Choice of prosthetic treatment

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Choice of prosthetic treatment

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Interview Oral examination Study
cast Radiographic Exam
INFORMATION
Fixed partial denture Removable partial
denture Complete denture Implant
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CONSIDERING FACTORS

• The patients systemic and oral health
• Patients age
• Physiologic mechanical consideration
• Desire of patient
• The patients psychological status
• The economic status priorities of patient

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CONSIDERING FACTORS

• The patients systemic and oral health
• Generally a health patient has a healthy mouth
  and a patient with weak systemic condition has a
  poor oral cavity
• Patient with chronic disease complicated
  prosthetic treatment is not OK

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CONSIDERING FACTORS

• Patients age
• Child
• Adolescent
• Adult
• Middle aged
• Old (geriatric)

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CONSIDERING FACTORS

• Physiologic mechanical consideration
• Prosthetic material
• Occlusal force
• Distribution of stress

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CONSIDERING FACTORS

• Desire of patient
• Tooth ? save or not, need or not
• Esthetics
• Mastication

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CONSIDERING FACTORS

• The patients psychological status
• Discuss with patient
• Need patients agreement with the plan

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CONSIDERING FACTORS

• The economic status priorities of patient
• DDS ideal treatment plan, Patient best
  quality with lowest cost
• Need modification

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Fixed partial denture

• Most nearly ideal prosthetic treatment
• function as natural dentition
• feel as natural dentition
• fixed, will not be lost
• Esthetic

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Fixed partial denture

• Indication
• span is short, straight
• strong well supported abutment
• condition of opposing dentition
• bone level is more important than mobility
• patients hygiene is good
• if poor hygiene removable type is better

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Fixed partial denture

• Indication
• can do reduction of teeth
• if patient dislike reduction removable type or
  implant or adhesive type is better
• force of mastication can be transmitted so
  direction of long axis of teeth
• inclination of abutment is greater than 25
  degree, do not use it as fixed abutment
• in oral cavity vs on the study cast

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Combination of fixed and removable partial denture

• anterior and posterior teeth missing anterior
  fixed bridge , posterior removable partial
  denture (esthetic problem, leverage of movement)
  (consider the combination syndrome)

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Combination of fixed and removable partial denture

• splint and removable partial denture
• avoid isolating teeth
• anterior alveolar ridge defect for esthetic,
  flange is better than pontic base

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REMOVABLE PARTIAL DENTURE

• no posterior terminal abutment ( distal extension
  case )
• edentulous space are too long, too curve
  especially anterior and canine
• severe soft and/or hard tissue defect
• cross arch splint effect consider this effect
  in unilateral partial denture case

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REMOVABLE PARTIAL DENTURE

• not fully erupted abutment young patient
• expectation of additional extraction tooth
  supported ? tissue supported type
• cast removable lt fixed

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COMPLETE DENTURE

• advanced periodontal disease
• excessive mobility, reduced alveolar bone level
• transitional denture ? final denture
• uncontrolled rampant caries
• cosmetic result

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COMPLETE DENTURE

• better comfort, esthetics, retention, stability
• especially upper case
• economic factor

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CHOICE OF RETAINER

• Kinds of Retainer FVC, 7/8, 3/4, half crown,
  pin-ledge crown, inlay or onlay
• How to choice the retainer?
• Balance

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Considering factors

• Retention
• Esthetic
• Path of insertion
• Abutment of partial denture area of clasp
  placing

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Considering factors

• Retention
• force individual difference, occlusal facet,
  opposing dentition
• occlusion curve
• span especially distal abutment
• presence of adjacent tooth
• amount of remaining tooth structure
• fixed or semi-rigid (in long bridge)

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Considering factors

• Retention
• Esthetic
• Path of insertion
• Abutment of partial denture area of clasp
  placing

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Considering factors

• Esthetic
• partial veneered crown VS full veneered crown
• PFM VS pin-ledge, 3/4, inlay, resin facing
• In long bridge PVC is not good

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Considering factors

• Retention
• Esthetic
• Path of insertion
• Abutment of partial denture area of clasp
  placing

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Considering factors

• Path of insertion
• lingually tilted molar ? reverse 3/4 crown
• mesially tilted molar

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Considering factors

• Retention
• Esthetic
• Path of insertion
• Abutment of partial denture area of clasp
  placing

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Considering factors

• Abutment of partial denture area of clasp
  placing
• Path of insertion
• Re-contouring abutment

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Considering factors

• Economics non-precious or precious
• Oral hygiene
• Diet habit and other habits
• Material

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Considering factors

• Economics non-precious or precious
• Oral hygiene
• Diet habit and other habits
• Material

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Considering factors

• Oral hygiene
• caries activity
• condition of previous restoration
• in poor oral hygiene   FVCgtPVC, sub-gingival
  margin gt supra-gingival margin

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Considering factors

• Economics non-precious or precious
• Oral hygiene
• Diet habit and other habits
• Material

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Considering factors

• Diet habit and other habits
• grind, amount of force ( character of food )
• clenching or bruxism need much resistance

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Considering factors

• Economics non-precious or precious
• Oral hygiene
• Diet habit and other habits
• Material

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Considering factors

• Material
• accuracy of metal after casting
• rigidity of metal

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Implant

• First choice VS Second choice
• Advantage, disadvantage
• Limitation , application
• Maintenance program

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KEEP IN MIND

• RETENTION TEETH ? ALVEOLAR BONE PRESERVATION
• NON-FUNCTIONING BONE ? ATROPHY, RECESSION, LOSS
  OF TRABECULAE
• CONSERVATION OF TOOTH STRUCTURE IS RESPONSIBILITY
  OF DDS

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KEEP IN MIND

• ESTHETIC IS ESSENTIAL
• MANDIBLULAR DENTITION RETENTION PROBLEM IS
  HIGHLY GREATER THAN MAXILLA

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KEEP IN MIND

• COMBINATION OF COMPLETE DENTURE REMOVABLE
  APRTIAL DENTURE MAXILLA COMPLETE DENTURE,
  MANDIBLE RPD( favorable but consider the
  combination syndrome)

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KEEP IN MIND

• MAXILLA ANTURAL DENTITION, MANDIBLE COMPLETE
  DENTURE (not good), MAXILLA COMPLETE DENTURE,
  MANDIBLE-NATURAL DENTITION ( not so bad )

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Thank you for your attention