Comprehensive Treatment Planning and Treatment Sequencing for the Partially Edentulous Patient

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• Comprehensive Treatment Planning and Treatment
  Sequencing for the Partially Edentulous Patient

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Ensuring Predictability

• Occlusion
• Esthetics

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Ensuring Predictability

• Occlusion
• Esthetics

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• Comprehensive Treatment Planning and Treatment
  Sequencing for the Partially Edentulous Patient

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Ensuring Predictability

• Occlusion
• Esthetics

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Step 1 Observe Existing Occlusion

• Type

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Type

• Mutually protected (Anterior Disclusion)

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Type

• Mutually protected (Anterior Disclusion)
• Group Function

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Type

• Mutually protected (Anterior Disclusion)
• Group Function
• Bilateral Balance

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Type

• Mutually protected (Anterior Disclusion)
• Group Function
• Bilateral Balance
• Mutilated

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Step 1 Observe Existing Occlusion

• Type
• Occlusal Plane

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Occlusal Plane

• Is the occlusal plane appropriate
• Extruded teeth
• Tipped teeth

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Step 1 Observe Existing Occlusion

• Type
• Occlusal plane
• Vertical dimension of occlusion

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Vertical Dimension

• Appropriate Dimension
• Space for Restorations

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Step 1 Observe Existing Occlusion

• Type
• Occlusal plane
• Vertical dimension of occlusion
• Centric contacts

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Step 1 Observe Existing Occlusion

• Type
• Occlusal plane
• Vertical dimension of occlusion
• Centric contacts
• Interferences

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Step 1 Observe Existing Occlusion

• Type
• Occlusal Plane
• Vertical Plane
• Centric Contacts
• Interferences

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Step 2 Plan Ideal Occlusion

• Type

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Type

• Mutually Protected
• (Anterior Disclusion)
• (Cuspid Guidance)
• Group Function
• Bilateral Balance

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Step 2 Plan Ideal Occlusion

• Type
• Occlusal Plane

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Occlusal Plane

• Change Location or Orientation
• To make selected type of occlusion possible
• To improve esthetics
• Determine Treatment for Tipped or Extruded Teeth.

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Step 2 Plan Ideal Occlusion

• Type
• Occlusal Plane
• Vertical Dimension

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Vertical Dimension

• Lack of Space
• Very rarely change vertical dimension
• Consider crown lengthening
• Do not use attachments
• Probably require preprosthetic surgery prior to
  implants

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Step 2 Plan Ideal Occlusion

• Type
• Occlusal Plane
• Vertical Dimension
• Centric Contacts

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Centric Contatcs

• Select Ideal Location for EACH Contact

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Step 2 Plan Ideal Occlusion

• Type
• Occlusal Plane
• Vertical Dimension
• Centric Contacts
• Interferences

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Interferences

• Determine If Interference is
• Significant
• On a Tooth to be Restored

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Step 2 Plan Ideal Occlusion

• Type
• Occlusal Plane
• Vertical Plane
• Centric Contacts
• Interferences

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Step 3 Determing Treatment Options (and
Prognosis)

• No Treatment
• Resin Bonded Partial Denture
• Fixed Partial Denture
• Implant Prosthesis
• Removable Partial Denture
• Combinations

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• Treatment Options
• Prognosis
• Informed Consent

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Step 3 Determine Treatment Options (and
Prognosis)

• No Treatment

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No Treatment

• Occlusion Stable Functional
• Esthetics Acceptable
• Contraindications to Treatment
• Hygiene
• Medical
• Psychological

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Step 3 Determine Treatment Options (and
Prognosis)

• No Treatment
• Resin Bonded Partial Denture

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Resin Bonded Partial Denture

• Abutment Teeth Do Not Need Cast Restorations
• Adequate Periodontal Support
• Occlusal Clearance

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Step 3 Determine Treatment Options (and
Prognosis)

• No Treatment
• Resin Bonded Partial Denture
• Fixed Partial Denture

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Fixed Partial Denture

• Abutment teeth need cast restorations
• Abutment teeth can survive preparation
• Adequate periodontal support
• No room for Resin Bonded Bridge

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Step 3 Determine Treatment Options (and
Prognosis)

• No Treatment
• Resin Bonded Partial Denture
• Fixed Partial Denture
• Implant Prosthesis

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Implant Prosthesis

• Abutment Teeth Do NotNeed Cast Restorations
• Lack of Periodontal Support

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Step 3 Determine Treatment Options (and
Prognosis)

• No Treatment
• Resin Bonded Partial Denture
• Fixed Partial Denture
• Implant Prosthesis
• Removable Partial Denture

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Removable Partial Denture

• Successful History of Wearing Previous RPDs
• Lack of Periodontal Support
• Probable Need for Future Additions
• Soft Tissue Replacement
• Patient Not Suitable for More Complex Treatment.

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Step 3 Determine Treatment Options (and
Prognosis)

• No Treatment
• Resin Bonded Partial Denture
• Fixed Partial Denture
• Implant Prosthesis
• Removable Partial Denture
• Combinations

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Combinations

• Multiple Missing Teeth

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Step 4 Design the Implant and/or Removable
Framework

• Occlusion

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Occlusion

• Position of Rests and Minor Connectors
• Position of Implant Screws

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Step 4 Design the Implant and/or Removable
Framework

• Occlusion
• Esthetics

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Step 4 Design the Implant and/or Removable
Framework

• Occlusion
• Esthetics
• Castings

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Castings

• Rests
• Ledges
• Undercuts
• Guide planes
• Attachments

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Step 4 Design the Implant and/or Removable
Framework

• Occlusion
• Esthetics
• Castings
• Overdenture?

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Step 5 Diagnostic Set-up and Wax-Up

• Type
• Occlusal Plane
• Vertical Dimension
• Centric Contacts
• Interferences
• Esthetics

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Step 5 Diagnostic Set-up and Wax-Up

• Type
• Occlusal Plane
• Vertical Dimension
• Centric Contacts
• Interferences
• Esthetics

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Esthetics

• Verification of Esthetics Before commencing
  Treatment

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Step 6 Plan Treatment Sequence

• Maintenance of Vertical Dimension of Occlusion.

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Maintenance of Vertical Dimension

• Plan sequence to preserve centric stops

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Step 6 Plan Treatment Sequence

• Maintenance of Vertical Dimension of Occlusion.
• Assure Optimal Occlusal and Esthetic Results.

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Occlusion and Esthetics

• Use Diagnostic Set-up during Preparation
• Survey Master Casts for Fixed Restorations
• Wax-up Fixed Restorations against Set-up

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• Do Not Wax-Up
• Against Air!

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• PLAN
• Removable Implants
• FIRST