Mouth Preparation Lecture Notes PDF

All Ceramic Restorations Mouth Preparation Presented by Dr. Mohammed Hosny Professor of Fixed Prosthodontics Collage of Dentistry Taibah University 11/14/2023 M.Hosny 2  Introduction Outline  Treatment Sequence  Professional hygiene  Oral Surgery  Caries and Existing Restorations  E...

All Ceramic Restorations Mouth Preparation Presented by Dr. Mohammed Hosny Professor of Fixed Prosthodontics Collage of Dentistry Taibah University 11/14/2023 M.Hosny 2  Introduction Outline  Treatment Sequence  Professional hygiene  Oral Surgery  Caries and Existing Restorations  Endodontics  Definitive Periodontal Treatment  Crown lengthening  Orthodontic treatment  Definitive Occlusal treatment 11/14/2023 M.Hosny 3 Introduction  Mouth preparation refers to the dental procedures that need to be accomplished before fixed prosthodontics can be properly undertaken.  Failures in fixed prosthodontics are often due to inadequate mouth preparation.  Comprehensive treatment planning ensures that mouth preparation is undertaken in a logical and efficient sequence aimed at bringing the teeth and their supporting structures to optimum health. 11/14/2023 M.Hosny 4 Introduction Equally important is the need to educate and motivate the patient to maintain long-term dental health through meticulous oral hygiene practices.  As a general plan, treatment procedures should be performed in the following sequence: 1- Relief of symptoms (chief complaint) 2- Removal of etiologic factors (excavation of caries and removal of deposits). 3- Repair of damage. 4- Maintenance of dental health. 11/14/2023 M.Hosny 5 Sequence in the treatment of a patient with extensive dental disease. 1- Preliminary assessment. 2- Emergency treatment of presenting symptoms. 3- Oral Surgery. 4- Caries control and replacement of existing restorations. 5- Endodontic treatment . 6- Definitive periodontal treatment. 7- Orthodontic treatment 8- Definitive occlusal treatment. 9- Fixed prosthodontics. 10- Removable prosthodontics. 11- Follow up care. N.B: The sequence of preparatory ttt should be flexible 11/14/2023 M.Hosny 6 11/14/2023 M.Hosny Relief of acute problem by endo ttt of the incisor. 7 Removal of deposits and unrestorable teeth. 11/14/2023 Caries controlled and defective restorations are replaced. M.Hosny 8 Endodontic treatment. Implant placement in left and right posterior quadrants and post-and-core restoration and interim restoration are placed. 11/14/2023 M.Hosny Definitive periodontal treatment & implants are uncovered. 9 Teeth are prepared for final restoration. 11/14/2023 Fixed restorations are completed & mandibular arch is treated with implant supported prostheses. M.Hosny Fabrication of removable dental prosthesis 10 Professional hygiene • Scaling • Root planning • Polishing 11/14/2023 M.Hosny 11 Oral Surgery Soft Tissue Procedures Soft tissue surgery Hyperplastic tissue 11/14/2023 M.Hosny 12 Hard Tissue Procedures Mandibular tori Tuberosity reduction 11/14/2023Buccal torus M.Hosny Impacted tooth 13 Extraction Of Hopeless teeth 11/14/2023 M.Hosny 14 Caries and Existing Restorations 11/14/2023 M.Hosny 15 Caries and Existing restorations 11/14/2023 M.Hosny 16 Endodontics During the initial examination attention must be directed towards the potential endodontic needs of the patient. This should include vitality testing of all teeth in the dental arch, and full mouth radiographs. 11/14/2023 M.Hosny 17 11/14/2023 M.Hosny 18 Definitive Periodontal Treatment Gingivectomy 11/14/2023 M.Hosny 19 Mucosal Reparative Therapy Mucosal reparative therapy is indicated to increase the width of the band of gingiva through surgical grafting. Grafting techniques are described as follows. Free Autogenous Gingival Graft Indication: to increase the width of the attached gingiva in areas where it is deemed inadequate. Used with multiple teeth Donor site used is hard palate - edentulous area Healing time 6 week 11/14/2023 M.Hosny 20 11/14/2023 M.Hosny 21 Laterally Positioned Pedicle Graft Indication: used for an area of recession or lack of attached gingiva on a single tooth when there are adequate gingiva amounts in of adjacent keratinized teeth or edentulous spaces. 11/14/2023 M.Hosny 22 11/14/2023 M.Hosny 23 Coronally Positioned Pedicle Graft Indication: When a single tooth or multiple teeth exhibits gingival recession and sensitivity. 11/14/2023 M.Hosny 24 11/14/2023 M.Hosny 25 Crown lengthening (Exposure of sound tooth structure)  Conventional surgery Indications: 1-Short clinical crown (e.g. tooth wear or fracture). 2- Subgingival placement of crown margin. 3-Subgingival caries. 11/14/2023 M.Hosny 26 4-Esthetic improvement for anterior teeth with short clinical crowns & high lip line. Gummy smile 11/14/2023 Surgery or laser are used to mark the gum tissue that would be removed, without damaging any underlying tissue. M.Hosny 27 Disadvantages: 1-Affect the crown root ratio 2-Removal of alveolar bone & c.t. attachment. 3-Problems of esthetic. 11/14/2023 M.Hosny 28 Factors should be considered before crown lengthening 1. Esthetics 2. Root length within bone 3. Effect on adjacent teeth 4. Root furcation exposure in a posterior tooth 5. Mobility 6. Extent of the defect 7. Root perforation 8. Thickness of the soft tissue 11/14/2023 M.Hosny 29 11/14/2023 M.Hosny 30 N.B: Restoration of the tooth is initially 4-6 week after surgical crown lengthening Final restoration after 3monthes 11/14/2023 M.Hosny 31  With electro-surgery Indication:  If there is sufficient wide band of attached gingiva surrounding the tooth.  Removal of an edentulous cuff It is a remnant of interdental papilla present adjacent to the edentulous space in some cases this enlargement will affect proper pontic placement & size of the connector. 11/14/2023 M.Hosny 32 11/14/2023 M.Hosny 33  with orthodontic-periodontic extrusion Indications: (1) Sub gingival fracture (2)Caries (3) Presence of root perforation apical to the osseous crest. Contraindications:  Ankyloses or hypercementosis  Vertical root fracture  Short root (crown-root ratio less than1:1)  Exposure of furcation  Insufficient space for prosthesis  Root proximity & premature closure of embrasures 11/14/2023 M.Hosny 34 Technique 0.016 nickel titanium wire attached to brackets 11/14/2023 M.Hosny 35 ORTHODONTIC TREATMENT Minor orthodontic tooth movement can significantly enhance the prognosis of subsequent restorative treatment. Up- righting a mal-positioned abutment tooth offers several advantages: 1- Improves the axial alignment. 2- Creates more favorable pontic spaces. 3- Improves the embrasure form in fixed prosthesis. 4- Directs the occlusal forces along the long axes of the abutments. 5- Offers substantial conservation of tooth structure. 11/14/2023 M.Hosny 36 Assessment: The need for orthodontic treatment should be determined after: 1- Careful analysis of articulated diagnostic casts and the use of a dental surveyor. 2-Trial diagnostic preparations and waxing up procedures. 11/14/2023 M.Hosny 37 3- Diagnostic cast sectioning and reassembling according to the proposed orthodontic modifications. 11/14/2023 M.Hosny 38 11/14/2023 M.Hosny 39 Treatment in the Horizontal Dimension 1- Computer imaging technology can optimize the esthetic treatment plan and improve the patient communication and ascertains the post-treatment appearance. 11/14/2023 M.Hosny 40 2. Orthodontic treatment 11/14/2023 M.Hosny 41 Treatment in loss vertical Dimension due to overeruption of opposing teeth 11/14/2023 M.Hosny 42 Definitive Occlusal treatment This involves reorganization of the patient’s occlusion, typically to make maximum intercuspation coincident with centric relation and remove eccentric interferences. 11/14/2023 M.Hosny 43 11/14/2023 M.Hosny 44 11/14/2023 M.Hosny 45 The primary objectives of selective occlusal reshaping 1- To redistribute the forces parallel to the long axes of the teeth by creating a cusp-fossa occlusion. 2- To eliminate deflective occlusal contacts: centric relation coincides with maximum intercuspation. 3- To correct marginal ridge discrepancies and extrusions so that oral hygiene will be easier. 4- To correct tooth malalignment through selective reshaping. 11/14/2023 M.Hosny 46 Contraindication to make definitive occlusal adjustment 1- A patient with bruxism whose habit cannot be controlled. 2- If too much tooth structure must be removed. 3- Maxillary lingual cusps contacting mandibular buccal cusps. 4- Excessive wear. 5- Before orthodontic or orthognathic treatment. 6- Before physical or occlusal appliance therapy. 7- A patient whose jaw movements cannot be manipulated easily. 11/14/2023 M.Hosny 47 Reference Contemporary of fixed prosthodontics. {6th edition} Page 173-198 11/14/2023 M.Hosny 48