Download Treatment planning for the class 0, 1A, 1B dental arches Treatment

Treatment planning for the
class 0, 1A, 1B dental arches
Dr.. Peter Hermann
Dr
Reminder:
Torquing movement on
tooth supported denture :
• no movement
Class 1
• movement in one direction (depression)
Class 2
• movement in more than one directions (tilting)
Class 3
Class 0
• Single-Tooth Restorations
• No actual missing teeth
• Large areas of missing coronal tooth structure can be
replaced while that which remains is preserved and
protected
Destruction of tooth structure
Modifying contours to refine occlusion
Esthetic needs
Defective position in the arch
Incisal restorations
Single-Tooth Restorations in Class 0
• Intracoronal
• Extracoronal
Inlay
Onlay
• Sufficient tooth structure
exist to retain and protect
restoration
Partial veneer crown
Full veneer crown
Ceramic veneer
• Insufficient coronal tooth
structure to retain the
restoration within the
crown of the tooth
• Dowel core restorations
•
Little or no coronal tooth structure, a core may not have
sufficient resistance to dislodgement without a dowel that extends
into the root
Ceplatek-Captek
• The most common method of producing crowns and
bridges utilizes the lost wax technique ~ which requires
firing several layers of porcelain onto a cast metal
framework.
• CAPTEK crowns and bridges use a technology which
does not require any waxing or casting to produce the
copings or bridge understructures for ceramic application.
• Instead, a material called CAPTEK P is applied directly to
a refractory die by hand.
• CAPTEK P is an alloy of Gold, Platinum & Palladium.
This material establishes the capillary network for the
application of the second layer of material - CAPTEK G.
• CAPTEK G is a gold layer which covers the first layer
and, when heated, interlocks completely with the CAPTEK
P giving the CAPTEK coping or bridge understructure its'
strength.
High strength porcelain crowns HSPC
• High strength underlying
core to support veneering
porcelain which gives the
final shape and aesthetic
attributes required for the
restoration.
• No need for metal
substructure
• CAD/CAM systems
Fundamentals of
Class 1:
•
•
•
Tooth support: total abutment
support available
Torqueing movement on occlusal or
incisal surface of constructed
denture: curvature of the arch in the
edentulous region determines
whether the pontics will act as a lever
arm on the abutment teeth
Secondary retention can compensate
torquing force produced
Frequency of edentulous arches classified
Upper jaw
Lower jaw
Class 1A
•
•
•
•
One or more axis lines
Pontics lie in the interabutment axis line
No torquing forces produced on the FPD
Tooth supported partial denture to be
constructed
• FPD recommended
• Primary (adjacent to the edentulous space)
abutments to support the prosthesis
Class 1A
• Lateral span: maximum of 4 missing teeth
with teeth remaining anterior and posterior
to it
• Missing lower incisors
• Missing upper incisor
• Primary abutment only when tooth adjacent
to edentulous space are Type I or Type II
• Tooth posterior to distal abutment of
strategic importance
Abutment Evaluation
•
Abutment teeth must be able to withstand the forces
normally directed to the missing teeth, in addition to
those normally applied to them.
Type I
Type II
Type III
Canines
1. and 2. premolars Lower incisors
Upper central incisors
Upper lateral incisors
1. and 2. molars
Wisdomteeth
•
According to crown-root ratio, root configuration,
periodontal ligament area and position in the arch.
Class 1B
• One or more axis lines
• Pontics lie outside the interabutment
axis line
• Torquing movement produced
• Sufficient number of remaining teeth in
adequat position can compensate this
torque
Class 1B
• Completely tooth supported denture to
design
• FPD recommended
• Secondary (remote from the edentulous
space) abutment is to strengthen the
FPD
Class 1B
• (Even) one missing canine
• Edentulous space in the arch combined with a
missing canine
• Upper incisors
• Arch curvature has its effect on the stresses
occuring in a FPD
• Pontics outside the interabutment axis line act as
lever arm, which can produce torquing movement
• To offset the torque additional retention needed by
secondary abutments
Removable Partial Denture
in Class 1A and 1B
• Accident (severe loss of tissue in the
edentulous ridge)
• Embryonological anomalies
• Limited patient finances
• Unfavorable attitude toward tooth
preparation
• Treatment simplification
• Totally tooth borne base plate design !
Implant-Supported
Fixed Partial Dentures
• Solitair implant (no destructive effects
of retainer crown preparation)
• No distal abutment (implants at both
ends preferred)
• Consider: maxillary sinus, inferior
alveolar nerve
Cantilever
Fixed Partial Dentures
• Abutments at one end of pontic only, with
the other end remaining unattached
• Pontic acts as a lever
• When pontic loaded occlusally, the adjacent
abutment tends to act as a fulcrum, with a
lifting tendency on the farthest retainer
• Torqueing forces produced depend upon
the distance that the pontic lever arm
extends
Cantilever
Fixed Partial Dentures
• Mesial : edentulous area located anterior
abutment teeth-abutments only at distal end
of pontic
• Distal: edentulous area located posterior
abutment teeth- abutments only at mesial
end of pontic
• Mesiodistal: No see-saw!
• Distal-distal: edentulous area located
bilateral abutment teeth
Mesial Cantilever FPD
• Routine FPD (abutments at both
end) always possible
• Replacing a premolar
• Replacing a lateral incisor
Distal Cantilever FPD
•
•
•
•
Replacing a second molar
Replacing a first molar
Occlusal contact limited
Pontic should be kept as small as
posibble, more nearly representing a
premolar than a molar
Materials
Biomechanics
Esthetics
• Metal
• Veneer fused to metal base
• All-Ceramic
• Acrylic resin
Appearance zone!
Two opposing ceramic surfaces!
Thank You for Your Attention!