treatment planing in dental implants/ orthodontic continuing education

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Page 1: Treatment planing in dental implants/ orthodontic continuing education

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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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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