patient selection

PATIENT SELECTION, DIAGNOSTIC CASTS Dr. Makdad Chakmakchi

IMPRESSION MAKING FORDIAGNOSTIC CASTS
Making an alginate impression for diagnostic casts.
A small nonadjustable or semiadjustable articulator are used.


Soften half a sheet of occlusal wax in warm water and adapt it to the maxillary cusp tips. Allow the patient to close tightly, and make cuspal indentations of the mandibular teeth
Diagnostic procedures such as diagnostic waxing, tooth preparation, and diagnostic cast modification can greatly enhance diagnosis and treatment planning.

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Diagnostic casts
Study casts made from stable alginate impression accurate, reproducible without positive nodules Articulation using semiadjustable articulators is recommended Provide information about edentulous ridge, occlusion, abutment length and inclination arch curvature, drifting and rotation Occlusal analysis. Planning for the pontic size and design Diagnostic wax-up

Radiographic Evaluation

Signs of primary or recurrent caries Presence pf periapical lesion Quality of existing endodontic treatment Alveolar bone level Crow:root ration Length, configuration and direction of roots Widening of periodontal membrane Presence of root tips or pathology in the edentulous area

TREATMENT PLANNING 

Identification of Patient Needs
Treatment is necessary to accomplish one or more of the following objectives: correcting an existing disease, preventing future disease, restoring function, and improving appearance.

SELECTION OF ABUTMENT TEETH

Whenever possible, FDPs should be designed as simply as possible, with a single well-anchored retainer fixed rigidly at each end of the pontic. The use of multiple splinted abutment teeth, nonrigid connectors, or intermediate abutments makes the procedure much more difficult, and often the result compromises the long-term prognosis

Replacement of a Single Missing Tooth

Assessment of abutment teeth
- Radiographs are made - pulpal health is assessed by evaluating the response to thermal and electrical imulation. - Existing restorations, cavity liners, and residual caries are removed, A careful check is made for possible pulpal exposure. - Teeth in which pulpal health is doubtful should be endodontically treated before the initiation of fixed prosthodontics. Although a direct pulp cap may be an acceptable risk for a simple amalgam or composite resin, conventional endodontic treatment is normally preferred for cast restorations, especially when the later need for endodontic treatment would jeopardize the overall success of treatment.

Endodontically treated abutments

If a tooth is properly treated endodontically, it can serve well as an abutment with a post and core foundation for retention and strength.Conservation of Tooth StructurePreparation of the canal• Apical seal• Minimal enlargement• Length• Stop• Antirotation• Margin extension

Post Classification

Custom
Prefabricated
Can be cast from: -Direct pattern in pt mouth - In direct pattern in laboratory
Noble alloy Carbon fiber posts Composite fiber posts Ceramic (zirconia) posts ceramic composite
William C. A review of the management of endodontically treated teeth: post and core and the final restoration.2005; J Am Dent Assoc.

Advantages of Composite Fiber Post

Can bonded to the tooth with resin cement Modulus of elasticity similar to dentin Ease of removal for retreatment Excellent esthetics Non corrosive Richard S.S.Post placement and restoration of edodontically terated teeth.2004; J Endod

Fiber reinforced composite bridges

Fiber reinforced composite bridges
• easy to use• minimally invasive• superior strength • scientifically proven• cost effective • aesthetic

Fiber reinforcements for daily dentistry

C&B For minimally invasive fiber reinforced composite bridges Surface retained bridges Inlay and onlay bridges Hybrid bridges and Temporary bridges Laboratory-made bridges
A
C
B

2. Root canal post

For advanced root canal post and core structures Individually formed root canal posts
A
B
C
A

3. PERIO

For patient friendly splinting• Periodontal splinting• Combined periodontal splint and surface-retained bridge A
B
C

4. traumatized teeth

For easy and aesthetic splinting of traumatized teeth• Labial splinting of traumatized teeth• Labial periodontal splinting• Repair and reinforcing of veneers A
B
C

5. For reliable anchoring

Indicated for orthodontic splinting e.g. anchoring
C
B
A

6. For aesthetic retention

For patient-friendly metal free orthodontic retainer
A
C
A



Competitive advantages of everStick® fibres• Minimally invasive and reversible; leave other treatment options available• Superior mechanical properties• Unique patented bond• As strong as metal• Elasticity close to that of dentin• Extensive research data• More than 300 publications and several dissertations• Long term clinical data with excellent success ratio

For minimally invasive fibre reinforced composite bridges Surface retained bridges Inlay and onlay bridges Hybrid bridges and Temporary bridges Laboratory-made bridges