What is the correct sequence of steps for prosthetic treatment? anamnesis clinical examination (extraoral and intraoral) X-ray photos models 1- em...

What is the correct sequence of steps for prosthetic treatment?
anamnesis
clinical examination (extraoral and intraoral)
X-ray photos
models

1- emergencies (patient complaint?): fracture, pain, aesthetics..
2- adequacy of the oral environment (scaling, caries lesions, elimination of plaque retentive factors, hygiene instruction, motivation...)
3- need for other specialties: ortho, endo, perio, dentistry, or other medical specialties
4- Start the prosthetic planning.
Crown total and partial
Intracanal pin
Core filling
Facet
Fixed partial prosthesis PPF
What to evaluate?
⁃ edentulous space: location, extension, and thickness
⁃ periodontal insertion of the pillars: quality and quantity
⁃ quality of the pillar teeth structure
⁃ antagonist
⁃ insertion axis
Removable partial denture
The Removable Partial Dentures (RPD) are used to restore partially edentulous arches, replacing lost teeth and tissues.
⁃ They are prostheses designed to be removed and inserted by users
Components of the RPD:
⁃ metal frame
⁃ base
⁃ artificial teeth.
Summary of prosthesis
Every support tooth has its retainer!
Type of support in RPD
• TOOTH-SUPPORTED: Support of natural teeth at the ends of the edentulous space
• TOOTH-MUCOSALLY SUPPORTED: Support of natural teeth on only one side of the edentulous space: FREE END
Indications of RPD
• Free end prosthetic space
• Extensive edentulous space
• Reduced periodontal support
• Excessive bone loss in the residual ridge
• Economic situation
RPD X Implants
• Bone capital
• Anatomy of the remaining bone
• Systemic conditions
• Time
• Physical sacrifice
• Cost
RPD X PPF
• Contraindications of PPF
✓ patient's age
✓ extent of the edentulous space
✓ great loss of residual ridge
• Disadvantages of PPF
✓ dental wear
✓ hygiene
Planning
TREATMENT SEQUENCE
• Initial consultation: DIAGNOSIS
• Oral preparation
1st Consultation for RPD fabrication:
• Impression to obtain the study model (Anatomical, initial, study impression)
Most used material:
⁃ alginate
⁃ Stock tray
⁃ Study model in Gypsum III
• Delineation for planning the components of the metal frame and the amount of wear of the support teeth.
Components
Metal frame or metal structure:
• Major connector
• Minor connector
• Support
• Direct retainer / clip
• Indirect retainer
• Base
• Artificial teeth
MAJOR CONNECTOR
• Structural rigidity
• Vertical support and protection of soft tissues (minimum distance from the free marginal gingiva)
• Auxiliary form of indirect retention
• Form of fixing the base
Lingual Bar:
⁃ Advantages: simplicity of fabrication; greater stimulation of soft tissues.
⁃ Disadvantages: may not be rigid enough. Indicated for tooth-supported RPDs with sufficient space between the GML and the floor
Lingual Bar with continuous clip:
⁃ Advantages: contribution to the stability and indirect retention of the prosthesis.
⁃ Disadvantages: more difficult adaptation; tendency to food impaction if adaptation is inadequate; discomfort due to multiple edges.
Vestibular Bar
⁃ Used only when another major connector is unfeasible (wide torus, teeth with exaggerated lingual inclination)
⁃ Disadvantages: discomfort, volume, reduced space
Lingual Plate:
⁃ Advantages: various indications; can contribute to indirect retention; no problem with space (GML); greater rigidity, smaller volume.
⁃ Disadvantages: greater coverage; problems for patients with poor hygiene.
Lingual Bar x Lingual Plate
⁃ Lingual Bar
• Class III
• Must have at least 8mm from the GML to the lingual floor
⁃ Lingual Plate
• Class I or II
• There are no distance problems
• Stabilization of periodontally weakened teeth
Palatal Bar
⁃ <8mm wide
⁃ little used;
⁃ small support on the palate;
⁃ needs greater volume not to deform;
⁃ Indicated for small extension Class III.
Anteroposterior or double bar
⁃ Advantages: rigidity; resistance to deformation. Indicated for anterior and posterior pillars more separated.