For the sake of consistency, the right infraorbital point is generally used and the facebow assembled in this relationship. It is removed from the mouth and chilled in cold water and then replaced in position in the patient’s mouth. Although formats for sequencing the patient interview (and clinical examination) vary, to ensure thoroughness the dentist should follow a sequence that includes: It is from the above interaction that patient uniqueness, as mentioned earlier, is best defined. For most partially edentulous patients, the discussion may involve fairly complex rehabilitation options for addressing their missing teeth. During the examination, not only each arch but also its occlusal relationship with the opposing arch must be considered separately. An example of such a case would be people who have gastroesophageal reflux disease or bulimia along with a parafunctional habit resulting in the loss of tooth structure requiring reconstruction. The diagnostic cast is too valuable for purposes of future reference to risk damage resulting from the making of an impression tray. The older Hanau model H articulator usually will not permit a facebow transfer with an infraorbital pointer. The importance of the examination, the consideration of favorable and unfavorable aspects relative to movement control, and the importance of planning the elimination of unfavorable influences cannot be overemphasized (see Chapter 2). The stability of tooth and prosthesis position is the goal of such an evaluation. The size of the arch will determine the size of the tray to be used. Treatment Planning; Prosthodontics. Although it is true that an axis-orbital mounting has no functional value on a nonarcon instrument because that plane ceases to exist when opposing casts are separated, the value of such a mounting lies in the orientation of the casts in occlusion. Diagnosis and treatment of the transverse dimension are important steps on the way to attain a stable treatment outcome. It should be understood that the fee for examination is based on the time involved and the service rendered, and that the material value of the radiograph and diagnostic casts is incidental to the effectiveness of the examination. The initial steps allow recording of the maxilla–temporomandibular joint (TMJ) relationship: The next steps allow transfer of the recorded relationship to the articulator: The facebow is a relatively simple device used to obtain a transfer record for orienting a maxillary cast on an articulating instrument. With experience, this subtle point becomes a major component of a clinician’s management focus. Figuring out what to do in the phase 1 part of the prosthodontic treatment is the most challenging part of treatment planning. A fundamental objective of the patient interview, which accompanies the diagnostic examination, is to gain a clear understanding of why the patient is presenting for evaluation; this involves having the patient describe the history related to the chief complaint. Such an examination will not provide sufficient information to allow a definitive diagnosis and treatment plan. Secure the bite fork vertical rod, then the horizontal rod (holding the bow securely to prevent torque). With the facebow fork in position, the facebow toggle is slipped over the anterior projection of the facebow fork (. DIAGNOSIS AND TREATMENT PLANNING IN FIXED PROSTHODONTICS Successful management of cases begin with a thorough assessment of the patient’s physical and psychological condition and determining a treatment that will satisfy the realistic expectations of the patient Diagnosis The determination of the nature of a disease. These include the teeth locations, contours, and occlusal plane relationship; the residual ridge contour, size, and mucosal consistency; and the oral anatomy delineating the prosthesis extensions (vestibules, retromolar pads, pterygomaxillary notch, hard/soft palatal junction, floor of the mouth, and frena). This results in failure to prepare the patient and the oral tissues properly before the master cast is fabricated. It can be a very complex and confusing process if the patients needs are great. The facebow fork is covered with a polyether, polyvinyl siloxane or a roll of softened baseplate wax with the material distributed equally on the top and on the underneath side of the facebow fork. Polyvinyl siloxane material has been evenly distributed around the facebow fork, and care is exercised to position the fork to be centered at the mid-incisal position without any fork extension posterior to the record base, which could cause discomfort. What is the periodontal health and tooth stability (mobile or stable? Program Goals. The older patient often presents with clinically challenging dental problems combined with complex medical, social, psychological, and financial barriers to oral health. However, when the natural dentition is not harmonious and/or when the replacement teeth must be positioned within the normal movement patterns of the jaws, the diagnostic casts must be related in an anatomically appropriate manner for diagnosis. Finally, the procedures of stabilizing the patient’s posterior support and testing out the patient’s tolerance to the altered occlusal scheme are all part of phase 1 therapy to me. This is more anatomically accurate than a simple hinge mounting. Therefore diagnostic casts should be duplicated, with one cast serving as a permanent record and the duplicate cast used in situations that may require alterations to it. The cast support is raised to supporting contact with the facebow fork after the facebow height has been adjusted to the level of the orbital plane. The process of treatment planning involves the diagnostic phase, the goals setting phase and then choosing your treatment phase. This process recognizes that there may be complex “trade-offs” in care choice, and it addresses the need to fully inform patients about risks and benefits of care options, as well as ensuring that patient values and preferences play a prominent role in the process. The treatment plan for the removable partial denture, which is often the final step in a lengthy sequence of treatment, should precede all but emergency treatment. Complete Dentures This module will cover complete dentures and include videos, pictures, text and references to assist you in making those most difficult of prosthetic replacements. Although most authorities agree that any of the three axes will permit transfer of the maxillary cast with reasonable accuracy, it would seem that the Bergström point compares most favorably with the kinematic axis. Treatment plan The sequence of procedures planned for the treatment … Generally the improved dental stones (die stones) are not used for diagnostic casts because of their cost. 5. The department provides a diagnostic and treatment planning service for fixed prosthodontics. Description: Treatment planning is commonly considered one of the most important phases of any dental treatment and vital for achieving successful long-term results. A diagnostic cast is usually made of dental stone because of its strength and the fact that it is less easily abraded than is dental plaster. Diagnostic casts may be used as a constant reference as the work progresses. The interview, an opportunity to develop rapport with the patient, involves listening to and understanding the patient’s chief complaint or concern about his or her oral health. Such a discussion at the outset of patient care helps to outline realistic expectations. B, Following placement of the maxillary anterior teeth in an ideal position, diagnostic arrangement of occlusion results in a space posterior to surveyed crown #27. The ultimate treatment is individualized to address disease management and the coordinated restorative and prosthetic needs that are unique to the patient. Treatment planning concerns the treatment procedures by which the dentist will restore the patient to an optimum state of dental health. Rodrigues, Antonio H. C. Treatment planning is commonly considered one of the most important phases of any dental treatment and vital for achieving successful long-term results. The tray should be sufficiently oversized to ensure an optimum thickness of impression material to avoid distortion or tearing on removal from the mouth. The patient then helps guide plastic earpieces into the external auditory meatus and holds them in place while the operator tightens three thumb screws (2) and centers the plastic nosepiece (3) securely on the nasion. During the examination, the objective to be kept foremost in mind should be the consideration of possibilities for restoring and maintaining the remaining oral structures in a state of health for the longest period of time. The fee for examination, which should include the cost of the radiographic survey and the examination of articulated diagnostic casts, should be established before the examination is performed and should not be related to the cost of treatment. Some of these conditions, if not corrected, can influence the outcome of your prosthetic treatment plan. Prosthodontics enables dentists to develop up-to-date skills, knowledge and expertise to confidently manage the treatment needs of patients in a holistic and comprehensive manner. If the patient presents with a harmonious occlusion and the edentulous span is a tooth-bound space, simple hand articulation is generally all that is required. Or how do I improve the esthetics with veneers or crowns? Note the horizontal changes occurring from 17 to 59 years of age. Prosthodontics has an emphasis on the diagnosis and treatment planning of patients who have complex dental needs and on providing treatment services that primarily involve the repair or replacement of natural teeth with a variety of fixed or removable … So, having a well-thought-out plan prior to beginning any treatment is a key to success. • Removing non-restorable teeth It must be a flexible one, where both the clinician and the patient have a better understanding of what options are available. It should include visual and digital examination of the teeth and surrounding tissues with a mouth mirror, explorer, and periodontal probe, vitality tests of critical teeth, and examination of casts correctly oriented on a suitable articulator. If an earpiece facebow is to be used, the patient should be reminded that the plastic earpieces in the auditory canals will greatly amplify noise. Figure 12-6 Use of the facebow makes possible the recording of the spatial relationship of the maxillae to some anatomic reference points and transference of this relationship to an articulator. Bergström has located the arbitrary axis 10 mm anterior to the center of a spherical insert for the external auditory meatus and 7 mm below the Frankfort horizontal plane. Such use of diagnostic casts permits justification of the proposed fee through the patient’s understanding of the problems involved and of the treatment needed. Why Eastman? There are many factors to consider: medical, social, dental condition and the patient’s decision. • Provision of posterior support to minimize occlusal trauma to anterior teeth It is also a phase of treatment that allows the patient to test out what works and what does not work in the mouth. We are located one block south Close the articulator and check clearance for mounting plaster (modify the cast as needed). initially on a Fixed Prosthodontics Treatment Plan & Sequencing form (yellow) in preparation for entering as an unapproved treatment plan in Axium. Produce a graduate who is competent and proficient in all aspects of prosthodontics. Another example of phase 1 therapy would be a process of evaluating pre-prosthetic orthodontic, surgical and/or endodontic options prior to finalizing the most suitable treatment option for the patient. The objectives of any prosthodontic treatment may be stated as follows: (1) the elimination of disease; (2) the preservation, restoration, and maintenance of the health of the remaining teeth and oral tissues (which will enhance the removable partial denture design); and (3) the selected replacement of lost teeth; for the purpose of (4) restoration of function in a manner that ensures optimum stability and comfort in an esthetically pleasing manner. Some Common Prosthodontic Goals can be: (An arcon articulator is one in which the condyles are attached to the lower member as they are in nature, the term being a derivation coined by Bergström from the words articulation and condyle. Although oral health is an important aspect of overall health, it is an elective health pursuit for most individuals. The keyed and lubricated maxillary cast is now attached to the upper arm of the articulator with the mounting stone, thus completing the facebow transfer (Figure 12-11). When helping patients understand their oral health status, comprising both disease and deficit considerations, and the means to address both, we should carefully consider what it is they need to hear from us. It is recommended that deflective occlusal contacts in the maximum intercuspal and eccentric positions be corrected as a preventive measure. The keyed and lubricated maxillary cast is now attached to the upper arm of the articulator with the mounting stone, thus completing the facebow transfer (. Many people will focus on the definitive treatment plan of teeth replacement. This includes four distinct processes: (1) understanding the patient’s desires or chief concerns/complaints regarding his or her condition (including its history) through a systematic interview process, (2) ascertaining the patient’s dental needs through a diagnostic clinical examination, (3) developing a treatment plan that reflects the best management of desires and needs (with influences unique to the medical condition or oral environment), and (4) executing appropriately sequenced treatment with planned follow-up. Release the bow anteriorly to allow spread, and disengage from the ears. Choosing your treatment phase is often the part of what you learn in dental school. 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