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PROSTHODONTICS:
Definition:
Is the dental specialty pertaining to the diagnosis , treatment
planning, rehabilitation ,and maintenance of the oral function ,
comfort , appearance , and health of patients ,with clinical
conditions associated with missing or deficient teeth and or
maxillofacial tissues using biocompatible substitutes
BRANCHES OF PROSTHODONTICS
1) removable
prosthodontics
2) fixed prosthodontics
3)maxillofacial
4)implant
FIXED PROSTHODONTICS
Fixed prosthodontics is the art and science
of :
A) restoring damaged teeth of full function .
B) replacing missing teeth with fixed
prosthesis .
( The term fixed implies that the prosthesis
are permanently retained to the teeth )
Scope of fixed prosthodontics :
The scope of fixed prosthodontics
treatment can range from the
restoration of a single tooth to the
rehabilitation of the entire occlusion .
Types of restorations :
1) Extra-coronal :
a) full coverage
b) partial coverage
2) Intra-coronal :
a) Direct : amalgam , tooth
colored filling materials
b) Indirect : Inlays ,
Onlays , Overlays
3) laminated veneers
Types of crowns :
1) clinical crown : part of the tooth
showing in the oral cavity .
2) Anatomical crown : part of the tooth
covered by enamel
3) Artificial crown : a
cemented veneer
restoration which
replaces the
morphology ,
function , and
contour of the
damaged coronal
portion of a tooth
CLASSIFICATIONS OF CROWNS ACCORDING TO :
1) Number of surfaces
involved :
1) Full veneer
2) Partial veneer
3) Post crown
2) material :
1) Metal
2) Plastic materials ( porcelain ,
acryl )
3) Combined
CROWN
*full metal crown :
Completely covers the coronal part of
an individual tooth
Porcelain fused to metal crowns ( PFM) :
Full metal crown with outer surfaces covered with a veneer
of porcelain
Porcelain jacket crown :
it is made entirely from ceramic
substance, it is the weakest
type of crown restorations (more
susceptible to fracture) and it is
the least conservative type of
crowns.
Three quarter crown : covers
the anatomic crown of a
tooth except for the facial
portion
FIXED BRIDGE
A prosthesis replaces one or more
missing teeth with in the same
arch and permanently attached
to the remaining teeth
RESIN BONDED BRIDGES
Also known as adhesive , minimal
preparation bridges , with wing like
extensions coming from the proximal
sides of the pontic and attached to the
palatal surface of the abutment
INLAY
Intracoronal restoration that covers a portion of the occlusal
and proximal surface.
ONLAY
Intra coronal restorations that covers the proximal surfaces and
most or all of the occlusal surface ( extend to replace a cusp or
more )
PORCELAIN VENEERS
Thin shell like covering placed on the labial surface to
improve the appearance of the anterior teeth.
PROSTHODONTICS TREATMENT SEQUENCE
1) preparation :
* diagnosis and treatment planning .
*Treatment of symptoms.
* stabilization of the deteriorating conditions :
# caries control
# periodontal therapy
2) pre prosthetic treatment :
* Pre prosthetic surgery
* Periodontal therapy
* Endodontic
* Orthodontics
* Occlusal adjustments
3) Prosthodontics treatment
4) Follow up and maintenance
OVER VIEW OF FIXED PROSTHODONTIC PROCEDURES :
* primary impression
Material : alginate , irreversible
hydrocolloids
Study cast : trial preparation , provisional
restoration , occlusal analysis
* Tooth preparation : the tooth is prepared
so the cast restoration can slide into
place and be able to withstand the
forces of occlusion , rotary instruments
are used to reduce the height and
contour
Retention aids :
It may be neccesary to provide
additional support for the crown if
the tooth is extensively decayed ,
fractured , or has been
endodontically treated .
Core build up (post and core )
Pin retention
Gingival retraction and tissue
management :
Cord temporarily displaces the gingival
tissue and widens the gingival
sulcus so impression material can
flow around all parts of the
preparation .
*Final impression :
Elastomeric impression materials
are used to create extremely
accurate impressions .
* Bite registration:
Provide the laboratory technician
with thea reproduction of
patients bite .
PROVISIONAL RESTORATION
Used to keep the patient comfortable during the
period from the tooth preparation to final
cementation of the fixed prosthetic .
Function:
1)Reduce sensitivity and discomfort .
2)Maintain the function and aesthetic.
3) Protect the remaining tooth tissues .
4) Protect the margins .
5)Prevent movement of adjacent teeth .
( proximal , opposing )
INDICATIONS OF CROWNS
1) badly broken down teeth :
Mostly these teeth will have been previously restored and developed
secondary caries or parts of the tooth or the restoration broken off .
Before crowns are made for these teeth the lost dentine should be
replaced with suitable core or restoration material .
2) trauma : an intact tooth may have a large fragment broken off
with out damaging the pulp and leaving sufficient dentine to
support a crown .
3) tooth wear :
Erosion : tooth surface loss due to non
bacterial acids
Abrasion : mechanical wear by externous
agents .
Attrition : mechanical wear of one tooth
against another .
Although tooth wear is normal if it is extensive or early in life
crowns may be needed .
Management of tooth wear should go through this stages:
* diagnosis and prevention .
*Monitor any further progression if there is a complain of
sensitivity , appearance , function.
*Provide minimal restorations
*Provide crowns if the problem continues
4) non vital teeth :
1) aesthetic : when the pulp become
necrotic the tooth often become
discolored due to hemoglobin
breakdown products ( heamosidren
)
2) Support : to support thin and
undermine cusps in root canal
treated teeth need to be protected
especially with original damage
and the access activity .
5) Hypo plastic conditions : they could be:
A) Hereditary : amelogenesis imperfecta , dentinogensis
imperfecta ,hypodontia .
b) Acquired : fluorosis , tetracycline staining
6) To alter the shape , size or inclination of the teeth , only
minor changes can be achived by crown ,eg : teeth can be
made larger in size
7) To alter occlusion :
8) As part of another restoration :
Crowns are made to
1)support bridge as components of fixed splints
2) To carry precision attachments retained partial dentures
3) Alter the alignment of teeth to produce guide planes for
partial denture
9) Combined indications: more than one of these indications
may be present
eg: broken down posterior tooth near an edentulous area
CONTRAINDICATIONS :
(No absolute contra indications)
1) Poor oral hygiene
2) The patient is in poor health due to medical history ( DM)
3) Coast the patient can not afford the treatment
4) Necessary supportive tissues are diseased or missing
5) Suitable abutment teeth are not available .
6) Causes related to the tooth itself and related supportive
tissues
Eg: thickness and height of the tooth ,mobility of the tooth ,
bone resorption .
thank you
