Dental Treatment Procedures Overview

Mouth Preparation

• Refers to procedures before fixed prosthodontic treatment.
• Crowns or fixed dental prostheses are rarely provided without initial therapy.
• Caries and periodontal disease must be corrected early in treatment to stabilize existing teeth and prevent further damage.

Treatment Sequence

• Procedures should follow a specific order:
  • Relief of symptoms (chief complaint).
  • Removal of causes (e.g., caries, calculus).
  • Repair of damage.
  • Maintenance of dental health.

Treatment Sequence (Extensive Dental Disease)

• Typical steps in extensive dental disease treatment:
  • Preliminary assessment
  • Emergency treatment of presenting symptoms
  • Oral Surgery
  • Caries control & replacement of existing restorations
  • Endodontic treatment
  • Definitive periodontal treatment
  • Orthodontic treatment
  • Definitive occlusal treatment
  • Fixed prosthodontics
  • Removable prosthodontics
  • Follow-up care

Professional Hygiene

• Procedures for professional hygiene include:
  • Scaling
  • Root planning
  • Polishing

Oral Surgery

• Includes soft tissue procedures (details not provided).
• Also includes hard tissue procedures (details not provided).

Orthodontic Treatment

• Severe skeletal discrepancies require surgical correction before treatment.

Implant-Supported Fixed Prostheses

• Procedures for implant-supported fixed prostheses are discussed.

Caries and Existing Restorations

• Procedures for dealing with and/or replacing existing restorations, which have been affected by caries.

Materials Selection

• Factors considered for material selection in dental restorations:
  • Extent of tooth destruction.
  • Overall treatment plan.
  • Operator's preference

Endodontics

• Elective (intentional) endodontics may be needed in certain situations:
  • Problems with obtaining a common path of insertion between abutments
  • Inadequate retention in badly worn/damaged teeth
  • Questionable cases

Definitive Periodontal Treatment

• Keratinized gingival tissue is crucial, needing at least 5mm of keratinized tissue, with 3mm being attached tissue.

Mucosal Reparative Therapy

• Technique for increasing the width of attached gingiva.
  • Free autogenous gingival graft is one type.

Laterally Positioned Pedicle Graft

• Used for recession or lack of attached gingiva on a single tooth.
• Successful if adequate keratinized gingiva exists in adjacent teeth/edentulous spaces.
• Advantage: predictable due to maintained blood supply.

Limitations of Laterally Positioned Pedicle Graft (LPPG)

• Typically results in 1mm recession in the donor area.
• Severe recession is possible if bony defects (fenestrations/dehiscences) are uncovered.

Coronally Positioned Pedicle Graft

• Used for gingival recession/sensitivity on a single tooth.

Pouch and Tunnel Technique (Connective Tissue Graft)

• Root coverage is a primary goal.
• May address deficient ridge augmentation.
• Aids in rebuilding papillae.

Crown Lengthening Procedure

• Performed when the clinical crown is too short, needing adequate retention without affecting the biologic width.
• Process repositions osseous crest, creating space between existing restorations/carious lesions.

Esthetics (Crown Lengthening)

• Esthetic concerns (problems) can occur after surgery, especially when anterior teeth are lengthened.

Crown Lengthening - Assessment Factors

• Analyzing factors including root length in bone, effect on adjacent teeth, furcation exposures (posterior), post-surgical mobility (small conical roots), extent of the defect, perforation, and soft tissue thickness.
• Provisional restoration may be done before or soon after surgery.
• Definitive restoration often happens after 3 months.

Maintenance and Reconstruction of the Interdental Papilla

• Surgical techniques are used to reproduce/recreate papillae.
• Success depends on attachment loss, blood supply, and distance to interproximal bone crest.
• computer imaging often utilized

Orthodontic-Periodontic Extrusion

• Performed when fracture or carious lesion extends below gingival margin
• Flap is reflected/used to treat perforation.
• Technique addresses perforation and related lesions.

Orthodontic Treatment - Uprighting

• Advantages of uprighting mal-positioned abutments for fixed prostheses
  • Improves alignment.
  • Creates ideal pontic spaces.
  • Improves embrasure form.
  • Directs occlusal forces along the correct axis.
  • Conserves tooth structure.

Assessment - Diagnostic Procedures

• Assessment steps, including diagnostic preparations, cast sectioning, and computer imaging techniques.

Treatment - Orthodontic Procedures

• Correcting diastema.
• Uprighting a mesially tilted molar.
• Repositioning teeth.
• Orthodontic extrusion.
• Orthodontic intrusion when tooth position needs adjustment.

Definitive Occlusal Treatment

• Current research shows that occlusion has limited impact on development of TMJ disorders and associated muscle issues.

This quiz covers essential procedures involved in mouth preparation and treatment sequencing for fixed prosthodontics. Key steps include symptom relief, removal of causes, and maintenance of dental health, especially in cases of extensive dental disease. It emphasizes the importance of prior therapy before providing crowns or fixed dental prostheses.