Rpd Lecture #2 Fall 09

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INITIAL EXAMINATION PROCEDURES MUST HAVE

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1. COLLECTED INFO
2. COMPLETED/INTERPRETED PRIOR TO DIAGNOSIS OF CASE
3. TREATMENT PLAN FORMULATED BASED ON INITIAL EXAM AND DIAGNOSIS
4. ASCERTAIN PATIENT CC
5. PATIENT DESIRED EXPECTATION
6. THOROUGH MEDICAL/DENTAL HISTORY
7. WILL MEDICAL HISTORY AFFECT TREATMENT DELIVERY OR PLAN
8. MEDICAL CONSULT AS NEEDED

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AFTER EVALRATING THE CASE AT THE INITIAL APPOINTMENT WHY TO REFERAL TO A PROSTHODONTIST

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1. COMPLEXITY OF CASE
2. PATIENT DESIRES/EXPECTATION
3. DENTIST'S TRAINING AND CAPABILITIES
4. BEFORE INITIATING EXTENSIVE DIAGNOSTIC PROCEDURES

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RADIAGRAPHIC EXAMINATION MUST CONTAIN

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1. FULL MOUTH RADIOGRAPHS: (PERIAPICAL/BITEWING FILMS)
2. IF PANORAMIC RADIAGRAPH TAKEN: PERIAPICAL/BITEWING FILMS OF REMAINING TEETH MAY BE INDICATED

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WHY TAKE PANORAMIC THEN PERIAPICAL(PA)/BITEWING OF REMAINING TEETH

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1. TO VISUALIZE: PA AREAS
2. BONE LEVEL
3. CHECK FOR PROXIMAL DECAY
4. EVALUATE INDIRECT OR DIRECT RESTORATION MARGIN
5. TEETH PLANNED FOR ABUTMENT USED

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WHY IS EVALUATION OF RADIOGRAPHS IMPORTANT

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1. CARIES (INTERPROXIAL AREA)
2. BONE LEVEL/BONE SUPPORT
3. BONE INDEX (RESPONSE TO STRESS)
4. INFECTIONS, CYSTS, NEOPLASTIC PROCESSES
5. ROOT FRAGMENTS
6. ENDODONTICALLY TREATED TEETH

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WHY REMOVE ROOT FRAGMENT

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1. IF ANATOMICALLY FEASIBLE TO DO SO
2. MAY BE SOURCE OF INFECTION LEFT IN BONE

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WHERE ARE CYSTS APPARENT

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1. AREA OF DEVELOPING FIRST MOLAR

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A ROOT MORE RESISTANT TO STRESSES AND A MORE DESIRABLE ABUTMENT

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1. DIVERGENT ROOT

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A ROOT LESS RESISTANT TO STRESSES AND LESS DESIRABLE ABUTMENT

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1. CONICAL ROOT

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SHOULD ISOLATED ABUTMENT TOOTH BE USED AS AN RPD ABUTMENT

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1. YES, IF FPD RESTORATION PREVENT TORQUING OF ISOLATED ABUTMENT

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EXTRAORAL EXAM PROCEDURES PREFORMED FOR

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1. CANCER SCREENING
2. HEAD/NECK EVALUATION (COMPLETE)
3. EVALUATE SUBMENTAL, SUBMADIBULAR, PAROTID AND CERVICAL AREA FOR LYMPHADENOPATHY OR UNUSAL SWELLING
4. EVALUATE FACIAL SYMMETRY

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WHICH EXTRAORAL EXAM IS REFER TO ORAL SURGEON OR MD ASAP

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1. POSSIBLE MALIGNANT LESION
2. PHILTRUM OF NOSE

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INTRAORAL EXAM PROCEDURES PREFORMED FOR

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1. CANCER SCREENING
2. EXAMINATION OF THE: LIPS, LABIAL, AND BUCCAL MUCOSA
3. EXAMINATION OF THE: HARD AND SOFT PALATE, TONGUE AND ORAL PHARYNX

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MOST LIKELY TO BE FOUND IN INTRAORAL EXAM PROCEDURES

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1. AMALGAM TATTOO

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LESIONS FOUND IN INTRAORAL EXAM THAT ARE DANGEROUS AND NEED TREATMENT W/ SURGEON ASAP

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1. MALIGNANT MELANOMA OF BUCCAL MUCOSA
2. CARCINOMA OF THE VENTRAL SURFACE OF TONGUE

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OPERATIVE CHARTING MUST SHOW

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1. CHART EXISTING RESTORATIONS
2. CHART CLINICAL PATHOLOGY( DECAY, MISSING OR FRACTURED RESTORATIONS AND DEFECTIVE MARGINS)
3. CHART RADIOGRAPHIC PATHOLOGY (DECAY, DEFECTIVE MARGINS)

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WHEN CARIES FINDING IS CHARTED, NEXT STEP IS START THINKING ABOUT

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1. ETIOLOGY (CAUSE)
2. DIAGNOSIS
3. TREATMENT TO ARREST PROCESS
4. DENTIST/PATIENT ACTIVE ROLE IN DISEASE PREVENTION AND CONTROL

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PERIODONTAL CHARTING SHOULD INCLUDE

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1. POCKET DEPTHS
2. ASSESSMENT OF ATTACHMENT LEVELS
3. FURCATIONS
4. MUCOGINGIVAL PROBLEMS
5. TOOTH MOBILITY
6. CHART RADIOGRAPHIC PATHOLOGY (BONE LOSS:VERTICAL OR HORIZONTAL)

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WHEN PERIODONTAL DISEASE IS CHARTED, NEXT STEP IS START THINKING ABOUT

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1. ETIOLOGY
2. DIAGNOSIS
3. TREATMENT TO ARREST PROCESS
4. DENTIST/PATIENT ACTIVE ROLE IN DISEASE PREVENTION AND CONTROL

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ENDODONTIC EVALUATION SHOULD INCLUDE

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1. VITALITY TESTS OF REMAINING TEETH (POSSIBLE ABUTMENT)
2. EVALUATE PREVIOUS ENDODONTIC TREATMENT
3. CHART RADIOGRAPHIC PATHOLOGY(WIDENED APICAL PDL)

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OCCLUSAL EXAMINATION SHOULD INCLUDE

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1. EVALUATE/DOCUMENT INFO AS ON OCCLUSAL EXAM FORM
2. AXIUM (DIFFERENT FORM REQUESTS SIMILAR INFO)

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EDENTULOUS RIDGE EXAM MUST INCLUDE

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1. EVALUATE/DOCUMENT INFO AS ON EDENTULOUS RIGDE FORM
2. DETERMINE NEED FOR PRE-PROSTHETIC PROCEDURE
3. PRE-PROSTHETIC TISSUE CONDITIONING FOR INFLAMED SOFT TISSUES
4. PRE-PROSTHETIC SURGERY(REDUCTION OF PALATAL TORUS, MANDIBULAR LINGUAL TORI

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PROCEDURES FOR AN EDENTULOUS EXAM THAT NEED FOR PRE-PROSTHETIC SURGERY

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1. REVEIW CASE W/ ORAL SURGEON
2. MARK AREA ON CAST, REDUCTION OF EXOSTOSED NEEDED
3. SURGICAL GUIDE MADE FROM ORIGINAL CAST MODIFIED BY REMOVING EXOSTOSES FROM CAST
4. MODIFIED CAST AND TRANSPARENT SURGICAL GUIDE GIVEN TO ORAL SURGEON

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PROSTHETIC HISTORY MUST SHOW

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1. EVALUATE/DOCUMENT INFO AS INDICATED ON THE PROSTHETIC HISTORY FORM
2. EVALUATE PATIENT'S EXISTING PROSTHESIS
3. DECIDE ON RECOMMENDATION: REMAKE, RELINE/REBASE OR NO TREATMENT

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EVALUATED PROSTHESIS MUST SHOW

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1. NO DIRECT RETAINER LEFT SIDE OF ARCH
2. NO REST SUPPORTING 3 INCISOR REPLACEMENT SEGMENT IN ANTERRIOR
3. RECOMMENDATION:REMAKE RPD AFTER OTHER PROBLEMS ADDRESSED

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PRODTHESIS SHALL SHOW NO DIRECT RETAINER LEFT SIDE OF ARCH BECAUSE

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1. CANNOT HAVE UNILATERAL DIRECT RETAINER

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WHAT HAPPENED WHEN NO REST SUPPORTING 3 INCISOR REPLACEMENT SEGMENT IN ANTERIOR

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1. W/O RESTS, ANTERIOR SEGMENT WILL BE DRIVEN INTO TISSUE WHEN PATIENT BITES ON FOOD

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EXAMPLES OF PROBLEMS ADDRESSED BEFORE RPD REMAKE RPD

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1. DECAY
2. PERIO PROBLEM

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STATES THE RATIONALE FOR MOUNTED CAST

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1. PROVIDE ACCURATE REPRODUCTION OF TEETH/ ADJACENT TISSUES
2. EDENTULOUS SPACES MUST BE REPRODUCED TO ALLOW DETERMINATION OF THE DENTURE BASE TO BE USED AND THE EXTENT OF AVAILABLE DENTURE-SUPPORTING AREA
3. EVALUATION OF INTERARCH RELATIONS AND OCCLUSAL CONTACTS IN CENTRIC/ECCENTRIC JAW POSITION
4. TOPOGRAPHICAL SURVEY OF TEETH/TISSUES
5. GAUGE TOOTH/TISSUE ALTERATIONS THAT ARE NEEEDED TO COMPLETE THE RPD AS PLANNED
6. TREATMENT PLAN PRESENTATION TO PATIENT
7. FABRICATE CUSTOM TRAYS
8. SENT TO DENTAL LAB AS SUPPLEMENT TO LABORATORY PRESCRIPTION
9. PART OF PATIENT'S PERMANENT RECORD

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PRELIMINARY PARTIAL DENTURE DESIGN SHOULD:

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1. PROVIDE PARTIAL DENTURE DESIGN FOR MAXILLARY AND/OR MANDIBULAR ARCH
2. DETERMINATION OF TOOTH MODIFICATIONS AND/OR RESTORATION NEEDED TO COMPLETE THE RPD AS DESIGNED
3. STATEMENT 1 AND 2 MUST BE CONSIDERED IN FORMULATING THE TREATMENT PLAN
4. TRIPOD AND SURVEY CAST PRIOR TO DESIGN

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TREATMENT PLAN CONTAIN

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1. SEQUENCE OF PROCEDURES PLANNED FOR PATIENT AFTER DIAGNOSIS
2. FABRICATION OF THE RPD IS THE LAST STEP IN THE TREATMENT PLAN
3. SUCCESS OF RPD CASE DEPEND ON ACCURATE DIAGNOSIS AND PROPERLY SEQUENCED TREATMENT PLAN

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ADVANTAGE OF RPD SELECTION OVER FIXED PARTIAL DENTURE (FPD)

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1. REPLACEMENT OF TEETH AND TISSUE
2. LONG SPAN EDENTULOUS SPACES NOT SUITABLE FOR FIXED PROSTHODONTICS
3. EXTENSION BASES NEEDED
4. PATIENTS WHO CANNOT TOLERATE LONG DENTAL PROCEDURES
5. FINANCIAL CONSTRAINTS

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ADVANTAGE OF COMPLETE DENTURE (CD) SELECTION OVER RPD

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1. POOR ABUTMENTS
2. RAMPANT CARIES
3. PERIODONTAL DISEASE
4. POOR ALIGNMENT OF ABUTMENT
5. PATIENT GIVEN OPTIONS RPD vs CD AND PATIENT SELECTS CD (FINANCES, DENTAL ANXIETY)

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CONSIDERATION OF RPD SHALL INCLUDE THAT:

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1. AN RPD WILL RESULT IN SUPERIOR FUNCTION
2. PATIENT'S SYSTEMIC HEALTH
3. WHICH PROSTHESIS BEST MEETS THE PSYCHOLOGICAL NEEDS OF THE PATIENT
4. WHICH PROSTHESIS BEST MEETS THE COSMETIC REQUIREMENT OF THE PATIENT

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WHY DO RPD RESULTS IN SUPERIOR FUNCTION

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1. COMPLETE DENTURE HAVE 20%-30% OF CHEWING POWER AS COMPARED TO NATURAL DENTITION
2. MANDIBLE RESORBS 4X FASTER THAN THE MAXILLA ONCE TEETH HAVE BEEN REMOVE
3. TRY TO RETAIN TEETH WHENEVER POSSIBLE

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WHY TRY TO RETAIN TEETH WHENEVER POSSIBLE

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1. TO RETAIN PROSTHESIS(RPD)
2. TO PROVIDE SUPERIOR FUNCTION COMPARED TO THE COMPLETELY EDENTULOUS ARCH
3. TO MAINTAIN BONE LEVELS IN AREAS OF RETAINED TEETH

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IN ORDER TO RECEIVE PROSTHESIS PATIENT'S SYSTEMIC HEALTH SHOULD INCLUDE

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1. HEALING POTENTIAL ( Hx OF DIABETES)
2. ABILITY TO MANAGE PROSTHESIS (ARTHRITIS OF FINGERS, COMPROMISED MANUAL DEXTERITY)

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REASON A PROSTHESIS MAY BEST MEETS THE PSYCHOLOGICAL NEEDS OF THE PATIENT

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1. PATIENT MAY DESIRE RETAINING TEETH TO AVOID COMPLETELY EDENTULOUS SITUATION

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LAST STEP IN TREATMENT PLAN

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1. RPD

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ALL OTHER TREATMENT MUST PRECEDE( GO BEFOR)

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1. RPD FABRICATION

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TRUE OR FALSE: RESTORATION MUST BE DESIGNED TO ACCEPT RPD

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1. TRUE

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A PRELIMINARY PARTIAL DENTURE DESIGN MUST BE

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1. COMPLETED AT TIME OF TREATMENT PLANNING
2. RESTORATION MUST BE PLANNED TO ACCEPT THE PLANNED RPD DESIGN

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TYPES OF IMPRESSION TRAYS

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1. STOCK TRAYS
2. CUSTOM TRAYS
3. MODIFIED STOCK TRAYS

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STOCK IMPRESSION TRAYS ARE ASSOCIATED W/

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1. PERFORATED OR RIM LOCK
2. WATER COOLED TRAYS FOR REVERSIBLE HYDROCOLLOID TECHNIQUE
3. METAL OR PLASTIC

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WHY WATER COOLED TRAYS FOR REVERSIBLE HYDROCOLLOID NOT A PREFERRED TECHNIQUE TODAY

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1. DUE TO INFECTION CONTROL
2. OLD TECHNOLOGY

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CUSTOM IMPRESSION TRAYS ARE ASSOCIATED W/

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1. FABRICATED IN TRAY ACRYLIC OR LIGHT CURED RESIN (TRIAD)
2. FIT SPECIFIC PATIENT
3. ACCURATE FIT TO DENTAL ARCH
4. ALLOWS FOR A UNIFORM THICKNESS OF IMPRESSION MATERIAL
5. ALSO CALLED TRIAD CUSTOM TRAYS OR ACRYLIC CUSTOM TRAYS

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CHARACTERISTICS OF MODIFIED STOCK IMPRESSION TRAYS

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1. USEFUL IN KENNEDY CLASS I AND CLASS II CASES
2. MODIFIED STOCK TRAY USING MODELING COMPOUND
3. AVAILABLE FROM DENTAL MANUFACTURER
4. ALLOW FOR A MORE ACCURATE FIT TO EDENTULOUS RIDGE

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METHODS OF MAKING IMPRESSIONS

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1. OPEN MOUTH METHOD
2. CLOSED MOUTH METHOD

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A PROCESS USED WHEN TAKING A OPEN MOUTH IMPRESSION

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1. TRAYS W// IMPRESSION MATERIAL SEATED ON THE DENTAL ARCH AND HELD IN PLACE BY DENTIST UNTIL MATERIAL HAS SET
2. NO CONTACT B/W TRAY/OPPOSING ARCH
3. METHOD OBTAINED BY: DIAGNOSTIC MODEL, RPD MASTER MODEL

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OPEN MOUTH DIAGNOTIC MODEL METHOD

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1. IRREVERSIBLE HYDROCOLLOID

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OPEN MOUTH RPD MASTER MODEL MODEL

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1. IMPRESSION MATERIAL/TECHNIQUE DEPENDS ON TOOTH SUPPORTED vs TOOTH TISSUE SUPPORTED (RPD)

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PROCESS WHEN TAKING A CLOSED MOUTH IMPRESSION

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1. TRAY OR REMOVABLE PROSTHESIS CONTAINING IMPRESSION MATERIAL IS SEATED ON THE DENTAL ARCH AND HELD IN PLACE BY THE PATIENT'S OCCLUSION
2. FOR RELINE/REBASE OF REMOVABLE PROSTHESIS

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IMPORTANCE OF RELINE/REBASE OF REMOVABLE PROSTHESIS

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1. IMPERATIVE THAT PATIENT MAINTAIN THE INTERARCH OCCLUSAL RELATIONSHIP BY OCCLUDING THE PROSTHESIS BEING RELINED W/ THE OPPOSING NATURAL AND/OR ARTIFICIAL TEETH
2. RELINE/ REBASE ONE ARCH AT A TIME

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EXAMPLE OF CLOSED MOUTH IMPRESSION

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1. RELINE OF COPLETE DENTURE OR RPD

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NAME THE 2 IMPRESSION TECHNIQUE

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1. PRESSURE
2. NON PRESSURE

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A NON PRESSURE IMPRESSION TECHNIQUE THAT USES MINIMAL PRESSURE ON TISSUES WHEN MAKING IMPRESSION

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1. ANATOMIC TECHNIQUE

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AN IMPRESSION TECHNIQUE THAT RECORD TISSUES IN A RELAXED STATE

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1. ANATOMIC (NON-PRESSURE) TECHNIQUE

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EXAMPLE OF ANATOMIC (NON-PRESSSURE) TECHNIQUE

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1. IRREVERSIBLE HYDROCOLLOID IMPRESSION USING A STOCK TRAY FOR DIAGNOSTIC STOCK

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A PRESSURE IMPRESSION TECHNIQUE IS CALLED

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1. FUNCTIONAL TECHNIQUE

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FUNCTIONAL (PRESSURE) IMPRESSION TECHNIQUE IS ASSOCIATED W/

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1. PRESSURE APPLY TO TISSUES
2. RECORD TISSUES IN A FUNCTIONAL STATE
3. TISSUES ARE DISPLACED DURING MASTICATION, RECORD TISSUES IN FUNCTIONAL STATE

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EXAMPLE OF FUNCTIONAL(PRESSURE) IMPRESSION TECHNIQUE

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1. IMPRESSION FOR DISTAL EXTENSION RPD( HELPS PREVENT TORQUING OF ABUTMENT)

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AN IMPRESSION OF THE EDENTULOUS DENTURE-BEARING AREA(S)

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1. ALTERED CAST IMPRESSION

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PROCESS OF ALTERED CAST IMPRESSION ASSOCIATED W/ ANATOMIC IMPRESSION(AI)

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1. TAKEN AFTER FABRICATION OF RPD FRAMEWORK ON CAST MADE A (AI)

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PROCESS OF ALTERED CAST IMPRESSION ASSOCIATED W/ FUNCTIONAL IMPRESSION(FI)

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1. IMPRESSION TRAY ARE ATTACHED TO THE EDENTULOUS AREA OF THE RPD FRAMEWORK TO ALLOW FOR A (FI) OF EDENTULOUS AREAS

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TYPES OF DENTAL CASTS IN RPD THERAPY

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1. DIAGNOSTIC CAST
2. MASTER CAST
3. REFRACTORY CAST

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FUNCTIONS OF A MASTER CAST

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1. USED BY LABORATORY TECH TO FABRICATE A PROSTHESIS
2. ACCURATE REPLICA OF THE PREPARED MOUTH
3. USED TO FABRICATE DUPLICATE MODELS FOR USE IN SEATING RPD FRAMEWORK TO AVOID DAMAGE TO MASTER CAST
4. USED TO FABRICATE REFRACTORY CAST

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AN ACCURATE REPLICA OF MASTER CAST FOLLOWING BLOCKOUT OF UNDESIRABLE UNDERCUT AREAS

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1. REFRACTORY CAST

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WHICH CAST IS POURED IN AN INVESTMENT MATERIAL

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1. REFRACTORY CAST

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RPD FRAMEWORK IS WAXED, INVESTED, BURNED OUT, AND CAST ON WHICH CAST

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1. INVESTMENT CAST PRODUCED FROM REFRACTORY CAST

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A CAST BROKEN UP AND LOST TO RETRIEVE THE CASTED RPD FRAMEWORK

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1. INVESTMENT CAST

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WHAT IS ADJUSTED AND FIT TO DUPLICATES OF MASTER CAST (AVOIDS DAMAGE TO MASTER CAST)

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1. COMPLETED RPD FRAMEWORK

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MATERIAL USED FOR PATIENT TRY-IN APPOINTMENT

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1. COMPLETED RPD FRAMEWORK

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A THEORETICAL LINE AROUND WHICH A REMOVABLE PARTIAL DENTURE TENDS TO ROTATE

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1. FULCRUM OR AXIS OF ROTATION

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NAME THE 3 AXES OF ROTATION TO EVALUATE FOR THE RPD

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1. HORIZONTAL ROTATIONAL AXIS(FULCRUM LINE AXIS)
2. LONGITUDINAL ROTATIONAL AXIS
3. VERTICAL ROTATIONAL AXIS

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AN AXIS CONNECTING OCCLUSAL RESTS, AROUND WHICH A REMOVABLE DENTURE TENDS TO ROTATES UNDER BILATERAL VERTICAL SEATING FORCES

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1. HORIZONTAL ROTATIONAL AXIS(FULCRUM LINE AXIS)

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NAME THE VERITICAL SEATING FORCES (BILATERAL)

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1. MASTICATION (BILATERAL)
2. SWALLOWING
3. PARAFUNCTION (CLENCHING)

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AN AXIS PASSING THROUGH THE TWO REST CLOSEST TO THE EDENTULOUS AREAS

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1. FULCRUM LINE AXIS

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A LINE(AXIS) PASSING ALONG THE EDENTULOUS RIDGE CREST

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1. LONGITUDINAL AXIS

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A POINT ON VERTICAL AXIS WHICH IS USUALLY LOCATED NEAR THE CENTER OR TOWARD THE ANTERIOR OF THE ARCH

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1. VERTICAL ROTATION AXIS

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VERTICAL SEATING FORCES (UNILATERAL) FOR LONGITUDINAL AXIS

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1. MASTICATION (UNILATERAL)
2. PARAFUNCTIONAL (UNILATERAL)

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AN AXIS THAT PASSES PERPENDICULAR TO THE OCCLUSAL PLANE AND IS LOCATED NEAR THE CENTER OF THE ARCH

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1. VERTICAL AXIS

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HORIZONTAL (LATERAL) FORCES ASSOCIATED W/ VERTICAL AXIS

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1. MASTICATION
2. PARAFUNCTIONAL (BRUXING)

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HOW MASTICATION IS APPLY TO VERTICAL AXIS

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1. LOADING FORCES MAY BE APPLIED OBLIQUELY AND GENERATE HORIZONTAL COMPONENT OF FORCES

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WHERE DOES THE HORIZONTAL (LATERAL) FORCES OF ASSOCIATED W/ VERTICAL AXIS IS APPLIED

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1. EXTENSION BASES CAUSE OF BUCCOLINGUAL MOVEMENT OF THE PARTIAL DENTURE

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WHERE DOES THE FORCES ASSOCIATED W/ LONGITUDINAL AXIS APPLIED

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1. EXTENSION BASE CAUSES TISSUE WARD MOVEMENT ON LOADED SIDE
2. ROTATE AROUND LONGITUDINAL AXIS FORMED BY THE RIDGE CREST