Mouth Preparation PDF

# Mouth Preparation ## By Prof. Dr. Lamia Dawood ### Mouth Preparation Refers to procedures that must be accomplished before fixed prosthodontic treatment can be properly undertaken. Rarely, crowns or fixed dental prostheses are provided without some initial therapy. Caries and periodontal dis...

# Mouth Preparation ## By Prof. Dr. Lamia Dawood ### Mouth Preparation Refers to procedures that must be accomplished before fixed prosthodontic treatment can be properly undertaken. Rarely, crowns or fixed dental prostheses are provided without some initial therapy. Caries and periodontal disease must be corrected in the early preparatory phase of treatment to stabilize the residual dentition and prevent further deterioration. ### Treatment procedures should be performed in the following sequence: 1. Relief of symptoms (chief complaint). 2. Removal of causes (e.g., excavation of caries, calculus removal). 3. Repair of damage. 4. Maintenance of dental health ### Typical 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. ### **Professional hygiene** - Scaling - Root planning - Polishing ### **ORAL SURGERY** - A) Soft Tissue Procedures - B) Hard Tissue Procedures ### **ORTHODONTIC TREATMENT** Severe skeletal discrepancies → surgical correction before any treatment is begun. ### **IMPLANT-SUPPORTED FIXED PROSTHESES** ### **CARIES AND EXISTING RESTORATIONS** ### **Material selection:** - Extent of tooth destruction. - Overall treatment plan. - The operator's preference. ### **Types:** - Dental Amalgam. - Resin-Modified Glass Ionomer Cement. - Composite Resin. - Pin-Retained Cast Metal Core. ### **ENDODONTICS** ### **Performing elective (intentional) endodontics in:** 1. Problems in obtaining common path of insertion between multiple abutments. 2. Impossible to gain adequate retention in a badly worn or damaged tooth. 3. Questionable cases. ### **DEFINITIVE PERIODONTAL TREATMENT** - Keratinized Gingival Tissue For a tooth or implant to be treated with a restoration extending into the gingival sulcus → approximately 5 mm of keratinized gingiva, at least 3 mm of which is attached gingiva. ### **Mucosal Reparative Therapy** 1. **Free Autogenous Gingival Graft:** - Indication: - To increase the width of the attached gingiva. 2. **Laterally Positioned Pedicle Graft:** - Indication: - Area of recession or lack of attached gingiva on a single tooth. - There are adequate amounts of keratinized gingiva in adjacent teeth or edentulous spaces. - Advantage: - More predictable because of the maintained blood supply to the pedicle. 3. **Coronally Positioned Pedicle Graft** - Indication: - When a single tooth exhibits gingival recession and sensitivity. 4. **Pouch and tunnel technique (the connective tissue graft)** - Indication: - Root coverage - Deficient ridge augmentation - Attempt to rebuild papillae ### **Crown Lengthening Procedure** - Indication: - When the clinical crown is too short in order to provide adequate retention without impinging on the biologic width. - The osseous resection creates 3.5 to 4.0 mm of space between the osseous crest and the margin of the existing restoration or carious lesion. - When surgical crown lengthening is indicated, the following factors should be considered: 1- Esthetics: - Esthetic problems can occur after surgical crown lengthening of anterior tooth. 2- Root length within the bone. 3- Effect on adjacent teeth. 4- Root furcation exposure in a posterior tooth. 5- Postsurgical mobility esp with small conical roots. 6- Extent of the defect. 7- Root perforation. 8- Thickness of the soft tissue. ### **Maintenance and Reconstruction of the Interdental Papilla** 1. Surgical reproduction of the interdental papilla - Success depends on: 1. The amount of attachment loss in the area. 2. The blood supply available for the newly created papilla. 3. The distance from the contact area to the crest of the interproximal bone. 2. Computer imaging technology ### **Orthodontic-Periodontic Extrusion** Is considered whenever a fracture or carious lesion extends apical to the free margin of the gingiva - A flap was reflected to debride the perforation and associated lesion. - Mesially perforated maxillary first premolar ### **ORTHODONTIC TREATMENT** - Advantages of uprighting a mal-positioned abutment tooth: 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. ### **Assessment:** 1. Diagnostic preparations 2. Diagnostic cast sectioning 3. Computer imaging technology ### **Treatment:** 1. Correct a diastema 2. Uprighting a mesially tilted molar 3. Tooth repositioning 4. Orthodontic extrusion - Orthodontic extrusion if the periodontal attachment is required to come with the tooth → a more complex slow controlled force is indicated. - Extrusion of 0.5 mm per month will of gingiva gain. - An additional 6 months for retention. 5. Orthodontic intrusion ### **DEFINITIVE OCCLUSAL TREATMENT** - Current researches, occlusion has a limited impact on the development of disorders of the TMJ and associated musculature. The document includes images of teeth, dental procedures, oral diagrams and x-rays to illustrate different parts of oral surgery and dentistry.