treatment planing in dental implants/ orthodontic continuing education

Treatment planningINDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com

Loss of teeth

•Loss of function•Disuse atrophy of ridge

•Migration of teeth•TMJ

Sequelae Of Loss Of Teeth

Occlusal Plane Derangement

Shift Of Masticatory Apparatus

Treatment plan•Fixed dentures•Implant supported fixed denture

•Removable partials•Make a dental cripple

Fixed dentures are the most preferred!

Removable partial dentures may be the

treatment choice

Solution or the problem?

Problem continues….

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

Contraindications• Epileptic patient having frequent

and severe attacks, without premonition

• Poor patient attitude

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

Treatment planning

• Identification of patients needs

• Correction of existing disease

• Prevention of future disease• Restoration of function• Improvement of appearance

Evaluation of existing prosthesis

Treatment of abused tissues

• Inflammed and irritated mucosa

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

Signs of collapse of occlusion

• Collapse of vertical dimension of occlusion– Requires extensive treatment

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

Diagnostic wax up

Modified dentures

Diagnostic casts

•Analysis of the existing occlusion»Angulation»inclination» supraeruption» elongation» jaw relation» occlusal plane» occlusal contacts» interference» interocclusal space» proximal tooth contacts» guide planes

Analysis of existing occlusion

» Angulation» Inclination» Supraeruption» Elongation

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.

Management of increased Interarch space.

•MMay be decreased by addition of onlay grafts .•AAutogenous and /or membrane grafts.–AAlloplastic grafts

» Jaw relation» Occlusal plane

» Occlusal contacts» Interference

Occlusion

• Occlusal plane

• Occlusal relation

• CO CR discrepancy

Correction of occlusal plane

• Enameloplasty• Onlay restoration• Intentional RCT & crown• Orthodontics• Extraction• Sinus lift• Increase VD

Intentional RCT

Tilted abutment

• Angulation of abutment

• Tooth contact

Orthodontic up righting

Analysis of abutment• Root length• Size• Form• Crown root ratio

Abutment evaluation

• Dentition and abutment• Caries susceptibility

Restorations

Caries susceptibilityrestorative status

Post-Endodontic Restorations

Presented byDr.T.V.Padmanabhan

Salvage or Sacrifice

Periodontal conditions

Fixed Splinting• Incase of compromised periodontal support

of remaining teeth• Short tapered roots• To improve support for the partial denture

Convert modification areas to

FPDs, making design simple

Missing teeth

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

• 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

Existing prosthesis

• Response of teeth and residual ridge to previous stress

• Arch form

Plan the prosthesis

1 Knowledge of design2 Incorporation in to present

clinical situation

Design 1

•Cingulam rest•I-bar clasp•A-P palatal

bar•Proximal plate

Design 2 Only possible

modification is to incorporate embrasure clasp to manage the space

Alternative treatment modalities

Thank you

For more details please visit www.indiandentalacademy.com

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