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Treatment Planning in FPD: DR Kaushal Kishor Agrawal Assistant Professor Departmnent of Prosthodontics KGMU Lucknow
Treatment Planning in FPD: DR Kaushal Kishor Agrawal Assistant Professor Departmnent of Prosthodontics KGMU Lucknow
Treatment Planning in FPD: DR Kaushal Kishor Agrawal Assistant Professor Departmnent of Prosthodontics KGMU Lucknow
FPD
Clinician should understand the limitations of appropriate materials and procedures &
this will help prevent experimental approach to treatment.
a) Plastic materials (e.g. AgAm & Composite)
b) Cast Metal – intracoronal restoration & extracoronal restoration
c) Metal ceramic
d) Resin Veneered
e) Fiber-reinforced resin
f) Complete ceramic
g) Fixed partial denture
h) Implant supported prosthesis
i) Removable partial dentures
III-Treatment of tooth loss
Causes- caries, pdl disease, trauma, neoplasm, congenitally absent
Smith (1993)
- Proximal half crowns can be used as a retainer on distal abutment.
this is simply a three –quarter crown that has been rotated 90 degrees
so that the distal surface is uncovered.
- Possible only if – the distal surface is caries free
- the distal surface is not decalcified
- there is a very low incidence of proximal caries throughout the mouth
- the patient is able to keep the area exceptionally clean.
- Contraindicated - where there is severe marginal ridge height discrepancy between the distal
of the 2nd molar and the mesial of 3rd molar as a result of tipping.
Shillingburg HT (1972)
- A telescope crown and coping can be used as a retainer on the distal abutment
i.e. full crown preparation with heavy reduction is made to follow the long axis of
tilted molar. An inner coping is made to fit the tooth preparation and a proximal half
crown that will serve as a retainer for the FPD is fitted over the coping.
Advantages- allows total coverage of the clinical crown while
- compensating for the discrepancy between the path of insertion of the
abutments
- the marginal adaptation is provided by the coping.
Another alternative treatment for mesially tilted 2nd molar
Uses – when molar exhibits marked lingual as well as mesial inclination because
the routine FPD in such cases will lead to drastically overtapered preparation with no retention.
Because telescope crowns and non-rigid connectors both require tooth preparations that are more
destructive than normal, the selection of one of these would be influenced by the nature of previous
destruction of the prospective abutment tooth
for e.g. – the presence of a dowel core or a D.O amalgam on the premolar would favour placement of a
non-rigid connector
- while extensive facial and / or lingual restorations on the tilted molar would call for the use of
a telescope crown.
v) Canine replacement FPD
- FPD’s replacing canine may be difficult because canine often lies outside the interabutment line.
- Prospective abutments are - Lateral Incisor ( Weakest tooth in the entire arch)
- First premolar ( Weakest posterior tooth)
Jepsen (1963) reported the areas of the root surfaces of various teeth.
Tylman (1970) - stated that two abutment teeth could support two pontics.
Irvin H Ante (1926) – suggested that in fixed partial prosthodontics for the observation that, the
combined pericemental area of the abutment teeth supporting a fixed partial
denture should be equal or greater in pericemental area than the tooth or teeth to
be replaced.
Johnson et al (1974) – designated “ ANTE’S LAW “ which states that the root surface area of the
abutment teeth had to equal or surpass that of the teeth being replaced with pontics
Therefore according to this premise :
One missing tooth can be successfully replaced
if abutment teeth are healthy .
Multirooted posterior teeth with widely separated roots will offer better
periodontal support than roots that converge, fuse or generally present a
conical configuration. Teeth with conical roots can be used as an
abutment for a short span FPD if all other factors are optimal.
iii) Crown - root ratio.
- This ratio is a measure of the length of the tooth occlusal to
the alveolar crest of bone compared with the length of
root embedded in the bone.
- Optimum crown-root ratio for a tooth to be utilized as
a FPD abutment is 2:3
- A ratio of 1:1 is the minimum ratio that is acceptable
for a prospective abutment under normal circumstances.
If the occlusion opposing a proposed fixed partial denture is composed of artificial teeth, the
occlusal force will be diminished with less stress on the abutment teeth.
Kaffenbach (1936) - showed that the occlusal force exerted against prosthetic appliance has
been shown to be considerably less than against natural teeth.
i.e. 26.0 lbs for removeable partial dentures,
54.5 lbs for fixed partial dentures versus
150 lbs for naural teeth.
After a horizontal bone loss from periodontal disease the pdl supported root surface areas can be
dramatically reduced.
Because of the conical shape of most roots, when one third of the
root length has been exposed half of the supporting area is lost.
In addition, the forces applied to the supporting bone are magnified because
of the greater leverage associated with the lengthened clinical crown.
Healthy periodontal tissues are prerequisites for all FPD’s and it is important that excellent plaque
removal techniques be implemented and maintained at all times.
Since there are limits to increase a retainers capacity to withstand displacing forces, some
means must be used to neutralize the effects of those factors.
Shillingburg and Fisher (1973) recommended the use of a NON-RIGID CONNECTOR
to reduce this hazard.
It has an apparently close fit
Enough movement to prevent the transfer of stress from the
segment being loaded to the rest of the FPD.
- It is a broken stress mechanical union of retainer and pontic
- It transfers shear stress to supporting bone rather than
concentrating it in the connectors
- It appears to minimize mesiodistal torquing of the abutment,
while permitting them to move independently
- most commonly used non-rigid design -------- T- shaped key that is attached to the pontic & a dovetail
keyway placed in the retainer
A rigid FPD distributes the load more evenly than a non-rigid design, making it preferable for teeth with
decreased periodontal attachment where as ,
A non rigid FPD should not be used if prospective abutment teeth exhibit significant mobility.
Whenever possible edentulous spaces will should be restored with FPD than RPD,
however under the following circumstances RPD is indicated.
Where vertical support from the edentulous ridge is needed .
E.g. in the absence of a distal abutment.
Where resistance to lateral movement is needed from contra-lateral teeth and
soft tissues.
E.g. to ensure stability with a long edentulous space
When there is a considerable bone loss in the visible anterior region and an FPD
would have an unacceptable appearance.
V) Sequence of treatment
Includes :
a) Treatment of symptoms
Relief of discomfort accompanying acute conditions
Urgent treatment of non-acute problems
b) Stabilization of deteriorating factors
Dental caries
Periodontal disease
c) Definitive therapy
Oral surgery, Periodontics, Endodontics, Orthodontics,
Fixed Prosthodontics – Occlusal adjustments
- Anterior restorations
- Posterior Restorations
- Complex Prosthodontics
d) Follow up specific program of follow up care & regular recall visits.
References
1) Contemporary Fixed Prosthodontics – Rosenstiel, Land & Fujimoto
2) Fundamentals of Fixed Prosthodontics – Shillingburg
3) A preliminary diagnostic and treatment protocol – J Bowley et al
DCNA.July 1992,36(3) 551-567.