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Diagnosis and Treatment Company Logo


Planning in Fixed Partial
Dentures

Presented by
Dr.Abbasi Begum .M
P.G Department of Prosthodontics
Narayana Dental College
Contents
1. Introduction
2. Definitions and terminologies
3.Diagnostic aids
– Personal information
– Patient evaluation
– Medical history
– Past dental history
 Clinical examination
• General examination
• Extra oral examination
• Intraoral examination
– Radiographic examination
- Vitality testing 102
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 4.Treatment plan
 Treatment planning for single – tooth restorations

 Treatment planning for the replacement of missing teeth


- Selection of the type of prosthesis
- Abutment evaluation
- Biomechanical considerations
- Special problems

 5.Conclusion
 6.References
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Sequelae of tooth loss Company Logo

Migration
Unilateral chewing
Alveolar bone loss
Occlusal interference
Loss of proximal contact
Overloading of anteriors
Loss of VD
TMD

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The traditional restorative
approach in prosthetic
dentistry
Treatment options for missing teeth
INTRODUCTION Company Logo

Fixed prosthodontics :

The art and science of restoring damaged teeth


with cast metal, metal-ceramic,or all-ceramic
restorations, and of replacing missing teeth with
fixed prostheses.
Successful
fixed
prosth-
odontic
treat- ment
Definitions and terminologies Company Logo

 Fixed partial denture:


A dental prosthesis that is luted,screwed or mechanically
attached or otherwise securely retained to the natural teeth,
tooth roots, and /or dental implant abutments that furnish
primary support for the dental prosthesis.

 Commonly referred to as BRIDGES

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Diagnosis
 DIAGNOSIS
 The determination of the
nature of a disease.
Glossary of Prosthodontic terms 8

 TREATMENT PLAN
 The sequence of procedures
planned for the treatment
of a patient after diagnosis.
Glossary of Prosthodontic terms 8
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“Nothing is more critical to


success than beginning with all
the necessary data.”

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5 elements to a good Company Logo

diagnostic workup
1. History
2. TMJ/occlusal evaluation
3. Intraoral examination
4. Diagnostic casts
5. Full mouth radiographs

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MEDICAL HISTORY-outline Company Logo

Accurate and current general medical history should


include
 Medication.

 As well as relevant medical conditions.

 If necessary the patients physician(s) can be


contacted for clarification.
 Conditions affecting the treatment methods
 Conditions affecting treatment plan
 Systemic conditions with oral manifestations
 Possible risk factors for the dental surgeon and
His tory Company Logo

 Any special precautions are necessary ??????


 To premedicate some patients for certain conditions
or to avoid medication for others
 History of infectious diseases

Serum Hepatitis
AIDS
 previous reaction to a drug:
 an allergic reaction
 or syncope resulting from anxiety in the dental chair
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A reaction to a dental material : nickel-containing alloys


 Patients who present with a history of cardiovascular

problems may require special treatment


 Patient with uncontrolled hypertension should

not be treated
 A systolic reading 160 mm of mercury or a

diastolic reading 95 preempts dental treatment


 Refer the patient to his or her physician for evaluation

and treatment
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 Hypertension
or Coronary artery disease……………..
epinephrme X since this drug has a tendency
heart rate
elevate blood pressure
PREMEDICATION ON 1991 GUIDELINES
BASED (AHA)
Amoxicillin in case of allergy Prosthetic heart valve

Erythromycin OR History of previous


bacterial endocarditis,
Clindamycin Congenital heart
malformations,
or mitral valve prolapse
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 Previous radiation therapy, hemorrhagic disorders,


extremes of age, and terminal illness

 Expected to modify the patient's response to dental


treatment

affect the prognosis


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 Systemic conditions with oral


manifestations
 Eg periodontitis modified by

diabetes, menopause, pregnancy, or the use of


anticonvulsant drugs
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 Epilepsy
 Diabetic patients
 Dental treatment for the diabetic should
interfere as little as possible with the patient's
dietary
routine, and the patient's stress level should be
reduced
Xe ro s to m ia : conductive to greater carious activity
extremely hostile to the margins of
cast metal or ceramic restorations
DENTA
L
HISTO
RY
Periodontal History Company Logo

 The patients oral hygiene is assessed, current


plaque control measures are discussed, as are
previously received oral hygiene
instructions.

 The frequency of any previous debridement


should be recorded

 Nature of any previous periodontal surgery


should be noted.
Restorative History Company Logo

 Simple composite resin or dental amalgam fillings,


or it may involve crowns and extensive fixed partial
dentures
 Prognosis and probable longevity of any future
fixed prostheses
Endodontic History
 Monitoring periapical health and
 Detecting recurring lesions promptly

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Orthodontic History Company Logo

Apical root resorption subsequent to


orthodontic
treatment.
As the crown/root ratio is affected, future
prosthodontic treatment and its prognosis
may also be affected

Removable
Prosthodontic History
Helpful in assessing whether future treatment will
be more successful
Oral Surgical History Company Logo

 Missingteeth and any


complications that may have
occurred during tooth removal is
obtained

 Before any treatment is


undertaken,
the prosthodontic component of
the proposal treatment should
be fully co-ordinated with
surgical component
Radiographic History Company Logo

 Judging the progress of dental disease


 A current diagnostic radiographic series is
essential and should be obtained as part of the
examination.
TMJ Dysfunction History Company Logo

 A history of pain or clicking in the TMJ or neuromuscular


systems, such as tenderness to palpation, may be due to
TMJ DYSFUNCTION, which should be normally be
treated and resolved before fixed prosthodontic treatment
begins
EXAMINATION Company Logo

 General Examination

 Extraoral Examination
 Temporomandibular Joints
 Muscles of Mastication
 Lips

 Intraoral Examination
 Periodontal Examination
 Gingiva 75

 Periodontium
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 Occlusal Examination
 Initial Tooth Contact
 Lateral and Protrusive Contacts
 Jaw Maneuverability

 Radiographic Examination
 Vitality Testing
EXAMINATION Company Logo

 Clinician's use of
 Sight,
 Touch, And
 Hearing to detect conditions outside the normal
range
 It is critical to record what is actually observed
rather than to make diagnostic comments
about the condition.
 EX:- Gingival inflammation - swelling, redness,
and bleeding on probing…
GENERAL EXAMINATION Company Logo

 General appearance, gait, and weight


 Skin color-signs of anemia or jaundice
 Vital signs-respiration, pulse, temperature,
and blood pressure
 vital signs outside normal ranges should
be referred for a comprehensive
medical evaluation
EXTRAORAL EXAMINATION Company Logo

1. Facial symmetry: Special attention


2. Cervical lymph nodes are palpate
3. TMJ

This permits a
comparison between
relative timing of left
and right condylar
movements.
Asynchronous movement
– anterior disk
displacement.
Auricular palpation Company Logo

 Light anterior pressure


-Identify potential disorders
in the posterior
attachment of the disk
 Tenderness, or pain on
movement- Inflammatory
changes in the
Retrodiscal tissues
 Palpation at Angles of the
mandible- Identify even
a minimal click
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4. Maximum mandibular opening Logo Company

 Normal values to maximum opening range


from 45 to 55 mm
 < 35mm – restricted – intra capsular
changes.
 Midline deviation on opening and/or
closing is recorded
 The maximum lateral movements of the
patient can be measured
 (normal is about 12 mm)
EXAMINATION OF TEMPOROMANDIBULAR DISORDERS
IN THE ORTHODONTIC PATIENT: A CLINICAL GUIDE, J Appl Oral Sci.
Muscles of Mastication. Company Logo

 Palpated for signs of tenderness.

 Palpation is best accomplished bilaterally and


simultaneously.

 This allows the patient to compare and report


any
differences between the left and right sides.
Masseter muscle Palpation Medial pterygoid

Lateral pterygoid
Temporalis
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The sternocleidomastoid muscle is


Trapezius muscle is felt
grasped
at the base of the skull, between the thumb and forefingers on the
high on the neck side
of the neck.
The muscle will be accentuated by a
slight
turn of the patient's head
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A brief palpation of masseter, temporalis,


medial pterygoid, lateral pteregoid, trapezius
and
sternocleido mastoid muscles may reveal
tenderness.

Any difference – classify the discomfort as mild,


moderate , severe.

Each palpation site is given a numerical score..


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Treatment initiated – asses the response to
5. LIPS :- Company Logo

 Next, the patient is observed for tooth exposure


during normal and exaggerated smiling.
 This may be critical in treatment planning and

particularly for margin placement of metal-


ceramic crowns.

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INTRA ORAL EXAMINATIONLogo Company

 Evaluate the condition of the soft


tissues, teeth, and supporting
structures.

A) SOFT TISSUE EXAMINATION:-


 Lips, tongue, floor of the mouth,
gingiva, vestibule, cheeks, hard and
soft palate…

 Any abnormalities of the soft tissues


should be noted and the patient
informed
Classification of Ridge Defects:Company Logo

 Seibert 1983 classified the


various types of ridge loss
into 3 classes [1]:
 Class I: Buccolingual loss of
tissue with normal ridge
height in apicocoronal
dimension
 Class II: Apicocoronal loss
of tissue with normal ridge
width in a Buccolingual
dimension
 Class III: Combination
Bucco - lingual and apico-
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 Later, Allen et al (1985) introduced severity as a


classification criterion in the evaluation of alveolar
deformities.
 Severity is classified as-
 Mild deformity < 3mm
 Moderate deformity 3 - 6mm
 Severe deformity > 6mm

Periodontal Plastic Surgery For Alveolar Ridge Augmentation: A Case Report,


Ashish Agarwal et al, Indian Journal of Dental Sciences.
June 2012 Issue:2, Vol.:4
61
Gingiva :- Company Logo

 Lightly dried before examination so that moisture


does not obscure subtle changes.
 Color, texture, size, contour, consistency and
position are noted
 carefully palpated to express any exudate or pus
that may be present in the sulcular area
PERIODONTAL EXAMINATION : Logo Company

Should include ;
 Assessment of the quality and quantity Of
Attached Gingiva
 Depth of Periodontal Pockets measured with a

periodontal probe
 Degree of tooth mobility
 Degree of recession
Periodontal Pockets And Attachment Company Logo
Levels
 In this examination the probe is inserted
essentially parallel to the tooth and is
“walked” circumferentially through the sulcus in
firm but gentle steps, determining the
measurement when the probe is in contact with
the apical portion of the sulcus .

 Thus any sudden change in the attachment level


can be detected.
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Examination of tooth structure: 


Carious lesions:- 
-determine Rate and Extent of carious lesions.

 Theamount and location of caries, coupled


with an evaluation of plaque retention, can offer
some
prognosis for new restorations that will be placed.
 It will also help to determine the preparation
designs to be used.

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Occlusal Examination Company Logo

 Special attention is given to


 initial contact,
 tooth alignment,
 eccentric contacts,
 and jaw maneuverability.

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General Alignment :- Company Logo

 Crowding, rotation, supra-eruption, spacing,


malocclusion, and vertical and horizontal
overlap.
 Teeth adjacent to edentulous spaces often have
shifted position slightly.
 Small amounts of tooth movement can significantly
affect fixed prosthodontic treatment.
Analysis of occlusion Company Logo

 Any TMJ Pain, muscle spasm.

 Ease or Difficulty with which the various


excursions can be made voluntarily by the
patient.

 Any occlusal interferences.

 Over erupted or tilted teeth interfering with the


occlusion.
RADIOGRAPHIC EXAMINATION Company Logo

 Can help to evaluate the following areas:


- Degree of bone loss
- Impacted teeth, residual roots
- Root morphology, crown-root ratio
- Presence of apical disease
- Caries
- calculus
- pulp chambers & canals
- Periodontal ligament and surrounding bone
- existing restorations (marginal fit, contour)
 PANO RO MIC RADIO G RAPHS
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Presence or absence of teeth

Assessing third molars impactions,

Evaluating the bone before implant placement.

Screening edentulous arches for buried root tips


Special Radiograph’s For TMJ Company Logo
Disorders
 Transcranialexposure-reveal the lateral third of
the mandibular condyle and can be used to
detect structural and positional
changes
 More information can be obtained from
Tomography

Arthrography

C T scanning

Magnetic resonance 52
imaging
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Vitality Testing

Pulpal health must be measured before


restorative treatment to

 PERCUSSION and

 THERMAL STIMULATION

 TEST CAVITY-nonvitality without L.A

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Company Logo

VITALITY TEST asses only afferent Nerve


supply.

MISDIAGNOSIS occurs if N S is damaged and


blood supply intact .

Careful inspection of radiographs therefore


provide an essential aid in the
examination.
DIAGNOSTIC CASTS Company Logo

 Articulateddiagnostic
casts are essential in
planning fixed
Prosthodontic treatment.

 They must be accurate reproductions of the


maxillary and mandibular arches made from
distortion free alginate impressions.

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Advantages of Diagnostic Casts:- Company Logo

1)   Allow an unobstructed view of the edentulous


spaces and an accurate assessment of the span
length, as well as occlusogingival dimension.

2) Length of the abutment teeth can be accurately


gauged to determine which preparation designs
will provide adequate retention and
resistance.

3) The true inclination of the abutment teeth will


also became evident, so that the problems in
a common path of insertion can be anticipated.
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Company Logo

4) Mesiodistal drifting, rotation and faciolingual


displacement of prospective abutment teeth can
be
clearly seen.

5) A thorough evaluation of wear facets – their


number, size and location is possible.

6) Diagnostic wax-up can be carried out in


situations calling for the use of pontics which
are wider or narrower than the teeth that would
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normally occupy the edentulous space
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7) Teeth that have supraerupted into the opposing
edentulous spaces are easily spotted and the amount
of correction needed can be determined.

8) Occlusal discrepancies can be evaluated and the


presence of centric prematurities or excursive
interferences can be determined.

9) Discrepancies in the occlusal plane become very


apparent on the articulated casts.

46
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Treatment Planning for Single-Tooth
Restorations
The selection of the material and design of the
restoration is based on several factors:
1 Destruction of tooth structure
2. Esthetics
3. Plaque control
4. Financial considerations
5. Retention

44
Destruction of tooth structure: Company Logo

 If the amount of destruction is such that the


remaining tooth structure must gain strength and
protection from the restoration, cast metal or
ceramic is indicated over amalgam or composite
resin.
Esthetics
 All-ceramic crowns-incisors
 Metal-ceramic crowns can be used for
 Single-unit anterior or posterior crowns

 Fixed partial dentures. 43


Plaque control Company Logo

 Use of a cemented restoration-

“A Good Plaque control program”


 If extensive plaque, decalcification, and caries are present
in a mouth, the use of crowns of any kind should be
carefully weighed
 Motivated to follow a regime of brushing, flossing and
dietary regulation to control or eliminate the disease
process responsible for destruction of tooth structure.
 If these measures prove to be successful
cast metal, ceramic or metal ceramic restorations can be
42
FINANCIALCONSIDERATIONS Company Logo

 “SOME
ONE” ?????????????????
Government agency
A branch of military
Insurance company
 Selection should not be less than optimum just
because the patient cannot afford

 Sound alternative to the preferred treatment 41


plan
Retention Company Logo

 Fullveneer crowns are unquestionably the most


retentive

 Special concern for ;


 Short teeth
 Removable partial denture abutment.

40
TWELVE RESTORATION TYPES Company Logo

 "plastic
restoration" or a "cemented
restoration ?????????
INTRA CORONAL RESTORATION
 When sufficient coronal tooth structure exist to retain and
protect a restoration under the anticipated stresses of
mastication an intracoronal restoration can be
employed.

 In this circumstance , the crown of the tooth and the


restoration itself are dependent upon the strength of
remaining tooth structure to provide structural integrity.
39
GLASS IONOMER Company Logo

 Where extensions can be kept minimal.


 Class V lesions
 Incipient lesions
 Root caries in geriatric patients & periodontal
patients
 Interim treatment restoration to assist in the
control of a mouth with rampant caries
further enhanced by the release of
fluoride by the material.
38
COMPOSITE Company Logo

 Restoration of incisal angles assisted by acid


etching, a tooth that has received a class 4 resin
restoration ultimately will require a crown.

37
SILVER AMALGAM Company Logo

 Minor to moderate sized lesions in


esthetically non critical areas.

36
COMPLEX AMALGAM Company Logo

 Moderate to severe lesions - amalgam


augmented by pins.

 As a final restoration when a crown is


contraindicated .

 Missing cusps or endodontically treated


premolars and molars.

 Teeth that ordinarily would be restored with


mesio-occulso-distal (MOD)onlays or other
extracoronal
restorations.
35
METAL INLAY Company Logo

 Minor to moderate lesions where esthetic


requirements are low .
 Usually made of softer gold alloys
 Etchable base metal alloys- if a bonding effect is
desired.

 Restoration of MOD on molars.

34
CERAMIC INLAY Company Logo

 Minor to moderate sized lesion where esthetic demand is


high.

 B’coz this type of restoration can be etched to enhance


bonding the structural
integrity of tooth cusps may be
stabilized by bonding

33
MOD ONLAY Company Logo

 Moderately large lesions on premolars and molars with


intact facial and lingual surfaces.

 It will accomodate a wide isthmus and upto one


missing cusp on molar.

32
EXTRA CORONALRESTORATION Company Logo

 Insufficient coronal tooth.

 Deflective axial tooth structure.

 Modify contours to refine occlusion or improve

esthetics.

31
PARTIALVENEERCROWN Company Logo

 To restore a tooth with one or more intact axial


surfaces with half or more of the coronal tooth
structure remaining.

 For short span fixed partial dentures.

 If tooth destruction is not extensive.

30
FULLMETAL Company Logo

 Restore teeth with multiple defective axial


surfaces.

 Restricted to situation where there are no


esthetic
expectations.
METALCERAMIC CROWN Company Logo

 Multiple defective axial surfaces


 Fixed partial dentures retainer where
full coverage and good cosmetic
results must be obtained.
ALLCERAMIC CROWN Company Logo

 Full coverage and maximum esthetics.

 Restricted
to situation likely to produce low
moderate stress .

 Usually used on incisors.


CERAMIC VEENERS Company Logo

 Intact anterior tooth that are marred by


severe staining or developmental defects
restricted to facial surface of the tooth.

 Moderate incisal clipping and proximal


lesions.

26
TREATMENT PLANNING FORTHEREPLACEMENT OF
MISSING TEETH Company Logo

SELECTION OF THE TYPE OF THE


POSTHESIS
 A REMOVAL PARTIAL DENTURE.
 A TOOTH SUPPORTED FIXED PARTIAL DENTURE
OR
 AN IMPLANT SUPPORTED FIXED PARTIAL
DENTURE

25
FACTORS CONSIDERED Company Logo

 BIOMECHANICAL
 PERIODONTAL
 ESTHETIC
 FINANCIAL and
 PATIENTS WISHES.

It is not uncommon to combine two types in the


same arch.

24
REMOVABLE PARTIAL DENTURE
Company Logo

 Edentulous spaces greater than two posterior


teeth.

 Anterior space greater than four lncisors.

 Edentulous space with no distal abutment.

 Multiple edentulous spaces.

 Tipped teeth adjoining edentulous spaces and


prospect-ive abutments with divergent
alignment. 23
Company Logo

 Periodontally weakened.

 Teeth with short clinical crowns.

 Insufficient number of abutments.

 If there has been a severe loss of tissues


in the edentulous ridge.

22
CONVENTIONAL TOOTH Company Logo
SUPPORTED FIXED
PARTIAL DENTURE
 Abutment teeth are periodontally sound.

 Edentulous span is short and straight.

 Expected to provide a longlife of function for the


patient.

 No gross soft tissue defect in the edentulous ridge.

 Reserved for patients who are both highly motivated


and able to afford.
21
RESIN BONDED TOOTH Company Logo
SUPPORTED
FIXED PARTIAL DENTURE
 Defect free abutments where single missing
tooth.

A single molar (muscles are not well developed).

 Mesial and distal abutment are present.

 Moderate resorption and no gross soft tissue


defects on edentulous ridges.

20
Company Logo

 Younger patients whose immature teeth with


large pulps are poor risks for endodontic free
abutment preparation.

 Tilted tooth can be accommodated only if there


is enough tooth structure to allow a change
in the normal alligment of axial reduction.

 Periodontal splints.

19
IMPLANT SUPPORTED FIXED PARTIALCompany Logo
DENTURE

 Insufficient number of abutments.

 Patient’s attitude and or a combination of


intra oral factors make a removable partial
denture or FPD a poor choice.

 No distal abutment.

 Alveolar bone with satisfactory density and


thickness in a broad, flat ridges.
Company Logo

 Configuration that permit implant


placement.
 Single tooth where defect free adjacent
teeth.
A span length of two or six teeth can be
replaced by multiple implants.
 Pierin an edentulous span (three or more
teeth long).
17
NO PROSTHETIC TREATMENT Company Logo

 Long standing edentulous space into which


there has been little or no drifting or
elongation of the adjacent teeth.

 Ifthe patients percieves no functional ,


occlusal or esthetic impairement.

16
CASEPRESENTATION Company Logo

In cases where the choice between a fixed


partial denture and a removable partial
denture is not clear cut, two or more
treatment options should be presented to
the patients along with their
advantages and disadvantages.
Company Logo

The prosthodontist is the best person to


evaluate the physical and biological
factors present , while the patients
feelings should carry
considerable weight on matters of
esthetics & finances .

14
ABUTMENT EVALUATION Company Logo

The roots and their supporting tissues


should be evaluated for three factors

 Crown root ratio

 Root configuration

 Periodontal ligament area

13
CROWN ROOT RATIO Company Logo

 Optimum -2:3

 Minimum -1:1 (acceptable)


ROOT CONFIGERATION Company Logo

 Broader Labiolingullay than Mesiodistally.

 Multirooted posterior teeth with widely separated


roots.

 Conical roots can be used -for short span.

A single rooted tooth with evidence of irregular


configu- ration or with some curvature in the tooth
–is preferable than that which has a nearly
taper.
PERIODONTAL LIGAMENT Company Logo
AREA
 Larger teeth have a greater surface area
and better able to bear added stress.

“ ANTE’S LAW” the root surface area of


the abutment teeth had to equal or
surpassed that of the teeth being
replaced with pontics.

10
BIOMECHANICAL Company Logo
CONSIDERATIONS
 Inaddition to the increased load placed on the
pdl by a long span FPD.

 Longer spans are less rigid.

 Bending or deflection varies directly with the


cube of the length and inversely with cube of
the occlusogingival thickness of the pontic .

9
Company Logo

8
Company Logo

TO MINIMIZE –

 Greater occlusogingival dimension


 Nickel chromium
 Double abutment
 Multiple grooves

7
Special Situations Company Logo

PIER ABUTMENTS
 Non rigid connector

 Restrict to short span FPD

 key way -distal contours of pier a abutment

 key - mesial side of the distal pontic

6
Company Logo

A Nonrigid connector on the


middle abutment isolates
force to that segment of the
fixed partial denture to which
it is applied
THIRD MOLAR ABUTMENTS Company Logo

 Mild encroaching- restoring and recontouring

 Tilting is severe –corrective measures

5
Company Logo

 Orthodontic appliance for


uprighting a tilted molar

 Proximal half crown as a retainer

Non rigid connector on distal aspect of premolar


retainer
CANINE – REPLACEMENT FIXED
Company Logo

PARTIAL DENTURE
 Fixed partial dentures replacing canines can be difficult
because the canine often lies outside the interabutment
axis.

 FPD replacing a maxillary canine is subjected to more


stresses than that replacing a mandibular canine

 Edentulous spaces created by the loss of canine and any contiguous


teeth is best restored with Implants.

4
CANTILEVER FIXED PARTIAL Company Logo
DENTURES
 Lengthy roots with favourable
configuration.

 Long clinical crowns.

 Good crown root ratios and healthy


periodontium.

 Should replace only one tooth and have


atleast two abutments.

 Ponticshould posses maximum


occlusogingival height to ensure a rigid 3
Company Logo

Forces on the pontic of a cantilever fixed


partial denture tend to tip the fixed partial
denture or the abutment tooth

Cantilever fixed partial denture replacing


maxillary lateral incisor, using the canine as
the abutment

Cantilever pontics can be used to replace


a 1st premolar, if full veneers are used on
2nd PM,and 1st molar
CONCLUSION Company Logo

The history and clinical examination must provide sufficient


data for the practioner to formulate a successful treatment
plan.

The overall prognosis is influenced by general and local


factors

1
References Company Logo

1. Fundamentals of fixed prosthodontics-3rd edition,


Shillingburg
2. Contemporary Fixed Prosthodontics-Rosenstiel-
3rd edition
3. Examination Of Temporomandibular Disorders .

A Clinical Guide, J Appl Oral Sci.


2 0 0 7 ; 1 5 (1 ): 7 7 -8 2 , Ana Claúdia de Castro
Ferreira et al
4. Pocket Dentistry-Fastest Clinical Dentistry
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5.History of and Examination for


Temporomandibular Disorders
6.Supplement the Base to Complement the Crown:
Localized Ridge Augmentation using
Connective Tissue Graft-
7. Hemini Shah et al, IJSS Case Reports &
Reviews | April 2015 | Vol 1 | Issue 11
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