Fpd Diagnosis and Treatment Planning Pk

Diagnosis and treatment planning in fixed partial denture

Preeti Kalia2nd Year P.G.

Department of ProsthodonticsAECS Maaruti Dental College

Planning is bringing the future into the present so that you can do something

about it now

Diagnosis and treatment planning in fixed partial dentue

Definitive diagnosis

Identification of the patient’s

needs

Treatment planning for single tooth restoration

Treatment planning for

multiple missing teeth

Abutment evaluation

Canine replacement

Cantilever fixed partial

denture

Special problems

Treatment sequence

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

Removable partial

denture

Tooth supported

fixed partial denture

Implant supported

fixed partial denture

Resin bonded bridges

Conventional

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

References

Thomas J . Mc Garry ,Classification system for partial edentulism , J Prosthodont 2002; 11,3:181-193

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