Diagnosis and treatment planning in fixed partial denture
Preeti Kalia 2nd Year P.G. Department of Prosthodontics
Planning is bringing the future into the present so that you can do something about it now
Special problems
Cantilever fixed partial denture Canine replacement
Treatment sequence
Diagnosis and treatment planning in fixed partial dentue
Abutment evaluation
Treatment planning for multiple missing teeth
Definitive diagnosis Identification of the patient’s needs Treatment planning for single tooth restoration
Definition Diagnosis: Determination of the nature of the disease
Diagnostic casts
Radiographic interpretation
Definitive diagnosis
Periodontal health Occlusal relationships TMJ function Condition of edentulous areas Anatomic abnormalities ,servicibility of the existing prostheses Status of the remaining dentition – including previous dental treatment Dental caries,defective restorations and pulpal disease
ACP Classification Class I Ideal or minimally compromised -
The edentulous span is confined to a single arch and 1 of the following*Any anterior maxillary edentulous area that does not exceed 2 incisors. *Any anterior mandibular edentulous area that does not exceed 4 incisors. *Any posterior maxillary or mandibular edentulous area that does not exceed 2 premolars, or 1 premolar and 1 molar.
Class I
Abutment conditions No preprosthetic therapy is indicated. Occlusal characteristics- Class I molar and jaw relationships are seen. Residual bone height of ≥21 mm
Class II- Moderately compromised
Edentulous area – Both arches Abutment- Abutments in 1 or 2 sextants Occlusion- Localized adjunctive therapy . Class I molar and jaw relationships are seen. Residual bone height of 16 to 20 mm
Class III – Substantially compromised
Any posterior maxillary or mandibular edentulous area greater than 3 teeth or 2 molars. Abutments in 3 sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations. Entire occlusion must be reestablished.Class II molar and jaw relationships are seen. Residual alveolar bone height of 11 to 15 mm
Class IV – Severely compromised
Any edentulous area or combination of edentulous areas requiring a high level of patient compliance Abutments in 4 or more sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations. Entire occlusion must be reestablished, including changes in the occlusal vertical dimension.Class II division 2 and Class III molar and jaw relationships are seen. Residual vertical bone height of ≤10 mm measured at the least vertical height of the mandible on a panoramic radiograph
Definition Treatment plan: Sequence of procedures planned for a patient after diagnosis
Identification of patients needs
An attempt to conform the patient to the ideal treatment plan rather than have treatment plan conform to patients needs will not lead to success
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Objectives of treatment Objectives Correcting an existing disease Prevention of disease
Restoration of function Improvement of appearance
Correcting an existing disease
Prevention of future disease
Restoration of function
Improvement of appearance
Why do we need to replace missing teeth?
Parts of fixed partial denture
Selection of abutment teeth
splinted abutment
Ideal abutment
Treatment planning for single tooth Treatment planning for single tooth
Intracoronal
Extracoronal
Intracoronal restorations Glass ionomer restoration
Composite resin restoration
Simple amalgam restoration
Complex amalgam restoration
Metal inlay
MOD Onaly
Ceramic inlay
Extracoronal restoration Resin veneer crowns
Partial veneer crown
Full metal crown
Metal ceramic crown
All ceramic crown
Ceramic veneer crown
Treatment planning for replacement of missing teeth Replacement of missing teeth
Tooth supported fixed partial denture
Removable partial denture
Resin bonded bridges
Conventional
Implant supported fixed partial denture
Removable partial denture
Conventional fixed partial denture
Resin bonded bridge
Implant supported fixed partial denture
No treatment
Long standing edentulous ridge
No drifting or elongation of adjacent teeth
Patient’s wish
Abutment evaluation
Forces that would normally be absorbed by the missing tooth are transmitted through the pontic,connectors and retainers to the abutments. Vital tooth Endodontically treated teeth
Dowel core
Pulp capped teeth
Crown to root ratio
Root configuration
Periodontal ligament area
Support calculation
Maxillary
1,2 ………………….. 1 3,4,5 ……………….. 1.5 6,7 ………………….. 2.5
Mandibular
1,2 ………………….. 1 3 ………………......... 1.5 4,5………………….. 1.2 6,7 …………………
2.8
Biomechanical considerations 1) Span length Bending or deflection varies directly with the cube of the bridge length
2)Double abutment
Double abutments are sometimes used as a means of overcoming problems created by unfavorable crown-root ratios and long spans A secondary abutment must have at least as much root surface area and as favorable a crown-root ratio as the primary
3) Arch curvature
Replacement of a single missing tooth Canine replacement FPD Canine is outside interabutment axis Maxillary canine - more stresses than a mandibular canine
Cantilever fixed partial denture
Assessment of the abutment teeth
Radiographs ,pulpal health
Endodontically treated abutments
Unrestored abutments
Assessment of the abutment teeth Mesially tilted second molar
Corrective measures of mesially tilted second molar
orthodontic treatment
Proximal half crown
Corrective measures of mesially tilted second molar
Telescoping crown and coping
Corrective measures of mesially tilted second molar
Non rigid connector
Span length Replacing 3 posterior teeth with FPD unfavorable- implant supported FPD Long span FPD – pontics and connectors should be made bulky
Replacing multiple anterior teeth
Special problems Pier abutments
Non rigid connector
Simple fixed partial denture (One tooth)
Replace central incisor Abutments are central incisor and lateral incisor Abutment pontic- root ratio Maxilla- 1.9 Mandible – 2.1
Simple fixed partial denture (two teeth)
Replace maxillary central incisor and lateral incisor Abutment – Central incisor and canine Abutment – pontic root ratio – 1.2
Complex fixed partial denture (two teeth)
Replace mandibular central incisor and lateral incisor Abutments- Central incisor, lateral incisor and canine Abutment- pontic root ratio- 1.8
Complex fixed partial denture (more than two teeth)
Replace maxillary central incisors and one lateral incisor Abutments- Both canines and the remaining lateral incisor Abutment-pontic root ratio- 1.3
Complex fixed partial denture (pier abutment)
Replace maxillary central incisor and opposite side lateral incisor Abutments- Lateral incisor, central incisor and canine Abutment- pontic root ratio- 1.7
Phase I : Symptomatic treatment
Phase II Stabilization phase
Phase III: Definitive treatment
Oral surgery Periodontal surgery Endodontic treatment Orthodontic treatment
Phase III: Definitive treatment
Fixed prosthodontics Occlusal adjustments Anterior teeth restored first Restoring opposing posterior segments
Phase IV: follow up
References
Malone W.F.P., Koth D.L., Cavazos E. : Tylman’s theory of practice of fixed prosthodontics. 8 th edition,1977, lshiyaku publications, St.Louis,1-24 Rosenstiel R.F., Land M.F., Fujimoto J.: Contemporary fixed prosthodontics. 4th edition,1988, Mosby Publications, India, 42-109 Shillingburg H.T., Hobo S., Whisett L.D., Jacobi R., Brackett S.E. Fundamentals of fixed prosthodontics, 3 Ed., Quintessence Publication,2007,India ,73-104.
References
D.J Jacobs, J.G Steele, R.W Wassell,Considerations when planning treatment, British Dental Journal 2002;192,5:257-267 D.J Jacobs, J.G Steele, R.W Wassell,Changing patterns and the need for quality, British Dental Journal 2002;192,3: 144-148 D.J Jacobs, J.G Steele, R.W Wassell,Material selection, British Dental Journal 2002;192,4: 199-211
