Introduction to Fixed Prosthdontics

1. Introduction to Fixed Prosthdontics Wael Al-Omari. BDS, MDentSci, PhD

2. Definition of Fixed Prosthodontics Fixed Prosthodontic Treatment involves the replacement and restoration of teeth with by artificial substitutes that are not readily removable from the mouth

3. Scope of Fixed Prosthodontics Restoration of single tooth with a cast crown. Replacement of one or more missing teeth with a fixed partial denture (FPD). Rehabilitation of the entire occlusion.

4. Aims of Fixed Prosthodontics The aims of fixed prosthodontic treatments are to: Restore Function and mastication Restore aesthetics Maintain health and integrity of dental arch Support the treatment of problems related to TMJ

5. Terminology Crown: A cemented extracoronal restoration that covers or veneers the outer surface of the clinical crown: 1- Full or complete veneer crown 2- Partial veneer crown 3- Laminate Veneers Inlays and Onlays

8. Fixed Partial Denture (PDF) or Bridge: Defined as a prosthetic appliance permanently attached to remaining teeth, which replaces one or more missing teeth. Components of FPD: Abutment: A tooth serving as attachment to FPD Pontic: The artificial tooth suspended from abutment teeth Retainer: Extracoronal restorations cemented to prepared abutment teeth Connector: rigid o non-rigid joint connection between the pontic and the retainer

11. Diagnosis History TMJ/Occlusal evaluation Intraoral examination Diagnostic casts Radiographic examination

12. History Chief Complaint Infectious Disease: Hepatitis and AIDS. Non-Infectious Disease Allergies to drugs, anesthetic solutions, Allergy to dental materials: impression materials, Nickel containing materials. Medications Cardiovascular diseases: hypertension, coronary heart disease---No epinephrine Indications for antibiotic prophylaxis Patients on coagulants Epilepsy Diabetes Mellitus Xerostomia

13. TMJ/Occlusal Evaluation A prerequisite to fixed prosthodontic treatment is a healthy joint and supporting skeletal musculature. Examine occlusion: normal versus dysfunctional Frequent occasion of head, neck and shoulder pain should be investigated.

14. Assessment of TMJ Clicking, crepitation, limitation of movement on opening, closing, and laterally, limitation of mouth opening. Palpation of the joint Parafunctional activity Assessment of musculature: palpation of masseter, temporalis, medial pterygoid, lateral pterygoid, trapezius and sternocleidomastoid muscle Pt. to indicate the area that hurts

15. Intraoral examination Periodontal examination: 1- General Oral Hygiene 2- Periodontal condition 3- Gingival inflammation 4- Attached gingiva 5- Pocket and attachment level 6- Mobility

16. Restorative condition: 1- Caries extension 2- Presence of faulty restoration 3- Suitability of existing prostheses. 4- Vitality Occlusal examination 1- presence of wear facet 2- Occlusal interferences 3- Interocclusal relationship. 4- Deviation 5- Anterior and posterior guidance Examination of edentulous ridge

17. Diagnostic casts Study casts made from stable alginate impression accurate, reproducible without positive nodules Articulation using semiadjustable articulators is recommended Provide information about edentulous ridge, occlusion, abutment length and inclination arch curvature, drifting and rotation Occlusal analysis. Planning for the pontic size and design Diagnostic wax-up

18. Radiographic Evaluation Signs of primary or recurrent caries Presence pf periapical lesion Quality of existing endodontic treatment Alveolar bone level Crow:root ration Length, configuration and direction of roots Widening of periodontal membrane Presence of root tips or pathology in the edentulous area

19. Protection against infectious Diseases Hepatitis and AIDS Treat each patient as being potentially infectious. Vaccination. Rubber gloves, surgical mask, face shield, protective eyeglasses and protective uniform. Disinfect impression, and laboratory appliances