Diagnosis and treatment planning in FPD Final.ppt

diagnosis and treatment planning in FPD

2. DIAGNOSIS AND TREATMENT
PLANNING IN FIXED PARTIAL
PROSTHODONTICS

3. DIAGNOSIS :
Is the determination of the nature of a disease process.
Treatment plan :
The sequence of procedures planned for the treatment of a
patient following diagnosis.
Treatment : Is any measure designed to remedy a careful
evaluation of all available information, a definitive diagnosis and a
realistic treatment plan that offers a favourable prognosis.
“A good clinician is one who is able to diagnose potential
problems during the initial examination and suggest the best
possible treatment plan compatible with the age, physical, mental
and financial status of the patient”.

4. TERMINOLOGY :
Prosthodontics : is that discipline of dentistry pertaining to the
restoration of oral function, comfort, appearance and health by
restoring natural teeth and replacing missing teeth and contiguous
oral and maxillofacial tissues with artificial substitutes (GPT).
Fixed prosthodontics : pertains to the restoration or replacement
of teeth with artificial substitutes that are attached to natural teeth,
roots or implants and that are not readily removable.
Retainer RetainerPontic
connectorconnector
Abutment

5. Drift of neighboring : Effect depends upon
•intercuspation of teeth on either side of space with those of
opposing arch.
•Age and periodontal condition.
•Tooth movements depend upon position of tooth in arch.
oLower molars and Upper molars tilt mesially.
oThe premolars stay upright and move bodily into any space.
Over-eruption of opposing teeth
•Loss of bony support for tooth
•Overgrowth of alveolus.
•Traumatic occlusion.
•Loss of contacts which leads to food impaction, periodontal
breakdown and subgingival caries.

6. Reasons of Treating Tooth Loss :
1.
 Esthetics.
2.
 Function.
3.
 Pain due to TMJ dysfunction.
4.
 Speech.
5.
 Maintenance of dental health.

7. Components :
•Pontic – the replacement tooth.
•Retainers – the restorations that are cemented to the abutments.
•Connector – the joint between the retainers and the pontic.
•Abutments are the teeth that support the FPD.
Retainer RetainerPontic
connectorconnector
Abutment

8. Indications :
Short span edentulous arches.
Presence of sound teeth that can offer sufficient support
adjacent to the edentulous space.
Patients preference.
Mentally compromised and physically handicapped patients
who cannot maintain the removable prosthesis.

9. Large amount of bone loss as in
trauma.
Very young patients where teeth
have large pulp chambers.
Long span edentulous spaces.
Bilateral edentulous arches
which require bilateral
stabilization.
Distal extensions edentulousness
as in class I and II Kennedy’s
classification.
CONTRAINDICATIONS

10. Congenitally malformed teeth, which do not have adequate
tooth structure to offer support.
Mentally sensitive patients who cannot cooperate with
invasive treatment procedures.
Medically compromised patients (eg: leukemia,
hypertension).
Very old patients.

11. DIAGNOSIS :
A patients history should include all pertinent information
concerning the reasons for seeking, treatment, along with any
personal information, including relevant pervious medical and
dental experiences.
Chief complaint :
The chief complaint should be recorded, preferably in the
patient’s own words. A screening questionnaire is useful in history
taking which should be reviewed in the presence of the patient to
correct any mistakes. If the patient is a minor, or a mentally retarded
person, the parent or the guardian should be present.

12. The accuracy and the significance of patient’s primary
reason(s) for seeking treatment should be analyzed first.
The chief complaint usually fall into one of the following
categories.
Comfort (pain, sensitivity, swelling)
Function (difficulty in mastication or speech)
Social (Bad taste or odour)
Appearance (fractured or unattractive teeth or restorations,
discolorations).

13. Personal details :
The patient’s name, address, phone number, sex, occupation,
work schedule and marital and financial status are noted.
Medical history :
The medical history should include the medications the
patient is taking and all the relevant medical conditions. Patient’s
physician may be contacted if needed.
The medical conditions may be classified as
Those affecting the treatment methodology. (eg: any disorders
requiring prophylactic antibiotic therapy, use of steroids,
anticoagulants, allergic response to medication or dental
material).

14. Those conditions affecting the treatment plan (eg: previous
radiation therapy, hemorrhagic disorders, extremes of age and
terminal illness).
Systemic conditions with oral manifestations. (eg: periodontitis
may be modified by diabetes, menopause, pregnancy, use of
anticonvulsants, teeth may be eroded by regurgitation of
stomach acid, certain drugs show side effects that minic
temporomandibular disorders (TMDs) or reduce salivary flow).
Possible risk factors to the dentist and auxiliary personnel (eg:
patients who are suspected or confirmed carriers of hepatitis B,
acquired immunodeficiency syndrome or syphilis).

15. Periodontal history :
The patients oral hygiene is assessed and current plaque
control measures are discussed the frequency of any previous
debridements, any oral hygiene instructions received, all should
be recorded. The dates and nature of any previous periodontal
surgery should be noted.
Restorative history :
This may include simple composite resin or dental
amalgam fillings or it may involve crowns and extensive fixed
bridges. The age of existing restorations can help establish the
prognosis and probable longevity of any future fixed prosthesis.
DENTAL HISTORY

16. Endodontic history :
Patients often forget which teeth have been endodontically
treated. These can be identified with radiographs. The findings
should be reviewed periodically so that periapical health can be
monitored and any recurring lesions promptly detected.
Orthodontic history :
Root resorption (may be detected on radiographs) may be
attributable to previous orthodontic treatment. This may affect the
crown/root ratio for future prosthodontic restorations.
Removable prosthodontic history :
Patient’s experience with previous partial denture can be
evaluated. The success of the future treatment can be assessed.

17. Oral surgical history :
Information about missing teeth and any complications that
may have occurred during tooth removal is obtained. If a patient
requires prosthodontic care subsequent to orthognathic surgery, the
prosthodontic component of the proposed treatment should be fully
coordinated with the surgical component.
Radiographic history :
Previous radiographs may prove helpful in judging the
progress of dental disease. This may avoid exposing the patient to
unnecessary ionizing radiation.

18. TMJ dysfunction history :
A history of pain or clicking in the temporomandibular
joints or neuromuscular symptoms, such as tenderness to
palpation, may be due to TMJ dysfunction. Patient should be
questioned regarding any previous treatment for joint dysfunction
(eg: occlusal devices, medications, biofeedback or physio therapy
exercises).

19. CLINICAL EXAMINATION :
Basic principles of examination :
•Inspection: It is defined as observation with an unaided eye.
•Palpation: It is the act of feeling by the sense of touch.
Techniques: bilateral palpation, bimanual palpation,
bidigital palpation.
•Percussion: Is an act of striking a portion of a body with a
finger or an instrument to evaluate the condition of the
underlying structures by careful attention to the sound or echo
produced, and noting the response of the patient.
•Auscultation: It is the act of listening to functional sounds of the
body.
•Supplemental Aids: Radiographs, vitality tests, trans
illumination, biopsies and other lab diagnostic tests.

20. Head and neck examination :
An evaluation of the size, shape and symmetry of the face
including the overall profile (retrognathic, mesiognathic or
prognathic) is made.
The skin and hair are examined.
Any abnormalities like lymphnode enlargements, cutaneous
ulcers, scars, exophytic growths or anomalous pigmentations should
be given special attention.
The TMJs and muscles of mastication are evaluated for
dysfunction.

21. TEMPOROMANDIBULAR JOINT

22. PALPATION
Muscles
Floor of the mouth

23. LIPS

24. Oral examination :
The oral examination begins with a screening for
malignancy, and the patient is referred to an appropriate specialist
if any suspicious lesions are discovered.
General oral assessment :
This includes an evaluation of the oral hygiene, overall
caries activity general periodontal status, the quality and quantity
of saliva.

25. Debris Index
BuccalLabialBuccal
16 11 26
46 31 36
Lingual LabialLingual
Calculus Index
Good  (0-1.2)
Fair  (1.3-3)
Poor  (3.1-6)
Oral Hygiene Index-Simplified
BuccalLabialBuccal
16 11 26
46 31 36
Lingual LabialLingual
OHI-Simplified =
Debris Index+ Calculus Index

26. Scoring Debris Calculus
Score1 Gingival 1/3 of tooth i.e.,
Cervical 1/3 is covered with
debris
Supragingival
calculus
Score2 Between 1/3 to 2/3 Specks of subgingival
calculus
Score3 >2/3 Ring of subgingival
calculus

27. Examination of teeth :
Each tooth is examined for dental caries, decalcifications,
erosion, abrasion, occlusal attrition, sensitive exposed root
surfaces or fractures.
The restorations are scrutinized for defects or recurrent
caries and abnormalities in crown height, contour or alignment are
recorded.
Occlusal examination :
The initial examination starts by asking the patient to
make a few simple opening and closing movements while
carefully observing the opening and closing strokes. This
determines to what extent the occlusion differs from the ideal and
how well the patient has adapted to this difference. Special
attention should be given to the initial contact, tooth alignment,
eccentric contacts and jaw maneuverability.

28. Initial tooth contact :
General alignment :
Lateral and protrusive contacts :
The type of lateral guidance
•Canine guided occlusion
•Group function
•Mutually protected
Jaw maneuverability :

29. Periodontal examination :
Gingiva :
Periodontium :
Other details include
•Tooth mobility
•Malpositioned tooth
•Open or deficient contact-areas
•Missing or impacted teeth
•Areas of inadequate attached keratinized gingiva
•Gingival recession
•Furcation involvements
•Malpositioned frenum attachments.

30. Clinical attachment level (CAL or AL) :
Documenting the level of attachment
•Determines the amount of periodontal destruction that has
occurred.
•Provides information regarding the prognosis of an individual
tooth.
•It is determined by measuring the distance between the apical
extent of the probing depth and a fixed reference point on the
tooth, most commonly either the apical extent of a restoration
and/or the cemento enamel junction.

31. DENTAL CHARTING

32. The Edentulous Ridge :
Classification :
Ridge deformities have been grouped into three categories
by Siebert, and this classification has been widely accepted:
•Class 1. Loss of faciolingual ridge width with normal
apicocoronal height.
•Class 11. Loss of ridge height with normal width.
•Class 111. Loss of both ridge width and height.
If a “normal” classification (Class N) with minimal
deformity is added, there are four classes of ridge contours.

33. Radiographic examination :
•Full series of intraoral periapical
•Digital radiography
•Panoramic films
•Special radiograph for TMJs
Transcranial exposure
Serial tomography
Arthrography
•CT scanning
•MRI (magnetic resonance imaging)
•Digital subtraction radiography

34. PANORAMIC FILMS provide information about
•Presence or absence of teeth
•Third molars and impactions
•Retained root tips.
IOPA, however provides details about
•Bone support and quality, trabecular patterns.
•Root number and morphology (short, long, slender, broad,
bifurcated, fused dilacerated etc).
•Caries
•Root proximity

35. Radiographic interpretation :
•Width of the periodontal ligament spaces and evidence of
trauma from occlusion.
•Areas of vertical and horizontal osseous resorption and
furcation invasions.
•Axial inclination of teeth (degree of non parallelism present)
•Continuity and integrity of the lamina dura.
•Pulpal morphology and previous endodontic treatment with or
without posts and cores.

36. •Presence of apical diseases, root resorption or root fractures.
•Retained root fragments, radiolucent areas, calcifications,
foreign bodies or impacted teeth.
•Presence of caries lesions, the condition of existing
restorations and the proximity of caries and the restorations to
the dental pulp.
•Proximity of carious lesions and restorations to the alveolar
crest.
•Calculus deposits.
•Oral roentogenographic manifestations of systemic disease.

37. VITALITY TESTING :
Pulpal health must be assessed by measuring the response to
•Percussion
•Thermal or electrical stimulation
•Preparation of test cavity without LA

38. The definitive diagnosis :
The dental diagnosis includes
Determination of the periodontal health, occlusal
relationships, TMJ function, condition of the edentulous areas,
anatomic abnormalities, serviceability of existing prosthesis and
status of remaining dentition – including previous dental
treatment, dental caries, defective restorations and pulpal disease.
Treatment options follow logically from the diagnosis.

39. TREATMENT PLANNING
Objectives of Treatment Planning:
•Correction of existing disease
•Prevention of future disease
•Restoration of function
•Improvement of appearance.

40. DECIDING FACTORS FOR TOOTH REPLACEMENT
WITH FPD
Two important factors
•Support (abutment teeth considerations)
•Occlusal forces (biomechanical considerations)
Abutment teeth considerations :
•supporting tissues
•Crown root ratio
•Root configuration
•Periodontal ligament space

41. Biomechanical considerations :
•Long span bridges
Bending & deflection
Torquing forces – flexing
•Double abutments
Unfavorable crown-root ratio
Secondary abutment crown root ratio as much as
primary abutment
•Arch curvature
Pontic lever arm lying outside the inter abutment axis –
torquing movement
Additional retention by secondary abutments
Canine replacement FPD

42. CLASSIFICATION OF BRIDGES
1.Depending upon location – Anterior bridges
– Posterior
bridges
2.Depending number of teeth – 2 unit bridges
– 3 unit bridges
3.Recent classification – Tooth supported FPD
– Implant supported
FPD
– Resin bonded FPD
Tooth supported FPD – Conventional or rigid FPD
– Cantilever FPD
Resin bonded FPD – Conventional
– Fiber reinforced

43. Implant supported FPD – Screw retained FPD
– Cement retained FPD
•Depending on material used– Cast metal FPD
– All ceramic FPD
– Metal ceramic FPD
– Resin veneered FPD
•Depending upon construction – Cast metal FPD
– CAD CAM assisted
FPD
– Direct fibre
reinforced FPD

44. TYPES OF BRIDGES
Fixed-fixed bridge
Fixed removable bridge

45. Spring cantilever bridge
Fixed movable bridge
Cantilever bridge

46. Compound bridge
Adhesive bridges

47. Advantages Disadvantages
A.Fixed-fixed
•Maximum retention and strength
•More practical for larger bridges
•Requires parallel preparation more
tooth reduction
•Parallelism is difficult to achieve in
widely separated abutment teeth and
malaligned teeth
B. Fixed – Movable
•Preparation need not be parallel
•More conservative preparation for
minor retainers
•Allows minor movement of tooth
•Parts can be cemented separately
•Cannot be given in long edentulous
spans
•More complicated lab procedure
C. Cantilever
•Most conservative design as only
one tooth is involved
•Easy laboratory construction
•Length of span is limited
•Can lead to tipping and rotation of
abutment tooth

48. Advantages Disadvantages
•The sound anterior teeth need not be
prepared as abutments
•Patient may not tolerate the bar
•Difficulty in maintaining hygiene
beneath bar
•Pontic may be traumatic to the
gingiva because of springiness of
bar that allows for pontic movement
E. Compound bridge : Ex: Fixed-fixed and cantilever bridges
Fixed-fixed and fixed moveable
Advantages Disadvantages
•A relatively complex bridge is
broken down into smaller units
permitting any repair work when
necessitated at any time.
•Simplifies the fabrication process of
the prosthesis
•Number of appointments are
increased
D. Spring cantilever

49. F. Adhesive bridges :
Eg: Rochette bridges, Maryland bridges
Advantages Disadvantages
•Minimal tooth reduction
•Esthetic
•May lead to overcontouring of the
metal plate
•Plaque retention at the margins –
hence cannot be used in cases with
high caries rate

50. RETAINERS
Extracoronal restorations : use a veneer to restore external
portions of a prepared tooth to tissue compatible contour and
obtain retention and resistance to displacement primarily form the
fit of the restorations to the external walls of the preparation.
Complete veneer crowns : restore all surfaces of the clinical
crown. The restorative material may be all metal, all ceramic
(porcelain), a metal-ceramic combination or a metal with
processed resin (cross-linked).
Partial veneer crowns : restore only a portion of the clinical
crown.
Three-quarter crowns : restore the occlusal surface and three of
the four axial surfaces (not including the facial surface).
Reverse three-quarter crowns : restore all surfaces except the
lingual surface.

51. Seven eighths crowns : are extensions of the three quarter crown
to include a major portion of the facial surface.
One half crown : veneers restore the occlusal and mesial surfaces,
as well as portions of the facial and lingual surfaces. Used as a
retainer for fixed partial denture abutment with a pronounced
mesial inclination.
Laminates : are veneer restorations that restore the facial surface
of a tooth for esthetic purposes. They are fabricated from resin or
dental porcelain : they bond to etched enamel with a composite
resin luting agent.
Resin-bonded restorations : are cast metal partial veneers that are
bonded to etched enamel. Used as retainer for an FPD. Commonly
referred to as “Maryland Bridge”.
Intracoronal restorations : obtain their retention and resistance to
displacement from the intimate fit of the restoration within the
confines of the coronal portion of the tooth.

52. An inlay is the classic intracoronal restoration.
The onlay is a modification of the inlay to restore the occlusal
surface of the tooth.
Pinledge : is a modification of an anterior three quarter crown
preparation to obtain primary retention and resistance from long
parallel pins.
Radicular retained restorations : consist of a post or dowel with
an attached core that obtains it retention and resistance to
displacement from the prepared root portion of an endodontically
treated tooth.
The post and core (dowel and core) may be
•Custom cast, where the radicular retainer is fabricated to fit the
root preparation OR
•Prefabricated, where the root preparation is designed to fit a
stock post and a core is built up with silver amalgam or rarely,
composite resin.

53. PONTICS
Fucntions :
•To improve esthetics
•To stabilize occlusion
•To improve masticatory efficiency
Principles that guide design of pontic :
•Cleansibility
•Appearance
•Strength

54. Features in pontic design :
Biologic
cleansable surface
no pressure on tissues
Mechanical
Rigid and strong
Connector
Metal ceramic
frame work
Esthetic
Morphology of tooth
Sufficient space for
procelain

55. CLASSIFICATION OF PONTIC DESIGN
Mucosal contact
•Saddle
•Modified saddle
•Ridge lap
•Modified ridge lap
•Bullet
•Ovate
•Conical

56. No-mucosal contact
Modified sanitarySanitary (Hygienic)

57. Treatment planning for fixed prosthesis includes following
considerations :
Patient’s desires, expectations and needs
Systemic and emotional health
•Elderly or debilitated patients
•Patients requiring antibiotic prophylaxis
•Medications - xerostomia
•Bruxism
•Carrier states of infectious diseases such as hepatitis B and
AIDS
Periodontal factors
•Inflammation
•Furcation invasions

58. CLASSIFICATION OF FURCATION INVOLVEMENT
The following classification, introduced by Glickman in
1953, allows a better understanding of patient prognosis and
therapy for furcation involvements.
Grade I involvement : is the incipient or early lesion. The
pocket is suprabony, involving the soft tissue; there is slight bone
loss in the furcation area. Radiographic change is not usual, as
bone loss is minimal.
Grade II (cul-de-sac) involvement : The radiograph may or
may not reveal the grade II furcation involvement.
Grade III involvement : In this type of furcation involvement,
the interradicular bone is completely absent. By the facial and/or
lingual-orifices of the furcation are occluded by gingival tissue.
Therefore, the furcation opening cannot be seen clinically, but it
is essentially a through and-through tunnel.

59. Grade IV involvement : As in grade III lesions, the
interradicular bone is completely destroyed, but in grade IV
involvement, the gingival tissue is also recessed apically so that
the furcation opening is clinically visible. Therefore, these
involvement also exhibit tunnels, without the orifices being
occluded by the gingiva.
The radiographic picture is essentially the same as that of
grade III lesions.

60. Margin placement :
The gingiva is healthiest when margins are placed well above (i.e.
1 to 2 mm) the gingival crest (supragingival)
Subgingival margins are recommended when
•Esthetics demand.
•Retention requirements.
•The location of caries or persisting restoration.
•Root sensitivity.
•Areas of cervical erosion or root fracture.
In these cases supragingival margins is impractical.
Supragingival margin may also be more susceptible to
cement dissolution.

61. Biologic width :
Histologic studies by Gargiulo et al have demonstrated a band of
soft tissue attachment between the base of the gingival sulcus and
the alveolar crest that is composed of approximately 1 mm of
junctional epithelium (attachment epithelium) and 1 mm of
connective tissue fibers. This dentogingival attachment, referred to
as the “biologic width”.
An encroachment on the biologic
width can be prevented by placing
the preparation margins at least
2 mm coronal to the alveolar
crest.

62. Occlusion :
Every fixed restoration affects occlusion. Occlusal
restoration should result in
•Simultaneous equalized contact of all teeth (anterior and
posterior) in maximum intercuspation (CO) at a physiologic
vertical dimension of occlusion.
•A physiologic plane of occlusion.
•A functional anterior guidance (vertical and horizontal
overlap of the anterior teeth) that will protect the posterior
teeth form interceptive occlusal contacts in eccentric
positions.
•A comfortable, unlocked arrangement of cusps, fossae,
grooves and ridges that will not restrict functional jaw
movements.

63. •Axial loading of all posterior teeth.
•An anatomic form to the cusps, fossae, marginal ridges and
sluiceways that will minimize interdental food impaction and
contribute to efficient communication of food.
•Occlusal and proximal tooth contacts that will lend long-term
stability to the occlusal scheme.
•An aesthetic and phonetic relationship of the anterior teeth.
•Occlusal surfaces fabricated of a material that wears like
natural enamel.

64. Esthetics :
The patients concern with esthetics should not be under
estimated.
Factors affecting esthetics (unnatural appearance).
•Unfavourable anterior guidance
•Unfavourable plane of occlusion.
•Pontic space
oNarrow – due to drifting of teeth
oWide – due to diastema present before extraction.
•Thin, friable, translucent gingiva combined with a high lip line
can defy inconspicuous finish lines for maxillary anterior
esthetic veneer crowns.

65. •The long clinical crowns, that commonly result from surgical
periodontics are particularly troublesome to restore esthetically.
•A defective anterior ridge area as a result of trauma,
developmental abnormality or severe periodontal disease may
require ridge augmentation followed by a conventional FPD.
Prosthetic restoration may be employed using an FPD (i.e. with
gingival colored porcelain) or more commonly, with a
removable partial denture (RPD).
•Bonded laminate veneers may be recommended to restore
esthetics to blemished but sound anterior teeth and particularly
for tetracycline stained teeth.

66. ENDODONTIC CONSIDERATION :
The endodontically treated tooth : an endodontically
treated tooth is commonly restored with conservative tooth
preparation and a cast restoration.
When there is insufficient remaining tooth structure to
support an extracoronal restoration, coronoradicular stabilization
with a post and core is indicated.
Pulpless teeth can successfully
function as of abutments to an FPD
or RPD whereas the one with a short
root and a narrow canal that cannot
be negotiated to place a post is a
poor candidate as an abutment for
FPD.

67. Elective endodontic therapy :
Endodontic therapy may be necessary for a supraerupted
or malaligned tooth to improve the arch relationship, occlusion as
well as esthetics.

68. ABUTMENT SELECTION
Bone support :
Ante (1926) stated that “the abutment teeth should have a
combined pericemental area more than that of the tooth or teeth to
be replaced” – Ante’s law.
A ratio of 1:1 or greater would satisfy “Ante’s law”.

69. Nymen and Ericsson (1982)
(J. of Clinical Periodontology).
This study is anti-Antes law.
The success of the treatment was
attributed to
•Proper elimination of all bacterial
deposits from crown and root
surfaces during active phase of
therapy and supplemented by
maintenance phase.
•The second feature was proper
bridge design which prevented
undue stress concentrations on
remaining periodontal tissues.

70. Root proximities:
There must be adequate clearance between the roots of
proposed abutments to permit the development of physiologic
embrasures in the completed prosthesis.
Selective extraction or root resection procedures may be
the only solution to the root proximity.
Common path of insertion:
Abutment teeth to an FPD must be prepared with a
common path of insertion for all retainers when a rigid design is
employed.
If the long axes of the teeth diverge or converge from
parallelism by more than 25 degrees, tooth preparation becomes
more difficult.

71. MESIALLY TILTED MOLAR
The mesial one-half crown preparation, the non-rigid
attachment (semiprecision or stress breaker attachment) and the
telescope prosthesis have been suggested as solutions to the
problem.

72. With extreme malalignment, orthodontic therapy may be only
logical approach

73. Abutment selection for the cantilever:
A classic FPD design is the lateral incisor cantilever pontic
supported by a strong canine. A cantilever first premolar pontic can
occasionally eliminate the need to prepare the canine-thus
preserving the natural canine function.
The abutments must offer better than average support tooth
preparations must be extremely retentive and the occlusal scheme
must be as close to ideal as possible.

74. Pier abutments:
A pier (intermediate) abutment has the potential to
produce unfavorable leverage and an unseating effect on
terminal retainers. Fracture of the cement seal and cement
failure is a distinct possibility.
The non-rigid connector has been suggested as a
solution to this problem.
The female portion of the non-
rigid connector is commonly
placed within the confines of
normal tooth contours on the distal
surface of the intermediate
abutment.

75. Splinting:
Splinting was once widely accepted in prosthodontics.
Immobilization of teeth by joining them together with soldered
retainers was thought to prevent the periodontal breakdown of
healthy teeth and to arrest bone loss in compromised teeth.
Splinting is arduous, expensive, and time consuming; the
completed restoration is difficult for the patient to clean. Long
term serviceability is a significant disadvantage of splinting, and
the failure of a single abutment or retainer can jeopardize the
entire prosthesis.
When in doubt do not splint!

76. Combining Fixed and Removable Prosthodontics :
As more patients retain their teeth into the later decades
of life, the need for innovative approaches to treatment
planning intensifies.
The two common clinical situations when fixed and
removable prosthodontics are integrated are
(a) the crowned abutment for a removable partial denture and
(b) the overdenture.

77. TMJ and Muscles of Mastication :
The statues of the patent’s muscles of mastication and
TMJ must be assessed. A quiescent TMJ problem may become
painfully apparent after fixed prosthodontic care with the dental
treatment seemingly the cause. Any evidence of dysfunction must
be addressed before any definitive prosthodontic care.

78. Comprehensive planning :
A comprehensive sequential approach to treatment planning
is essential. Planning for fixed prosthodontics must not be
independent of other disciplines of dentistry. Hasty, segmented
planning that ignores major aspects of needed treatment defies
modern concepts of treating “the whole patient” rather than
individual teeth.
Prognosis :
The dentist should propose a treatment plan that offers a
favorable prognosis. The less disease present at the onset and the
less complex the treatment, the more favorable the prognosis.

79. CONCLUSION
Successful treatment is the result of a logical diagnosis
and a rational sequence to the treatment plan. A comprehensive
oral examination, distinct radiographs and well defined
diagnostic casts are essential ingredients for diagnosis. The
approach to treatment planning should be meticulous, flexible
and scholarly.

80. REFERENCES
1.Contemporary fixed prosthodontics – 3
rd
edition
Stephen F. Rosensteil, Martin F. Land, Junhel Fujimoto.
2.Fundaments of fixed prosthodontics – 3
rd
edition
Herbert T. Shillingburg, Sumiyo Hobo.
3.Tylman’s theory & practice of fixed prosthodontics
- 8
th
edition, 1989 – William F.P. Malone, David L. Koth.
4.Planning & making crowns & bridges
- Bernard G.N. Smith – 3
rd
edition 1998.
5.Fixed prosthodontics – Keith E. Thayer.
6.Composite restorations – Jordan.

81. THANK YOU