Dental Caries

Vipeholm Study

Dental caries Fig. 32-8 is the most common cause of failure of a cast restoration. Detection can be very difficult,12 particularly where complete coverage is used. At each appointment, the teeth should be thoroughly dried and visually inspected Fig. 32-9 . The explorer must be used very carefully Fig. 32-5. Radiopacity of luting agents. These three in vitro studies compared the radiographic appearance of various luting agents to aluminum. The data were normalized to account for different...

Gingival Architecture Preservation

Onlay Connective Tissue Graft

Although the degree of residual ridge resorption following tooth extraction is unpredictable, resulting deformities are not an inevitable occurrence. Preservation of the alveolar process can be achieved through immediate restorative and periodontal intervention at the time of tooth removal. By conditioning the extraction site and providing a matrix for healing, the pre-extraction gingival architecture or socket can be preserved. Preparing the abutment teeth before the extraction is the...

Saddle Or Ridge Lap Pontic

Ridge Lap Pontic Design

The saddle pontic has a concave fitting surface that overlaps the residual ridge buccolingually, simulating the contours and emergence profile of the missing tooth on both sides of the residual ridge. How ever, saddle or ridge lap designs should be avoided because the concave gingival surface of the pontic is not accessible to cleaning with dental floss, which will lead to plaque accumulation Fig. 20-12 . This design deficiency has been shown to result in tissue inflammation' Fig. 20-13 ....

Proximal Reduction

Pinledge Crown

Prepare the proximal slice with a tapered diamond. Disks may be preferred by some operators. The diamond is either held parallel to the path of withdrawal or given a slight lingual inclination. The primary purpose of this step is to provide sufficient reduction to allow adequate metal in the area for a subsequent connector. The proximal reduction includes the proximal contact area, but care Fig. 10-39. A, Modified pinledge preparation with a proximal groove. The path of withdrawal of this...

Cuspal Fracture

Cuspal Coverage

A, Nonreplacement of missing teeth has led to supraocclusion and a protrusive interference arrow . B, Teeth reduced with the help of trial tooth preparations and diagnostic waxing. C, Restorations with anterior guidance. Fig. 7-24. A, Nonreplacement of missing teeth has led to supraocclusion and a protrusive interference arrow . B, Teeth reduced with the help of trial tooth preparations and diagnostic waxing. C, Restorations with anterior guidance. A 120-degree sloped shoulder margin...

Incisal and Lingual Reduction

Veneer Preparation Guide Lingual Ledge

Remove enough enamel to allow 1 mm of metal thickness. The design of the incisal bevel should prevent contact between oppos ing teeth and the incisal margin. However, the original configuration of the facial surface should be preserved without significant Fig. 10-24. The maxillary canine three-quarter crown preparation. A, A guiding groove is placed on the lingual surface. B, Half the lingual surface is reduced. Clearance is verified before reduction of the other half. C, Lingual reduction...

Saliva Control

Speejector

Depending on the location of the preparations in the dental arch, several techniques can be used to create the necessary dry field of operation Fig. 14-1 . In areas where only supragingival margins are present, Fig. 14-1. Saliva control for impression making. When correctly placed, maxillary cotton rolls block salivary flow from the parotid gland. A, The evacuator removes saliva from the floor of the mouth, keeping the prepared tooth dry while the flange displaces the tongue medially. B,...

Conservation Of Tooth Structure

When creating post space, great care must be used to remove only minimal tooth structure from the canal. Excessive enlargement can perforate or weaken the root, which then may split during cementation of the post or subsequent function. The thickness of the remaining dentin is the prime variable in fracture resistance of the root. Experimental impact testing of teeth with cemented posts of different diameters' showed that teeth with a thicker 1.8 mm post...

Ikontal Pune

Relationship Mastication And Tooth Wear

Comparison of border and chewing movements for soft food at the central incisor. Sagittal, frontal, and horizontal views in an orthographic projection. From Gibbs ch et ai j Prosthet Dent 46 308,1981. myositis, myalgia, and referred pain headaches from trigger point tenderness may also occur. The degree of symptoms varies considerably among individuals. The two most common forms of parafunc-tional activities are bruxism and clenching. Increased radiographic bone density is often seen...

The Metal Ceramic Crown Preparation

Full Metal Crownpreparation

In many dental practices the metal-ceramic crown is one of the most widely used fixed restorations. This has resulted in part from technologic improvements in the fabrication of restoration by dental laboratories and in part from the growing amount of cosmetic demands that challenge dentists today. The restoration consists of a complete-coverage cast metal crown or substructure that is veneered with a layer of fused porcelain to mimic the appearance of a natural tooth. The extent of the veneer...

Cavosurface Angle Amalgam

Cavosurface Angle Amalgam

Good strength intermediate restoration Preparation delay Condensation Corrosion No bonding Thermal expansion Setting contraction Bonding Highest strength Indirect procedure Delayed expansion Two-visit procedure Provisional needed Bonding can be achieved with 4-META products. Resin-modified formulations are less sensitive. Bonding can be achieved with 4-META products. Resin-modified formulations are less sensitive. infection control, and optimum visibility. Placement follows techniques developed...

Victor O Lucia. The Fundamentals Of Oral Physiology And Their Practical Application In The Securing And Reproducing Of

Contraction Sagittal Tooth

Fabrication of a custom anterior guidance table. A, Armamentarium. B, Incisal pin is raised 1 or 2 mm. C, Lubricate the tip of the pin. D, Wet the table with monomer. E, Dispense and mix resin of choice. F, Apply resin to acrylic table. G, Insert pin into doughy resin. H, Track the protrusive path. 1, Right working movement and all intermediate lat-erotrusive paths. J, Left working movement and all intermediate lat-ertrusive paths. K, Allow resin to set excess resin still needs to be...

Temporomandibular Joints

Bilaminar Zone

The major components of the temporomandibular joints are the cranial base, the mandible, and the muscles of mastication with their innervation and vascular supply. Each joint can be described as gin-glymoarthrodial, meaning that it is capable of both a hinging and a gliding articulation. An articular disk separates the mandibular fossa and articular tubercle of the temporal bone from the condylar process of the mandible. The articulating surfaces of the condylar processes and fossae are covered...

Retention Form

Tooth Restoration Interface Pictures

Certain forces e.g., when the jaws are moved apart after biting on very sticky food act on a cemented restoration in the same direction as the path of withdrawal. The quality of a preparation that prevents the restoration from becoming dislodged by such forces parallel to the path of withdrawal is known as retention. Only dental caries and porcelain failure outrank lack of retention as a cause of failure of crowns and fixed partial dentures . 48,49 The following factors must be considered when...

Metal Ceramic Crowns

Should be approximately 1 mm wide and should extend well into the proximal embrasures when viewed from the incisal occlusal side Fig. 9-8 . Where access permits, establishing this shoulder from the proximal gingival crest toward the middle of the facial wall is preferred. This will minimize placement of the initial shoulder preparation too close to the epithelial attachment. If the margin is established from facial to proximal, a tendency exists to bury the instrument and encroach on the...

Subgingival Margin Preparation

Undercontouring Dentistry

The development of good axial contours. This will enable the junction between the restoration and the tooth to be smooth and free of any ledges or abrupt changes in direction. Under most circumstances a crown should duplicate the contours and profile of the original tooth unless the restoration is needed to correct a malformed or malpositioned tooth . If an error is made, a slightly undercontoured flat restoration is better because it is easier to keep free of plaque however, increasing...

Pathogenesis

Bulbous Gingiva

The pathogenesis or sequence of events in the development of a gingivitis-periodontitis lesion is very complex. It involves not only local phenomena in the gingiva, PDL, tooth surface, and alveolar bone but also a number of complex host response mechanisms modified by the bacterial infection and behavioral factors.21 Implicated in the pathogenic mechanism are phagocytic cells, the lymphoid system, antibodies and immune complexes, complement and clotting cascades, immune reactions, and the...

Replacement Of Several Missing Teeth

Intermediate Abutment Fixed Prosth

Fixed prosthodontics becomes more difficult when several teeth must be replaced. Problems will be encountered when restoring a single long, uninterrupted edentulous area or multiple edentulous areas with intermediate abutment teeth Fig. 3-20 , especially when anterior and posterior teeth are to be replaced with a single fixed prosthesis. Underestimation of the problems involved in extensive prosthodontics can lead to failure. One key to ensuring a successful result is to plan the prostheses by...

Seven-eighths Crown Preparation

Three Quarter Crown Preparation Dent

After verifying the alignment, remove tooth structure between the guide grooves with a smooth continuous motion and place a cervical chamfer Fig. 10-7 . Carry the diamond into the proximal embrasure and reduce the proximal wall Fig. 10-3, E and F . For proper reduction of the axial tooth surface, it is important to understand the factors that determine correct positioning of the proximal groove. A proximal groove is placed parallel to the path of withdrawal. Normally, unsupported tooth...

Pinledge Preparations

Pinledge Retainer

A pinledge Fig. 10-34 is occasionally used as a single restoration, generally to reestablish anterior guidance, in which case only the lingual surface is prepared. More commonly, however, it is used as a retainer for a fixed partial denture Fig. 10-35 or to splint periodontally compromised teeth Fig. 10-36 . In these cases, one or more of the proximal surfaces are included in the preparation design to accommodate the required connector s . Retention and resistance are provided primarily by pins...

Prevention Of Damage During Tooth Preparation

Proximal Flange Dental

Adjacent Teeth. latrogenic damage to an adjacent tooth is a common error in dentistry. Even if a damaged proximal contact area is carefully reshaped and polished, it will be more susceptible to dental caries than the original undamaged tooth surface. This is presumably because the original surface enamel contains higher fluoride concentrations and the interrupted layer is more prone to plaque retention. The technique of tooth preparation must avoid and prevent damage to the adjacent tooth...

Treatment of Furcation Involvement

Furcation Involvement

Diagnosis and treatment of furcation involvement of multirooted teeth is one of the more difficult Fig. 5-25. Normal relationship of the CEJ and the osseous crest. FromBaimaRF J Prosthet Dent 56 138, 1986. Fig. 5-25. Normal relationship of the CEJ and the osseous crest. FromBaimaRF J Prosthet Dent 56 138, 1986. problems encountered in the periodontal-restora-tive dentistry continuum. Familiarity with the furcation's anatomic and morphologic variations is essential when formulating a treatment...

Osseous Resection with Apically Positioned

Mandibular Defect Background

Chronic inflammatory periodontitis results in the loss of osseous tissue, destruction of osseous architecture, and creation of an intrabony lesion. The osseous tissue has no predictable or simple pattern of loss the resorption may take the form of craters, hemiseptal defects, or well-like troughlike shapes. Craters in the interproximal areas Fig. 5-24 are the most common type of lesion. The objective of osseous resection is to shape the bone to form even contours. This is accomplished by...

Dentogingival Junction

Structure Periodontal Ligaments

At the base of the gingival sulcus crevice is the epithelium-tooth interface, also known as the den-togingival junction DGJ . This structural relationship between hard and soft tissues is unique in the body. At the ultrastructural level, it is made up of hemidesmosomes and a basal lamina, which anchor the epithelial cells to the enamel and cemental surfaces4-11 The depth of the sulcus varies in healthy individuals, averaging 1.8 mm.12 In general, the shallower it is, the more likely the gingiva...

Robert F Baima

Prosthodontic Temporal

A periodontal examination should provide information regarding the status of bacterial accumulation, the response of the host tissues, and the degree of irreversible damage. Because long-term periodontal health is essential to successful fixed prosthodontics see Chapter 5 , existing periodontal disease must be corrected before any definitive prosthodontic treatment is undertaken. Gingiva. The gingiva should be lightly dried before examination so that moisture does not obscure subtle changes or...

Supragingival Margin And Large Gingival Embrasure

Deflection Dental Fixed Prosthesis

Data from jepsen A Acta Odontol Scat id 21 35, 1963. Data from jepsen A Acta Odontol Scat id 21 35, 1963. Fig. 3-23. A, Because of the conical shape of most roots, the actual area of support A diminishes more than might be expected from the height of the bone H . In addition, the center of rotation R moves apically and the lever arm L increases, magnifying the forces on the supportive structure. B, A fixed partial denture replacing a maxitlary first molar. The first premolar is an abutment...

Gingiva

Free Gingival Groove

Normal gingiva Fig. 5-1 -exhibiting no fluid exudate or inflammation due to bacterial plaque-is pink and stippled. It varies in width from 1 to 9 mm and extends from the free margin of the gingiva to the alveolar mucosa. The gingivae and alveolar mucosa are separated by a demarcation called the mucogingival junction MGJ , which marks the differentiation between stippled keratinized tissue and smooth, shiny mucosa the latter contains more elastic fibers in its connective tissue. Apical to the...

Replacement Of A Single Missing Tooth

Uprighting Tilted Teeth

Unless bone support has been weakened by advanced periodontal disease, a single missing tooth can almost always be replaced by a three-unit FPD having one mesial and one distal abutment tooth. An exception is when the FPD is replacing a maxillary or mandibular canine. Under these circumstances, the small anterior abutment tooth needs to be splinted to the central incisor to prevent lateral drift of the FPD. Cantilever Fixed Partial Dentures. FPDs in which only one side of the pontic is attached...

Clinical Attachment Level

Documenting Clinical Attachment Loss

Documenting the level of attachment helps the clinician determine the amount of periodontal destruction that has occurred and is essential when rendering a diagnosis of periodontitis loss of connective tissue attachment 1617 This measurement also provides the clinician with more detailed and accurate information regarding the prognosis of an individual tooth. The clinical attachment level CAL or AL is determined by measuring the distance between the apical extent of the probing depth and a...

Kinematic Facebow

Kinematic Face Bow

Kinematic hinge axis facebow. A, Mandibular clutch. The clutch separates for removal into two components by loosening the screws on left and right sides. B, Transferring the position of the mandibular hinge axis. C, pointers aligned with the previously marked hinge axis location. D, Kinematic facebow aligned on the articulator. Fig. 2-10. Kinematic hinge axis facebow. A, Mandibular clutch. The clutch separates for removal into two components by loosening the screws on left and right...

Followup

After delivery to the patient, the occlusion must be verified and corrected as necessary. The patient is instructed to wear the device 24 hours a day, removing it only for oral hygiene, and to return at regular weekly and biweekly intervals or sooner if a problem is anticipated for modification. A reduction in discomfort suggests that definitive occlusal adjustment see Chapter 5 or restorative dentistry, or both, will likely be successful. If device therapy fails to relieve the discomfort,...

Border Movements

Incisal Guidance And Vertical Overlap

Mandibular movements are limited by the temporomandibular joints and ligaments, the neuromuscular system, and the teeth. Posselt was the first to describe the extremes of mandibular movement, which he called border movements Fig. 4-13 . His classic work is well worth reviewing as one attempts to understand how the determinants control the extent to which movement can occur. Posselt used a three-dimensional representation of the extreme movements the mandible is capable of Fig. 4-13, B . All...

Semiadjustable Articulators

Simple Articulator

For most routine fixed prostheses, the use of a semi- adjustable articulator Fig. 2-7 is a practical approach to providing the necessary diagnostic information while minimizing the need for clinical adjustment during treatment. Semiadjustable instruments do not require an inordinate amount of time or expertise. They are about the same size as the anatomic structures they represent. Therefore, the articulated casts can be positioned with sufficient accuracy so that arcing errors will be minimal...