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‫بسم هللا الرحمن الرحيم‬

‫ بس بسيطه‬, ‫ الدكتور موسى مراشده رائع مع انو عجب علي بعيادة البروستو‬,‫اول شي المحاضرة بتجنن من األخر‬
 ‫البد من ذلك كونا طالب التكنو‬
‫التسجيل كان واضح الحمدهلل بس شكرا الك اخ اياس ! التسجيل كان جنبوا و ما قصرت وهللا‬
‫ييجي‬ no need ‫ و قال اللي ما معو قلم‬quiz ‫ كيف ما معنا اقالم و عنا‬D‫دخل الدكتور و صار يبهدل‬
! ‫ فسأل اياس طب دكتور و اللي ما معو محاي و براي شو يعمل؟ هاهاهاها مش هيك خفة الدم‬, ‫المرة الجاي‬
‫و صوت االخ اياس و هو بغش مش طالع اال شوي و ياريتك بتغش صح ! يعني‬ quiz ‫بعدين بتذكروا اعطانا‬
(:.....‫انا بقلك جوابك غلط‬
‫ما تزعل منا بس حبينا نغير جوي بالبداية عشان هال بدنا نبلش المحاضرة بدها تركيز‬

Treatment planning of fixed prosthodontics:

Last time we talked about crown and bridge and we said


this fixed prosthodontic involves single tooth restoration
and replacement of missing tooth, so your treatment plane
should be aided in this direction other you will go for
single teeth restoration or you go for replacement missing
tooth .
Treatment planning will start with single tooth, right?ok
single tooth restoration ( simple filling , inlay , onlay ,
crown),veneers ok
You decide to make restoration of your tooth, type of
restoration depends on the type of restoration material and
design , and these 2 things will be controlled by the amount
of tooth structure left after damage.
Imagine you have a tooth with class 2, if it was simple
class 2, you will think of plastic restoration ( amalgam,
composite, cement) if more damaged u will go for inlay,
onlay, then crowns. So the amount of damage will
determine the type of your restoration, now the type of ur
restoration will depend on the material u will use and the
design u will choose !

Selection of material and design :

This will depends on :


1- general factor :remember all the speak about single
tooth restoration ok, and these are age ,cost ,like 20years
lady with class 2 on upper right 4 , and she is very concern
about esthetic so you think about composite, if 75 years old
man you will think about amalgam coz esthetic is 2nd
priority to the function.
Some restoration needs more oral hygiene control than
others, like if u go for cast restoration you need more oral
hygiene control than amalgam restoration, so if the patient
is motivated enough, I will go for more complex restoration
if not I will go for more simple one .

2- local factors:
1. destruction of tooth structure, if u have badly broken
lower left 6 with class 2 or DO, MO, when u prepare
amalgam cavity with outline form, convenience form,
retention form, true? So, how you get retention in class 2?
From undercuts, u create undercuts in box in dovetail area
and these undercut can be created in one scenario if there
is enough tooth structure, if not you cant place amalgam so
u think with something else .
Other thing if u have simple class 2, direct class 2, u don’t
open the marginal ridge in such a case it is direct access so
place composite coz there is no direct load, so amount of
destruction guide u to the type of material u will be using .
(Direct Load is the load from biting)
2. esthetic
3. plaque control : much easier be controlled in simple
restoration than complex one
4. retention , if u don’t have enough retentive feature for
the cavity then amalgam cant be used
Is that clear !
In single tooth restoration we will talk about intra coronal
restoration which are
1. Simple restoration – amalgam, composite, cement-
2. inlay
3. onlay
then extra coronal restoration
intra coronal restoration is very essential coz u have to
understand how to judge the restoration type u want .
intra coronal restoration is the restoration which r
retained within confines of the tooth, and when I spoke
about this I spoke about simple restoration, fixed
prosthodontic when are inlays and onlay, now if u decide
to place intra coronal restoration, there are 2 factors u
think about 1- sufficient remaining tooth structure, 2- that
will provide you by retention, support, integrity .
if u want to place inlay u need sufficient tooth structure so
that when u place it the tooth in function wont split
lower 1st premolars are very narrow tooth bucco-lingual
and if u have MOD on it, and u want to create inlay u will
cross from mesial to occlusal to distal and the occlusal
part is very narrow, so if u create ur inlay, there will be
very narrow structure, bucculy and lingualy to ur
restoration, this narrow walls could fracture for this
reason, such kind of tooth is unlikely for MOD inlay, I
might think MOD inlay if I have molar, coz B-L width quit
big,
then if sufficient tooth structure it will lead me what to do?
What kind of restoration I have to design, this tooth
structure will provide me retention, support, integrity and
for the last time if you have huge class 2 amalgam, and u
cant create contour so u cant use amalgam coz matrix
band will squeeze it and u cant reform the morphology in
such case inlay, onlay not amalgam!
so tooth want be suitable for intra coronal restoration if it
cant provide u retention, support, integrity .
‫ اللي يستحمل الحشوة و ما‬tooth structure ‫باختصار اذا كان السن كتير كتير مسوس و مو باقي عن‬
.‫ رح ادور على شيء يغطيه كله‬cracks or root fracture ‫ينكسر او بصير فيو‬

Intra coronal restoration :

1- plastic restoration
2- cement retained restoration
and if they are cement retained restoration they are fixed
prosthodontics. and they r:
1- metal inlay its class 2, MOD ok
onlay is like inlay but with occlusal coverage to protect
cusps
and for inlay there should be sufficient tooth structure and
in case lower premolars ,I can do MO, DO, inlay not MOD
inlay coz there is no tooth structure , I can do MOD onlay
on lower premolar, coz it will protect lingual+ buccal
walls and if it can not, we will go for crowns
2. ceramic inlay
3. MOD onlay, the message u should pick it from this
lecture is the onlay is preferred for metals, because u need
tooth preparation which is usually achievable, but MOD
ceramic onlay you need to cut too much occlusaly
The thickness of the cut 2-2.5 mm for ceramic onlay and
this is too much destructive .
MOD onlay with metal needs 1-1.5 mm cuts so more
conservative ,
In other words I can use MOD onlay for molars because
they are away from the patient smile, and here the tricks in
Qs come.
Can u use MOD onlay on posterior molar? yes
Is MOD onlay indicated for upper premolar? no
Neither MOD onlay with metal coz its unaesthetic, nor
MOD ceramic coz its destructive so…..crowns
Ceramic onlay are too destructive when prepared so not
recommended.

Extra coronal restoration :

The one that covers buccal, lingual, mesial, or distal, here


there is no sufficient tooth structure, so the underneath
support, retention, tooth structure is weak enough

General indications are:


1. badly broken, heavily restored teeth
2. primary truma
3. tooth wear
4. hypo plastic condition
5. altered shape
6. altered occlusion
7. appearance
8. non vital tooth
9. combined and others

slide 7 pic on upper left is for heavily restored molar with


cracked root
pic on upper right for rooted anterior teeth (RCT) with post
crowns
pics on lower are for advanced tooth wear where u can see
enamel rim and erosion.

Crowns :
Crowns there are anterior crowns and posterior crowns
Anterior one:
Could be classified according to the material u will use,
fabricate with, or by design
According to material :
1- metal ceramic crowns MCC or called PFM porcalin
fused metal
2- all ceramic crowns
3- others

according to design :
either 1. full crown or 2. partial crown were one of the
surfaces is not covered

dana asked : what is the difference btw partial crown and


onlay? Dr. answered partial crown is extra coronal
restoration, and the onlay is intracoronal restoration

Ameen asked: do we consider veneer as partial crowns?


No
Nisreen asked: do veneers need sufficient tooth structure?
yes
Ya jama3a veneers are ceramic restoration on the labial
face of upper anteriors mainly for esthetic reason ok
The partial crown is to strength the tooth ok

Posterior crowns:
According to material:
1- full mouth crowns
2- MCC
3- All ceramic crown
4- Other
And the first one is on the top of use

According to design :
1- full 2- partial ok

The other extra coronal restoration is ceramic laminate


veneers as other option for crown and they are:
1- Conservative alternative to crowns
2- Produce very cosmetic effect on anterior teeth
3- Are mainly stained or malformed

We end the first which was for about single tooth


restoration
Now we will talk about the other part which is about
replacement of missing teeth

Now why do we replace missing teeth?


1- esthetics
2- function as they cant eat
3- Occlusion as lower 5 extraced so the 4 will drift
distally and 6, 7 drift mesially and the upper will over
erupt so the occlusion is dynamic and I need to
prevent the occlusion deterioration as in pic in
slide13 page 3 ok
4- Combination
do we always need to replace missing teeth? No if we have
stable occlusion, and the patient doesn’t complain from
esthetic and function no need to replace ok
there is concept called short dental arch SDA, this concept
when patient come and he is missing molars (so from left 5
to right 5 )and he has 10 occlusion pairs (upper+lower)so
10 stopper or centric pairs, he doesn’t complain from
esthetic and he has stable occlusion so don’t rush to
replace them with kindy class1 bilateral free end saddle ok

now if we decide to replace, what are the types of


prostheses?
1- RPD is the only one removable
2- Conventional fixed partial denture\bridge
3- Resin-bonded FPD
4- Implant-supported FPD
What are the factors for selection of the prostheses?
1-general factor: age, health, occupation, cost, gender
those will dictate u to choose fixed or removable PD ok

2- Local factors: which will satisfactory the oral hygiene


Poor oral hygiene is contra indicate for RPD OK then
the dr mention from slide what are the local factor (slide
#17) and said that there is table in the book should be
memorized by heart ok
Now conventional FPD from now conventional related to
the type of cement will be loot (as I heard) ur restoration
with ok, and read the local factor from slide 18

Resin – bonded FPD :


Are Resin based cement Usually for single incisor for
lower central incisors and usually the abutments are defect
free ok, pic on slide 20 page 4 is for resin bonded bridge,2
wings cemented on the canine and central ( coz her we
have missing 2) , and we use the cement coz surface area
of looting is small only palatal surfaces, then if u use
conventional it wont be strong to retain it.

Bridges:

According to the design they could be :


1- fixed-fixed, the abutments are parallel to have single
line of draw
2- fixed-movable, here the pontic connected to major
retainer (fixed)by rigid connector and the other side
is connected by movable connecter to minor retainer,
which needs no parallel ok, so its more conservative
in preparation ok
3- cantilever bridge
4- hybrid\compound

direct canti lever when the pontic connected from oneside


has one retainer ,so the pontic and the retainer next to
gether, next to the saddle, and if it was far away its called
spring canti lever and it has tooth + mucosa support like
1st pic on slide 24, and the lower is for direct canti lever
where central incisor carried on the lateral, if we have
diastema and u want to close it so use spring cantilever not
direct one but the only disadvantage for it if the opposing
tooth for the prmolalr is missed which lead to supra
eruption and u want to put the retainer on this premolar it
will take the central incisor with it during supra eruption
coz they are connected together ok

retainer::
1- full covarge crown which is the best
2- 3\4 crown is not recommended
3- post retained crown
4- onlays
5- inlays
this pic on slide 26 is for implants joined by bridge ok
then the dr read the slides ok,
and he said these r guide lines not for Qs in the exam ok

the most important to know is prosto is the last treatment


plane or option ok……

thanks God
finish

Dina sameir
kamal
Special thanks for eman el ras who gave me her lap top to
print it in the sakn !
Meso o madoo7 as always
Gada, amane 3fane, dalia, sukainah, lina,
faroooooooooooo7 , shaheeed, fatoooom,
ferma, nissren, dana, arwa, dema a7la jeran
lamia, du3a2, maimaneh, aseel,
ronze, sheren
esra2 3bd el gane, jameleh,razan

the best best wishes for NOOR 3BD EL HANE for her
engagement    
32bal el kol yarab 

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