Fixed Pros. I ALL LECTURES

artifical replacement that restores missing tooth structure by surrounding all or part of remaining tooth structure with material (cast metal, porcelain, or combo)

-Dx, tx planning, rehab & maintenance of oral function, comfort, appearance & health of pts. with clinical conditions ass. with missing or deficient teeth &/ or maxillofacial tissues using biocompatible substitutes

-Fully dentate
-Partially edentulous
-Completely edentulous

Restoration &/ replacement of teeth by artificial substitutes that aren't readily removed from mouth

Replacement of teeth & contiguous structures for edentulous or partially edentulous pts by artificial substitute, easily removed from mouth

Restoration &/ or replacement of stomatognathic & craniofacial structures with prostheses that may/may not be removed on regular/elective basis

Replacement of teeth & or ass. structures by restoration attched to dental implants (fixed or removable)

core buildup portion of natural tooth restoration, replaces existing restorative material, excavated caries, missing tooth structure prior to crown prep.

any dental prosthesis that's luted, screwed, mechanically attached, or securely attached to teeth, roots, or implants that furnish primary support for dental prosthesis

Prothesis that replaces some teet in partially dentate mouth can be removed/replaced at will

Removable dental prosthesis that replaces entire dentition & ass. sturcture of maxilla or mandible

1.Meet pts
2. Do thorough clinical exam
3. Take accurate impressions
4. Pour/trim bubble free diagnostic casts
5. articulate with facebow and interocclusal records on semi-adjustable articulator (Teledyne WideVue)
6. Dx-waxed up for planned restoration
7. Anethestize pt
8. Prepare tooth for single unit crown
9. Ground down teeth with high speed diamonds, protecting gingival & pulpal tissues
10. Take accurate impression
11. Choose shade
12. Make temporary crown & cement

-Caries due to microleakage/

-Other: mechanical failure (bruxism), porcelain fracture

1.Turn incisal guide pin upside down so chisel is up
2. Dry anterior plastic table, place retentibve notches with small round bur
3. Mound mixed acrylic onto center of table
4. Once mixture is doughly, lower incisal pin onto acrylic
5. Make anterior & lateral excursive movements
6. Trim XS with carbide bur

-Place dowel pin channels in correct locations, utilized oritentaiton lgith to place channel in proper location
-Check if channels drilled to proper depth ( with dowel pin)

-Mixing investment materials, type 4 stone for working dies/cast --> Ensure thorough mix with no air

-After hand-mix 6 sec, close mixing bowel, attach hose, turn on pump
-Insert drive shaft into chuck of mixer, mix for 20-30 sec
-Onced mixed, pull out hose from bowel before turning off vaccum
-Leave mixer to run for 15 sec after
-Clean bowel and attachments immediately after pouring
-Gauge should be 25-30 on mixing

Always wash down blade after use to prevent clogging

-Dental Lathe: polishing wet side and dry side
-Stem generator: clean wax off model, clean sink

Systematic characterization of orofacial fxn when chewing/biting/speech

1: inner incline on non-supporting cusp
2: Central fossa
3: Inner incline of supporting cusp
4: Supporting cusp contact area
5: Outer incline of supporting cusp

MI contact zones 2 and 4

Working side contacts: 1 & 5

Non-working side contacts: 3

True

-Fracture
-Wear
-Periodontium trauma
-Esthetics; high in magnitude
-Parafunction

True

False: Articulator may not be needed to replicated dentition in MI, when there's sufficient # of teeth

True: Since the TMJ is the determining factor

-TMJ
-Angulation of anterior teeth
-O plane

Steepness of O plane < Steepness of anterior + Posterior guidance

-Mechanical model of skull & jaw
-Simulate pt';s occlusion

Relationship b/t max arch & anatomical plane (axis-orbital plane)

-CR to locate pt's terminal hinge axis
-Interocclusal records for posterior guidance: R & L lateral, protrusive

Horizontal components & lateral of posteiror guidance

Fossa: upper
Condyle: lower

Note: HCl independent of VDO

False: HCl is porportional to VDO

Determine terminal hinge axis precisely (True axis orbitale of pt)

Max. o plane referenced to plane that approximates axis-orbitale

-Set horizontal & lateral components of posterior gudiance for Left condyle

-Set horizontal & lateral components of posterior guidance for Right condyle

-Determined by path of condyle down articular eminence (30o)-->Protrusive checkbite

Determined by side to side looseness in TMJ (15o)

Determined by path of edges of lower anteriors down L surfaces of upper anteriors

-Material that enhances R&R form for full coverages restoration (made of amalgam. composite, metal alloy, hybrid)

-Slots & grooves within remaing tooth structure
-opposing vertical walls
-Pins
-Pulp chamber/canals
-Adhesives
-Endo dowel/post for RCT teeth

Final restoration that should be clincially acceptable (proper contours, dimension, location, intensity of O & proximal contacts), esthetics

May not fulfill all tenets of clinically acceptable restoration -->will be prepared & incorporated into final crown prep, leaving unsupported enamel in cavity prep is ok if it assists in restoring tooth for core foundation ONLY

-Opposing converging walls, undercuts inside DEJ, threaded pins, slot, bonding agents if with others.

-Take into accound the shape of crown prep.
-Think of how the tooth will look like after it's been prepared for crown --> retentive forms must be placed within confines of prep!

-Amalgam
-Composite
-Custom cast gold dowel/core
-Prefab. dowel & core
-Bonded ceramics
-NO RMGI

-Remaining tooth structure
-Pulp chamber/canals
-Dentin bonding
-Conventional retention
-Slot
-Threaded pin
-Cemented dowels

Zi > Ti > Cast Gold > Fiber posts

-Porion
-Orbitale

-Mouth the mandibular diagnostic cast to the maxillary diagnostic ast in centric

-Horizontal Condylar Inclination

-Lateral side shift, Bennett movement or Shift

-Horizontal component of posterior guidance for both condyles of a semi-adjustable articulator.

-Incisors guiding (Horizontal component

Canines guiding (Lateral component)

-Anterior guidance for dentures
-Measure anterior guidnace produced by natural teeth

1/3

clinical crown height

5-7 mm

Retain the core material

True

False

True

False: Do NOT bulk fill them (pulls the dentin adhesive away from the dentin walls, reducing the bond strength)

So you can discern the color of the tooth from the color of the composite when preparing margins, PLAN AHEAD

-Used for block out materials (undercut areas), but are NOT strong enough for core foundations.

Regardless the type of core selected, you MUST extend your prep 2.0 mm onto sound tooth structure apical to the core material.

False: Select what is best for the tooth to be restored.

-Occlusally converging walls are made to divere occlusally

-Visualization
-Moisture control (rubber dam placement)
-Adequate matrix stability
-Mimimum R&R for the foundation

-Unanticipated removal of foundation during temporary fabrication
-Unanticipated removal of the foundation during removal of a temporary for permanent crown insertion

-Whaledent Minikin pin set

-Line up pin drill with external surface of tooth

-Drill bottoms out to shoulder on drill shank

False: Run drill on very low speed

-Black spoon

Copper band or Automatrix

-Visualize pin and retention groove location
-Line pin drill with external surface of tooth
-Drill bottoms out to shoulder on drill shank
-Prepare retention grooves
-Pin placement. Run drill on very low speed
-Bend pins with black spoon
-Place matrix band and restore

-Amalgam removal
-Slot retention
-Etch & Protect adjacent teeth from etch with mylar strip
-Apply bond
-Matrix placement
-Place compcore

An Accurate diagnosis

-Good clinical photo
-Radiological evaluation
-Accurate diagnostic waxing

-Tooth, portion of it, or portion of implant that serves to support/retain prostehsis

Device used for stabilization or retention of prosthesis

Core buildup porotion of natural tooth restoration

Records made for purpose of diagnosis, recording of pt history, or tx planning

Determination of nature of disease

Causes implciated in cause/origin of disease/disorder

sequence of procedures planned for tx of pt after diagnosis; depends on what can lead to premature loss of tooth

Forecast as to probable resutl of disease or course of therapy

Removes questionable teeth, lets us know about prognosis, eliminate disease

-Excellent clinical exam: health history, BP, H&N exam, charting, perio charting, pulpal & caries status of existing teeth, O analysis, ortho assessment, TMJ assessment
-Appropriate radiograph & photo
-Complete control phase prior to implant placement to eliminate disease
-Diagnostic waxing of nearly all cases
-Develop template for fabrication of provisionals, or surgical template for implants
-Consults if required

-Perio & pulpal health, gingival embrasures, gingival countour, normal gingival elvels, proximal contact location, relative tooth dimensions, basic features of tooth anatomy, surface texture of tooth, color, long axes of all involved teeth, tooth display/smile line, tooth arrangment, C:R, mobility, I plane & occlusion, VDO, amt. of wear present vs. VDO
-Pt. expectation and whether you can meet them

root surface area of the abutment teeth has to equal or surpass that of the teeth being replaced with pontics

Mesial- distal width of the edentulous space

-Is restoration intact
-Can it survive long term
-Is existing restoration meeting (function, comfort, esthetics)
-

-Endo tx, periodontal crown lengthening, endo dowel, crown, ortho extrusion
-Alternatives available (extract, no other tx, RPD, FPD, implants)

True: if salvageable, seek appropriate referrals.
-Most teeth are deemed non-salvageable due to PERIO reasons

-Remove the existing restoration prior to (core foundation) or during crown prep.

True: Only exception is Mandibular 1st premolar

True

True

False: most likely require a core foundation prior to crown prep

-Is disease present
-Probable pocket depths vs. inflammation
-Cortical bone loss vs. mobility- clinical crown
-Attachment level
-Open proximal contact
-Esthetic periodontal parameters

-Ideal is 1:2 or better
-Minimally acceptable is 1:1
-Can depends on amount of tooth mobility
- Tooth mobility is more impt. than C/R ratio

-Bi-manual manipulation in F-L direction with fingure tip and or mirror handle

-Place finger tip on facial aspects of anterior, have pt. tap and slide

-Peridontal bone loss, must determine the activity level of periodontal disease
-Hyperocclusion or hyperfunction: assess and adjust the occlsuion to remove the offending non-functional contact and let teeth recover

-Class I: acceptable as abutments teeth for crowns or FPDs
-Class 2: may be acceptable as abutment teeth if splinted to other teeth (ex: FPD)
-Class 3: Never acceptable as abutment

-Rdige preservation grafting to preserve cortical bone/F plate for later

-Tooth has active disease (caries)
-Posterior tooth with existing RCT
-Tooth at risk to fracture
-Insufficient tooth structure left
-Significant tooth wear
-One or more cusps has fractured
-Existing restoration is failing
-Esthetics: pt. demand

-Replace a failing existing crown: marginal caries, fracture/wear of wear, esthetics
-Posterior tooth with RCT
-Significant tooth wear into dentin, require reconstruction of tooth
-Existing tooth is fractured with insufficient tooth structure remains to retain/support direct fill
-RCT posterior tooth to be used as RPD abutment

4"

1. Collect all pertinent clinical and radiographic data including clinical digital photo
2. Make a DX ( include PDI classification of pt)
3. Determine the etiology- it may help determine the course of therapy
4. Formulate TX plan(s): control phase, definitive phase

-Removes/eliminate disease/hopeless teeth
-Caries control with foundations or final restorations
-Perio. initial therapy
-Endodontic TX
-Extraction of hopeless teeth
-Ortho assessment
-Pre-prosthetic surgery/tissue conditioning

-Control phase builds the firm foundation for all subsequent TX-may ID other hopeless/questionable teeth

-Initally, after DX and TX planning, if you need it to generate a control phase
-After completion of control phase TX
-

-Road map
-Visual example of therapy for pt. review/approval
-Guide for development of surgical template
-Shim for provisional

-Accurately articulate diagnostic cast
-Use of facebow
-Semi-adjustable articulator with custom incisal guide table
-Properly extend impression
-Stabilized occlusion rims

False: refer for TX to Graduate Prosthodontics

True

True

6-10 um

Both canines are in contact to provide guidance in lateral excursions; each tooth should have at least 1 MI contact

-Shim stock thickeness: 8 um
-Exactafilm: 19 um
-Accufilm: 21 um
-Baush: 40 um
-Mynol: 100 um

1. Mark the entire arch w/ articulate paper in MI
2. Use shim stock to validate
3. Valid contact can result in Do nothing, Prematurity, Interferences
3a: Prematurity: Check Centric, lateral, protrusive--> Adjust cusp tip if high in centric and eccentric
- Adjust fossa if high in centric only
3b. Interference: Eliminate if in non functional area

-The opposing fossa is relieved to provide the remaining correction of the centric prematurity

Unless it is desirable that the cusp have contact in lateral function. In this case the cusp is relived until either one but not both of the premature relationships is corrected

Disclude the balancing, non-working, side.

Protrusive movement there are anterior tooth contacts that disclude the posterior teeth.

Working side contacts are either canine teeth alone or canine teeth with some combination of premolar/molars.

Elimination of occlusal interferences on the working side.
-Grind Bucco-occlusal inclines of max. teeth
-Grind Linguo-occlusal includes of mand. teeth

True

-When mand. is in MI, both canines are in contact to provide guidance in lateral excursions
-Each tooth have 1 contact
-During lateral excursions, working side disclude balancing, non-working side
-During protrusive movement, anterior contacts disclude poterior teeth

2-3 mm

5-10 min ( not on Directed Flow Impression tray)

-60 sec mixing time --> place into tray -->wipe on O of posteriors, F & L of anteriors --> pour within 10 min to avoid distortion by syneresis (absorbs fluid)

-10 min of removal

-Alginate substitute: VPS, require adhesive (dry for 5 min) or DFI --> allow to set in mouth for 3 mins --> Pour and re-pour anytime w/in 1-2 wks

Note: Don't use latex gloves w/ VPS

-Dimensionally stable, accurate, fast, predictable set times, won't absorb fluid.

-Expensive, requreis it own adhesives, Stiff (block undercuts is need)

-Alginate substitute: VPS, require adhesive (dry for 5 min) or DFI --> allow to set in mouth for 3 mins --> Pour and re-pour anytime w/in 1-2 wks

Note: Don't use latex gloves w/ VPS

-Dimensionally stable, accurate, fast, predictable set times, won't absorb fluid.

-Expensive, requreis it own adhesives, Stiff (block undercuts is need)

-When you have CR: MI discrepancy present. However this requires that the teeth NOT contact thur the bite registation material

-When no CR-MI discrepancy exists
-When you have enough posterio teeth to provide a stable relationship between the casts

-Use w/ semi-adjustable articulator
-Need to set HCI and Bennett angles (for fixed and RPD patients)

-Used w/ sem-adjustable articulator
-Only need to set HCI (for denture pt.)

-Expands when it sets (0.08% - 0.09%)
-Better option: wax and jumbo paper clips

-Lingual surfaces of anterior teeth is NOT linear
-Duplicate L countour of anterior (provide anterior guidance + protect casts from wear)

-Roughen the surface of guide table with E-cutter
-Place GC resin liquid on table
-Raise the incisal guide pin 1mm and lubricate tip w/ vaseline
-Mix 16-20 drops of GC resin liquid w/ enough powder and work quickly.
-Open upper member of articulator and place dent silk clear film in lower cast
-Close articulator and move into protrusive and lateral movements
-Trim XS material w/ E-cutter

-Mark center(depth) of the convexity and trim anything anterior to the guide table

-Improved intraoperator consistency
-Improved professional communication
-Insurance reimbursement w/ complexity of care
-Improve screen tool for dental school
-Standarized criteria for outcomes assessment & research
-Improve Diagnostic consistency
-Simplified aid in decision-making

-Intact continuous permeanent dentition w/ no missing teeth or roots (except 3rd molar)
-Include pt. with missing teeth or roots but have continuous symmetric dental arch of at least 12 teeth

1. Tooth Condition
2. Occlusal Scheme

-No localized adjunctive TX required
-Pathology affects coronal morphology in < or equal 3 teeth in 1 sextand

-Insufficient tooth structure to support restoration in 1 sextant
-Pathology affects > or equal 4 teeth/sextant
-Pathology can be in 2 sextands and in opposing arches
-Single tooth/Single sextand req. localized adj. therapy eg. perio

-Insufficient tooth struc. to retain restoration in > or equal 2 sextants
-Pathology affects coronal morphology in > or equal 4 in > or equal to sextands
-Localized adj. therapy required in 2 sextants
-Pathology can be in same arch or opposing

-Insufficient tooth structure to retain restoration in > or equal 3 sextants
-Patholog affects coronal morphology in > or equal to 4 teeth in ALL sextants
-Localized adj. therapy required in > or equal 3 sextands

-Ideal/Minimally OS: no pre-prosthetic TX required, intact arches

-Anteriot guidance intact
-OS required localized adjunctive therapy

-Major work required to maintain the entire OS w/o changing OVD

-Major worked required to maintain the entire OS. "Include changing OVD"

-Place pt. into more complex class

-Severe manifestations of local or systemic disease (Sequelae post Oncologic TX)
-Maxillomandibular dyskenesia +/or Ataxia
-A refractory pt. still has chronic complaints following app. TX

-Raise the classification in complexity by one or more level

True

False

-Raise classification in complexity by one or more levels in class

True

-Roadmap for dentist & lab
-Pre-tx guide to determine restorability
-Show pt. proposed tx
-Guide for tooth prep
-Permanent legal record
-Establish ideal O scheme

-2 sets of casts
-Facebow, semi-adjustable articulator
-Accurate CR, lateral, protrusive checkbites
-Instrument for modifications
-Knowledge of dental anatomy, occlusal plane (Curve of von speed, Curve of Wilson)
-Time and skill

-Make shim
-TX planning
-Evaluate occlusion
-Develop diagnostic waxing

-After control phase, prior to initating fixed pros. tx or desinign RPD

-Less expensive
-Judge tooth reduction
-Acurrate for multi. unit prostheses

-Adequate reduction of occlusal surface and axial surface
-Well-defined margin configuration
-Good prep. length, surface area, parallelism
-Smooth, rounded cavo-surface angles

-Retention
-Resistance
-Path of insertion

> or equal to 4 mm

-R&R forms
-Sturctural durability
-Marginal integrity

-Conservation of tooth
-Pulpal protection
-Soft tissue protection
-Occlusal harmony

-Minimize display of metal
-Max. porcelain vitality
-Subgingival margination
-Porcelain margins
-Ceramic restoraitons

-amt. of occlusal tooth structure removed during prep. to gain appropriate clearance w/ opposing arch

-Is the amt. of space between the reduced surface of prep. and the opposing tooth surface

-The desired contour of the restoration is a function of the restored plane of occlusion and is related to the position of the "opposing dentition".

-A function of the requirement for marginal ridge compatbility and is related to the position of the "adjacent dentition

-Prep. design that prevent dislodgement of restoration in a vertical direction along path of insertion

-Prep. design that prevent dislodgment of restoration along all other paths (FL, MD)

-Total Occlusal Convergence (TOC, Taper, Draw):
-Surface Area:

-The relationship b/t 2 opposing and converging external axial walls, or two opposed and diverging internal axial walls.

-The amt. of relatively parallel axial tooth structure. It is a function of axial wall heigh and preparation diameter

False: TOC and retention/resistance form are INVERSELY PROPORTIONAL

-Directly proportional b/t Height/Diameter vs. Retention form

-Prep. height is directly proportional with Resistance form
-Prep. diameter and resistance form are inversely proportional

-Is the long axis of clinical

-Shoulder margin
-Beveled shoulder margin
-Slice margin (rarely if ever used)
-Chamfer margin

-Existing restoration, decay or tooth defect
-Need to enhance R&R form
-Periodontal consideration/root or furcal exposure
-Esthetic demand

1. Adequate reduction of occlusal surface to provide clearance
2. Adeqaute reduction of axial surface to provide retention and resistance form
3. Good prep. length, surface area, parallelism
4. Well-defined margin
5. Smooth, rounded cavo-surface angles
5.

Yet, maintain structural integrity of the tooth

-Light Chamfer: gold crown
-Heavy Chamfer: PFM (narrow collar or collarless), some all-ceramic crowns (Proceram)
-Shoulder: All-ceramic crowns
-Combination: PFM corwn with labial shoulder margin
-Beveled shoulder: PFM

-Light chamfer: 0.3-0.5 mm
-Heavy chamfer: 1.0-1.5 mm
-Shoulder: 1.0-1.5 mm

-Margin MUST be located on sound tooth structure, with Ferrule rules (2 mm rule)
-Margin MUST be defined, crisp and concise
-Margins in enamel is preferred over cementum
-Impression MUST record both margin and unprep. tooth structure below margin

-Lower margins into the gingival crevice
-Expose margin for impression

-Above gingival crest
-At gingival crest
-In sub-gingival sulcus
-In the attachment apparatus (NEVER)

-Gingival suclus was caries free __> Margins were placed sub-g = Results
-Increase plaque retention,
-Increase Irritaiton
-Incrase Gram - bacteria

-Lengthen short prep. (Better R&R form)
-Extend prep. onto sound tooth structure (abfraction lesions, existing restoration, periodontal problem, caries)
-Cover exposed senstive root
-Esthetic demands

Inital Preparation
1. Occlusal reduction
2. Axial reduction
3. Functional Cusp bevel
Final Preparation
4. Gingival Retraction
5. Final Margination
6. Smoothing & Finishing

1.5 mm

See uniform dimension of margin width 360 around prep.

-Evaluate prep. from occlusal surface
-Close one eye and look at prep.
-You should be able to see margins 360 around the prep. and all axial walls

Occlusal: 11
Facial: 11
Interproximal: 11
Lingual: 7

Occlusal: 5
Facial: 5
Interproximal: 5
Lingual: 1

-Type 1: Impression plaster (mounting): Low expansion, quick set, large, irregular particles
-Type 2: Model plaster
-Type 3: Dental stone/Hydrocal: Diagnostic cast, removable pros
-Type 4: Improved Dental stone/ Densite: (max. strength, acurrate, low expand) = Gold, implants
Type 5: Die Stone High expansion --> PFM (need space in casting as metals shrink

CaSO4 + 2H2O ---> - Heat + CaSO4 .5H2O + H2O

-water doesn't rxn with gypsum

-Inc. Gauging water = Inc. Expansion (Except 1 & 5) = Inc. Porosity = Dec. Strength

-50 um or less for gypsum (limiting factor)

-Alginate is 80% H2O

-Accurate, elastic recovery (no material have 100%), dimensional stable (depend on compositions, byproducts), Flow & flexibility, workability, hydrophilic, Shelf life, Comfort, economic

Increase distortion

-Truly hydrophilic, pour w/in 1 hr, monophasic, not for use if humidity > 50%

-Stays where injectied & flows under pressure, rigid

-No byproduct (dimensional stable), pour whenever, best elastic recovery, stable, best fine detail reproduction

Latex gloves: Unreacted Sulfur in latex contaminates chloroplatinic acid catalyst in PVS

Polymerization (1-2 mm bulk)

Custom tray: More comfortable, limited material use, max accuracy

-Light body: low viscosity, low filler for fine detail

-Heavy body: Bulk of impression to decrease shrinkage

-Cast gold (yellow or white)
-Other metals (semi or non-precious)
-Porcelain-fused to metal (PFM)
-Ceromers
-All ceramic materials

-Longest track record in dentistry
-Good strength (Type II soft - Type IV hard
-Will not fracture
-Can be alloyed to improve strength
-Wear opposing natural teeth is negligible
-Non-estehtic

-Current "gold standard"
-Metal coping (substructure) veneered w/ porcelain for estehtics
-More "ESTHETIC" than gold
-Good flexual STRENGTH values
-Can use as single unit crowns or "LONG-SPAN FPDs

-Prone to ceramic fracture (framework is impt.)- Cusps tip or marginal ridges susceptible
-Wear opposing teeth/restoration
-Must be highly glazed/polished to minimize the wear
-Less translucent (less esthetic) than all-ceramic material (metal substructure)

-Pressed ceramics (Empress, others)
-Core strengthened ceramics w/ feldspathic porcelain veneering materials (Procera AlCeram, InCeram, others)
- Aluminum oxide or Zirconum oxide cores

-Mainly good on anterior teeth and 1st premolars
-Should be etched, silanated, and adhesively bonded to etched/bonded dentin to maximize their strength
-Esthetic is excellent

-Anterior teeth
-1st premolars

-Etched, silanated, adhesively bonded to etched/bonded dentin

-Core is made of Al2O3 or Zr Oxide
-Core provides strength, replaces the metal substrcuture found in PFMs
-Core are white = more translucent

False: Core design must follow same parameters as in PFM

False: Overlay feldspathic porcelain still requires lab technician

-Zirconium oxide
-Titanium
-CrCo
-Polycon cast
-Polyamide resin for long term provisional

Ceramic Optimized Polymers (Polymer Glass Systems)

-Weakest of all crown systems
-Rapid wear
-No long term outocme data on any
-Many labs have stopped using these materials

Cast gold, PFM

-Natural teeth: Natural teeth
-Gold: Natural teeth
-Gold: Gold
-Ceramic: Ceramic
-Ceramic: Natural Teeth
-Ceramic: Gold
-Plastics: Opposing anything

: 2-3 mm of MI
: Occluding surfaces are ough
: "Harder" materials oppose "softer" materials
: In group function posterior occlusal schemes
: When there is no posterior support
: Pt w/ parafunctional habits (bruxism)

-Pt's desires (esthetics)
-Strength of the various materials
-Wear resistance / wear compatability
-Location in the dental arch
-Pt.'s occlusion
-Condition of the remaining tooth/teeth

-Ideal tooth prep. to enhance retention and resistance form
-Tooth prep. to minimize trauma to pulp and periodontal tissues
-Adequate protection of the prepared tooth/teeth and exemplary provisonal restoration
-Maintenance of the proximal and occlusal contacts, proper emergence profiles to ehance the functional, esthetics.

-Elimanate inadequate impressions
-Enhance the marginal "fit" of provisional and final crowns and FPDs
-Promote tissue health before, during and after prosthesis delivery

-Method
-Mould (hold material)
-Material
-Healthy dental tissues (hard & soft)

-Retract tissues for sub-g margin prep.
-Retract tissues to enhance "fit" of temporary restorations
-Provide access for visual inspection prepared tooth
-Provide access for impression materials
-Promote/maintain tissue health

-Short clinical crowns (enhance R&R form w/ longer walls)
-To extend beyond Sub-g caries
-Extend beyond Sub-g restorative materials (2.0 mm)
-Extend beyond abfraction lesions
-Esthetics-NO (Only when root structure is discolored)

-Protect prepared tooth & pulp
-Protect gingival tissue
-Hold adjacent tooth position
-Hold opposing tooth position
-Esthetics prior to final crown

-Method (Intra-oral, extra-oral, lab)
-Mold (Thermoplastic shim, Pre-TX impression, crown form)
-Material (PMMA, PEMA, Bis-acryl composite resins, Polycarbonate or SS crown forms)

-Alginate
-VPS
-Thermoplastic Shims
-Pre-formed crown forms
-Keep mold until final restoration

-PMMA: shrinks a lot, and monomer had been linked to liver problems
-PEMA: tastes bad, flexes/debonds
-Bis-Acryl Composite Resin: expensive, fit very well, but are brittle, Good esthetic

-Immediately after the margination, prior to impression, when the retraction cord is removed

-Chlorhexidine soln (PerioGuard, Peridex)

-Consider injecting provisional material into gingival sulcus,

-Mechanical
-Mechanic-chemical
-Rotary gingival currettage
-Electrosurgical
-Laser

-Physically move gingival tissues laterally and apically away from tooth
-Trauma to tissue can be minimal
-Can repeat if miss impression

-Rubber dam (inverted)
-Non-medicated retraction cords
- Elastic retraction rings
-"Impression" materials
- Copper bands

-Retraction cord impregnated or pretreated with a chemical
-Non-impregnated cord soaked in a soln. agent

-Rotary Gingival Currettage
-Hemorrhage control required before impression
-Painful for pt.

-Doesn't retract tissues but burns them away.
-No hemorrhage control needed
-Unpredictable gingival crest when healed

Laser Tissue Retraction
-Heal well

-Epinephrine
-Alumunum chloride
-Alum
-Ferric Sulfate
-Visine

-Good: Excellent tissue displacement, excellent hemorrhage control, minimal tissue loss (Except XS time)
-Bad: Myocardial stimulant, Increases HR, Vasoconstrictor, Elevates blood pressure (Need healthy pt)

-Good hemostasis
-Minimal tissue loss / damage
-Local tissue loss w/ concentrations > 10%
-Example: Hemodent (Premier)

-Potassium Aluminum Sulfate
-Extend working time
-Minimal tissue loss / damage
-
Less Hemostasis and less tissue displacement than Epi.

-Good tissue response
-Excellent hemostasis
-Extended working time
-Works well w/ Aluminum chloride impregnated cords
-Will NOT work with epi cords-tissue discoloration
-Example: Astringident (Ultradent)

-A solution more acidic than either alone will increase potential for chemical tissue burn

-Astringent solution

Note: Rinse off Hemostatic agents

-Visine: Controls hemorrhage by functioning as a mild vasoconstrictor

All of the above

-All of the above

-Horizontal tissue displacement (expose gingival margin)
-Vertical Tissue displacement (expose tooth structure apical to margin)
-Hemorrhage control

-Probe gingival crevice prior to prep. to determine crevice depth
-Determing # of cords to use (one or two cord technique
-Use largest X-sectional cord diameter for crevice at hand
-Cut to proper length-overlap ends to prep, leave free end to impress
-Visualizing cord 360 around tooth

-Soak "dry" cord in hemostatic soln. and blot XS on 2X2
-Place cord in crevice
-Start in deepest part of gingival sulcus (interproximally)
-Use blunt instrument
-Use firm but gentle pressure
-Place parallel to root structure

-With firm pressure at a 45 angle, Parallel to the root surface

-1st cord is smaller, must be apical to prep. margin, stay in sulucs during impression (primarily for hemorrhage control)
-2nd cord is larger, laterally and apically retracts tissue, IS removed immediately BEFORE impression making (Primarily for tissue retraction)

-Inspect gingival crevice to insure all fragments are removed
-Check crevice for residual impression materials after it is removed from mouth

-Note: last placed, last removed

-Isolate, place retraction cords, dry
-Begin loading impression tray with heavy body material
-Remove cord, inspect for bleeding
-If non, inject light body material around prep & adj. occlusals
-Seat loaded stay, stabilized until set
-Removal w/ snap in long axis of prep.

All of the above

-Disposable, single-use
-Contains self-retentive fleece strap
-Rim-lock retentive elements
-Palatal reservoir minimizes gagging

-Re-pour
-Dimension stable
-More accurate
-Doesn't require adhesive on tray if used DFI

-ExaFlex

-Alignate

-Inadequate material in tray-fill tray 2/3 full use more syringe material

-Air incorporated into tray, or blood/saliva contamination-keep tip in contact w/ impression material, manage tissues better

-Tip not in contact w/ impression material, inadequate tooth prep, inadequate tissue control, excessive hemorrhage/saliva-manage tissues and technique better

-Tray seated too late; timing of wash/tray mixing; tray movement while material sets-master mix timing, stabilize tray in mouth

-Tray seated too late; timing of wash/tray mixing; tray movement while material sets-master mix timing, stabilize tray in mouth

-Poor tear strength, inadequate space, premature removal from mouth, undercuts-change materials, check fit of tray, time set of material, block out undercuts

-Poor tear strength, inadequate space, premature removal from mouth, undercuts-change materials, check fit of tray, time set of material, block out undercuts

-Tray doesn't support material, tray adhesive not set, wrong tray adhesive-use correct sized tray or make custom tray; allow tray adhesive to set 5-10 mins.

-Tray doesn't support material, tray adhesive not set, wrong tray adhesive-use correct sized tray or make custom tray; allow tray adhesive to set 5-10 mins.

-Timing of mixing materials, latex contamination, material not setting, contamination by hemostatic agents
-Soln: Master materials mixing, do not touch material with gloves, carefully rinse prep., do not reline impression

-Timing of mixing materials, latex contamination, material not setting, contamination by hemostatic agents
-Soln: Master materials mixing, do not touch material with gloves, carefully rinse prep., do not reline impression

-Digital intraoral capture of prep. tooth structure-CEREC 3D, CAD/CAM machine, Brontas Scanner.

-Digital intraoral capture of prep. tooth structure-CEREC 3D, CAD/CAM machine, Brontas Scanner.

-Protect ST with proper tooth prep, tissue retraction, provisional restorations, cement removal.

-Records the margin and unprepared tooth structure apical to the margin, circumferentially around the prep.

-Name and Address of Lab
-Name or ID of pt.
-Date of Work Order
-Description of Work
-Specification of Type & Quality of Materials
-Dentist Signature
-License Number

-6.5
-Due to poor record keeping

-Condition when teeth are missing and no terminal teeth remain (except for missing 3rd molars)

-Periodontal and pulpal health
-Pt. desires and expectations
-Interarch space (Occlusal-gingival dimension)
-Law of Beams
-Ante's Law
-Vertical dimension of occlusion

-Implants
-Posterior FPDs, limit to 4 units

-a fixed prosthesis designed to enhance esthetics, stabilization, function for a limited period of time, after which it is replaced by a definitive prosthesis.
-Prostheses can asist in effectivenss of specific TX and form & function of planned definitive prosthesis.

-Biocompatible
-Covers all prep. tooth
-Provide marginal seal
-Provide occlusal contacts
-Provide proximal contacts
-Provide emergence profile and axial contours
-Color & contours are compatible w/ esthetics
-Easy to fabricate, cost effective, repairable, strength

-Method: intra-oral, extra-oral, or lab-processed temporaries
-Mould: Thermoplastic shim, pre-TX impression, crown form
-Material: (PMMA, PEMA, Bis-acryl composite resins, polycarbonate or SS crowns forms)

-PMMA: shrinks a lot, and monomer has been linked to liver problems
-PEMA tastes bad, flexes, debonds
-Bis-Acryl composite resin are easy to use, very expensive, fit very well, but are brittle
-Polycarbonate & SS crowns are ugly

-Pre-op impression (alginate, VPS)
-Wax shim
-Thermoplastic shim
-Pre-formed crown

-Poor fit: distorations w/ initial crown
-Poor color: prep. inadequate, over-seating of matrix, wrong shade selected
-Poor Esthetics: inadequate contours
-Short Margins: over-polishing
-Voids: lifting the tip too soon, trapping air

1. Adjust the internal surfaces (leave room for cement)
2.Adjust proximal contacts: Correct location, dimension, intensity (flossing)
3. Check margins & adjust accordingly or repaired as needed
4. Check/adjust the occlusion
5. Check/modify contours
6. Smooth/polish restoration
7. Cementation
8. Post-op instructions, OHI diet adjustments.

-Poor fit: distorations w/ initial crown
-Poor color: prep. inadequate, over-seating of matrix, wrong shade selected
-Poor Esthetics: inadequate contours
-Short Margins: over-polishing
-Voids: lifting the tip too soon, trapping air

1. Adjust the internal surfaces (leave room for cement)
2.Adjust proximal contacts: Correct location, dimension, intensity (flossing)
3. Check margins & adjust accordingly or repaired as needed
4. Check/adjust the occlusion
5. Check/modify contours
6. Smooth/polish restoration
7. Cementation
8. Post-op instructions, OHI diet adjustments.

-Bis-acryl composite resin

-Composite finishing burs/disks

-Premolars & molars only

-Green Coarse
-Black Medium
-Yellow Fine

-When cast is free from moisture.

-45 degrees
-0.5 mm
-Places recesses facial and lingual to the dowel pin

-45 degrees
-0.5 mm
-Places recesses facial and lingual to the dowel pin

-Must be tucked into the gingival sulcus
-Margins at the retracted crest of tissue with no tissue damage

-Margins exposed, no hemorrhage, clean and dry environment

-Unprepared tooth structure apical to margins, 360 around prep.
-Prep. tooth completely impressed w/ no voids, tears, missing parts
-Margin present 360 around prep
-

-Condyles fully seated superiorally in fossa
-Condyles act (rotate) against thinnest avascular part of disk
-Condyles positioned to act anteriorally against slope of articular eminence
-Indpt. of teeth and occlusal contacts on teeth
-Repoducible jaw position for prosthodontic TX of pt.

-TMJ
-Jaw movement measurement technique/conventions
-Border movements and positions
-Functional chewing movements

-Positional limits in space to which the mandible can be moved w/o damage to hard and soft tissue;
-Determined by anatomy not physiology (spatial capacity of the jaw for motion or displacement)

-Used to set anterior and posterior guidance of semi- and fully adjustable articulators
-Reflect pt.'s jaw mobility and disorders thereof (TMD)
-Posselt's Diagram

-Path of the edges of the lower anterior teeth down the palatal surfaces of the upper anterior teeth
-AKA Incisors Guiding

-Determined by the path of the condyle down the articular eminence
-AKA Horizontal Condylar Inclination

-Determined by the paths of the lower anterior teeth across the palatal surfaces of the upper anterior teeth
-AKA Canines Guiding

-Cases for which there is no anterior guidance and must be established by the prostheses

-Determined by the side-to-side looseness in TMJ
-AKA Lateral Side Shift or Bennett Movement or Shift

-By Anterior and Posterior guidance

-Shield: 2cm width, 5 cm height
-Baseball: 1 cmm height

Max: central facial (working), Mesial Lingual cusp (Balance), Mesial (Protrusive)

Man: Central lingual (working), Middle Facial Cusp (Balance), Distal (Protusive)

-Used to characterize disordered limitations
-capacity of jaw movement and displacement

-Captures horizontal, lateral components of anterior guidance

-Captures horizontal, lateral components of posterior guidance

-Anterior and Posterior guidance
-Eccentric contacts on posterior teeth

-Working condyle: moves less anteriorly returns to posterior border prior to final closure in IP
-Non-working condyle moves further anteriorly reutnrs to posterior border only at final closure in IP

-Beginning of slow closing phase

It remains "advanced" until the end of the chewing cycle

-The working side mandibular cusps move anteriorally and medially into contact w/ the maxillary teeth at the end of the cycle

-Nonworking side mandibular cusps move posterially and laterally into contact w/ maxillary teeth at the end of the cycle.

False: More likely

-Occlusal phase (end of the chew cycling) and thus is tooth guided

-Occurs near the end of the opening phase or the beginning of the fast closing phase
-Due to looseness in the TMJ
-Is caused by the actions of the muscles on the jaw (Neuromuscle system)

-Slower
-Non-working
-Intercuspal position

False: Increase

-Decrease
-Horizontal component

-Underestimate
-Less anatomic

-Maximal

-Lateral shift (Bennett shift or movement) to the working side, using a check bite

-Non-adjustable hinge

-Semi-adjustable
-Fully adjustable

-Semi-adjustable
-Fully adjustable

-Semi-adjustable
-Fully adjustable

-Set posterior guidance

-Left condyle of articulator for lateral and horizontal components of posterior guidance

-Right condyle of articulator for lateral and horizontal components of posterior guidance

-Horizontal components of posterior guidance for both condyles of articulator

-Routine cases, too much time required but little to no intraoral adjustment of restorations is required; for complex cases, total chair time is minimized and profit is maximized.

Dentulous patient

-For a single denture, particularly an upper denture, even when it occludes w/ natural teeth or a removable partial denture in opposing arch

-Minimize torquing forces on its abutment teeth

-Pro: Esthetic veneer
-Cons: Potential wear, fracture and pulpal problems

-Functions: Marginal adaptation & strength
-Failure: marginal discrepancies & procelain fracture

-Functions: Bonds with metal, masks metal color
-Failure: procelain debonding, porcelain discoloration

-Function: Esthetics and contour
-Failure: Esthetic compromise and XS contour

-Full Porcelain Coverage
-Facial Veneer Porcelain
-Facial Window Porcelain
-Partial Facial Window Porcelain

-All contacts in Porcelain
-Incisofacial Porcelain
-Intermediate Strength

-Most contacts in metal
-Incisofacial procelain
-Weakest PFM design due to junction near contact

-All contact in metals
-Incisofacial Metal band
-Strongest PFM design

-Metal should ONLY be present where functional occlusal contact are.

3 mm

90 degree

1. Occlusal reduction
2. Inital Axial reduction
3. Second plane reduction
4. Gingival retraction
5. Final margination
6. Smoothing/Finishing

-Metal substructure
-Oxide layer
-Opaque porcelain
-Dentin and enamel veneers
-Surface glaze

-Cement: <25 micron
-Metal substructure: 0.3 mm
-Opaque porcelain: 0.3-0.5 mm
-Body/Incisal porcelain: > 1.0 mm

1.Accurate abutment castings and ease of casting
2. Accurate soldering and ease of soldering
3. Rigidity of the metal frame
4. Ability of the porcelain to fuse to metal
5. Adequate strength of the final restoration
6. Esthetic appearance
7. Tissue tolerance ease of repair

1. Metal occlusion: requires more conservative prep.
2. Metal axial wall support components of removable and fixed partial dentures

-Occlusal contacts in porcelain or metal
-Occlusal contacts 1.5- 2.00 mm
-Proximal contact in porcelain or metal
-No more than 2mm of unsupported porcelain
-Substructure thick enough to provide rigid foundation for porcelain veneer

-Marginal ridges: support w/ interproximal struts of metal that extend just inferior to proximal contact areas
-Pontic tips- often under supported

-Measuring thickness of casting

-Working model
-Full contour wax-up
-Wave pattern cutback
-Wax pattern thickness measurement, Spruing, Investing, Casting.
-Despruing and metal shaping
-Porcelain application and Glazed