Tooth Center

METHODS OF MOUTH PREPARATION

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A) Non surgical methods.

B) pre-prosthetic surgical preparation.

A) Non surgical methods

Including the management of abused soft tissues

Causes of abused soft tissues

1- denture base hypersensitivity.

2- Chronic poor oral hygiene.

3- Continuous denture wearing.

4- Systemic factors such as : endocrine deficiencies, deficiencies of iron, vitamin C&B , via lowering the resistance of the mucosa to trauma and fungal infection

5- Systemic disease as uncontrolled diabetic patient.

6- After Radiation therapy.

7- traumatic occlusion.

8- poor fit denture.

Treatment of abused soft tissues:

1) Rest of the denture supporting tissues.

2) Occlusal correction of the old prosthesis.

3) Good nutrition.

4) Anti fungal therapy.

5) Good oral hygiene.

6) Improvement of denture fitness.

7) Elimination of artificial relief and suction chamber in the maxillary complete denture.

Uses of tissue conditioning material.

9) Adequate relief of complete denture

10) Treatment of oral manifestation of systemic diseases

PREPARATION OF THE MOUTH

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INTRODUCTION

The oral mucosa (denture bearing mucosa) is not created to be covered or to carry prosthesis. Deviation from nature always results in changes in the tissues, which may be pathological.

Before the construction of new prosthesis, the supporting structures must be in a healthy condition.

A thorough examination of the mouth prior to construction of complete dentures is necessary to identify potential problem areas. Potential problem areas can be made with the aid of mounted diagnostic casts, intraoral radiographs and panoramic radiography.

A treatment plan calling for surgical correction should be made after alternate nonsurgical approaches have been considered and evaluated.

A nonsurgical approach to treatment when surgery is contraindicated or preservation of the height of bone is essential. Fabrication of new dentures using established prosthodontic would decrease occlusal loading over the affected area and distribute forces more to the primary support areas like the mandibular buccal shelf.

Reduction of the width of the occlusal table together with maximum denture base extension would reduce forces on the supporting tissues chronic. Temporary resilient liners can be used.

A diagram showing the various aspects of the preparation of the mouth for complete denture is shown in.

DENTURE TEETH

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DENTURE TEETH are
commercially available prosthetic teeth There are several manufacturers of denture teeth. Denture teeth are made of
plastic and porcelain The most frequently used prosthetic
teeth on a RPD are denture teeth attached to
the framework with a processed plastic base When a processed plastic
base will be used to attach the
prosthetic teeth to the
framework.
CONTRAINDICATIONS:
1. Where there is insufficient
space occlusal/incisalgingival
or mesiodistally for
a denture tooth-plastic base
combination.
a) Less than 5 mm between
the occlusal plane and the
edentulous ridge.
b) Single tooth edentulous
space.
2. Where protrusive or lateral
occlusal guidance will be on
the prosthetic teeth.
3. When available denture teeth
do not satisfy esthetic or
occlusal requirements. In
these situations a custom
made prosthetic tooth is
necessary.
ADVANTAGES:
1. Denture teeth are
prefabricated by several
manufactures.
2. There is a large selection of
shades, sizes, and shapes. An
acceptable denture tooth can
usually be found.
3. Available in plastic and
porcelain.
4. Can be easily adjusted
(particularly plastic) to fit the
framework, available
space, existing occlusion, and
desired size and shape of the
tooth.
5. There is great flexibility of
arrangement of denture teeth

PROSTHETIC TEETH

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DEFINITION
PROSTHETIC TEETH are the
artificial substitutes for the missing natural
teeth.
FUNCTIONS
The functions of prosthetic teeth are
to:
1. Restore the esthetic, phonetic
and masticatory functions of
the missing natural teeth.
2. Transmit forces to the
denture base through which
they may be distributed by
the prosthesis to all teeth and
tissues contacted by rigid
parts of the denture.
3. Maintain the integrity of the
arch by supplying missing
proximal contacts.
4. Maintain the position of
opposing teeth by supplying
missing incisal and occlusal
contacts.
DESIRABLE CHARACTERISTICS
The desirable characteristics specific for
prosthetic teeth are:
1. Have the color(shade),
translucency, size, shape, and
characterization similar to the
natural teeth they replace.
2. Be easily shaped with
conventional dental burs.
3. Be easily characterized with
conventional dental stains.
4. Have a hardness and abrasion
resistance similar to the
opposing enamel or dental
material.
5. Chemically bond to the
denture base material or RPD
alloy to which they are
attached.
6. Be resistant to staining by
oral fluids and
microorganisms
7. Be chemically inert.
8. Be odorless and tasteless and
not pick up odors or tastes
from oral fluids.
9. Have a surface which is
dense to avoid harboring oral
fluids and microorganisms.
10. Be capable of being cleaned
by customary oral hygiene
technics and materials.
11. Be of low initial cost and
inexpensively repaired or
replaced.
12. Be capable of being repaired
and replaced by customary
dental technics and materials.
13. Be strong enough to resist the
forces which will be applied.
14. Not soften or warp in hot
water or conventional denture
cleansing solutions.
TYPES
There are seven types of prosthetic
teeth: (1) denture teeth, (2) tube teeth, (3)
processed plastic teeth, (4) facings, (5)
custom-made facings, (6) metal reinforced
denture teeth, and (7) metal pontics

Parts of a Removable partial denture

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All definitive RPDs will have the
following components: (1) a major
connector, (2) several minor connectors, (3)
two or more direct retainers, (4) one or more
denture bases, and (5) one or more
prosthetic teeth (Fig. 3-1). Each component
or part one or more functions necessary for
the operation of the RPD. Each type of
component part has several possible designs.
In this chapter the various component parts
of a RPD will be defined and their functions
and desirable characteristics described. In
subsequent chapters the various possible
designs of each component part will be
discussed, and the criteria for selecting the
specific design of each component part
when designing a RPD will be described EIGHT FUNCTIONS OF RPD
COMPONENTS
Each component part of an RPD will
provide one or more of the following
functions:
Support: Resistance to movement
of the prosthesis toward the edentulous
ridge. Support is the means by which
occlusal forces are transferred to the teeth
and denture bearing tissues for dissipation
(Fig. 3-2).
Fig. 3-2. SUPPORT-resistance to
movement of a prosthesis toward the tissues
Retention: Resistance to movement
of the prosthesis away from the edentulous
ridge along the path of placement (Fig. 3-3).
Fig. 3-3. RETENTION-resistance to
movement of a prosthesis away from the
tissues along its path of placement and
removal
Reciprocation: The means by
which forces acting on one part of a RPD
are counterbalanced, counteracted or
negated by another part of the RPD.

RPD Removable partial dentures

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Definitive RPDs are
constructed after extensive diagnosis,
treatment planning, and thorough
preparation of the teeth and tissues for the
prosthesis. The length of service of
definitive RPDs is intended to be many
years (customarily 5-10 years).
There are three types of RPDs or
partially edentulous arches based on the
tissue(s) which provide support. Support is
the resistance to movement of the denture
toward the edentulous ridge. RPDs maybe
tooth supported, tissue supported, and toothtissue
supported. This is a simple
classification system and very meaningful
because the principles of RPD design depends, to a great extent, on its supporting
tissue

After dental filling

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When anesthetic has been used, your lips, cheek and tongue may be numb for several hours after the appointment. To prevent injury, avoid any chewing until the numbness has completely worn off.
It is normal to experience some hot, cold and pressure sensitivity after your appointment.
Your gums may be sore for a few days. Rinse three times a day with warm salt water (add a tsp. of salt to a cup of warm water, then rinse, swish and spit) to reduce discomfort, if needed.
Use medication only as directed.
We have used the best, strongest and most esthetic materials available to restore your teeth. However, you may still need to adjust your habits to protect your teeth.
Avoid any unusually hard foods or substances, such as peanut brittle, fingernails, pencils, ice, etc.
Avoid or minimize your use of foods that stain, such as tea, coffee, red wine and berries.
Smoking will quickly yellow your teeth.
Daipf your restorations and your teeth. Maintain a regular oral hygiene routine, which should include brushing a few times a day and flossing at least once a day. Regular professional cleaning appointments are also critically important

Tooth extraction and implant process

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After an extraction or implant placement, it is important for a blood clot to form to stop the bleeding and begin the healing process — that’s why we ask you to bite on a gauze pad for 30 to 45 minutes after surgery. If bleeding or oozing continues after you remove the gauze pad, place another sterile gauze pad and bite firmly for another thirty minutes.
After the blood clot forms, it is important to protect it, especially for the next 24 hours. So, for the next 24 hours, DON’T: smoke, suck through a straw, rinse vigorously or spit. These activities will dislodge the clot, possibly causing bleeding to recur and slow down the healing process.
Limit yourself to calm activities for the first 24 hours, this keeps your blood pressure lower, which reduces bleeding and helps the healing process.
You may feel some pain and have some swelling. You can use an ice bag to keep this to a minimum. The swelling, if any, usually starts to go down after 48 hours.
Use pain medications only as directed, call us at 753-7507 if it does not seem to be working. If antibiotics have been prescribed for you, continue to take them for the prescribed length of time, even if all symptoms and signs of infection are gone.
Drink lots of fluids and eat only soft nutritious foods on the day of the surgery. Don’t use alcoholic beverages and avoid hot and spicy foods. You can begin eating normally the next day or as soon thereafter as it is comfortable.
For the first 24 hours take care when cleaning the teeth next to the extraction or implant site. It is very important to resume your normal dental hygiene routine after 24 hours. This should include brushing your teeth and tongue a few times a day and flossing at least once a day. This speeds healing and helps keep your breath and mouth fresh.
After 24 hours, begin gently rinsing your mouth with saltwater three times a day (add a tsp. of salt to a cup of warm water, then swish gently and let it run out of your mouth without spitting). Also rinse gently after meals to keep food out of the extraction or implant site.

Therapeutics

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Actinomycosis
• Systemic therapy: penicillin or tetracycline in large doses for
3–6 mo
• Wide excision of infected tissue
Acute Herpetic Gingivostomatitis
• Systemic therapy
• Valacyclovir 500 mg #20; 1 tablet twice daily × 10 d
• Acyclovir 400 mg #50; 1 tablet 5 times daily × 10 d
• Fluids
• Analgesia
Acute Necrotizing Ulcerative Gingivitis
• Débridement of necrotic tissue
• Aggressive oral hygiene and plaque control
• Metronidazole 250 mg #40; 1 4 times daily × 10 d
Angioedema
• Systemic therapy
• Antihistamine: diphenhydramine 50 mg capsules #12;
1 every 6 h × 2–3 d
• Doxepin 25 mg tablets #12; 1 every 6 h × 2–3 d
• Prednisone 10 mg tablets #12; 4 tablets daily × 3 d
Aphthous Stomatitis
• See “Recurrent Aphthous Stomatitis.”
Behçet’s Disease
• Treat as for aphthosis (see “Recurrent Aphthous Stomatitis”).
• Refer to a dermatologist, a rheumatologist, or an ophthalmologist,
depending on organ involvement, for ongoing care,
which may include systemic immunosuppressive and/or
anti-inflammatory drugs.
Candidiasis
• Identify and correct provocative factors.
• Topical therapy
• Nystatin oral suspension (100,000 units/mL); rinse 5 mL
and swallow 4 times/d
• Clotrimazole (Lotrimin) solution 1%; rinse 5 mL and
swallow 4 times/d
Clotrimazole troches (Mycelex) 10 mg; dissolve 1 troche in
mouth 5 times/d
• Clotrimazole vaginal tablets 1/2 of 500 mg tablet dissolved
in mouth bid
• Systemic therapy
• Fluconazole (Diflucan) 100 mg #15; 2 tablets on the first day,
1 tablet days 2–7, 1 tablet every other day for days 8–21
• Ketoconazole (Nizoral) 200 mg #21; 1 tablet every day with
breakfast × 21 d
• Itraconazole (Sporanox) 200 mg #21; 1 tablet every day
with breakfast × 21 d
• May use shorter duration for less severe infections

Cleidocranial Dysplasia

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Cleidocranial Dysplasia
Etiology
• Autosomal-dominant trait with high penetrance and variable
expressivity
• Mutations in SH3-binding protein on chromosome 4p16.3
• Widespread membranous and endochondral defects in craniofacial
complex
Clinical Presentation
• Chief head and neck manifestations include the following:
• Defective ossification
• Wormian bones with calvarial defects
• Delayed fontanelle and suture closure
• Variably developed clavicles often a prominent skeletal finding
• Long, narrow neck with variably drooped shoulders
• Midface deficiency secondary to hypoplasia of facial bones
and paranasal sinuses
• Ocular hypertelorism
• Palate with narrow, high-arched quality
• Delayed closure of mandibular symphysis
• Multiple unerupted and malpositioned teeth with lack of
cellular cementum
• Multiple supernumerary teeth
Diagnosis
• Clinical features
• Radiographic findings (skull, jaw, chest)
Differential Diagnosis
• Achondroplasia
• Pyknodysostosis
• Hydrocephalus
Treatment
• Genetic counseling
• For dental abnormalities, treatment options are as follows:
• Early orthodontic intervention
• Surgical exposure of unerupted teeth
• Extraction of supernumerary teeth • Surgical correction of jaw deformities
• Dental reconstruction
Prognosis
• Stability with growth cessation
• Dental and oral rehabilitation can proceed as per usual after
surgery (see above) is completed.