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39 Cards in this Set

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Why try in the framework?
-to verify the marginal fit of both retainers
-verify inter abutment relationship
-verify occlusion
-verify pontic design AND framework design meets specification
-all prior to porcelain addition
prior to your patient appointment
-get prosthesis from the lab
-inspect master cast for broken or abraded dies
-check marginal fit of prosthesis
-check occlusion of prosthesis
-inspect for accuracy of prosthesis design relative to your lab Rx
what is die spacer?
-material applied to dies and represents the thickness of the cement space
-comes in many brands/colors
-usually applied in multiple coats (3-6)
-you're trying to approximate a cement thickness of approximately 50-75 microns
whats the benefit of die spacer?
-should allow the casting to seat/bind only at the marginal 2.00mm
-should speed delivery time (fit checker etc)
-without cement relief in casting, casting is difficult to seat fully during cementation
Down side of die spacer
-if too thick casting will rock
-too thin will give false sense of security that casting fits ok
-if applied over margins then margins will be OPEN by thickness of die spacer
-NEVER put die spacer over the margins
Metal alloys for PFMs
CANNOT be burnished to close the margin - they either fit or you remake them
Chipped die
-metal overextension/poor workmanship
Muscles inaccessible to palaption
1. lateral pterygoid
2. medial pterygoid
Functional manipulation
principle: function of painful muscles--> lead to more pain
aim: to determine if these muscles are the true source of pain
Inferior lateral pterygoid Contraction
- During protrusion and opening
- functional manipulation: protrude against resistance
Inferior lateral pterygoid stretching
-when teeth are in MI
-Functional manipulation: clench teeth
inferior lateral pterygoid additional test
-if teeth are not in MI this muscle does not stretch
-functional manipulation: clench on separator
Medial Pterygoid contraction
-during jaw closing
-functional manipulation: clench teeth & clench on separator
Medial Pterygoid stretching
-during jaw opening
-functional manipulation: open mouth wide
Intracapsular (TMJ) Pain
-TMJ Loading
-functional manipulation: open mouth wide, clench teeth, right & Left lateral movement
-unilateral clench on separator
Masseter
Origin: lower border, medial surface zygomatic arch
insertion: down & back to lateral ramus mand
nerve: V3
action: JAW CLOSING
Temporalis
Origin: floor of temporal fossa & deep surface temporal fascia
Insertion: Converge to tendon, passes deep to zygomatic arch, insert on coronoid & anterior border of ramus
Nerve supply: V3
Action: jaw CLOSING
anterior fibers elevate mandible and posterior fibers retrude the mandible
Lateral Pterygoid
Origin: Upper head from infratemporal surface greater wing sphenoid
lower head from lateral surface lateral pterygoid plate
Insertion: 2 heads converge to pass backward to anterior neck condyle & disc
Nerve supply: V3
action: Jaw OPENING pulls condyle neck forward
Medial Pterygoid
Origin: superficial head from max tuberosity
deep head from medial surface lateral pterygoid plate
insertion: down, back & lateral into medial surface angle mandible
-nerve supply: V3
Action: JAW CLOSING
Anterior Digastrci
Origin: held in position by loop of deep fascia. Bound down to hyoid
Insertion: forward & Medially to lower border body mandible near midline
Nerve supply: V3
Action: JAW OPENING
Subluxation
-on opening, condyle move beyond crest of articular eminence
Etiology: anatomy
CR: occurs on maximum opoening (yawning)
thud rather than click/pop
able to close mouth
Maximum opening
>/= 35mm
Anterior Abutment choices
-full cast metal (gold)
PFM:
-collar metal margin
-collarless margin
-labial shoulder margin
All ceramic
-pressable
-CAD CAM
Preparation Parameters for PFM (labial porcelain margin)
Incisal: 2.0mm
@ Facial margin: 1-1.3mm
Mid-facial: 1.5-1.8
lingual fossa: 0.8-1.3mm
@lingual margin: 0.8-1.3
M/D axial wall: 1.0-1.5
Margins: light chamfer lingual, shoulder on facial
Preparation Parameters for All Ceramic
Incisal: 2.0mm
@facial margin: 1.0-1.3
mid facial 1.5-1.8
lingual fossa: 1.0-1.5
@ lingual margin: 1.3-1.5
M/D axial wall 1.5-1.8
Margin: heavy chamfer or shoulder
Preparation Parameters PFM (labial metal margin)
incisal: 2.0mm
@ facial margin: 1.3-1.5
mid facial: 1.5-1.8
lingual fossa: .8-1.3mm
@ lingual margin: .8-1.3
M/D axial wall: 1.0-1.5
Margins: heavy chamfer facial, light lingual
F-L cross section of Anterior tooth
-triangular in shape from incisal edge to CEJ
-short cingulum (lingual wall)
-convex on facial aspect, with 3 distinct palnes (gingiva, mid facial, incisal)
-F-L resistance form must come from parallelism of gingival 1/3 on facial and short cingulum wall on lingual
-pulp location usually not critical unless patient is young or its a mandibular tooth
Important Considerations
-when preparing abutments for FPDs prepare one with least possible R&R form first
-common path of insertion of combined abutments in mandatory
-facial margin location is critical to esthetics
-select shade PRIOR to tooth prep
-measure depth of gingival sulcus BEFORE prep
-know amt of reduction required BEFORE prep
-check overall color of tooth and root BEFORE prep
Esthetics of pontic
1. length & width of pontic = these of the natural tooth replaced
2. minimal contact with mucosa
3. open embrasures
4. connectors in the middle of the proximal surfaces (F-L dimension)
Stabilization splint
-when splint in place, condyles in musculoskeleally stable position, teeth contact evenly & simultaneously
-canine guidance
-AIM: eliminate orthopedic instability between occlusal position & TMJ Position
Criteria for Stabilization Splint
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 is polished
Checklist for splint on model
-splint outline
-anterior stop
-fit
-retention
-stability
-anterior stop perpendicular to lower incisor
-2mm posterior teeth separation
Attrition
wearing away of one tooth surface by another tooth surface
Etiology of tooth wear
-attrition
-Congenital Anomalies: Amelogenesis imperfecta, dentinogenesis imperfecta
-Parafunctional occlusal habits: chronic bruxism usually triggered by emotional stress
-Abrasion: env. factors, tooth brush, diet, silica, tobacco
-Erosion: GERD
-Loss of posterior support: MOST commone cause of reduced VDO
Etiology of wear
-Iatrogenic factors: restorations in hyper occlusion
-Material factors: un-glazed porcelains, composites
-lack of posterior support
Minimizing wear
env: occlusal guards
Bruxism: biofeedback,occlusal guards, metal occlusal surfaces
Iatrogenic: Proper occlusion, polish porcelain, provide proper posterior occlusion using implants, RPDs or FPDs
Patients with Tooth wear 3 categories:
1. Excessive wear with loss of VDO
2. Excessive wear without loss of VDO but with space available
3. excessive wear without loss of VDO but with limited space available
Changing VDO
1. determine how much you can or cannot increase VDO
2. use exceptional diagnostic records
3. use APPROPRIATE articulator (and facebow)
4. use custom incisal guide table
Average tooth sizes (Maxillary, ht X width)
Central: 11.3 X9 mm
Lateral: 10.1 X 7mm
Canine: 11.4 X 7mm
1st Pre: 9.3 X 7.5mm
2nd Pre: 8.8 X 7.2mm
1st Molar: 8 X 11.3mm