dent 20-

21&, l&%.

00$. aseheart, #. *./on-veral communication in the dentist-patient relationship. # Prosthet

Dent$-10, 1&'%.

00. arone, #. . Diagnosis and prognosis in complete denture prosthesis. # Prosthet Dent120'-21$, 1&3.

00%. Koper, A.4h" dentures +ail. D5/A '21-'$, 1&3.

003. olender, 5. 6., Swoope, 5. 5., and Smith, D. 7. The 5ornell )edical !nde as a prognostic

aid +or complete denture patients. # Prosthet Dent 2220-2&, 1&3&.

00'. ergman, . , and 5arlsson, 8. 7. 5linical long-term stud" o+ complete denture wearers. #Prosthet Dent %$%3-31, 1&%.

00. *issin, 6., et al. Si "ear report o+ the periodontal health o+ +ied and removale partial

denture autment teeth. # Prosthet Dent %31-3', 1&%.

00&. #ohnson, P. 9., Ta"os, 8. ). , and 8risius, *. #. Prosthodontics. Diagnostic, treatmentplanning, and prognostic considerations.D5/A $0%0$-%1, 1&3.

010. 5haconas, S. #., and 8onidis, D. A cephalometric techni:ue +or prosthodontic diagnosis and

treatment planning.# Prosthet Dent %3%3'-%', 1&3.

011. 5ulpepper, 4illiam D. and )oulton, Patricia S. 5onsiderations in 9ied Prosthodontics.

012. 6anda, 6.S. Diagnosis and )anagement o+ Partiall" 7dentulous 5ases with a )inimal/umer o+ *emaining Teeth.D5/A - ol. 2&, /o. 1, #an 1&%.

01$. 4alton, T.*. A Ten ;ear 6ongitudinal Stud" o+ 9ied Prosthodontics 1. Protocol and

Patient Pro+ile. !nt # Prosthodont 1&&'< 10$2%-$$1.

Section 02: Prosthodontic Diagnosis

(Handout)


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missing document ......

- Abstracts -

02-001. Koper, A. he initia! inter"ie# #ith co$p!ete denture patients: %ts structure and

strateg&.

!ntroduction The initial interview allows the doctor and patient to meet each other. The

interview is not concluded until a decision regarding treatment and prognosis is made. The

doctor should +ul+ill two asic o=ectives. (e should evaluate the patient emotionall" andph"sicall" and he should allow the patient to assess him.

)ethods o+ !nterviewing 7plore the +ollowing using veral, etraveral, and nonveral

methods o+ communication >1?The patients desires +or, or dissatis+actions with, dentures< >2?The

ade:uac" o+ the dentures the patient is wearing< >$?5ondition o+ the oral tissues and associated

perioral structures< >?The health and living patterns o+ the patient.The 9irst )eeting @verloo nothing as the patient enters the operator" or consultation room.

5ompare apparent age to actual age. 6oo +or signs o+ +ear.7stalishment o+ Trust 8reeting the patient should var" with the age and t"pe o+ individual. Sit

e"e to e"e and let him now he has "our undivided attention. (ave a pen and pad out and tae

notes. )ae initial small tal with a +ear+ul patient and allow him to evaluate "ou +irst. Theauthor calls this a Btrust talB period.

The PatientCs Prolems Determine what concerns the patient the most. Know that com+ort,

esthetics, +unction, and retention are the most common areas o+ concern. Allow the patient toeep taling aout what others him until "ou are sure "ou have heard it all. As the patient how

it +elt to loose his natural teeth. As to see photos o+ the patient prior to having his teeth

etracted. 9inall", get a denture histor" on the patient.PatientCs (ealth and 6iving Patterns *eview the health histor" and in:uire aout medications thepatient ma" e taing. Discuss the patientCs occupation and living haits. !n:uire aout his diet.

The oral tissues o+ a malnourished individual are incapale o+ earing the stress o+ a denture

without pain, soreness, and one loss. As the patient to descrie ideal dentures.@ral 7amination !nclude the T)#, )asticator" muscles, structures o+ the +ace, as well as the

oral tissues. *ecognie the structural, s"stemic, and neuromuscular limitations o+ the patient. e

gentle, decisive, and thorough.@ther Sources o+ !n+ormation 5onsult with the patientCs ph"sician. Speaing with a +amil"

memer ma" e help+ul, and i+ necessar" consult with another dentist.

Application o+ the 9indings Decide whether or not it is possile to success+ull" construct a set o+

dentures +or the patient. Plan +or the emotional and ph"sical needs o+ the patient.Summar" 8ather in+ormation and ase the treatment plan on that in+ormation. The o=ectives

are to evaluate the patient emotionall" and ph"sicall" and let the patient evaluate the doctor.

5ommunication is the asic tool in the interview and can e encouraged " estalishing trust.This in+ormation must e otained to plan the est possile treatment +or the complete denture

patient.


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02-002.House, '. he e!ationship o *ra! +a$ination to Denta! Diagnosis. ProsthetDent, o! / 1/, 20/-1.

PurposeTo discuss the importance o+ per+orming a complete and thorough oral eamination andto present a s"stem o+ classi+"ing and accuratel" recording clinical +indings. The need to

care+ull" interpret and relate all data e+ore arriving at a +inal diagnosis is reviewed.)aterials E )ethods ased on authorCs eperience, perceptions, and personal philosoph".

Fnre+erenced.*esults A thorough dental eamination includes the +ollowing >1? Personal !n+ormation, >2?

5hie+ 5omplaint, >$? Dental (G, >? isual 7amination, >%? 7amination 4ith 7plorer, >3?

Diagnostic 5asts, >'? Transillumination, >? *adiographs, >&? )oilit" Assessment, >10? italit"Tests, >11? Special )edH6a Tests P*/, and >12? Pre-etraction *ecords.

To save time in recording oservations and to +acilitate the eamination o+ the edentulous

patient a numeric s"stem o+ classi+"ing iologic conditions is suggested using the numerals 1, 2,and $. >1? is +avorale or normal, >2? is less +avorale or medium, and >$? is un+avorale or poor.

iologic +actors evaluated include the +ollowing >1? )uscle Tonus, >2? )uscle Development,

>$? Ph"sical Sie o+ on" Structure, >? Arch 9orm >%? *idge *elations, >3? Ph"sical 9orm o+*esidual *idge, >'? So+t Tissues, >? order Tissue, )uscle, and 9renum Attachments, >&?

*etromolar Area, >10? Palatal Throat 9orm, >11? Saliva, >12? Tongue 9orm, >1$? Alveolar

*esorption, >1? Sensitivit" o+ Palate, >1%? Iualit" o+ one, and >13? 5ondition o+ )ucosa

5onclusion !t is essential that a comprehensive eamination with an accurate recording o++indings and care+ul anal"sis o+ those +indings alwa"s precede a prosthodontic diagnosis and

treatment plan

02-00.Baseheart, J.R., Nonverbal Communication in the Dentist-Patient Relationship. J Prosthet Dent Vol 34, 1!", 4-1#.

Purpose: Discuss the signifcance o environment, personal space, touching,and physical behaviors on dentist-patient interaction.Materials & Methods: Literature revie.!esults: Dentist-patient interaction can be altered depending on the dentist"saareness and response to non-verbal clues.

02-003.4arone, .. Diagnosis and Prognosis in 5o$p!ete Denture Prosthesis. ProsthetDent 163713:208-1.

e+ore denture construction is egun it is vital that a diagnosis and then a prognosis e made.

Diagnosis:

1. (ealth histor" >clinical interview? The patient is interviewed to determine past medical

and dental eperiences. A list o+ suggested :uestions is given and the impact that the

answers ma" have on the treatment and prognosis is discussed.2. 5linical eamination The patient and his eisting dentures >i+ he has an"? are eamined

and note is taen o+ the esthetics, +acial epression, +acial vertical dimension, centric

relation, centric occlusion, speech, stailit", retention. Shortcomings +ound in the old


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dentures are eplained to the patient. Stretching eercises are prescried to +acilitate 5*

registration at a later appointment.

$. !ntraoral eamination /ote throat +orm, tongue position, sie, and shape, character o+saliva, character o+ the ridge and so+t tissue, ridge relationship, position o+ muscle and

+renum attachments, interarch space, pathosis, as"mmetr" and height o+ lip line.*adiographs are taen, as are diagnostic casts >in duplicate? +or later stud".

Prognosis A+ter all the in+ormation collected at the +irst visit is evaluated, the patient returns +orthe second visit. (e is given the prognosis and an eplanation o+ one ph"siolog" o+ the

edentulous ridge and patient adaptailit" is given in la" terms.

Iuotation o+ the +ee @nl" a+ter diagnosis and estimate o+ prognosis is complete, is the +eediscussed with the patient. The +ee should re+lect the pro=ected time, care, sill, and =udgement

that will e used in the treatment o+ the patient.

02-00. Koper, A. 9h& Dentures ai!. D5;A /:821-83, 163.

!ntroduction The patient is chie+l" responsile +or the success o+ the e++ort. /o positive criteria

+or success o+ denture +arication are valid +or ever"one. 9re:uentl" a case will e unsatis+actor"+or a patient +or no discernile cause. 9or twelve "ears, the 6os Angles 5ount" Dental Societ"

processed over 2,%00 written complaints +rom patients. '0 percent o+ which involved complete

dentures. )an" were =usti+ied in their complaints ecause certain +undamentals o+ dentureconstruction had een disregarded in the +arication o+ their dentures. There were also numerous

unhapp" denture wearers who appeared +or eamination with well constructed dentures.

5riteria +or 7valuating Denture 9ailures An unsuccess+ul denture is one which +ails to +ul+illan" or all o+ the +ollowing criteria 1. *estore lost natural dentition and associated structures o+

the maillae or mandile. 2. maintain health o+ the tissues o+ the mouth. $. help to restore

+unction, phonetics, and esthetics. . e com+ortale@+ greater importance are the +ailures o+ which the patient ma" not e aware o+, such asdentures which violate certain asic principles o+ denture construction, which ma" permanentl"

damage the supporting oral structures. This article will discuss some o+ the sources o+ error in

denture construction and o++er certain suggestions.

!. !nade:uate Patient 7valuation The most +re:uent points o+ +ailure.

- 9ailure to recognie the ps"chological limitations imposed " the patient

1. )an" cannot accept the realit" o+ dentures

2. The" ma" have emotional prolems which inter+ere with their adaptive capailities.

7amples are clenchers, grinders, gaggers, oversalivation, those whose mouths ecome dr" whenthe" wear dentures.

- 9ailure to identi+" the ph"sical limitations o+ the patient


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1. Structural anormalities - resored alveolar ridges, diminutive mailla or mandile,

tuerosities, tori eostosis, a massive or h"peractive tongue, virating line position ma"

e more anterior and restrict denture space.2. S"stemic illness - is re+lected in the tissues o+ the mouth " poor tone, low pain threshold,

slow healing, sensitivities, and allergies.

$. 6ac o+ neuromuscular coordination - maes man" steps o+ denture construction di++icult,later these patients +ind it di++icult to adapt to dentures.

. Postsurgical and radiation Se:uelae - man" have swallowing and speaing di++iculties

which mae it harder to cope with dentures. *adiation o+ tissues causes pain , sloughing,and slow repair.

!!. 9ailure o+ the dentist to understand his own limitations

The two most common are

A. interpersonal emotional con+licts

. insu++icient pro+essional sill.

- 9ailure to prepare the patient +or dentures Preparation o+ the patient +or dentures is as

important as construction o+ the dentures themselves

1. Ph"sical preparation o+ the patient - tuerosities, on" overgrowths, sharp on" spicules

2. 7motional preparation o+ the patient - tr" to determine what dentures mean to the patient,ecause the mouth is one o+ the most emotionall" charged areas o+ the od".

$. 6imiting the epectations o+ the patient - the most universal anticipations are

"outh+ulness and the ailit" to use dentures lie the teeth the" once had.

- 9ailure to otain understanding and acceptance o+ the treatment plan and +ee - schedule an

Beplanation and arrangementsB session . De+ine the etent o+ services and the time period. The+ee and method o+ pa"ment should e agreed upon. A letter o+ con+irmation addressing the aove

issues should e sent i+ the spouse is not present. Place an outline in the patients chart and havethem sign it.

!. 7rrors in denture construction most +re:uent errors are +reewa" space, occlusion, improper

peripheral etension, poor adaptation o+ denture ase to tissues, poor esthetics.

. 9ailure to see consultation when indicated

consultant should eamine the patient in the o++ice o+ the doctor re:uesting the consultconsult should e returned in writing

patient ma" receive reassurance +rom a third part"

!. 6ac o+ proper a+tercare it occasionall" happens that more time is spent with the patient

a+ter the dentures are completed than during the construction. 4hen such a contingenc" isplanned +or, no prolem occurs. /othing should e done that would alter the dentures in such a

wa" as to mae them unacceptale +rom the standpoint o+ good denture construction practices.

Summar" Denture +ailure causes are +re:uentl" due to human +actors as lac o+ patientevaluation, emotionall" distured patients, and patients with ph"sical handicaps. The dentist


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must now his reactions to his patients and now his limitations as a therapist. S"stemic and oral

corrective procedures should e instituted. Patient epectations o+ the dentures discussed.

Treatment plan and +ee agreed upon. 9ul+ill asic standards o+ denture construction. 8ive propera+ter care.

02-006. 4o!ender, 5.


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5onclusionThe +unctional state o+ the masticator" s"stem, oth according to patient reports and

the clinical signs, were generall" good compared with previousl" pulished epidemiologic

studies. *PDCs and overdentures are a valuale treatment +or patients who can not adapt well tocomplete dentures. 6ow +re:uenc" o+ mandiular dis+unction was proal" related to the good

adaptation to wearing dentures +ound in most o+ the group studied.

02-00/. issin, e!d$an, Kapur and 5haunce&. Si->ear eport o the Periodonta! Hea!th

o ied and e$o"ab!e Partia! Denture Abut$ent eeth. Prosthet Dent 3, 3, *ct. 1/.

Purpose 6ongitudinal studies indicate that +ied and removale partial dentures have een

associated with increased gingivitis, periodontitis, and tooth moilit". !t has also een

demonstrated that with the proper oral h"giene, minimal periodontal changes develop aroundautment teeth. Although +ied or removale partial dentures ma" in+luence the periodontal

health o+ the autment teeth, no studies have directl" compared the two +or their e++ects on the

periodontium.)aterials E )ethods The data was collected +rom a comple series o+ dental eaminations o+

1221 health" men etween the ages o+ $0 and 0. The eaminations were repeated at $-"ear

intervals. Teeth supporting +ied partial dentures, removale partial dentures, and analogous

unrestored edentulous ridges were scored and recorded +or si measures o+ periodontal healthincluding pla:ue accumulation, calculus deposition, gingival in+lammation, periodontal pocet

depth, alveolar one lose, and tooth moilit". 7aminer ias and reliailit" were determined at

the onset " comparing the eaminerCs results with data +rom other trained investigators.*esults Although 30 partiall" edentulous maillar" or mandiular :uadrants were initiall"

eamined, comprehensive longitudinal in+ormation was availale +or 2$ :uadrants. The

longitudinal anal"sis o+ 2$ :uadrants, spanning 3 "ears, included 1% persons with a missing

tooth and no prosthesis, 2% individuals with a removale partial denture, and 2 participants witha +ied partial denture.

The longitudinal e++ects o+ the +ied or removale partial dentures on the periodontium weresimilar. There were minimal di++erences noted +or pla:ue accumulation, gingival in+lammation,

and pocet depth. An increased rate o+ pla:ue accumulation was noted a+ter 3 "ears on the +ied

partial denture distal autment teeth. *eplacing missing teeth reduced moilit" o+ the autment

teeth.5onclusion 9ied and removale partial dentures provide long-term periodontal health and

should e considered +or the restoration o+ a partiall" edentulous arch. *egardless o+ treatment

modalit", conscientious home care and pro+essional proph"lais are recommended.

02-00. ohnson, P.., a&bos, =.'., and =risius, .. Prosthodontics. Diagnostic,treat$ent p!anning, and prognostic considerations. Dent 5!in ;orth A$. 0:0-1/, 1/6.

PurposeDiscussion o+ diagnostic, treatment planning, and prognostic considerations +or

Prosthodontic patient.)aterials and )ethods@servation and investigation o+ those conditions needing treatment.


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Diagnosis: The Prosthodontic Patient - compromised condition caused " disease or

trauma causing tooth loss. 7pectations o+ the patientJs esthetic and +unctional

re:uirements. Attitude o+ the patient toward prosthodontic care, i.e. +ear or resentment. Specia! considerations or the Prosthodontic Patient: Aging population have uni:ue

re:uirements. Diminished neural and muscular +unction, decrease sensor" and mental

capailities. Depletion o+ sucutaneous adipose tissue, loss o+ muscle tone, decrease o+dermal elasticit", increased loss o+ periodontal attachment and increased crown length.

Diseases aecting treat$ent:S"stemic disease - cardiac and pulmonar" a++ect length o+

appointment. Diaetes a++ects tissue health. Arthritis and ParinsonJs disease a++ect

ailit" to remove prosthesis and h"giene. )ucosal disease, pathosis, and nutritionaldisorders a++ects treatment.

reat$ent P!anning: 5hoice o+ prosthesis +or each tooth or arch. Selection o+ corrective

and augmentive procedure needed. Selection o+ appropriate materials, design o+ the

prosthesis occlusal scheme, and t"pe o+ articulator needed. Diagnostic 4a Fp allowsvisualiation o+ the +inal esthetics, anticipate prolems utilied to mae vacu+orm splints

+or reduction guides and provisionals.

reat$ent choice: 9ied restorations pre+erred with short edentulous spaces, ade:uateperiodontal support, su++icient coronal structure, ade:uate clearance. *emovale

restorations pre+erred with increased edentulous spaces, length, periodontal weaened

teeth, wea terminal autments, moilit" o+ teeth, lac o+ inter-ridge distance, loss o+tissue in edentulous area. 7sthetic clasping +or *PDJs using attachments, retentive tissue

ar, a rotational or dual path *PD.

*"erdenture Abut$ents Ad"antages: !mproves crown to root ratio, provides

proprioception, ps"chologic ene+its, preserves alveolar ridge, retention and stailit".

'odi&ing actors to a reat$ent P!an: Alternative methods o+ treatment. !+ teeth are

non-restorale how will it a++ect the treatment plan, T)D, implant therap".

*esultsAccurate diagnosis and nowledge o+ the patient, a thorough understanding o+ treatmentmodalities and materials, all a++ect the outcome o+ a patientJs treatment.5onclusion)ultiple ariales mae each treatment uni:ue.

02-010. 5haconas, Spiro . and =onidis, De$itrios. A 5epha!o$etric echni?ue or

Prosthodontic Diagnosis and reat$ent P!anning. he ourna! o Prosthetic Dentistr&, ;o"

1/6, o! 6, ;u$ .

This article reviews the asic cephalometric landmars and anal"ses, and suggests a method o+

use +or complete denture patients.

Prosthodontic 5ephalometric Anal"sis

Seletal criteria

1. )aillar" depth >/A to 9(< &0 degrees? +ig gives an indication o+ the anteroposteriorposition o+ the apical ase o+ the mailla relative to a horiontal +acial plane >9(?.

The angle is larger in a seletal class 2, mailla is protracted, conve pro+ile.


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The angle is smaller than normal in a class $, mailla is retracted, concave pro+ile.

!n class 2 or class $ patients, the denture teeth should e set with the appropriate

discrepanc" in the horiontal overlap o+ the incisors.

2. )andiular depth >/Po to 9(< average &0 degrees? +ig % the anteroposterior position o+ the

most anterior point o+ the mandile.

A smaller than normal measurement is a class 2 retrognathic mandile.

A larger than normal measurement is a class $ malocclusion, prognathic mandile

$. )aillomandiular relationship >maillar" depth less mandiular depth? >average 0 degree?.

!n adult, the average maillar" and mandiular depth angles measure &0 degrees. A line

drawn +rom / to Po should pass through point A in a normal adult. This gives a straight

seletal and so+t tissue pro+ile >+ig 3 center?.

A straight pro+ile is less prolematic in prosthodontic treatment ecause o+ the

harmonious relationship etween the mailla and mandile and the associated musclepressures against the dentition.

!+ point A is anterior to /Po, the patients pro+ile is retrognathic, conve, class 2 >+ig 3

le+t?.

The denture teeth would e placed in a retrognathic relationship.

!+ point A is posterior to the /Po line, the maillomandiular relationship is prognathic,

concave, class $ >+ig 3 right?.

The denture teeth would e placed in a reverse laiolingual relationship to harmonie

with the seletal and muscle pattern o+ the patient.

)P angle >)PA? >)P to 9(< average 2% degrees? >+ig. '?.

This angle gives an indication o+ the vertical height o+ the mandiular ramus.

This angle is larger in a class 2, div 1, ecause the mandile has not grown.

This angle also aids in determining +acial t"pe >+ig ?.

6arger angle - dolicho+acial pattern >+ ig c?. ecause o+ the narrow nasal cavities and di++icult"with nasal reathing, the patient will have mouth reathing tendencies. The" ma" thrust the

tongue +orward. The tongue thrust must e considered in setting the arti+icial teeth to produce

dentures that are stale and in harmon" with the neuromuscular +orces. This patient is usuall"class 2 seletall", conve +ace, seletal open ite, and the denture teeth should e set with the

appropriate horiontal overlap o+ the incisors. This patient will e the most di++icult to treat in

most instances.

6ower angle - rach"+acial is associated with a class 2, div 2 t"pe o+ seletal malocclusion >+ig a?.

The masseter muscle activit" is stronger than normal, resulting in the potential +or more soreness

eneath dentures. This patient is predisposed to T)# disease ecause the mandile has a

tendenc" to overclose causing muscle spasm. There+ore it is important to achieve correct vertical


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dimension with the occlusal plane as close to the center o+ the ramus as possile to insure proper

mandiular +unction..

6ower +ace height >A/S -LGi - P)< average ' degrees? >+ig &?.

6arger angle >dolicho+acial? indicates the presence o+ a seletal open ite. Smaller angle >rach"+acial? indicates the presence o+ a deep ite.

Determination o+ this angle is one o+ the most scienti+ic methods o+ determining the

correct vertical dimension. This measurement, along with phonetics and esthetics, ishelp+ul in determining the divergence o+ the oral cavit" with regard to the vertical

maillomandiular relationship. This relationship aids in setting denture teeth and helps

the patient in preventing possile T)# prolems.

Dental 5riteria

1. @cclusal plane >average -$.%mm to lip emrasure? >+ig. 10?.

This is a linear measurement to determine the correct vertical position o+ the occlusal plane. The

negative average measurement indicates that the occlusal plane is elow the lip emrasure. This

is important in setting teeth +or proper esthetics. The posterior level o+ the occlusal pane is

important +or mandiular +unction and the health o+ the temporomandiular structures. There isstrong clinical indication that T)# prolems occur when the posterior position o+ the occlusal

plane is the +urthest +rom the center o+ the ramus >Gi point?. There+ore the occlusal plane should

pass through the center o+ the ramus to ensure proper occlusal +unction. This plane will passthrough the superior hal+ o+ the retromolar pad clinicall".

)andiular incisor protruson >incisor to Apo< average 1Mmm0 >+ig.11?.

This measurement determines the anteroposterior position o+ the incisal edge o+ the mandiular

central incisor relative to the point +rom line A on the mailla to Po on the mandile.!n as muchas the position o+ the APo line is an indication o+ the maillomandiular relationship, this

measurement relates the lower incisor to the mailla and mandile. erticall", the incisal edge o+

the mandiular incisor is placed approimatel" 1.2% mm aove the level o+ the occlusal plane.

The incisal edge o+ the maillar" incisor would then e placed 1.2% mm elow the level o+ theocclusal plane, giving the patient a normal 2.% mm vertical overlap. !+ the patient is either a 5lass

2, div 1 or a 5lass $ malocclusion t"pe, the incisors are placed to represent an appropriate

amount o+ horiontal overlap.

Set the incisal edge o+ the lower incisor 1 mm anterior to this A Po line. The position o+ this toothma" e e" to the denture set up, and all o+ the remaining teeth might e positioned in a

s"stematic and almost e++ortless manner. (owever the relative degree o+ resorption o+ the

residual ridge and the need to alance tooth position with associated muscle +unction should alsoe considered +or complete denture stailit".


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Pro+ile anal"sis 7 line >lower lip to Pn-PoJ line< no average? >+ig 12?. This measurement relates

the lower lip to a line +rom the tip o+ the nose >Pn? to the tip o+ the so+t tissue o+ the chin >PoJ?.

Appearance is most estheticall" pleasing when the lips are relativel" close to the 7 line.

Summar" A review o+ cephalometric landmars has een discussed and related to the needs o+

complete denture +arication. A techni:ue +or use o+ the cephalogram in complete denture+arication is presented.

02-011. 5u!pepper, 9i!!ia$ D. and 'ou!ton, Patricia S. 5onsiderations in ied

Prosthodontics.

!ntroduction Preservation o+ the teeth, the supporting structures, and the residual ridges are the

chie+ concern when providing restorative treatment to the partiall" edentulous patient. Success or

+ailure will e in+luenced " diagnosis and treatment planning, se:uence o+ treatment, andpatient education. 5ommunication should not e neglected.

7ssentials +or Treatment Planning !n addition to the complete oral and etraoral eamination the

dentist should review a complete medical histor". A past dental histor" is also help+ul. 9ullmouth radiographs provide much in+ormation, as well diagnostic cast mounted on an ad=ustale

articulator.

5oordination o+ Treatment Se:uencing treatment correctl" and utiliing the other specialties as

indicated will help achieve success. 7ndodontic treatment should e completed as necessar" andthe teeth rein+orced to protect them during the restorative phase. Periodontal treatment should e

per+ormed to achieve a more predictale prognosis. Preprosthetic surger" can e completed with

the periodontal therap". @rthodontic care will provide a more predictale clinical result.According to rehn, teeth which are tipped more than 2% degrees should never e utilied as an

autment. During the restorative phase reevaluate tentative autments, speci+icall" tooth moilit"

and crown to root ratio. *eevaluate the occlusion and complete all operative procedures and

caries control prior to eginning prosthodontic treatment.Preparation Design +or Autment Teeth The preparation design must satis+" the criteria +or the

+ied restoration and removale prosthesis. Place margins supragingival i+ possile. 5aries,eisting restorations, short clinical crowns, and esthetic demands ma" necessitate the placement

o+ sugingival margins. *easons +or restoring autment teeth with crowns include etensive

deca", large or unserviceale restorations that should e replaced, lac o+ a naturall" occurring

undercut, or anterior teeth designated +or cingulum rest. The amount o+ reduction should allow+or the placement o+ rest seats in the crown. 7nsure space eist +or the minor connector. A

vacuum +ormed tra" is an ecellent aid in evaluating reduction. !+ possile the line o+ draw +or

the autment crown should e di++erent +rom the path o+ placement o+ the removale partialdenture.

*estoration o+ a 5rown to an eisting *emoval Partial Denture 5lasp @ccasionall" an autmentcrown must e remade. A techni:ue is presented that recommends +aricating an acr"lic copingover the die, then adding acr"lic to the coping while seated in the mouth with the partial denture

in place to estalish the contours under the clasp and rest seat in acr"lic. The remaining contours

and occlusal morpholog" is then completed in wa, and the crown is +aricated in the usual

manner.Ftiliation o+ )ultiple Autments @ccasionall" splinting autment teeth is necessar". 7amples

include teeth with loss o+ periodontal support or a lower premolar with a small cone shaped root.


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The rational o+ splinting is to improve support, stailit" and +unction. )c5racen has stated a

lone standing tooth has a more +avorale prognosis i+ it is splinted to another tooth " a +ied

ridge. Periodontal health must not e compromised and ample emrasure space must e presentto allow +or proper home care.

Summar" The success o+ removale partial denture prosthodontics depends on planning and

coordination o+ treatment. 9ied restorations are o+ten the +oundation on which removale partialdentures are constructed, and their contriution to the overall success cannot e minimied.

02-012. posterior or anterior?, it ma" e necessar"

to provide treatment in a BconvenienceB relationship.

Anterior *egion

7. Si mandiular anteriors >+ig 1?.

T 1. splinting and utiliing precision or semiprecision attachments is acceptale, with good

one and periodontal support. 2. i+ no restorations are to e made in the anterior region and the

canine contours are ade:uate, the use o+ conventional circum+erential clasps, with indirectretention is indicated. $. a swing loc retainer is also indicated.

)andiular Anterior *egion ilateral

*emovale partial dentures can e retained on two +reestanding canines in the mandile "

clasp retainers, circum+erential or *P!-t"pe.

splinting with pontics or a ar etween teeth and clasps.

splinting with intracoronal retainers.

splintng with etracoronal retainers.

overdentures

over amalgam class 1 restorations


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over individual copings

over post copings splinted " means o+ a ar.

The +ollowing ars can e used

a round ar with one or more clasps an ovoid with its retaining mechanism

a ar +aricated " a technician, cast +rom a wa +orm . This is utilied when no clip or

other +emale t"pe mechanism will e used to anchor the overdenture to the ar. The

+unction o+ the ar is purel" +or its splinting e++ect. A ar without clips is used when thereis too little occlusogingival height, it serves to help in anterioposterior stailit". 5ross

arch splinting o+ the canines helps to increase their longevit", which helps maintain

mandiular anterior one.

Fnilateral

!n situations where a central, lateral, and canine or lateral and canine on the same side remain,the options are more limited >+ig '?.

!t is possile to use clasps or rests >incisal, cingulum? 20 degree +acets, or reciprocating

lingual rests. !t is +re:uentl" advisale to use a lingual plate in these situations. Somepractitioners splint, using intracoronal attachments to avoid showing clasps. These patients are

etter to have an overdenture, with or without attachments. !+ a clip is used , mae certain that it

lines up with the ais o+ rotation, and not the line =oining the centers o+ the teeth. !+ there is room,a 5ea, utton, stud or other simple movement attachment is pre+erred. Ade:uate room is

+re:uentl" a prolem in this location, and it is etter to sacri+ice retention " a clip or other

device in +avor o+ a simple overdenture. The simple overdenture creates less stress on the roots,which will proal" result in retaining the roots and alveolar one longer.

)aillar" Anterior *egion

4hen teeth remain on oth sides o+ the midline, man" o+ the comments are the same i+ +ive or

si teeth are to e splinted. !+ canines are short, use precision attachments rather than

semiprecision attachments ecause the +rictional retention +rom opposing parallel walls iscompromised owing to the wall on the palatal side eing shorter than on the laial side, and oth

walls diverging >+ig ?. This is due to the curvature o+ the lingual anatom" o+ maillar" canines.

The indirect retention " a precision or semiprecision attachment is ecellent. A semiprecision +its less well, the male is cast usuall" +rom coalt chromium allo" that will

wear the +emale crown. This slow wear and nonparallel walls provide a less stress to autments.

!t is recommended that a lingual clasp arm e utilied with oth precision and semiprecisionattachments.

4hen two maillar" canines remain, there are two choices

- the" ma" e utilied as +ree standing canines using rests and conventional

circum+erential clasps or an *P! design.


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- anterior pontics or a ar +or cross-arch splinting

- the ar +ollows the arch and is not utilied +or rotation or with an attachment.

!t is rarel" =usti+ied to retain one or two maillar" anterior roots +or an overdenture. The"create an anterior ulge o+ the laial overdenture +lange, and mae esthetics di++icult.

!t ma" e advantageous to save maillar" anterior roots +or an overdenture when macomplete dentures oppose a man partial denture with natural anterior teeth. This can result in

settling and rotation o+ oth prosthesis over time and a class $ relationship. A +la",h"pertrophic maillar" anterior ridge results. *etained ma anterior roots would help preserve

the alveolar ridge.

Posterior *egion

!n the mandiular situation, the choice is +leile >ad=ustale? circum+erential clasps withocclusal rests.

A single man molar can e retained on a temporar" asis in the transition to a complete denture.!n the mandiular one molar case there is little need +or indirect retention, and gravit" is a

+avorale +actor.

!n the maillar" arch, there are several considerations

circum+erential clasps with occlusal rests, however there is little or no indirect retention

>stic" +oods, gravit"?. The +ulcrum line is etween the occlusal rests o+ the molars. The

onl" wa" to get indirect retention is to etend the ma denture ase posterior to this+ulcrum line.

when crowns are +aricated, use mesial semiprecision rests with +leile lingual arms.

There is no need +or posterior etension, indirect retention is provided " the depth o+ thesemiprecision attachment.

it is advisale to etract a single ma molar, gravit" is the enem", it is net to impossile

to achieve indirect retention on a single tooth. This tooth prevents peripheral seal.

Premolar region Patients who have one or two teeth in the mandile or mailla are +aced with a

class 1 lever s"stem acting around the rest on the teeth. This soon causes loosening andpremature loss o+ the teeth. These >and a single mandiular molar? are almost the onl" t"pes o+

cases that should e constructed as tissue orne cases without occlusal rests. 6ong guide planes

are placed on the lingual, mesial, and distal sur+aces. A hal+ round passive wrought wire clasp isused on the uccal.

5anine and Two Premolars Fnilaterall"

- !n the mailla Splint with crowns, use semiprecision attachments. This will give +rictional

retention and indirect retention. 5over as much o+ the palate to resist occlusal +orces.


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- !n the mandile Splinting and semiprecision attachments is not an option, ecause there is no

palate to resist occlusal +orces. !t is etter to institute endo, mae copings with or without

attachments and treat the occlusion as one would with a set o+ complete dentures.

Summar" 4henever possile, the minimal numer and simplest attachments should e used.

02-01. 9a!ton, .. A en >ear 3N?, improved +unction >22N?, and replacement o+ *PDJs >22N?. T)D s"mptoms+ound in 1$N prior to restoration with N +emale. 2N developed s"mptoms a+ter treatment.

@cclusal vertical dimension increased in 2$N. ecause a re+erral ased Prosthodontic practice

concentrates on di++icult and +ailed restorations, mean service time o+ +ailed restorations was

eight "ears. Per+oration o+ a prosthesis +or root canal therap" was not considered in theretreatment categor". .%N o+ prosthesis re:uired retreatment over the surve" period, $N were

ale to e repaired, and %.%N +ailed.5onclusionAn Australian Prosthodontist conducted a 10 "ear stud" o+ +ied prosthodontic

treatment in his practice with .%N recall rate. .%N o+ treatment episodes re:uired some +orm

o+ retreatment. %.%N +ailed and $N were ale to e repaired. 9emales sought treatment 2 to 1

over males. 7sthetic desires was the most common reason +or patients seeing crowns and +ailedprosthesis was the predominant reason +or seeing 9PDJs.

Prosthodontic Diagnosis

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