Treatment planing in dental implants/ orthodontic continuing education

Treatment planning
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Loss of teeth
• Loss of function
• Disuse atrophy of
ridge
• Migration of teeth
• TMJ

Sequelae Of Loss Of
Teeth

Occlusal Plane
Derangement

Shift Of Masticatory
Apparatus

Treatment plan
• Fixed dentures
• Implant supported
fixed denture
• Removable partials
• Make a dental cripple

Fixed dentures are the
most preferred!

Removable partial
dentures may be the
IDEAL
treatment choice

Solution or the problem?

Problem continues….

Indications for a RPD
• Length of edentulous span
• No abutment tooth posterior to the
edentulous area
• Need for cross arch stabilization
• Excessive bone loss of the residual ridgewww.indiandentalacademy.com

• Reduced Periodontal support of the
remaining teeth
• Patient desires
• Youth
• Physically or emotionally
handicapped

• Abutments with guarded
prognosis
• Economic considerations

Contraindications
• Epileptic patient having frequent
and severe attacks, without
premonition
• Poor patient attitude

Treatment plan
• Examination
• Diagnosis & prognosis
• Comprehensive rehabilitation
• Pre prosthetic treatment
• Revaluation
• Prosthetic treatment plan
• Treatment phase
• Maintenance phasewww.indiandentalacademy.com

Principle of RPD is
the
DE VAN’s
principle.
Broad distribution of
forces
Least damage to the
abutments
Effective utilization ofwww.indiandentalacademy.com

THE SOLUTION IS
Keep the end in mind
Plan treatment for a favorable and
predictable prognosis

Treatment planning
• Identification of patients needs
• Correction of existing disease
• Prevention of future disease
• Restoration of function
• Improvement of appearance

Evaluation of existing
prosthesis

Treatment of abused tissues
• Inflammed and
irritated mucosa

Steps for successful treatment
• Step 1  ascertaining what the patient desires
or wants
• Step 2  finding what he actually needs
• Step 3  developing a treatment plan
relevant to the patient’s wants and needs
• Step 4  executing the treatment plan after
explaining the plan to the patient
McCracken's Removable Partial Prosthodontics

Evaluation of occlusion
• Collapsed occlusion
• Traumatic occlusion
• Deranged occlusal plane
Herbert T. Shillingburgwww.indiandentalacademy.com

• Signs of traumatic occlusion
– Excessive wear of teeth
– Chipping or fracture
– Tooth mobility, migration or discomfort during
occlusal contact
– Pain in the T.M.J , muscle spasm or joint
dysfunction
• Radiographic
– Widening of periodontal ligament space
– Thickening of lamina dura
– Root resorption or alveolar resorption

Signs of collapse of occlusion
• Collapse of vertical dimension of
occlusion
– Requires extensive treatment

Treatment Objectives
• Restore lost tooth structure
• Restore lost VD
• Establish new horizontal relation
• Develop new engram
• Transfer data to articulator
• Develop new occlusal relationship for
the established VD&HR

Diagnostic wax up

Modified dentures

Diagnostic casts

•Analysis of the existing occlusion
»Angulation
»inclination
» supraeruption
» elongation
» jaw relation
» occlusal plane
» occlusal contacts
» interference
» interocclusal space
» proximal tooth contacts
» guide planeswww.indiandentalacademy.com

Analysis of existing occlusion
» Angulation
» Inclination
» Supraeruption
» Elongation

» Interocclusal space
» Proximal tooth contacts
Type of
restoration
Anterior Posterior
Removable 12 mm. 12 mm

Management of less
Interarch space.
1. Surgical reduction of
tuberosities.
2. Osteoplasty and /or soft tissue
reduction of implant region
3. Selective grinding
4. Prosthodontic restorations
5. Endodontic therapy.

Management of increased
Interarch space.
•MMay be decreased by addition
of onlay grafts .
•AAutogenous and /or membrane
grafts.
–AAlloplastic grafts

» Jaw relation
» Occlusal plane

» Occlusal contacts
» Interference

Occlusion
• Occlusal plane
• Occlusal relation
• CO CR discrepancy

Correction of occlusal plane
• Enameloplasty
• Onlay restoration
• Intentional RCT & crown
• Orthodontics
• Extraction
• Sinus lift
• Increase VD

Intentional RCT

Tilted abutment

• Angulation of
abutment
• Tooth contact

Orthodontic up righting

Analysis of abutment
• Root length
• Size
• Form
• Crown root ratio

Abutment evaluation
• Dentition and abutment
• Caries susceptibility

Restorations

Caries susceptibility
restorative status

Post-Endodontic
Restorations
Presented by
Dr.T.V.Padmanabhan

Salvage or Sacrifice

Periodontal conditions

Fixed Splinting
• Incase of compromised periodontal support
of remaining teeth
• Short tapered roots
• To improve support for the partial denture

Convert modification
areas to
FPDs, making
design simple

Missing teeth

Removable splinting
• When abutment teeth exhibit a alveolar bone
loss of greater than 50% splinting them by
means of fixed splints to adjacent healthy
teeth, the adjacent teeth is also subsequently
weakened
• Splinting may also be accomplished using
properly designed removable partial dentures

• This is done by means of lingual plating in
conjunction with multiple facially positioned
clasp arms
• Thus remaining teeth and removable
prosthesis functions as a single functional unit
• Forces are distributed over increased number
of teeth, increasing the longevity of the
remaining teeth

Existing prosthesis
• Response of teeth and
residual ridge to
previous stress
• Arch form

Plan the prosthesis

1 Knowledge of design
2 Incorporation in to present
clinical situation

Design 1
• Cingulam
rest
• I-bar clasp
• A-P palatal
bar
• Proximal
plate

Design 2
Only
possible
modificatio
n is to
incorporate
embrasure
clasp towww.indiandentalacademy.com

Alternative treatment modalities

Thank you
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Treatment planing in dental implants/ orthodontic continuing education

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