Cons lec. No.
..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 :
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 :
2.modified ridge lap
4.sanitary (hygienic )
*Treatment modalities fixed or Removable :
-Depends on :
1.abutment condition and number =>
-root morphology & cr/root ratio
4.pt related factors => age , cost and demands .
*Biomechanical management :
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) ..
*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 :
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 :
3. root resection
4.amputation and hemisection
*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 :
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 .