7 Preventive Prosthodontics

SEMINAR ON
PREVENTIVE
PROSTHODONTICS
Presented by:
Dr. Ch. Praveena,
First year Graduate Student,
Dept. of Prosthodontics,
Sibar Institute of Dental Sciences,
Guntur-09.
INTRODUCTION
06/26/2023
Preventive prosthodontics-100
“ Perpertualpreservation of what remains,
rather than meticulous restoration of what is lost”
 An attempt to converge to the dictum.
2
WHAT IS PREVENTIVE
PROSTHODONTICS?
06/26/2023
Any procedure that can delay or eliminate the future
prosthodontic problem.
 Attention ---- preservation of residual ridge.
 Bone dynamic tissue.
3
CLASSIFICATION
Preventive
06/26/2023
Prosthodontics
Removable Fixed
Tooth Implant
CD RPD
supported supported
4
Complete Denture
06/26/2023
Preventive
Prosthodontics
5
Diagnosis & Treatment Planning
06/26/2023

As it is rightly said in a Latin proverb
Complete Denture Prosthodontics
“The first step towards cure is to know what the disease is”
The goal in clinical examination is to recognize normal
anatomy and physiology, normal variations, and early signs
and symptoms of any disease. A through, comprehensive
examination also allows modification or possible deferment of
treatment when indicated.
6
06/26/2023 Preventive prosthodontics-100
7
06/26/2023
As a rule of thumb,
Every extra minute spent for clinical
examination, reduces the time for ur
further treatment steps as well
as eliminates the future prosthodontic
problems.
8
Role of nutrition
 Oral cavity tissues… affected by nutritional
06/26/2023
disturbances.
 Denture failures are not only due to imperfect design but
also to poorly nourished tissues.
9
Role of Impression Procedures
The
 journey towards successful denture fabrication begins with making
06/26/2023
accurate impression.
Impression
 should cover as much available area of support as possible
ending our perpheries compact bone, and provide functioning borders
where muscle attachments exist.
Mucostatic/
 selective pressure techniqes are preferred to preserve the
health of the tissues.
To
 foreshorten impressions will result in loose dentures with constant
adverse pressures on supporting bone and tissue and subseqent resorption
of bone.
10
11
Restoration of VD
06/26/2023
 The restoration of the vertical dimension of occlusion
requires strict attention in order not to encroach on the
interocclusal distance (free-way space).
 To do so causes further bone resorption if one errs by

increasing the vertical dimension beyond physiologic
limits.
 In this case it is better to err on decrease VDO.
12
Restoration of VD
06/26/2023
 Important to record and to register is centric jaw
relationship.
 To err on this relation can wreak havoc on all oral tissues
and literally destroy the temporomandibular articluation!
13
Role of occlusion
06/26/2023
Goal
 of complete denture occlusion is preservation of
structure and restoration of function and esthetics.
Consequences
 of tooth loss create anatomic changes which
result in differences in derivation of retention, stability
and support between natural and complete denture teeth.
Enhancement
 of neuromuscular control and function is a
primary determinant of tooth position.
14
DIFFERENCES BETWEEN NATURAL &
ARTIFICIAL DENTITION
06/26/2023
Natural Dentition Denture “Dentition”
 Retained in PDL  Mobile bases on mucosa
 Units move independently  Teeth move as an unit
 Malocclusion effects not  Malocclusion affects entire base

immediate immediately
 Non-vertical forces affect  Non-vertical forces affect all teeth
only teeth involved and and is traumatic
usually well tolerated  Incising affects all teeth attached
 Incising doesn’t affect to base
posteriors  Bilateral balance is often desired
 Bilateral balance is rare for base stability
 Tactile sensitivity  Decreased tactile sense 15
Role of occlusion
06/26/2023
 Bilateral Posterior
Centric Contact
 Centralized Forces
 “Balance” to
16
minimize tipping
Requirements of artificial occlusion
Stability
 of occlusion at centric relation position and in an area
06/26/2023
forward and lateral to it.

Balanced occlusal contacts bilaterally for eccentric contacts.
Unlocking
 the cusps mesiodistally to allow for gradual but inevitable
settling of the bases due to tissue deformation and bone resorption.
Control
 of horizontal force by buccolingual cusp height reduction
according to residual ridge resistance form and interarch distance.

17
Requirements of artificial occlusion
Functional
 lever balance by favorable tooth to ridge crest position.
06/26/2023

Cutting, penetrating and shearing efficiency of occlusal surfaces.

Anterior incisal clearance during posterior masticatory function.
Minimum
 occlusal contact areas for reduced pressure in comminuting food..

Sharp ridges or cusps and generous sluice ways to shear and shred food with
the minimum of force necessary.

18
THREE BASIC SCHEMES OF POSTERIOR OCCLUSION
- HAROLD. R. ORTMAL (1971)
06/26/2023
 Spherical scheme- uses anatomic teeth in balance occlusion

and lingualized occlusion.
 Flat occlusal scheme- non-anatomic teeth are used. Balance
occlusion does not exist unless compensating curve, balancing
inclines are used.
 Reverse curve –given by Dr. Max pleasure. Modified the

lower posterior teeth occlusal surface to a reverse curve by
tilting the tooth bucally, this did not provide balancing contact.

19

PHYSIOLOGICALLY GENERATED
OCCLUSION

Mehringer
 J E(1973) developed this occlusion to harmonize complete
denture occlusion neuromuscular system and Right and Left TMJ.
06/26/2023

It is mainly indicated for patients having adequate foundation with

stable record bases. And good neuromuscular control & can give
functional movements consistently.

Advantages
It is comfortable to patient as it is built physiologically, and
swallowing and masticatory movements are taken into consideration.

20
Post- insertion maintenance of CD’s
 Precludes further bone loss.
06/26/2023
 This entails remounting, selective grinding procedures,
rebasing and relining, and constant patient education on
the care of the dentures and oral hygiene of the
edentulous ridges.
21
Overdentures
06/26/2023
REGARDED AS A FORM OF
PREVENTIVE THERAPY.
PREVENTIVE
PROTHODONTICS
22
Definition
A removable partial denture or complete denture that
06/26/2023
covers and rests on one or more remaining natural teeth,

the roots of the natural teeth, and/or dental implants.
A prosthesis that covers and is partially supported by
natural teeth ,natural tooth roots and/or dental implants.
-GPT-8,2005.
23
SYNONYMS
06/26/2023
Overlay dentures
Onlay dentures
Hybrid dentures
Superimposed dentures
Telescoped dentures
Biologic dentures
Coping prosthesis
24
TWO TYPES
06/26/2023
 Tooth supported  Implant supported
overdentures overdentures
25
GOALS OF OVERDENTURES
06/26/2023
 Maintains teeth as part of  Withstands more occlusal
the residual ridge load
 More support
 Decrease in the rate of  Retention improve

resorption  Alveolar bone exists as a
 Retaining the support for teeth
proprioception  An increase in the patients
manipulative skills in
handling the denture
26
Advantages of Overdentures
06/26/2023
 Preservation of alveolar bone.
 Preservation of proprioceptive response.
 A simple approach to a problem patient.
 Simplicity of construction –ease of obtaining

accurate records and superior denture stability
 Support
 Periodontal maintainence
27
Disadvantages
06/26/2023
Caries susceptibility.
Bony undercuts:‐ overcontoured and undercontoured
flanges.
Encroachment of interocclusal distance.
Demand for meticulous oral hygiene
28
IDEAL REQUIREMENTS OF THE ABUTMENTS
FOR TOOTH- SUPPORTED OVER DENTURES
The
 gingival tissue should be firm, pink & tightly
06/26/2023
attached to the neck of the tooth & underlying bone.
A sufficient
 level of alveolar & supporting bone should
remain free from angular bony defects.
The
 abutments should be definitely root filled and free
from caries.
The
 abutments should exhibit a minimal degree of
mobility once they have been sectioned 2-3mm above
gingival margin
29
PLANNING FOR OVER DENTURES
06/26/2023
Periodontal
 considerations of the over denture.
Tooth location.

Endodontic considerations

No. of overdenture abutment teeth.


The amount of space between the abutments


Space requirements.

Bare root face.


30
31
METHODS OF RETENTION
Borders
 seal always plays an important role in retention
06/26/2023
In case of over dentures simple copings are involved in

the primary form of retention.
After
 the root preparation there different methods for
obtaining retention &stability.
Precious metal copings.

Dome shaped copings.


Attachments.

32
Attachment Systems
06/26/2023
They
 are of two types :
1.Extra radicular:-in which male elements projects
from the root surface of the preparation.
2.Intra radicular:-in which the male element form

the part of the denture base & engages a specially
produced depression with in the root contour.
33
34
Attachments
Dalbo
35
Rotherman Attachment
36
Zest Anchor Attachments
37
Multiple sleeves
Bar Attachment
Role of Immediate denture
06/26/2023
Peri-oral musculature
Tongue
n
So
ti o
ci
n
i ca
al
i t io
Appearance VD
st
l if e
tr
Ma
Nu
Reduced bleeding
Better healing
Carry medicament 38
Role of tissue conditioners & soft liners
06/26/2023
Soft
 & flexible polymers- protects from occlusal stresses.
Flows under static load.


Used
 in ridge atrophy.
Surgical contraindications

Parafunctional habits

Irradiated patients

Xerostomia

Nerve dehiscence

39
06/26/2023
REMOVABLE PARTIAL DENTURE
PREVENTIVE PROSTHODONTICS
40
06/26/2023
 Correct
design incorporates proper use & application of
mechanical & biological principles.
Removable Partial Denture
Biological
 considerations
Periodontium
Edentulous alveolar ridges
Soft tissues
oMechanical considerations
Movements of partial denture
Stresses induced
41
Periodontium
06/26/2023
Arrangement of periodontal tissues accept axial
loads.
Tension in periodontal fibres tend to promote

bone formation.
Lateral loads resorption occurs.
Some cases both resorption & necrosis occurs.

42
Edentulous alveolar ridges
In
 the absence of functional stimuli or reduction,
06/26/2023
lamellae of the cortical bone & trabeculae of the
medullary bone are decreased in number & size.
When
 pressure is increased, but it is still below
the physiological limit, according to Wolf’s law
on osteosclerotic reaction occurs.
Wolf’slaw
 refers to both the magnitude &
direction of applied force.
43
Soft tissues
Soft
 tissues covering the alveolar process consists of
06/26/2023
3 layers
Mucosa
Submucosa
Periosteum
Less
 compressible areas receive greater force & the
underlying those areas is subjected to osteolytic
reaction.
44
Mechanical considerations
 Direction, duration and magnitude of the force.
06/26/2023
 Bone maximum support.
 An appropriate design includes the selection &

location of components in conjunction with a
harmonious occlusion.
45
Possible movements
 Difference in
06/26/2023
displaceability
of the periodontal
ligament of the
supporting abutment
teeth and the soft tissue
covering the residual
ridge permits rotation
46
Stresses induced by RPD
 Appliance inaccuracy
06/26/2023
 Interference to appliance insertion
 Gingival impingement by RPD
 Occlusal rests placed on inclines.
 Major connector may cause trauma from flexing

 Flexing
 Lateral movement
 Major connector settlement
 Stresses which torque/ twist the abutment
 Stresses which tilt the abutment teeth

47
Relationship between Prosthesis Design &
Support System
 Tooth-supported removable partial denture
06/26/2023
requires no indirect retention.
 Basematerial need not be correctable for the all

tooth- supported prosthesis.
 Base extension should allow equitable

distribution of forces between components of the
dual support system.
48
Relationship between Prosthesis Design &
Support System
06/26/2023
 Location of primary rest seats.
 The impression procedure & choice of materials

is important for the distal extension partial
prosthesis.
 The selection of the retention mechanism.
49
Philosophy of Design
Based upon 3 approaches to force distribution:
06/26/2023
1. Stress equalization
2. Physiologic basing
3. Broad stress distribution
50
Methods to control load distribution
 Distributing the load between the teeth & ridges.
06/26/2023
1. By varying the connection between clasp &
saddle.
 Stress breaking
 Combined rigid connection between saddle
& clasp arm
2. Functional impressions
51
Methods to control load distribution
 Distributing the load widely
06/26/2023
1. Over more than abutment teeth on each side.
2. Over maximal area of edentulous ridge.
 Reducing the load by selection & arrangement of

teeth.
 Others
1. Major connectors
2. Guiding planes
52
PREVENTIVE
06/26/2023
PHILOSOPHY IN FIXED
PROSTHODONTICS
53
Examination, Diagnosis & Treatment Plan
 Thorough examination is essential to identify the
06/26/2023
early tooth loss. The consequences of tooth loss can
be eliminated by early replacement.
Fixed Prosthodontics
 In
cases of patients with Bruxism, occlusal splints
can be given.
54
Tooth preparation principles
1. Use of partial coverage rather than complete
06/26/2023
coverage restorations.
2. Preparation of teeth with the minimum convergence
angle between the axial walls.
3. Preparation of the occlusal surface so the reduction

follows the anatomic planes.
4. Preparation of the axial surfaces –Tooth structure
removed uniformly.
5. Selection of conservative tooth margin.
6. Avoidance of unnecessary apical extension of
preparation.
55
06/26/2023
Use of partial rather than Preparing teeth with

complete coverage retainers minimal practical taper
56
06/26/2023
Preparation of occlusal surface Preparing axial surfaces

following anatomic planes
evenly 57
06/26/2023
• Selection of
conservative margin
where indicated
• Avoid unnecessary
apical extension
58
Resin bonded FPD
 Minimal tooth preparation (0.5mm reduction, remaining
06/26/2023
in enamel)
 Supragingival margins
 Reduced intraoral procedures (comparatively)
 Rebond possible
 Reduced cost
 No anesthesia required
 Interim prosthesis
 Economical
59
Fiber Reinforced Composite Fixed
Prostheses
 Alternative to traditional metal ceramic
06/26/2023
restorations.
 Provide a conservative approach...
 Consists of fiber reinforced composite

substructure veneered with particulate composite
material.
 Minimal removal of crown structure & provides
no nickel allergy.
 Less wear of opposing tooth structure.
60
Prevention of Iatrogenic Damage During
Crown Preparation
Adjacent tooth structure
06/26/2023
• Iatrogenic
• Damaged surface
more prone to dental
caries
• Use proximal enamel
for protection
61
Soft tissues
 Tongue & cheeks can be prevented by careful
06/26/2023
retraction with an aspirator tip, mouth mirror, or
a flanged saliva ejector.
 Protectthe tongue when the lingual surfaces of

molars are prepared.
62
Pulp
 Extreme temperature
06/26/2023
 Chemical irritation
 Micro organisms
Air water spray:

 Keep the pulp within
+10 ˚ of 98.6 ˚ F.
63
Caries
 Active caries pentrate the dentin 1mm every 6 months.
06/26/2023
 All caries dentin should be removed before placing
restoration.
 An indirect pulp capping is
not recommended.
Direct pulp exposure

 CaOH recommended.
 Chemical cauterization.
 Regeneration starts at mummified tissue.
64
Provisional Crown
06/26/2023
 Reduces sensitivity & accumulation of plaque
 Loss prevents drifting of teeth.
 Free monomer is toxic to the pulp. Hence a protective

varnish / calcium hydroxide lining should be applied
before proceeding the temporary fabrication.
65
Microleakage
 Integrity
of the margins essential to avoid
06/26/2023
cement dissolution & plaque accumulation.
 Less soluble cement in oral environment to

prevent secondary caries of the abutment.
66
Cementing the
completed restoration
06/26/2023
 Penetration of phosphoric acid from zinc
phoshate & silicophosphate cement causes

trauma to the pulp.
 Cavity varnish can be applied.
 When a complete crown is seated cement

creates hydraulic pressure in every direction.
 If the crown is vented, much of the hydraulic
pressure will be relieved.
67
Margin placement
 Supra gingival vs sub gingival.
06/26/2023
 Place margins supra gingival whenever possible.
Indications for subgingival margins

 Esthetics
 Additional retention
 Root sensitivity
 Modification of axial contour
 Proximal contact extending to gingival crest
 Caries, erosion or restorations extending sub
gingivally 68
Subgingival margins
06/26/2023
2 mm away from alveolar crest

 loss of alveolar crest height & formation of pocket
69
Pontic
06/26/2023
 Open embrasure space adjacent to abutments to allow

room for interproximal tissue & access for oral hygiene.
 The embrasure space between the two adjacent pontics is
usually closed.
70
Role of facebow
 Allows more arc of closure on the articulator.
06/26/2023
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SEMINAR ON

 An attempt to converge to the dictum.

 Bone dynamic tissue.

Every extra minute spent for clinical

 Denture failures are not only due to imperfect design but

requires strict attention in order not to encroach on the

 To do so causes further bone resorption if one errs by

 In this case it is better to err on decrease VDO.

 Malocclusion effects not  Malocclusion affects entire base

Cutting, penetrating and shearing efficiency of occlusal surfaces.

 Spherical scheme- uses anatomic teeth in balance occlusion

 Reverse curve –given by Dr. Max pleasure. Modified the

It is mainly indicated for patients having adequate foundation with

swallowing and masticatory movements are taken into consideration.

 This entails remounting, selective grinding procedures,

covers and rests on one or more remaining natural teeth,

 Decrease in the rate of  Retention improve

 Preservation of proprioceptive response.

 Simplicity of construction –ease of obtaining

Encroachment of interocclusal distance.

Demand for meticulous oral hygiene

No. of overdenture abutment teeth.

The amount of space between the abutments

Bare root face.

Dome shaped copings.

2.Intra radicular:-in which the male element form

Flows under static load.

Tension in periodontal fibres tend to promote

Lateral loads resorption occurs.

Some cases both resorption & necrosis occurs.

 An appropriate design includes the selection &

 Gingival impingement by RPD

 Occlusal rests placed on inclines.

 Major connector may cause trauma from flexing

 Major connector settlement

 Stresses which torque/ twist the abutment

 Stresses which tilt the abutment teeth

 Basematerial need not be correctable for the all

 Base extension should allow equitable

 The impression procedure & choice of materials

 The selection of the retention mechanism.

 Combined rigid connection between saddle

& clasp arm

 Reducing the load by selection & arrangement of

3. Preparation of the occlusal surface so the reduction

Use of partial rather than Preparing teeth with

Preparation of occlusal surface Preparing axial surfaces

 Consists of fiber reinforced composite

Adjacent tooth structure

 Protectthe tongue when the lingual surfaces of

Air water spray:

Direct pulp exposure

 Regeneration starts at mummified tissue.

 Free monomer is toxic to the pulp. Hence a protective

 Less soluble cement in oral environment to

phoshate & silicophosphate cement causes

 When a complete crown is seated cement

Indications for subgingival margins

2 mm away from alveolar crest