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158 Cards in this Set
- Front
- Back
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What causes tooth loss?
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Common:
-caries -periodontal disease -iatrogenia Uncommon: -congenitally missing -trauma |
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Occlusal lesion treatment options
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minimal: sealant
Moderate: composite enlarged: onlay extensive: full crown + RCT + core build up or perio surgery |
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Proximal lesion treatment options
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minimal: amalgam or composite
moderate: amalgam enlarged: onlay full crown extensive: Full Crown + RCT _ core build up or perio surgery |
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Gingival lesion treatment options
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minimal: composite
moderate: glass ionomer and composite enlarged: Veneer extensive: Full crown + RCT + core build up or perio surgery |
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Treatment options for restoring the single missing tooth
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-no tx
-FPD: when tooth bounded edentulous space and abutment teeth are acceptable to hold prosthesis: - conventional FPD (Gold, PFM, all ceramic) - partial veneer FPD - resin bonded FPD - catilever FPD -Dental Implant -Removable partial denture (RPD) |
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Implatns?
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-their success rates (10 years) are better than FPD equivalents
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RPDs?
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-restore soft and hard tissue with minimum tooth preparations
-it is an option when dealing with a challenging bounded edentulous space (BES) b/c they restore soft tissue also or you don't have a BES at all- JUST edentulous space -minimally invasive -provide an economical option for patients that have several teeth missing |
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cantilevers?
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-sometimes can be the answer to a short RR
-areas to consider their use: missing lateral incisors, 1st premolars, or in conjection with dental implants |
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Prosthesis
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an artificial replacement for a missing part of the human body
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Fixed partial denture or Prosthesis (FPD)
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any dental prosthesis that is luted, scred or mechanically attached or otherwise secruely attached to natural teeth or tooth roots and/or dental implants that furnish the primary support for the dental prosthesis
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Abutment:
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a tooth, a portion of a tooth or that protion of a dental implant that serves to support and/or retain a prosthesis
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Retainer:
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any type of device used for the stabilization or retention of a prosthesis
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Pontic:
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an artificial tooth on a fixed dental prosthesis (FPD) that replaces a missing natural tooth, restores its function, and usually fills the space occupied by the clinical crown
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Connector (rigid):
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the portion of a fixed dental prosthesis that unites the retainer(s) to the pontic(s)
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Framework:
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the metal or ceramic substructure portion of a fixed prosthesis (single tooth or FPD)
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Residual ridge:
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the portion of the residual bone and its soft tissue covering that remains after the removal of the tooth
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residual ridge crest:
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the most coronal portion of the residual ridge
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bounded edentulous space (BES):
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the condition that exists when a tooth or teeth is extracted and both adjacent teeth remain
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Cantilever fixed dental prosthesis:
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a fixed dental prosthesis in which the pontic is supported only on one end, and by one or more abutments
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Resin-bonded prosthesis
(Definition) |
a fixed dental prosthesis that is luted to tooth structures, primarily enamel, that has been etched to provide mechanical retention for the resin cement
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Interarch space:
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the interridge distance; the vertical distance between the maxillary and mandibular dentate or edentate arches under specified conditions
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Ante's Law
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eponym, in fixed dental prosthodontics, for the observation that the combined pericemental area of all abutment teeth supporting a fixed dental prosthesis should be equal to or greate rin pericemental area than the tooth or teeth to be replaced; as formulated for removable dental prosthodontics, the combined pericemental area of the abutment teeth plus the mucosa area of the denture base should be equal to or greater than the pericemental area of the missing teeth
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Law of Beams
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This theorem states that the amount of defection of the FPD is proportional to the cube of the length of its span (e.g. 1 pontic =x, 2 pontics=2^3x, 3 pontics =3^3x with same force)
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Is the Ceramic Crown translucent?
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-the color of the cement will aftfect the final shade IF the crown is translucent (this is crown material specific - veneers, Empress).
- use cement system with try-in water soluble cement pastes (for composite cement systems) |
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Ceramics that CAN be etched
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-Feldspathic Porcelains
-IPS Empress (Leucite) |
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Ceramics that CANNOT be etched
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-alumina or Zirconia Core
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Etching of Silica Based Ceramics
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-hydrofluoric acid or ammonium bifluoride
-the optimum concentration and duration of application has not been established -it creates microporosities on the porcelain. After intraoral manipulations during crown seating, restore etched surface with 15 sec application of 37% phosphoric acid -a 7-day delay between etching and silane application does not affect bonding |
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Silane Application
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-Ethanol solution of y-methacryloxypropyltrimethoxysilane (MPTS-EtOH)
-It increases the ceramic-resin cement bond by 20% - It is mediated thorugh the silica at the interface of ceramics -its bonding to alumina or zirconia is low and unstable over time -siloxane bonds between ceramics and silane coupling agent |
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Resin Luting Cements
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-variations of filled BIS-GMA resin and other methacrylates = modified composites
-auto-cure, light cure, dual cure types -powder-liquid, paste-paste consistencies -setting results from self cured or light cured polymerization; they increase the fracture resistance of ceramic materials that can be etched and silanated |
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Adhesion to Enamel
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-micromechanical interlocking of resin to the hydroxyapatite crystals and rods of etched enamel
-strength of enamel to composite bond 40-60 MPA |
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Adhesion to Dentin
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-infiltration of resin into etched dentin
-15 sec application of etchant produces a zone of demineralized dentin (hybrid layer) of 2-5 microns and opens 20-30 nm channels around the collagen fibers -Primer: HEMA or 4-META in multiple coats -Adhesive: stabilizes the dentin and penetrates into the tubules -strength of dentin to composite bond: 18-40 MPA |
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Alumina/Zirconia Cores
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- CANNOT BE ETCHED
-silanation provides little benefit -sandblast with 50microns Al2O3 (micro-mechanical retention) -bond strength = 22 MPA -use cement of choice -bonding of cement to core material does not occur |
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Predominantly Glass
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-aluminum oxide
-apply 10% HF acid for 1 min. rinse and dry, apply silane 1 minute, air dry -Examples: Ceramco 3, IPS e max, Ceram, Vita VM7 |
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Particle Filled Glass
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-Leucite ex. IPS Empress
- Lithium Disilicate ex. IPS e. max Press -Glass-infiltrated alumina ex. Vita in-ceram alumina |
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Polycrystalline
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-Aluminum Oxide ex. Procera
-Zirconium Oxide ex. Cercon Zirconia, Lava Zirconia, IPS e. max ZirCAD |
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Post-cementation Sensitivity
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-ASsociated with freshly prepeed/etched prepared dentin
-remnants of etching acid -low pH of certain cements -increase L/P ration of glass-ionomer cements -over-ethcing, dessication and collapse of dentinal tubules |
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Can you temporarily cement all-ceramic crowns?
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-usually no- how to retrieve it?
-if so, do not use cement containing eugenol as it inhibits polymerization of the resin -if eugenol cement was used, etching with 37% phosphoric acid after cleaning with pumice, may be the best way tto remove ZOE |
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Marginal Configurations
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1. Gold restoration: light chamfer
2. Lava restoration: heavy chamfer 3. All other all-ceramic crowns: can have shoulder or heavy chamfer 4. PFM restoration a. wide metal collar: light chamfer b. narrow metal collar: beveled shoulder c. collarles: heavy chamfer d. porcelain margin: shoulder |
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light chmfer
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-.3-.5mm dimension
-gold restorations -wide metal lingual collars of PFMs |
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Narrow metal collar
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-PFM
-.2-.3mm vertical height to facial collar |
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Why would you leave wide metal collar exposed on lower anterior tooth?
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-porcelain/metal jxn has same "issues" as the collarless margin desing- metal, opaque and porcelain being at the same interface at the same time. It is therefore the roughest, most abrasive area of a PFM restoration, with resultant periodontal implications. Most optimum material to place in contact with tissues is either metal or porcelain (not opaque)
-lower lip will cover this exposure of metal in 99% of patients -because you can (pt acceptance?) |
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How do you get metal, opaque and body porcelain to all converge at a finite, discrete, sharp margin position?
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-it's impossible- three materials cannot occupy the same location spatially simultaneously you either have metal, opaque or porcelain that is exposed at the margin
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Design "Flow"
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-metal can be polished, porcelain can be polished or glazed, opaque can have neither occur- if opaque is exposed, it is very plaque retentive (cause periodontal and recurrent caries issues)
-if margins do not fit, there's no metal to be able to burnish it closed (it fits or is a remake) -depending on alloy type, porcelain application can cause the margin to distort (porc firing contraction) and become "open" |
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Shoulder Porcelain PFM Crown
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Improve maximize esthetics
- eliminate the display/discoloration of metal - maximized thickness of gingival porcelain Aggressive preparation - potential for pulpal embarrasssment - weakness remaining prepared tooth structure Weaker/more brittle margin (maybe) |
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Shoulder final Preparation Margin
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90- 110 Degrees!!
-1-1.5mm dimension |
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Shoulder Porcelain PFM restorations
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-1.3-1.5mm collar width
all ceramic restorations 1.5-1.8mm |
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Shoulder margin requirements
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-if angle formed between the shoulder and the external root surface is <90 degrees there is unsupported tooth structure
-if angle is >110 degrees there is unsupported porcelain on the crown -margin must be smooth |
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Crown Construction
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-impress as usual, pour working cast
-fabricate metal framework- stop metal at shoulder/axial wall junction or 1-2mm short (coronal to shoulder) -apply opaque porcelain (2 firings) -apply shoulder porcelains (may take 2-3 applications/firings) -apply body/incisal porcelain (min 2 firings) -adjust, occlude, characterize, glaze and polish (one glaze firing) |
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Prefabricated Posts
(Types) |
1. integraPost
2. Parapost |
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Core Materials
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1. Amalgam
2. Reinforced composite |
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General Observations -DXT FPDs
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-identical to abutment evaluation for single crown
-asses the relative paralellism -prepare them with the same TOC -anatomy of edentulous space assessed -greatest challenge is to determine what to restore the edentulous space with or whether to restore the space at all |
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Factors to determine what to do with edentulous space
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-length of edentulous space
-available inter-arch space -condition of the edentulous space -abutment teeth -pontics -expectation of the patients (esthetics or function) |
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General TxP Issues
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-a good treatment plan starts with an accurate diagnosis- CRITICAL
-accurate diagnosis requires a good clincal and radiological evaluations, PLUS an accurate diagnostic wax up -you must inform the patient of treatment options |
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For accurate treatment plan
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-med dental hx
-clinical exam -radiographic exam -photographic evaluation if possible -complete required consultation with other specialties -PDI -diagnosis and prognosis |
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control phase
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-eliminates ACTIVE disease (caries and periodontal disease and occlusal imbalance)
-allows you to evaluate the staus of remaining tissue -sometimes temporary crowns or prosthesis are necessary |
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Definitive Phase
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-teeth or edentulous spaces are restore permanently materials or prosthesis
-amalgam, composite resin -gold or ceramic single crowns -implant restorations -FPDs -RPD |
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Maintenance Phase
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-follows up care and regular recall
-monitors dental health -identifies early signs of disease -it allows you to initiate prompt corrective measures |
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Fixed Partial Denture
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-perform better than complex amalgams
-10-21 years mean 8.3 years -good dx, caries control, recall appt quality of work -mechanical 69%, caries 24%, porcelain 7%, cementation 15% |
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Cantilever FPD
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-2 unit cantilever 3.7 years
-occlusal/gingival marginal seal broken -max lat or premolars. If molars are replaced then 2 premolars abutment and 1/2 pontic |
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Resin Bonded FPD
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-marilyn bridge
-74% after 5 years, drop to singifcantly after 8 years |
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Evaluation of Abutment teeth
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-clinical crown
-root ratio -mutual parllelism -root surface area -supraerrupted -mesially inclined |
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Clinical Crown
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-the portion of a tooth that extends from the occlusal table or incisal edge to the free gingival margin
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Root Ratio
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-it is the relationship that exists between the supported and unsupported part of the tooth
-CEJ=alveolar bone height -Many factors (caries, perio, occlusal factors, mechanical factors change) -2:1 or 1:1 |
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Mutual Parallelism
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-abutment teeth must exhibit a line of draw or path of insertion that would allow for the full seating of a fixed prosthesis in a direct vertical palne without rotation either mesio-distally or bucco-lingually
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Antes Law 1926
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-the combined pericemental area of all abutment teeth supporting a FPD should be equal or greater than the pericemental of the tooth or teeth being replaced
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Space for Pontics
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-pontics replace and function as missing b/c they restore the BES and sometime tissue bound edentulous areas
-they must be functional, esthetic and cleansable -different types according to the clinical situation |
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Restoration of endodontically treated teeth
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-custom cast posts
-prefabricated posts |
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Custom Cast posts Advantages
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-high strength
-better fit than prefabricated -cement thickness |
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Custom Cast posts Disadvantages
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-time consuming
-less stiff -complex procedure |
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Post space requirements
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-5mm (ideal) 3-4mm minimum gutta percha
-post width 1/3 root diameter -ferrule and anti-rotational features -Ideally length of post 2/3 root lengh (in bone) -length of post at least as long as clinical crown -length of post at least 1/2 root length (in bone) |
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custom cast direct vs. indirect fabrication
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-make it yourself using GC pattern resin
-send an impression of the canal and tooth to the lab |
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Adequate preparations with adequate margin design ...
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promotes good pulp, perio health
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Good provisionals
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-cover preps to the margins
-have good emergence profiles -good embrasures |
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Purpose of soft tissue management
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-eliminate inadequate impressions
-enhance the marginal "fit" of provisional and final crowns and FPDs -promote tissue health before, during and after prosthesis delivery |
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Objectives of Soft tissue management
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-retract tissues for sub-gingival margin preparation (tissue protection)
-retract tissues to enhance "fit" of temporary restorations (tissue health) -provide access for visual inspection of prepared tooth -provide access for visual inspection of prepared tooth -provide access for impression materials -promote/maintain tissue health |
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tissue retraction types
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-mechanical
-mechanico-chemical -rotary gingival curettage -electrosurgical -laser |
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mechanical tissue retraction
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-physically moves gingival tissues laterally and apically away from prepared tooth and margin
-retraction time is brief -trauma to tissues CAN be minimal -repeat if necessary on multiple occasions if you mis the impression |
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Mechanical tissue retraction methods
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NICER
-Non-medicated retraction cords -"Impression" materials -Copper bands -Elastic retraction rings -Rubber dam (inverted) |
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Mechanico-Chemical Tissue retraction
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-retraction cord impregnated or pretreated with a chemical
-non-impregnated cord soaked in a solution agent -function to mechanically, and chemically retract tissues |
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Chemical Solutions
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-epinephrine
-aluminum chloride -alum -ferric sulfate -"visine" |
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Epinephrine .1% or 8%
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-excellent tissue displacement
-excellent hemorrhage control -minimal tissue loss (unless left in place excessive amount of time) bad= -myocardial stimulant -increases heart rate -vasocontrictor -elevates blood pressure -requires a healthy pt -requires instructor signature in clinics |
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Aluminum Chloride 5% or 25%
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-good hemostasis
-minimal tissue loss/damage -local tissue loss with concentrations >10% -example: Hemodent (premier) |
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Alum
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-potassium Aluminum Sulfate
-extendedworking time -minimal tissue loss/damage -less hemostasis, and less tissue displacement than epinephrine |
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Ferric Sulfate 13%
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-good tissue response
-excellent hemostasis -extended working time -works well with aluminum chloride impregnated cords -will NOT work with epi cords-tissue discoloration -example: astringident (ultradent) |
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Rinsing off hemostatic agents
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-astringent solutions are a strong inhibitor to polymerization of VPS impression materials
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Tissue retraction technique
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-horizontal tissue displacement to expose the gingival margin and unprepared tooth structure apical to margins
-vertical tissue displacement to expose tooth structure apical to margin -hemorrhage control -hard and soft tissues to be impressed are clean, exposed and dry |
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Retraction procedure
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-use of local anesthetic
-for patient comfort -to reduce salivary flow (primarily in mandibular arch) -vasocontrictors (if used) can lead to good hemostasis |
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Is endo or the restorative more important for ETT?
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They are both important
2 studies- 1 found that restorative was more important and 1 found that endo was more important |
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Evidence base on ETT prior to 1987
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technique and opinion articles
-load to failure studies (weak) |
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Evidence base ETT after 1987
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-retrospective clinical analyses
-few randomized clinical trails -fatigue studies- much better |
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Is endo or the restorative more important for ETT?
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They are both important
2 studies- 1 found that restorative was more important and 1 found that endo was more important |
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Crown prepped teeth
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-17% of those will eventually need RCT
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Evidence base on ETT prior to 1987
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technique and opinion articles
-load to failure studies (weak) |
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Failures with ETT
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-stripping, perforation, root fracture
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Evidence base ETT after 1987
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-retrospective clinical analyses
-few randomized clinical trails -fatigue studies- much better |
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Crown prepped teeth
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-17% of those will eventually need RCT
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Failures with ETT
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-stripping, perforation, root fracture
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ETT fracture because of
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1. loss of tooth structure (main reason)
2. loss of proprioception |
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Multifactorial loss of tooth structure
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1. disease
2. trauma 3. restorative therapy 4. endodontic therapy |
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Does moisture control affect strength of ETT?
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-no statistical difference between moisture content of ETT and vital teeth
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Effect of restorative procedrues on the strength of ETT molars
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-by covering the cusps you will prevent the tooth from fracture
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Loss of tooth structure: restorative therapy
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1. tooth preparation
2. dowel preparation 3. iatrogenic 4. inappropriate occlusal loads 5. Endodontic therapy |
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Do dowels reinforce teeth?
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NO
the only function of a dowel is to RETAIN the core buildup and stress distribution is importnat with the design of the dowel but does not determine whether one is needed or not |
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Clinically significant factors in dowel design
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1. dowel design
2. surface configuration 3. length 4. diameter |
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Dowel design
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-tapered (low retention)
-parallel sided (best) -threaded (increased retention create increased strain) |
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indications for active threaded screw posts or flexi posts
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-there are none!!
-they cause increased strain |
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Optimum dowel length must be determined on tooth by tooth bases
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-crown/root ratio
-root in bone -root anatomy |
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Criteria for determining dowel length
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-equal to clinical crown
-1/2 length of root in bone -as long as possible -3-5mm gutta percha apical seal -1/3 the diameter of the root |
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Dowel diameter
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-is not related to retention
-increased diameter= increased stress and decreased strength |
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Restoration components
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-crown
-dowel core -anti-rotation -ferrule |
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Ferrule effect
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-Dr. H. eissman
-circumferential 1.5-2mm band of metal around the tooth -contra-beveled core |
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What cement can you not use with endodontic posts?
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-RMGI cement or glass ionomer cement
-they do not work well in anaerobic -use resin cement- chemical cure with primer |
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Core Materials
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1. silver amalgam
2. composite resin (chemical, photo, & dual cure) 3. Glass ionomer |
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Glass ionomer core material
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-miracle mix (fuji type II)
-ketac/chelon silver -RMGI (vitremer) -Fuji IX should be used as "block-out" materials |
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Advantages & disadvantages Glass ionomer
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Advantages
-bonds to tooth structure -prepares like dentin -fluoride release Disadvantages -strength |
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Advantages & disadvantage Silver amalgam core materials
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Advantages
-easy to use -strength -1 visit (spherical) Disadvantages -Color -Mercury |
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Alloy particles
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-lathe cut
-sphererical -ad-mixed |
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Advantages Spherical alloy
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-condesability
-high early strength -dont have to wait 24 hours after placement to prep as you would with ad-mixed |
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Bonded amalgam?
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-reduced sensitivity
-augment retention -increased cost |
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Composite Resin Core material
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-physical properties adeuate
-polymerization shrinkage -incompatibility with specific bonding agents -water sorption |
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Photo-cure composite resin
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-bonding agent of choice
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Summary of Core materials
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-glass ionomers (:()
-spherical silver amalgam (:)) -composite resin - ok physical properties ok polymerization shrinkage must match material/BA |
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Benefits of PDI for partially edentulous
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-imporved intra-operator consistency
-improved professional communication -insurance reimbursement commensurate with complexity of care -objective method for patient screening -standardized criteria for outcome asessment and research -improved diagnostic criteria -simplified, organized aid in decision to refer a patient |
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PDI for partialy edentulous
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Class 1: ideal/minimally compromised
Class 2: moderately compromised Class 3: substantially compromised Class 4- severely compromised |
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Diagnostic Criteria for PDI
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1. location and extent of edentulous ridge
2. condition of abutments 3. occlusal scheme 4. residual ridge |
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Class 1
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1. EA in single arch and one quardrant with one of the folliwng missing teeth
-ant max </= 2 incisors -ant mand </= 4 incisors -post max/mand </= 2 premolars or 1 premolar and 1 molar 2. no pre-prosthetic tx indicated 3. Class 1 4. Class I complete edentulism ridge |
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Class 2
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1. EA in one or both arches with same criteria as Class 1 OR/PLUS max or mand canine is missing
2. tooth structure is insufficinet to retain or support intracoronal restoration 1 or 2 sextants AND locallized adjunct therapy 3. Class 1 4. Class 2 complete edentulism ridge |
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Class 3
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1. any post. max/mand span >/= 3 missing teeth OR 2 molars
any span including ant and post >/= 3 mising teeth 2. tooth structure insufficient to retain restorations in 4 or more sextants AND AT need adjunctive therapy 3. occlusal scheme resqures reestablishment without changing VDO Class II 4. Class III complete edentulism |
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Class 4
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1. any EA requiring a high level of patient complience
2. abutment teeth with guarded prognosis 3. occlusal scheme requires reestablisment WITH changing VDO Class II div 2 and Class III 4. Class 4 complete edentualism morphology |
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Class 4 additional criteria
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-refractory patient (a patient who has chronic complaints following appropriate therapy)
-these patients continue to have difficulty in achieving their treatment expectations despite the thoroughness or frequency of the treatment provided -severe manifestations of local or systemic disease including sequelae from oncologic treatment -maxillo-mandibular dyskinesia and/or ataxia |
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Guidlines for PDI use
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- if patient is mixed between 2 or more classes any single criterion of one or more comlex class places them into the more complex class
-periodontal health is intimately related to the diagnosis and prognosis for partially edentulous patients -for the purpose of this system it is assumed tha tpateints will receive periodontal therapy to achieve and maintain periodontal health so that prosthodontic care can be accomplished |
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Bruxism
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-diurnal/nocturnal parafunctional activity
-prevalence: 20% adult population -female>male -awake bruxism (AB) vs sleep bruxism (SB) |
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Awake Bruxism
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-usual orofacial activities: chewing, speaking, swallowing
-unusual/parafunctional orofacial activities: clenching, grinding, tooth tapping, lip/cheek/tongue biting, nail biting etc. -can be associated with parkinson's & other neurodegenerative diseases (refer neurologist) |
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Sleep Bruxism
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-sleep related movement disorder
-characterized by tooth grinding & clenching -no gender difference -1 in 5 sleep bruxers also brux when awake |
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Sleep bruxims Sub classifications
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1. Simple- sleep bruxism, periodic limb movt during sleep
2. Complex- REM behavior disorder, epileptic motor activity 1. primary-prevalence: 14-18% children, 8% adults, 3% elderly 2. secondary/iatrogenic (to medical disorder, medication/drug use) |
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Bruxism is exacerbated by:
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1. Smoking, caffeine, alcohol
2. Type A personality, anxiety 3. Sleep disorder (e.g. snoring, sleep apnea) |
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Sleep Bruxism
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-sleep = non-Rem & REM sleep
-Non- REM= light stages 1=2 deep stages 3+4 - REM = active sleep -1 cycel=90-110 mins -SB occurs mainly during stage 1 + 2 -10% of SB occur during REM |
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Bruxism
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-engagees autonomic nervous system
-increases brain activity -involves recruitment of motor muscles |
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Etiology of Bruxim
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-now thought to do with circadian rhythm, neurotransmitters and genetics involved
-older theories were occlusion, stress and dopamine |
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Role of Occlusion in Bruxism
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-little evidence to support role of occlusion in genesis of bruxims
-tooth contact only ocurs 17.5min/day SB lasts 8min/8hr sleep -relief from symptoms after occlusal equilibration or ortho tx is insufficient proff to justify extensive tx |
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Role of Stress
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Sleep bruxers reported significant greter
-daily problems -trouble at work -fatigue -physical problems -"escape" coping strategy |
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Consequence of Bruxism
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1. grinding sounds that interfere with sleep of family/partner
2. dental consequences: -tooth destruction -breakage of dental restoration or rehabilitation 3. induce or exacerbate TMD 4. induce or exaerbate TTH |
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Tension Type Headache (TTH)
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-30min for 7days
-bilateral -pressing/tighteining -mild to mod pain -not aggrevated by routine physical activity -no nausea/vomiting -photophobia -chronic TTH > 15 days per mth for > 3mths |
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Headache and orofacial pain
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-pravalence headache in OFP pts 72.7%
-prevalence of TMD in headache popo 56% -TMD significantly associated with headaches. |
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Methods for assing bruxims
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1. questionnaires
2. clincal findings 3. intra-oral appliance 4. masticatory muscle electromyographic recording (EMG) 5. polysomnography |
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Questionnaires
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1. has anyone heard you grinding your teeth at night?
2. is your jaw fatigured or sore on awakening in the morning? 3. are you teeth or gums ever sore on awakening in the morning? 4. do you ever experience temporal headaches on awakening in the morning? 5. are you ever aware of grinding your teeth during the day? 6. are you ever aware of clenching your teeth during the day? >/= 2 positive responses = BRUXER |
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Clinical Findings
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-history
-tooth wear -tooth mobility -cheek or tongue indentation -masticatory muscle hypertrophy -TMD symptoms: TMJ pain/clicking/locking |
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Temperomandibular disorders
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-a collective term embracing a number of clinical problems involving masticatory musculature, TMJ and associated structures or both
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Factors assoc with onset TMD pain
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-multiple pre-existing pain conditions
-female -self-reported bruxism -depression |
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Etiologic consdierations TMD
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-occlusion/orthopedic instability
-trauma -emotional stress -deep pain input -muscle hyperactivity |
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Uses of occlusal splints
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1. alter occlusal relationship
2. redistribute occlusal forces 3. prevent teeth wear 4. reduce bruxims & parafunctions 5. treat masticatory muscle pain & dysfunction 6. alter structural relationships in the TMJ |
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Advantages of Maxillary stabilization splint
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1. covers more tissue --> stable, retentive and < likely to break
2. easier to achieve occlusion in Class II & III 3. lower teeth contact on flat surface --> stable 4. easier to locate CR position Mandibular splint advantaes = aesthetics |
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Criteria for Stabilization Splint
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1. good fit, stability & retention
2. in CR, mandibular buccal cusps contact flat surfaces evenly 3. protrusion on canines 4. laterotrusion on canines 5. mandibular posterior teeth contact splint only in CR 6. upright position, posterior occlusion more prominent than anterior 7. splint occlusal surface is flat 8. splint polished |
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Stabilization splint
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-when splint is in place condyles in musculoskeletally stable position, teeth contact evenly & simultaneously
-canine guidance -AIM: eliminate orthopedic instability between occlusal position & TMJ position |
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contraindications to splints
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1. Mixed Dentition
2. Orthodontic Treatment |
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Many techniques
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-none better than the other
-indirect (lab) vs Direct (chair side) techniques -technique sensitive -the best technique is the technique you are most experienced in & most comfortable with |
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Indirect technique
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1. Max & mand impresion & models
2. bite registration 3. facebow 4. send to laboratory 5. finished product from lab 6. splint delivery |
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Direct Technique
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-is what you will learn in this course
-disadvantage: chair time -advantae: if you can do this you can do any splint |
