Enjoy what left of the semester seniors xd



Download 30.83 Kb.
Date conversion08.12.2016
Size30.83 Kb.




Cons lec. No.

2.3.2015

Dr.suzan

..ENJOY WHAT LEFT OF THE SEMESTER SENIORS XD ..

Management of periodontally involved teeth :

*Success of any Restorative or prosthodontic treatment largely depends on long term healthy and stability of surrounding periodontal tissues .

If the pt have periodontitis u have to treat and wait then u have to evaluate , after that u can start your restorative work , the periodontal health must be in priority before initiation any work.

SO as a rule in your life , always make sure that periodontal status is healthy and stable before establishing restorative work .

*Periodontally compromised teeth : teeth that are surrounded by healthy periodontium , however reduced periodontium ( which means soft and hard tissues are less than normal ) usually have normal sulcus depth when probing between 1&2mm , have gingival recession but without any source or pathology .

-teeth concerned as abutment for RPD and FPD should have adequate attached gingiva , bone level ,sulcus depth not >3mm , mobility not more than Grade II and absence of any pathology .

If all these criteria present then this is healthy periodontal compromised teeth and can serve as abutment .

*Prerequisites of the restorative treatment :

1.Marginal location and integrity

Most favorable is supragingival , respective your biological width . you have to do probing if u have 1mm probing depth you can't do subgingival margin , but if u have 2-3mm u can do subgingival margin .

If u violate the biological width , u will end up with 2 scenarios :

A.gingival inflammation

B.recession

Biological width :distance between crest of the bone and the base of the sulcus , its 2.04mm and consist of junctional epithelium and connective tissue .

So always do supragingival margin whenever possible , avoid damage to attachment apparatus and always make the margin well adapted ( not positive or negative ledge or open margin ) .

2.Tooth preparation :

If u make inadequate buccal preparation u will end with over contoured crown .



3.provisional Restoration :

Don’t be impinging ,well polished and the embrasure should allow adequate OH .



4.impression procedure :

That least traumatic , Retraction cord placement is the most traumatic during impression procedure

5.Crown contour :

Always do a flat emergence profile.

6.pontic and embrasure design :

1.ridge lap

2.modified ridge lap

3.conical

4.sanitary (hygienic )

5.modified sanitary

*Treatment modalities fixed or Removable :

-Depends on :



1.abutment condition and number =>

-bone support

-root morphology & cr/root ratio

-mobility



2.Ridge contour

3.occlusal forces

4.pt related factors => age , cost and demands .

*Biomechanical management :

1.Mobility

Those teeth peridontally compromised so u have to expect that there is mobility .

Can result from :

1.reduced periodontal support … the resultant mobility is irreversible

2.increased periodontal ligament width (the mobility is reversible) ..

1.orthodontic trt

2.occlusal trauma

*if the tissues were healthy,the mobility called physiologic tooth mobility .

*in a tooth exposed to occlusal trauma there will be loss of bone level but without pocketing , however after relieving this occlusal trauma or selective grinding the level of the bone will return to normal level .

*Splinting : the only situation that we put 2 separate crowns as a one piece is to do splinting .

-we do splinting : 1.in grade II mobility

2.if a pt complain of tooth mobility

-Basic principles in splinting :

1.healthy periodontium

2.Multidirectional as much as possible

3.occlusal harmonized .. we try to distribute occlusal forces on a larges no. of teeth equivalently (equivalent simultaneous bilateral balanced occlusion so the occlusion will be stable and favorable) .

-its important to control direction , magnitude and the intensity of the functional forces .

-try to direct occlusal forces along the long axis of the tooth by achieving cusp to fossa points ( not cusp to margin or cusp to cusp points ) . Because lateral forces v.harmful to the teeth and forces along the long axis of the teeth will be dissipated alongperiodontal ligament in a harmonious healthy way .

-tooth mobility resulting from reduce periodontal support requires splinting only if masticatory function is disturbed .

*Types of splinting :



1.ligature wire .. not used anymore .

2.Acrylic Removable splint .. not v.comfortable to the pt and don’t do splinting all the time .

3.Direct composite resin .. between the teeth especially lower Ant. Teeth (Fixed) , in perio clinic when a pt come with reduced healthy periodontium in ant. Area we put composite and leave spaces to clean underneath . the problems here are the composite wear and it may breaks .

4.indirect composite .. we prepare the teeth then take an impression and the technician will prepare it .

-Metal veneers equivalent to direct composite in the past ,construct as a one metal piece we put it lingually .

5.cast metal splint

6.fiber reinforced composite .. mesh of polyethylene fibers or glass impregnated with composite .

Acid etch then bonding and apply the mesh .

7.Fixed Partial Denture … if we have a missing teeth and grade II mobility so we do a bridge to replace missing and do splinting.

*Splinting … in the final stages of periodontal diseases , the progressive breakdown of supporting tissues may reached an apical level , despite treatment and occlusal adjustment.



  • In a case report ; there were loss of periodontal tissues and when u see the radiograph definitely u will decide to extract the teeth , but here the dr. decide to put a bridge on the abutments and the bridge worked for 20 years .

  • Nowadays we don’t do FPD on mobile abutment because u have the implant choice , but if u have to choose between FPD and acrylic RPD .. the FPD will survive longer .

  • Conclusion from the case report : the functional forces exerted on the bridge are evenly distributed over the entire extension of the splint and their leathery effect is reduced especially when number and distribution is favorable ( Multidirectional or cross arch splinting ) .

  • Studies emphasize that success of treatment in these teeth u have to do adequate periodontal treatment , proper maintenance and stability of periodontal health and careful planning .

2. Furcation involvement :

You have many choices :

1.overlap treatment

2.tunneling procedure

3. root resection

4.amputation and hemisection

5.root separation

*prosthetic considerations for resected teeth :

1.the margin is thin chamfer or knife edge.

2.metal margin or gold

3. well adapted margin

4.minimal occlusion loading ( by evenly distributed forces )

5.make sure you have adequate biological width

6.make sure you have accessibility oral hygiene .

*Esthetic management :

-consequences of recession :

1.root caries

2.sensitivity

3.food impaction

4.phonetic concern

5.abrasion lesions

-management :



  • Perio treatment then treatment of recession .

  • If a pt have low lip line and the esthetic not in consideration you can treat the dentine hypersensitivity with any methods .



  • Acrylic Gingival prosthesis : difficult to accept it , but it solve many problems like esthetic , phonetics , give lip support and its removable and also it will reduce food impaction .

  • Colored ceramic could be a solution


Done by Sumaya H.Abuodeh

Forgive me for any mistake .


The database is protected by copyright ©dentisty.org 2016
send message

    Main page