Treatment planing in dental implants/ orthodontic continuing education
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Transcript of Treatment planing in dental implants/ orthodontic continuing education
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Treatment planningINDIAN DENTAL ACADEMY
Leader in continuing dental education www.indiandentalacademy.com
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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www.indiandentalacademy.com
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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
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• Reduced Periodontal support of the remaining teeth
• Patient desires
• Youth
• Physically or emotionally handicappedwww.indiandentalacademy.com
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• 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
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Principle of RPD is the DE VAN’s principle.
Broad distribution of forces Least
damage to the abutments
Effective utilization of componentswww.indiandentalacademy.com
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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
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Evaluation of occlusion
• Collapsed occlusion• Traumatic occlusion• Deranged occlusal plane
Herbert T. Shillingburgwww.indiandentalacademy.com
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• 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
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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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