endo ortho prostho

8/15/2019 Endo Ortho Prostho

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GoodMorning


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Ortho-Endo-Prostho

Relationship

DR. ASHISH DABAS


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•Concept of complete dentistry

• Ortho Endo Relationship

• Effect of Orthodontics on the ooth Bein! "o#ed

• Effect of orthodontics on #it$l $nd non #it$l teeth

• Orthodontics $s the etiolo!ic $!ent for endodontics

• Orthodontic f$ctors $ssoci$ted %ith non #it$lity of teeth

• Resorpti#e defects

•Endo tre$tment $fter orthodontic tre$tment

• Endo tre$tment d&rin! orthodontic tre$tment

• Boltons R$tio

• 'olden proportion

CONTENTS


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• Orthodontic Endodontic - Combined Therapy

oB$sic periodont$l principles for forces er&ption

oB$sic endodontic principles for forced er&ption

oB$sic orthodontic principles for tooth mo#ement

o)orced er&ption


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Ortho prostho relationship

•Introd&ction

• +hy repl$ce $ missin! ,$c- tooth

• Introd&ction to fi/ed p$rti$l dent&res

Combined ortho prostho therapy

• re$tment pl$nnin!0 A m&lti disciplin$ry $ppro$ch

• "issin! tooth 0 Sp$ce clos&re or prosthetic repl$cement

• "$n$!ement of $ sin!le tooth edent&lo&s sp$ce

• $ter$l incisors

• )orced er&ption

• Ali!nment of $nterior teeth


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• Ho% to &pri!ht inclined mol$r in prep$r$tion forrestor$ti#e tre$tment

• Orthodontic prosthodontic impl$nt inter$ction

• rosthodontic consider$tion %hen &sin! impl$nts for

orthodontic $nchor$!e

• "$/illof$ci$l prosthesis

• Clinic$l c$ses

• Concl&sion

• Reference


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THE CONCEPT OF COMPLETE DENTSTR!

• he est$,lishment of definiti#e !o$ls is the fo&nd$tion for

complete dentistry. If $ !o$l is cle$r eno&!h5 it c$n ,e

#is&$li6ed $nd in f$ct m&st ,e #is&$li6ed.

• Cle$rly defined !o$ls !i#e p&rpose to tre$tment pl$nnin! $nd

m$-e it possi,le to ,e hi!hly o,7ecti#e.


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Complete dentistry has "o#r comprehensi$e %oals &

19 Optim&m or$l he$lth

29 An$tomic h$rmony

39 )&nction$l h$rmony

(9 Occl&s$l st$,ility

" each o" these %oals is achie$ed' treatment s#ccess is ass#red(


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ndications "or orthodontic treatment in a ad#lt patient

can be broadly classi"ied into "o#r cate%ories &

1. rosthodontic

2. eriodont$l

3. emporom$ndi,&l$r 7oint ;"


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Orthodontics is $ centr$l pl$yer in this m&ltidisciplin$ry

dent$l te$m $nd h$s $llo%ed for ,etter m$n$!ement of these

ch$llen!in! dentof$ci$l pro,lems especi$lly presented ,y the

$d&lt pop&l$tion.


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A m&ltidisciplin$ry $ppro$ch to dent$l tre$tment is most

desir$,le $nd m$y dr$m$tic$lly impro#e the tre$tment o&tcome

$s %ell $s the lon!>term pro!nosis.


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he incre$sin! n&m,er of $d&lt p$tients see-in!

orthodontic ther$py h$s res&lted in $ pro!ressi#e modific$tion of

tre$tment mod$lities.


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ORTHODONTC- ENDODONTC

REL)TONSHP


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NTROD*CTON


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• Orthodontics ;AAO9 is defined $s the $re$ of dentistry

concerned %ith s&per#ision5 !&id$nce $nd correction of the

!ro%in! $nd m$t&re dentof$ci$l str&ct&res5 incl&din! those

conditions th$t re?&ire mo#ement of teeth or corrections of

m$lrel$tionships $nd m$lform$tions of rel$ted str&ct&res

,y the $d7&stment of rel$tionships ,et%een $nd $mon!

teeth $nd f$ci$l ,ones ,y the $pplic$tion of forces $nd @ or

the stim&l$tion $nd the redirection of the f&nd$ment$l

forces %ithin the cr$niof$ci$l comple/.


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• Endodontic tre$tment c$n simply ,e defined $s the

prec$&tions t$-en to m$int$in the he$lth of the #it$l p&lp in

$ tooth5 or the tre$tment of $ d$m$!ed or necrotic p&lp in $

tooth to $llo% the tooth to rem$in f&nction$l in the dent$l

$rch.


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he p&lp c$n ,ecome infl$mmed $nd

necrosed ,y the follo%in! re$sons.I. B$cteri$l

A. Coron$l in!ress1. C$ries

2. )r$ct&re

B. R$dic&l$r in!ress1. C$ries

2. Retro!enic infection

3. eriodont$l poc-et or $,scess

II. r$&m$ticA. Ac&te

1. Coron$l or r$dic&l$r fr$ct&re

2. &/$tion $nd $#&lsion

B. Chronic1. Ad&lt fem$le ,r&/ism

2. Attrition $nd $,r$sion

3. Erosion


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( tralA. C$#ity rep$r$tion

1. He$t of prep$r$tion

2. Depth of prep$r$tion

B. Restor$tion1. Insertion

2. )r$ct&re

C. Intention$l e/tirp$tion

D. Orthodontic mo#ement

E. eriodont$l c&rett$!e

). Electros&r!ery'. $ser ,&rn

H. erir$dic&l$r c&rett$!e


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+( Chemical

A. Restor$ti#e m$teri$ls

1. Cements

2. Etchin! $!ents

3. C$#ity liners

(. Dentin ,ondin! $!ents


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B. Disinfect$nts1. Sil#er nitr$te $nd henol

C. Dessic$nts

1. Alcohol $nd ether

. Idiop$thicA. A!in!

B. Intern$l resorption

C. E/tern$l resorption

D. Sic-le cell $nemi$E. Herpes oster infection


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he e/p$ndin! role of orthodontics into more ph$ses of

dent$l tre$tment is ill&str$ted ,y the $%$reness of rel$tionships

%ith endodontics.

here $re t%o m$7or $re$s %here endodontics $nd

orthodontics sh$re common !ro&nd.


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• One is etiolo!ic5 ,ec$&se orthodontic tre$tment $ffects the

tooth ,ein! mo#ed 5$nd some of the response m$y ,e noted in

the p&lp tiss&e.

• he second one is com,ined ther$py5 %here orthodontic

tre$tment is necess$ry to !$in $ desir$,le endodontic res&lt.


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EFFECT OF ORTHODONTCS ON THE

TOOTH ,EN MO+ED


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Orthodontic tre$tment is &sed

to !$in $ m&ch more esthetic

$ppe$r$nce for the p$tient $nd is

often f&rther &tili6ed to impro#e the

occl&sion. In the co&rse of s&ch

ther$py5 cert$in ch$n!es m$y occ&r tothe tooth ,ein! mo#ed.

he most common side effect

of orthodontics is to ,l&nt the root of

the mo#ed tooth5 d&e to $pic$l $ndsometimes l$ter$l resorption.


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E""ect o" orthodontics on $ital

and

non $ital teeth


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) COMP)RSON OF )PC)L ROOT RESORPTON

D*RN ORTHODONTC TRE)TMENT N

ENDODONTC)LL! TRE)TED )ND +T)L TEETH

STE+EN .( )/O DO 0112

• he p&rpose of this st&dy %$s to determine %hether #it$l $nd

endodontic$lly tre$ted incisors e/hi,it $ simil$r se#erity of

$pic$l root resorption in response to orthodontic tre$tment.

• he s$mple comprised of 2= m$le $nd 2= fem$le p$tients &nder

!oin! ortho tre$tment.


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CONCL*SON &

• Endodontic$lly tre$ted incisors resor, %ith less fre?&ency

$nd se#erity th$n #it$l control teeth.

• o si!nific$nt difference in root resorption ,et%een m$le $nd

fem$le p$tients %$s detected in endodontic$lly tre$ted

incisors.


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• Control teeth e/hi,ited si!nific$ntly more resorption in m$le

p$tients th$n in fem$le p$tents.

• E#en tho&!h st$tistic$l si!nific$nce %$s noted5 clinic$l

differences $re minim$l %hen endodontic$lly tre$ted $nd #it$l

incisors $re comp$red.


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Orthodontics as the Etiolo%ic

)%ent "or Endodontics


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Some teeth re?&ire endodontic

tre$tment $s $ res&lt of pre#io&s

orthodontics. Bec$&se the $ction of the

,l&ntin! of root tips &s&$lly occ&rs in the

$re$ %here the $pic$l ,lood #essels $nd

ner#es emer!e5 it c$n ,e seen th$t in7&ry

$t this s&scepti,le site co&ld $ffect p&lp

#it$lity.


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ORTHODONTC F)CTORS )SSOC)TED .TH

NON +T)LT! OF TEETH


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T!PE OF M)LOCCL*SON &

• Amon! different m$loccl&sions5 ,$sed on An!les

cl$ssific$tion system5 st&dies h$#e o,ser#ed $ st$tistic$lly

si!nific$nt difference ,et%een cl$ss I $nd cl$ss II di# 1

m$loccl&sion5 %ith the l$tter e/hi,itin! more resorption.


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•


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E3TR)CTON +S NON E3TR)CTON &

• he $n$lysis of liter$t&re re#e$ls th$t ,oth the e/tr$ction $nd

the non e/tr$ction tre$tment h$#e the potenti$l to prod&ce

d$m$!e5 %ith the e/tr$ction ther$py ,ein! potenti$lly more

detriment$l.

• Amon! $ll the e/tr$ction p$tterns5 e/tr$ction of $ll the first

premol$rs sho%ed the !re$test resorption potenti$l.


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Mechanotherapy ,e%% +s ed%e4ise &

•Altho&!h pre#io&s st&dies co&ld not find $ny si!nific$nt

resorption r$te ,et%een Be!! li!ht %ire mech$nics $nd

ed!e%ise ; %eed 9 techni?&es5 $ recent st&dy ,y "c$, et $l

h$s reported $ hi!her incidence of resorption5 $s %ell $s

$mo&nt of root resorption in p$tients tre$ted %ith the Be!!

$ppli$nce.


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T!PE OF TOOTH MO+EMENT &

• Intr&sion $nd tor?&e mo#ements $re fo&nd to ,e most

commonly $ssoci$ted %ith the resorption process.

• his is e#ident %hen st&dyin! cl$ss II di# 2 correction $s %ell

$s Be!! mech$nics.


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• he intr&sion performed in the first st$!e $nd the tor?&in! in

the third st$!e m$-e the Be!! techni?&e more #&lner$,le to

resorption.

• he hi!hest root resorption is reported to occ&r %hen 3 to (.*

mm of tor?&in! mo#ement %$s performed.


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Len%th o" treatment time

• he len!th of tre$tment time $nd root resorption h$#e ,een

positi#ely correl$ted ,y $lmost $ll st&dies.

• hese st&dies h$#e sho%n th$t incre$sed tre$tment time

m$-es tooth roots more prone to i$tro!enic response.


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Type o" "orce applied 5Contin#o#s $s interr#pted 6

• Interr&pted forces %ere sho%n $ccordin! to st&dies to c$&se

less se#ere $pic$l ,l&ntin! $nd sm$ller resorption $ffected

$re$s.

• he $&thors of these st&dies emph$si6e the &se of less

detriment$l forces ; in the form of el$stic &s$!e5 inste$d of

el$stomeric ch$ins 9 d&rin! sp$ce>clos&re st$!es of

orthodontic mech$nother$py.


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Tooth speci"icity&

• E#$l&$tion of the #&lner$,ility of specific teeth to the

resorption process in the liter$t&re h$s res&lted in common

$!reement $mon! $&thors th$t the m$/ill$ry incisors $re the

teeth th$t $re the most s&scepti,le to the process.

• Ho%e#er5 Contro#ersy still e/ists re!$rdin! %hich incisors

resor, the most0 the centr$ls or the l$ter$ls.


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• he m$7ority of the st&dies p&,lished reported th$t the

centr$l incisors %ere more s&scepti,le to the process.

• )ollo%in! the incisors in s&scepti,ility to resorption in the

m$/ill$ry $rch $re the mol$rs5 follo%ed ,y the c$nines.

• In the m$ndi,&l$r $rch the most resorption #&lner$,le tooth

is the c$nine5 follo%ed ,y the l$ter$l $nd centr$l incisors.


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•Amon! the posterior teeth5 the most resor,ed $re the

m$ndi,&l$r mol$rs ;%ith the dist$l root e/hi,itin! more

resorption95 follo%ed ,y m$/ill$ry mol$rs5 m$ndi,&l$r

premol$rs5 m$/ill$ry first premol$rs5 $nd m$/ill$ry second

premol$rs.


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• Bec- $nd H$rris;A


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Root shape &

• $rio&s $&thors h$#e e#$l&$ted $,norm$lities in root sh$pe

$nd its $ssoci$tion to the resorpti#e process.

• Amon! differently sh$ped root ends ;norm$l5 ,l&nted5

dil$cer$ted5 pipette sh$ped5 pointed5 $nd incomplete95 the

le$st resorption %$s o,ser#ed in ,l&nted root ends $nd the

!re$test %$s seen in pointed or t$pered root ends.


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• his phenomen$ is e/pl$ined ,y the f$ct th$t the press&re

from the $/i$l component of orthodontic forces is felt most

$t the root $pe/ re!ions %hich $re $,norm$l in sh$pe. his

res&lts in loc$li6ed ischemic necrosis5 %hich den&des the

pericement&m $nd cemento,l$sts5 permittin! coloni6$tion

of dentinocl$sts.


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• In comp$rison to the norm$l root sh$pe5 dil$cer$ted roots

sho% the most resorption follo%ed ,y pipette> sh$ped $nd the

incomplete roots.

• Hence5 $ny $,norm$l root sh$pes o,ser#ed in the pre>

tre$tment di$!nostic records sho&ld ,e o,ser#ed %ith c$&tion

$nd sho&ld ,e monitored thro&!ho&t the tre$tment period for

$ny i$tro!enic d$m$!e.


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Root len%th&

• A positi#e correl$tion is fo&nd ,et%een the root len!th $nd

root resorption. he st&dies in this re!$rd report th$t lon!er

roots $re more prone th$n shorter ones to resorption.

• his m$y ,e d&e to the !re$ter displ$cement re?&ired to

prod&ce $n e?&$l $mo&nt of tor?&e5 #ers&s shorter roots.


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History o" tra#ma&

• re#io&s history of tr$&m$ $nd the presence of pretre$tment

root resorption h$#e ,een positi#ely correl$ted %ith root

resorption seen $fter orthodontic tre$tment.

• Also st&dies h$#e fo&nd $ rel$tionship ,et%een cortic$l pl$te

pro/imity $nd incre$sed root resorption. All these findin!s

point to%$rds the import$nce of o,t$inin! pretre$tment

di$!nostic records $nd proper e#$l&$tion. So th$t $ny ris-

elements c$n ,e identified $nd descri,ed.


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O$er7et or o$erbite&

• St&dies to d$te h$#e $!reed %ith $ positi#e correl$tion ,et%een

$n incre$se in o#er7et $nd root resorption.

• he m$in re$sons $ttri,&ted to this phenomenon $re the

!re$ter $mo&nt of tor?&e $nd !re$ter root displ$cements

re?&ired to correct e/cessi#e o#er7et.


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)%e' ender and ethnicity& are they contrib#tin% "actors8

• Biolo!ic f$ctors s&ch $s $!e $t the st$rt of tre$tment $nd

!ender5 h$#e lon! ,een $ssoci$ted %ith ris- f$ctors for the

initi$tion of root resoption.

• A!e $t the st$rt of the orthodontic tre$tment $nd incidence of

root resorption h$#e ,een poorly correl$ted in $lmost $ll

recent st&dies.


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• Conflictin! res&lts h$#e ,een seen %hen !ender is considered.

$rio&s st&dies s&pported th$t fem$les $re more prone to root

resorption %here$s #$rio&s others st$ted th$t men %ere more

prone.

• he m$7ority of the st&dies s&pport $ l$c- of correl$tion

,et%een !ender $nd resorption.

• he rel$tionship ,et%een ethnicity $nd root resorption %$s

e#$l&$ted recently. he res&lts sho%ed less se#erity $mon!

Asi$ns in comp$rison to C$&c$si$ns $nd Hisp$nics.


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RESORPT+E DEFECTS


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+hether it %$s the orthodontic

ther$py or some other p$tholo!y th$t

c$&sed the resorption is ?&estion$,le

&nder $ny circ&mst$nces.

Ho%e#er5 7&st $s some p&lp$l

ch$n!es incl&de deposition of rep$r$ti#e

dentin5 resorption c$n $lso occ&r from

p&lp$l in7&ry th$t mi!ht h$#e ,een

initi$ted ,y orthodontic mo#ement.


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)&rthermore5 $ll teeth th$t h$#e ,een mo#ed5 p$rtic&l$rly

those th$t %ere p&lled into occl&sion5 sho&ld ,e monitored $t le$st

on $ once>$>ye$r ,$sis #i$ r$dio!r$ph $nd c$ref&l clinic$l

e/$min$tion to #erify norm$lcy of the p&lp.

If the p&lp c$n$l sp$ce does ,e!in to diminish or !et

l$r!er5 endodontic ther$py sho&ld not ,e del$yed.


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ROOT RESORPTON N M)3LL)R! CENTR)L

NCSORS FOLLO.N )CT+E ORTHODONTC

TRE)TMENT

Copeland S( )/O DO 019:

• he p&rpose of this st&dy %$s to determine if $pic$l root

resorption $ssoci$ted %ith orthodontic tre$tment contin&es $fter

the termin$tion of $cti#e tre$tment.

• A s$mple of (* s&,7ects %ho h$d e/perienced root resorption

d&rin! tre$tment %$s selected from the orthodontic clinic $t the

st$te &ni#ersity of e% For- $t B&ff$lo.


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ENDO TRE)TMENT

)FTER

ORTHODONTCS


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• herefore %or-in! len!th sho&ld

,e shortened %hen s&ch teeth $re

,ein! tre$ted5 $nd the c&stomi6ed

m$ster cone techni?&e sho&ld ,e

employed %here#er possi,le.


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ENDO TRE)TMENT

D*RNORTHODONTCS


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ro,lem c$n ,e f$ced here ,ec$&se of the cond&ction

potenti$l of the ,$nds $nd $rch%ires5 electric p&lp testin! is

impossi,le.

est c$#ity prep$r$tion is $#$il$,le5,&t it is diffic&lt to

drill into these teeth5 %hich !ener$lly $re nonc$rio&s $nd

&nrestored yet h$#e l$r!e p&lps %itho&t $,sol&te cert$inty th$t $

necrotic p&lp is present.


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Apic$l $nd l$ter$l r$diol&cencies $nd root resorption5

%hich $re common findin!s %hen endodontic ther$py is

needed5 $re fo&nd in these c$ses incident to orthodontics $nd

do not necess$rily indic$te p&lp d$m$!e. E#$l&$tion of these

is most complic$ted $nd conf&sin!.


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E#en %hen $ correct decision is m$de in determin$tion

of ther$py5 some postoper$ti#e films m$y indic$te the opposite.

It is e/tremely import$nt to -eep these p$tients &nder close

s&per#ision &ntil complete he$lin! is #erified or f&rther

tre$tment is indic$ted.


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BOOS RAIO


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• One of the ,$sic f&nd$ment$ls %ith %hich the orthodontist

h$s to de$l in reconstr&ctin! the dent&re is tooth si6e5

specific$lly the mesiodist$l %idth of the teeth.

• ooth si6e is $n import$nt f$ctor to ,e t$-en into

consider$tion in orthodontic di$!nosis $nd tre$tment

pl$nnin!.

• Accordin! to Bolton there e/ists $ r$tio ,et%een the

mesiodist$l %idths of m$/ill$ry $nd m$ndi,&l$r teeth.

"$ny m$loccl&sion occ&r $s $ res&lt of $,norm$lities in

tooth si6e.


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S#m o" mandib#lar 0;

he mesiodist$l %idth of $ll teeth mesi$l to m$ndi,&l$rsecond perm$nent mol$r is me$s&red $nd s&mmed &p.

S#m o" ma


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O#er $ll r$tio G S&m of m$ndi,&l$r 12 / 1== S&m of m$/ill$ry 12

If o#er$ll r$tio is less th$n :1.35 it indic$tes m$/ill$ry tooth

m$teri$l e/cess.

If o#er$ll r$tio is more th$n :1.35 it indic$tes m$ndi,&l$r

tooth m$teri$l e/cess.


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Anterior r$tio G S&m of m$ndi,&l$r / 1== S&m of m$/ill$ry

If $nterior r$tio is less th$n 44.25 it indic$tes m$/ill$ry

$nterior e/cess.

If $nterior r$tio is more th$n 44.25 it indic$tes m$ndi,&l$r

$nterior e/cess.


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• ,olton Ratio may be help"#l in cases in 4hich

• eeth m$y ,e lo!ic$lly e/tr$cted if s&ch $ proced&re deemed

necess$ry.

• E/tr$ction of teeth not confined to c$se in %hich shortened

$rch len!th e/ists.


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• 'ross dish$rmonies in tooth si6e m$y indic$te remo#$l of

dent$l &nit or &nits5 e#en %hen there is $de?&$te $rch

len!th.

• ooth si6e discrep$ncies m$y ,e corrected ,y pl$cin! o#er

conto&red restor$tions %hen indic$ted.


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So%my$ '.S. ost re$tment


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4:

OLDEN PROPORTON


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hilosophers $nd m$them$tici$ns h$#e $l%$ys ,een

f$scin$ted ,y the rel$tionship ,et%een m$them$tics $nd n$t&re.

he Ancient 'ree- philosopher yth$!or&s defined 'olden

roportion5 %hich e/pl$in ,e$&ty in n$t&re $s it rel$tes to the

science of n&m,ers.

OLDEN R)TO


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A B C

A

B C

B

AB ACG G 1.18


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• his r$tio is c$lled 'olden r$tio.

• he concept of !olden r$tio is of historic$l import$nce in

$esthetics5 $rt5 $nd $rchitect&re.

• It h$s often ,een tho&!ht th$t $ form5 incl&din! the h&m$n

form 5is most ple$sin! %hen its p$rts $re di#ided in !olden

sections.


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+inston Senior5 $n

eminent orthodontist in

"$nchester5 J %$s the firstorthodontist to $ppreci$te the

$pplic$tion of the 'olden

roportion to orthodontics. It

is %ith th$n-s to his

enth&si$stic lect&res $nd c$se

reports th$t so m$ny

orthodontists h$#e t$-en $

stron! interest in the

$pplic$tion of the 'olden

roportion.

Dr. "c. Arth&r 1:8* %rote $n


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8*

$rticle Km$/ill$ry $nd m$ndi,&l$r teeth

%idthsL in %hich he e/pl$ined the

$#er$!e r$tio of &pper centr$l incisor to

lo%er centr$l incisor is 1.2.

Dr. Stephen "$r?&$rdt5 $n

eminent Or$l s&r!eon in C$liforni$5

disco#ered th$t5 Khe Hei!ht of the

centr$l incisor is in 'olden roportion

to the %idth of t%o centr$l incisors.

h ' ld ti i id d K t ti i tL


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8

he 'olden roportion is considered $ Kst$rtin! pointL

in desi!nin! the rel$ti#e %idth of teeth in $ ,e$&tif&l smile.


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84

• ypic$lly the presence or $,sence of the 'olden roportion

%ithin $ smile is e#$l&$ted ,y me$s&rin! the $nterior teeth

from the front$l $spect.

• So %hen #ie%ed from front 5if the tooth $rr$n!ement h$s to ,e

in !olden proportion 5the r$tio ,et%een the percei#ed %idth of

the m$/ill$ry $nterior teeth %o&ld ,e


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88

$t$r$7 24 Fe$rs "$le


89/346


90/346

:=

'olden roportion done %ith hotoshop soft%$re


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:1

ENDODONTC =ORTHODONTC COM,NED THER)P! &

Endodontic>orthodontic cotre$tment m$y ,ecome necess$ry

to s$#e teeth %ith $d#$nced c$ries5 tr$&m$tic destr&ction of the

clinic$l cro%n5 l$ter$l root perfor$tion5 e/tern$l or intern$l resorption

ne$r the $l#eol$r crest5 or o#er6e$lo&s tooth prep$r$tion. +itho&t

s&ch tre$tment5 these teeth m$y not offer so&nd tooth str&ct&re on

%hich to pl$ce $ restor$tion.


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:2

An $ddition$l com,ined ther$py in#ol#es isol$ted

infr$,ony periodont$l defects %hich $lso m$y ,e $men$,le to

forced er&ption.

Orthodontic ther$py %ill impro#e the e/istin! periodont$l

en#ironment ,y modifyin! the osseo&s topo!r$phy $nd

minimi6in! the need to remo#e s&pportin! ,one on $d7$cent teeth.


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:(

,)SC PERODONT)L PRNCPLES FOR

FORCED ER*PTON


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:*

Orthodontic$lly er&ptin! the tooth %ith its $tt$chment

$pp$r$t&s $nd !in!i#$ m$y elimin$te the need for periodont$l

s&r!ery to e/pose so&nd tooth str&ct&re $nd red&ce $l#eol$r

s&pport on $d7$cent teeth.

S&r!ery m$y ,e necess$ry to le#el $n!&l$r interdent$l $l#eol$r

crests cre$ted ,y tooth mo#ement $nd reposition the o#erlyin!

soft tiss&e to its proper coron$l le#el.


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:

A. Resorpti#e lesion $t the

$l#eol$r crest c$&sin! $n

infr$,ony poc-et. $tient h$dhistory of orthodontic tre$tment.

B5 Endodontic tre$tment

completed $nd initi$l post room

prep$red for orthodonticmo#ement. If only s&r!ic$l

tre$tment %ere employed to

elimin$te the poc-et $nd e/pose

the resorpti#e lesion5 $ cro%n>to>

root r$tio of 201 %o&ld res&lt. By

forced er&ption $nd s&r!ic$l

e/pos&re5 $ more $ccept$,le

r$tio of 101 is o,t$ined.

A B

C D


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:4

C D

E )

C. he tooth is er&pted5 $nd the

$l#eol$r ,one $nd resorpti#elesion $re mo#ed to $ position

more $men$,le to s&r!ic$l

e/pos&re.

D5 An &pri!htin! sprin! is pl$ced to $li!n the tooth for

p$r$llelism to $d7$cent teeth.

E. )in$l tooth position.

). )in$l restor$tion


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::

here is th&s $ rel$ti#e impro#ement in the cro%n>to>root

r$tio of the tooth &nder!oin! orthodontic er&ption follo%ed ,y

periodont$l ther$py th$t does not occ&r $fter $ s&r!ic$l proced&re.


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101/346

1=1

eeth th$t $re cert$in to re?&ire endodontic ther$py

sho&ld h$#e s&ch tre$tment completed prior to the initi$tion of

tooth mo#ement. In the c$se of $n isol$ted periodont$l defect5

endodontic ther$py sho&ld ,e completed ,efore tooth

mo#ement if it $ppe$rs th$t intention$l e/tirp$tion %ill ,e

re?&ired to restore the tooth $fter er&ption.


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1=2

his decision is ,$sed on the morpholo!y of the

periodont$l lesion $nd the $mo&nt of tooth mo#ement re?&ired

to modify it. E$rly endodontic tre$tment elimin$tes the

pro,lem of const$ntly ch$n!in! %or-in! len!ths $s the tooth is

er&pted $nd the cro%n is $d7&sted to the opposin! $rtic&l$tion.


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1=3

eeth th$t h$#e no p&lp$l pro,lem $nd $re &nder!oin!

er&ption m$y h$#e endodontic ther$py completed in one sittin!.

eeth th$t present %ith c$ries5 resorpti#e or i$tro!enic

perfor$tion5 or post>tr$&m$tic destr&ction of the clinic$l cro%n

sho&ld recei#e $ m&ltisittin! re!imen.


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105/346

A5 Before orthodontics5 m$/ill$ry firstA B


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1=

,ic&spid h$s $ deep dist$l infr$,ony

poc-et.

B5 After ( %ee-s of orthodontic

mo#ement. &lp %$s e/tirp$ted5 $nd $

tempor$ry fillin! pl$ced.

C5 Contin&ed er&ption %ith conti!&o&s

occl&s$l $d7&stment.

D. )in$l #ie%

E5 )i#e ye$rs $fter ori!in$l tre$tment5

norm$l ,one $ppe$r$nce h$s ,een

m$int$ined.

C D

E


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1=4

,)SC ORTHODONTC PRNCPLES

FOR

TOOTH MO+EMENT


108/346


109/346

1=:

• rior to the initi$tion of tre$tment5 $n estim$te of the

$mo&nt of $tt$chment $pp$r$t&s rem$inin! $t the

completion of tooth mo#ement m&st ,e m$de. he tooth

m&st h$#e s&fficient r$dic&l$r $tt$chment to $ssist in the

s&pport of $ m&lti&nit restor$tion or m$int$in its indi#id&$l

inte!rity %hile contri,&tin! to esthetics5 phonetics $nd

f&nction.


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111/346

111

osterior teeth5 %ith their !re$ter osseo&s s&pport5 root

s&rf$ce $re$5 fl$tter interdent$l form5 $nd lesser esthetic

re?&irements5 $re more $men$,le to osseo&s s&r!ery th$n to

forced er&ption. )orced er&ption ris-s ,rin!in! f&rc$tions closer

to the le#el of the cementoen$mel 7&nction of $d7$cent teeth.

his m$y res&lt in f&rc$tion e/pos&re.


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112

Infection $nd infl$mm$tion m&st ,e controlled ,efore

tooth mo#ement. Control of the infl$mm$tory lesion ,y c&rett$!e

of the soft tiss&e poc-et %$ll $nd remo#$l of $ny !r$n&lom$to&s

tiss&e $nd !in!i#$l fi,ers to the $l#eol$r crest m&st precede tooth

mo#ement. o tooth mo#ement sho&ld ,e st$rted &nless the

retention $nd st$,ili6$tion ph$ses h$#e ,een f&lly pl$nned.


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113

• nless #ery li!ht force is &sed to e/tr&de the tooth5 $ l$!

period occ&rs ,et%een mo#ement of the tooth $nd

mo#ement of its $tt$chment $pp$r$t&s $nd s&rro&ndin!

!in!i#$. he $tt$chment $pp$r$t&s $nd !in!i#$l &nit follo%

the tooth $fter it ,e!ins to er&pt from the $l#eol&s.


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11(

he $mo&nt of force &sed $nd the speed of er&ption

determine the l$! time5 ,ec$&se the f$ster the tooth is forci,ly

e/tr&ded the !re$ter %ill ,e the l$! ,et%een the mo#ement of

tooth $nd $tt$chment $pp$r$t&s.

A5 reoper$ti#e #ie% of $ m$ndi,&l$r c&spid A


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11*

%ith $d#$nced c$ries e/tendin! to

$tt$chment $pp$r$t&s.

B5 El$stic li!$t&re is tied from e/istin!

,rid!e to %ire cemented into tooth.

C5 +ith r$pid er&ption5 tooth is e/tr&ded

from $l#eol&s5 e/posin! so&nd tooth

str&ct&re. "o#ement of $tt$chment $pp$r$t&s

$nd !in!i#$l tiss&e did occ&r5 $s indic$ted ,y

position of the soft tiss&e rel$ti#e to the

$d7$cent cro%ns.

A

B

C


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11

)orced Er&ption


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114

• +ith the $d#ent of orthodontic direct ,ondin! ,r$c-ets5$d7&ncti#e tooth mo#ement s&ch $s forced er&ption c$n ,e

pr$cticed efficiently $nd economic$lly.

• +ith the clinic$l sit&$tion pre#io&sly descri,ed5 the

techni?&e of forced er&ption t$-es on one of the t%o

clinic$l protocols

Tooth lac>in% a clinical cro4n & Endodontic ther$py is completed


118/346

118

% py p

immedi$tely. ost room of $de?&$te %idth $nd len!th is pro#ided.

Control of !in!i#$l infl$mm$tion ,y c&rett$!e is completed prior

to tooth mo#ement.

If necess$ry5 $ c&stomi6ed post m$y ,e f$,ric$ted ,y

$ddin! cold>c&re $crylic resin $ro&nd $ prefit post for m$/im&m

$d$pt$tion to the c$n$l %$lls.

Tooth ha$in% an intact clinical cro4n &


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11:

Tooth ha$in% an intact clinical cro4n &

• A direct ,ond ,r$c-et or orthodontic ,$nd is pl$ced $s f$r

$pic$l $s is permissi,le.


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12=

• he !re$ter the force pl$ced on the tooth5 the more r$pid the tooth

er&pt from the $l#eol&s. +ith slo%5 const$nt5 li!ht press&re5 the

$l#eol&s $nd soft tiss&e %ill mo#e %ith the tooth.

• Do not ,e fooled into thin-in! th$t the tooth is not er&ptin! if yo&

do not see it e/tr&din! from the soft tiss&e. If properly m$n$!ed5

the soft tiss&e %ill mo#e %ith the tooth.


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121

ORTHO PROSTHO - REL)TONSHP


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122

NTROD*CTON

rosthodontics is th$t discipline of dentistry pert$inin! to the


123/346

123

restor$tion of or$l f&nction5 comfort5 $ppe$r$nces5 $nd he$lth

,y restorin! n$t&r$l teeth $nd repl$cin! missin! teeth $nd

conti!&o&s or$l $nd m$/illof$ci$l tiss&es %ith $rtifici$l

s&,stit&tes. here $re three m$in ,r$nches of prosthodontics 0

• )i/ed

• Remo#$,le

• "$/illof$ci$l

)i/ed prosthodontics pert$ins to the restor$tion or


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12(

p p

repl$cement of teeth %ith $rtifici$l s&,stit&tes th$t $re

$tt$ched to n$t&r$l teeth5 or impl$nts $nd th$t $re not re$dily

remo#$,le.


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"$/illof$ci$l prosthetics pert$ins to the restor$tion of


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12

de#elopment$l or $c?&ired defects of the stom$to!n$thic

system $nd $ssoci$ted f$ci$l str&ct&res %ith $rtifici$l

s&,stit&tes.

)it6!i,,on;1:239


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124

.H! REPL)CE ) MSSN ,)C?

TOOTH8


128/346

128

If yo& f$il to repl$ce $n e/tr$cted ,$c- tooth %ith $ f$lse

tooth5 yo& co&ld lose $ll of yo&r teeth..


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12:

• E$ch tooth consists of t%o p$rts 0 the cro%n $nd the root ;s9.

• Only the cro%n is #isi,le in the mo&th. he roots $re in the

,one5 &nder the !&ms.


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13=

• he !&ms $re $ protecti#e type of s-in th$t clin!s to the nec-sof the teeth $nd co#ers the ,one holdin! the teeth.

• "ol$rs $re ,$c- teeth. hey h$#e t%o or three roots. "ost

other teeth h$#e one root.

L i T th @T F O A


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131

Losin% Teeth @T4o-For-OneA

Recent e/tr$ction of $ lo%er

mol$r h$s cre$ted sp$ce M.

pper tooth is no%

&seless ,ec$&se it no lon!er

h$s $ tooth to che% $!$inst.

• herefore5 losin! one tooth

c$n res&lt in the loss of the

&se of t%o. osin! t%o teeth

c$n res&lt in the loss of the

&se of fo&r5 $nd so on.


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132

) SERES OF PRO,LEMS

,ENS


133/346

133

O$erer#ption &

• B$c- teeth h$#e $ lifetime tendency to er&pt ;mo#e f$rther into

the mo&th9. Only the presence of $ tooth to che% $!$inst -eeps $

,$c- tooth from o#erer&ptin!.

• his p$tient h$d $ tooth e/tr$cted from sp$ce M. pper tooth

h$s o#erer&pted.


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13(

• he res&ltin! &ne#enness $mon! the &pper ,$c- teeth h$s

cre$ted $re$s ,et%een these teeth th$t tr$p de,ris. It is #ery

diffic&lt to -eep sp$ces ,et%een &ne#en teeth cle$n5 despite yo&r

,est efforts $t ,r&shin! $nd flossin!.

• ncle$n teeth &s&$lly c$&se infl$mm$tion of the s&rro&ndin!

!&ms. hey dec$y more re$dily too.


135/346

13*

• o%er mol$r 4 is 7$mmin! food in ,et%een o#erer&pted $nd 4

d&rin! e$tin! ;$rro%9.

• his press&re ,et%een &pper $nd 4 h$s c$&sed &pper 4 to mo#e

,$c-%$rd $nd sep$r$te sli!htly from &pper . It h$s cre$ted $

sp$ce ,et%een these teeth ;$rro%9.


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13

• )ood c$n p$c- into this sp$ce %ith !re$t force d&rin! che%in!.

his cre$tes $ serio&s infl$mm$tion of the !&m.• ote th$t o#erer&ption of &pper h$s c$&sed some of its root

to ,ecome e/posed. E/posed root dec$ys f$ster th$n the cro%n

of $ tooth5 $s %e %ill see l$ter.


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138/346

138

• o% th$t $ tooth h$s ,een e/tr$cted from position M5 $ sp$ce

is left. his $llo%s lo%er mol$r 4 to tilt $nd drift for%$rd.

• o%er 4 %ill tilt f$rther $nd f$rther o#er $s yo& che% on it.


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13:

#m poc>et "ormation &

A tooth tilted o#er %ill de#elop $ !&m poc-et $lon! its for%$rd

root5 $s sho%n here.

'&m poc-ets $re n$rro%5 $,norm$l sp$ces or clefts th$t

de#elop ,et%een the !&ms $nd the tooth root. hese poc-ets tr$p food

de,ris $nd ,$cteri$.


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141/346

1(1

Loss o" bone s#pportin% the tooth &

• +hen $n $re$ of the !&ms is const$ntly infl$med5 $s yo& see in

this !&m poc-et5 the ,one immedi$tely $d7$cent to it c$n

,ecome infl$med too. Infl$med ,one softens5 $nd slo%ly ,e!ins

to dis$ppe$r.


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1(2

Destr#ction spreads &

o%er mol$r 4 h$s drifted $nd tilted so f$r for%$rd th$t&pper 4 no lon!er ,ites on it. his $llo%s &pper 4 to o#erer&pt

too. Arro%s ;↑9 sho% $d#$ncin! !&m poc-ets5 !&m infl$mm$tion5

$nd ,one loss.


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1(3

• Dec$y h$s ,e!&n on &pper teeth $nd 45 p$rtic&l$rly on the

e/posed portions of the roots of $nd 4. E/posed roots $re

especi$lly prone to dec$y.


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1((

• Both &pper mol$rs $re deeply dec$yed. Dec$y h$s $lso st$rted on

lo%er 4.

• eriodont$l dise$se N !&m poc-ets5 !&m infl$mm$tion5 $nd loss of

,one N contin&es to %orsen.


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1(*

• Deep dec$y h$s $llo%ed ,$cteri$ to enter $nd infect the p&lps;Kner#esL9 of &pper $nd 4. hese t%o teeth h$#e $,scessed

;,ecome serio&sly infected9. hey $re so ,$dly d$m$!ed ,y dec$y

th$t they m&st ,e e/tr$cted.


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1(

• Bec$&se of infl$mm$tion from the !&m poc-et of lo%er 45 ,oneloss ;o&tlined ,y $rro%s9 h$s spre$d $ro&nd the front root of this

tooth $nd e/tended to p$rt of the ,$c- root too. his tooth h$s lost

so m&ch ,one s&pport th$t it is no% loose $nd m&st ,e e/tr$cted.


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1(4

• Bec$&se $ll the mol$rs on this side of the mo&th h$#e ,een

remo#ed5 the &pper $nd lo%er *s h$#e no s&pport ,ehind them

$nd $re forced ,$c-%$rd ,y the $ction of che%in!.


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1(8

• )ood 7$ms ,et%een the sep$r$ted teeth ;$rro%s9. '&m

infl$mm$tion h$s ,e!&n. '&m poc-ets %ill follo%5 $lon! %ith

,one loss $nd dec$y. E#ent&$lly the *s %ill h$#e to ,e e/tr$cted


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1(:

• After the loss of the &pper $nd lo%er *s5 the destr&cti#e process

c$n mo#e f$rther for%$rd. he front teeth %ill st$rt to spre$d

$p$rt5 !&m poc-ets %ill form5 dec$y ,e!in.

• o% yo& m$y lose yo&r front teeth too.

S*MM)R!


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1*=

S*MM)R!

• So f$il&re to repl$ce $ sin!le mol$r tooth m$y st$rt $ ch$in of

e#ents 0 o#erer&ption5 tilt5 !&m poc-ets5 dec$y5 ,one loss.

• O#er the ye$rs this ch$in of e#ents c$n le$d to the loss of $ll

yo&r teeth.

• Insertin! $ f$lse tooth tod$y %ill $#oid !rief $nd m&ch !re$ter

e/pense tomorro%.


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1*1

NTROD*CTON

TO

F3ED P)RT)L DENT*RES

• A "i


152/346

1*2

cemented to n$t&r$l teeth or roots %hich f&rnish the prim$ry

s&pport to the prosthesisL

• A "i


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1*3

) "i


154/346

1*(

)i/ed p$rti$l dent&res $re !ener$lly $#oided in the

follo%in! conditions 0

• $r!e $mo&nt of ,one loss $s in tr$&m$.

• ery yo&n! p$tients %here teeth h$#e l$r!e p&lp ch$m,ers.

• resence of periodont$lly compromised $,&tments.

• on! sp$n edent&lo&s sp$ces.

• Bil$ter$l edent&lo&s sp$ces5 %hich re?&ire cross $rch

st$,ili6$tion.


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1**

• Con!enit$lly m$lformed teeth5 %hich do not h$#e $de?&$te

tooth str&ct&re to offer s&pport.

• "ent$lly sensiti#e p$tients %ho c$nnot cooper$te %ith

in#$si#e tre$tment proced&res.

• "edic$lly compromised p$tients ;e.!. le&-emi$5 hypertension9.

• ery old p$tients.


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1*

P)RTS OF ) F3ED P)RT)L DENT*RE

RET)NER &


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1*4

Ret$iner in $ fi/ed p$rti$l dent&re is defined $s5 Kthe p$rt of

$ fi/ed p$rti$l dent&re %hich &nites the $,&tment;s9 to the

rem$inder of the restor$tionL.


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1*8

T!PES OF RET)NERS &

Ret$iners in fi/ed p$rti$l dent&res c$n ,e ,ro$dly

cl$ssified $s 0

,ased on tooth co$era%e &

• )&ll #eneer cro%ns

• $rti$l #eneer cro%ns

• Conser#$ti#e ;minim$l prep$r$tion9 ret$iners

,ased on the material bein% #sed &


159/346

1*:

,ased on the material bein% #sed &

• All met$l ret$iners

• "et$l cer$mic ret$iners

• All cer$mic ret$iners

• All $crylic ret$iners

Pontic &

KAn $rtifici$l tooth on $ fi ed p$rti$l dent re th$t repl$ces


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1=

KAn $rtifici$l tooth on $ fi/ed p$rti$l dent&re th$t repl$ces

$ missin! tooth5 restores its f&nctions $nd &s&$lly fills the sp$ce

pre#io&sly filled ,y $ n$t&r$l cro%nL.

DE)L REB*REMENTS OF ) PONTC &

) pontic sho#ld "#l"ill the "ollo4in% ideal re#irements


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11

) pontic sho#ld "#l"ill the "ollo4in% ideal re#irements(

• It sho&ld restore the f&nction of the tooth it repl$ces

• It sho&ld pro#ide !ood $esthetics

• It sho&ld ,e comfort$,le to the p$tient

• It sho&ld ,e ,iocomp$ti,le. It sho&ld not impin!e on thetiss&es or prod&ce $ny -ind of tiss&e re$ction.

• It sho&ld permit effecti#e or$l hy!iene. It sho&ld ,e e$sy to

cle$n $nd e$sy to m$int$in.

• It sho&ld preser#e &nderlyin! m&cos$ $nd ,one. It sho&ld not

prod&ce $ny &lcer$tion in the m&cos$. It sho&ld not prod&ce

resorption of the resid&$l $l#eol$r rid!e.

F)CTORS )FFECTN THE DESN OF ) PONTC &


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12

The ma7or "actors that determine the desi%n o" a pontic are &

• Sp$ce $#$il$,le for the pl$cement of the pontic.

• he conto&r of the resid&$l $l#eol$r rid!e.

• Amo&nt of occl&s$l lo$d th$t is $nticip$ted for th$t p$tient.

CONNECTOR &

C i fi d i l d , d fi d Kh


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13

• Connector in $ fi/ed p$rti$l dent&re c$n ,e defined $s5 Khe

portion of $ fi/ed p$rti$l dent&re th$t &nites the ret$iner $nd

ponticL.

C C


164/346

),*TMENT &

An $,&tment c$n ,e defined $s KA tooth $ portion of $


165/346

1*

An $,&tment c$n ,e defined $s A tooth5 $ portion of $

tooth or th$t portion of $n impl$nt &sed for the s&pport of $ fi/ed or

remo#$,le prosthesisL.

Healthy deal ab#tments &

• An &nrestored #it$l tooth in its norm$l $n$tomic position is


166/346

1

considered $s $n ide$l $,&tment.

• Ade?&$te tooth str&ct&re sho&ld ,e present to de#elop retention

$nd resist$nce forms.

)n ideal ab#tment sho#ld ha$e the "ollo4in% characteristics &


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14

• Ide$l cro%n root r$tio.

• Ade?&$te thic-ness of en$mel $nd dentin.

• Ade?&$te ,one s&pport

• A,sence of periodont$l dise$se

• roper !in!i#$l conto&r


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18

T!PES OF ),*TMENT

Cantile$er ab#tments &

h l ti f til , t t i iti l ,


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1:

• he selection of $ c$ntile#er $,&tment is more critic$l ,ec$&se

this prosthesis is !oin! to f$ce @ %ithst$nd more th$n norm$l

forces.

Pier ab#tments &

A i , i i l h i h d7


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A pier $,&tment is $ sin!le tooth %ith t%o $d7$cent

edent&lo&s sp$ces on either side. In this c$se5 the sin!le tooth

%ill h$#e to $ct $s $n $,&tment for ,oth the edent&lo&s sp$ces.

• Since $ sin!le $,&tment s&pports t%o edent&lo&s sp$ces5 it

%ill ,e s&,7ected to &n,$l$nced forces %hich c$n le$d to


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141

%ill ,e s&,7ected to &n,$l$nced forces5 %hich c$n le$d to

tr$&m$ of the periodonti&m.

Tilted ab#tments &

+hen $ tilted tooth is


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142

chosen $s $n $,&tment5 o,t$inin! $

sin!le p$th of insertion is diffic&lt.

Cert$in ,iomech$nic$l

consider$tions li-e p$th of insertion

$nd stress distri,&tion pl$y $n

import$nt role in the constr&ction of

the prosthesis.

ilted $,&tments $re

!ener$lly $#oided d&e to the

comple/ desi!n in#ol#ed in the

f$,ric$tion of the prosthesis.


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143

T!PES OF F3ED P)RT)L DENT*RE

CON+ENTON)L F3ED P)RT)L DENT*RES &

hey $re the most commonly &sed type of fi/ed p$rti$l


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14(

y y yp p

dent&res. he desi!n in#ol#es f$,ric$tion of $ fi/ed p$rti$ldent&re5 %hich t$-es s&pport from $,&tments on either side of

the edent&lo&s sp$ce. he desi!n m$y #$ry $ccordin! to the

condition of the $,&tments ,&t the $,&tments on either side

sho&ld ,e $,le to s&pport the fi/ed p$rti$l dent&re.

C)NTLE+ER F3ED P)RT)L DENT*RES &

A c$ntile#er fi/ed p$rti$l dent&re is &sed %hen s&pport c$n

, ,t i d l f id f th d t l h


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14*

,e o,t$ined only from one side of the edent&lo&s sp$ce. he

$,&tment teeth on the s&pportin! side sho&ld ,e stron! eno&!h to

%ithst$nd the $ddition$l torsion$l forces. S&pport c$n ,e o,t$ined

from more th$n one tooth on the s$me side of the edent&lo&s sp$ce.

)d$anta%es &


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14

)d$anta%es &

• ery conser#$ti#e desi!n especi$lly %hen $ sin!le $,&tment

is in#ol#ed.

• +hen second$ry $,&tments $re &sed5 p$r$llel prep$r$tion c$n

,e e$sily o,t$ined ,ec$&se the $,&tments $re $d7$cent to one

$nother.

• E$sy to f$,ric$te.


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144

Disad$anta%es &

• rod&ces tor?&in! forces on the $,&tment

• C$nnot ,e &sed to restore lon! sp$n edent&lo&s sp$ces

• "inor desi!n errors c$n $ffect the $,&tments in $ l$r!e sc$le.

SPRN C)NTLE+ER F3ED P)RT)L DENT*RES &

his is $ speci$l c$ntile#er ,rid!e e/cl&si#ely desi!ned


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148

for repl$cin! m$/ill$ry incisors ,&t these dent&res c$n s&pport

only $ sin!le pontic.

A lon! resilient ,$r connector is &sed to connect the

posterior ret$iner to the $nterior pontic.


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Disad$anta%es &

• he connector ,$r m$y interfere %ith speech $nd m$stic$tion.

• Deform$tion of the connector ,$r m$y prod&ce coron$l

displ$cement of the pontic.

• here m$y ,e food entr$pment &nder the connector ,$r5 %hich

m$y le$d to tiss&e hyperpl$si$.

F3ED F3ED P)RT)L DENT*RES &

he term denotes fi/ed p$rti$l dent&res %ith ri!id


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connectors. he desi!n of these dent&res is more con#ention$l.Since the connectors $re ri!id5 there c$n ,e no mo#ement

,et%een the connected components. hese $re the most

commonly &sed fi/ed p$rti$l dent&re desi!ns.

)d$anta%es &

The ma7or ad$anta%es o" these partial dent#res incl#de &


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182

The ma7or ad$anta%es o" these partial dent#res incl#de &

• E$sy to f$,ric$te

• Economic$l desi!n

• Stron!

• E$sy to m$int$in

• Ro,&st desi!n pro#ides m$/im&m retention $nd stren!th

• Helps to splint mo,ile $,&tments

• C$n ,e &sed for lon! ,rid!es $lon! %ith periodont$lly %e$-

$,&tments.

Disad$anta%es &

• Since the connectors $re ri!id5 &n%$nted stress $nd le#er


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183

forces $re directly tr$nsferred to the $,&tment prod&cin!

consider$,le d$m$!e.

• Re?&ires e/cessi#e tooth prep$r$tion to $chie#e $ sin!le p$th

of pl$cement.

• Diffic&lt to cement on m&ltiple $,&tments.

• Contr$indic$ted for pier $,&tments.


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+ENEERS &

• eneer is $ l$yer of restor$tion pl$ced o#er the l$,i$l s&rf$ce of

$ tooth. hey $re prim$rily &sed $s $esthetic $d7&ncts to

discolored or fr$ct&red teeth.

Type o" $eneers &

Ceramic &


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18*

• It is the most ide$l #eneerin! m$teri$l %hen &sed %ith met$l

s&,str&ct&re or in $ll cer$mic restor$tions.

)crylic &

• ooth colored $crylic c$n ,e &sed %ith met$llic restor$tions $s

$ #eneer. hey $re not considered $s $ perm$nent m$teri$l d&e

to poor %e$r resist$nce. Recent $d#$nces incl&de &se of

indirect composite resins $s #eneer m$teri$ls.

SHORT SP)N ,RDES &

• hese $re simple fi/ed p$rti$l dent&res5 %hich repl$ce one or

h d h h i h id id l ,


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18

t%o teeth5 $nd the teeth on either side $re ide$l $,&tments.

hese dent&res $re considered ide$l ,ec$&se they h$#e

minim$l tor?&in! forces. )or e/$mple first mol$r

repl$cement.

) short span - #nit FPD

LON SP)N ,RDES &

• on! sp$n ,rid!e denotes $ condition %here t%o or more teeth

h$#e to ,e repl$ced $nd more th$n one $,&tment h$s to ,e


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h$#e to ,e repl$ced $nd more th$n one $,&tment h$s to ,e

t$-en for s&pport on either side.

• on! sp$n ,rid!es h$#e the potenti$l for prod&cin! more

tor?&in! forces on the ,rid!e $nd the %e$-er $,&tment

;especi$lly %e$- $,&tments $re $d#ersely $ffected9.

Lon% span FPD replacin% more than one tooth

RESN ,ONDED F3ED P)RT)L DENT*RES


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188

RESN-,ONDED F3ED P)RT)L DENT*RES &

• As the n$me implies5 these $re fi/ed p$rti$l dent&res5

%hich $re cemented onto the $,&tments &sin! speci$l

resins.

Types o" resin bonded Fi


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18:

Rochette brid%eMaryland brid%e

Cast mesh FPD

Indic$tions


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1:=

• Ret$iners of fi/ed p$rti$l dent&res for $,&tments %ith

s&fficient en$mel to etch for retention.

• Splintin! of periodont$lly compromised teeth

• St$,ili6in! dentitions $fter orthodontics.

• "edic$lly compromised p$tients5 %ho c$n not cooper$te

%ith lon! sessions of ther$py.


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1:2

to ,e contin&ed


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1:3


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Ortho-Endo-Prostho

Relationship

DR. ASHISH DABAS

Ortho prostho relationship

• Introd&ction


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1:*

• +hy repl$ce $ missin! ,$c- tooth

• Introd&ction to fi/ed p$rti$l dent&res

Combined ortho prostho therapy

• re$tment pl$nnin!0 A m&lti disciplin$ry $ppro$ch• "issin! tooth 0 Sp$ce clos&re or prosthetic repl$cement

• $ter$l incisors

• )orced er&ption• Ali!nment of $nterior teeth

• Ho% to &pri!ht inclined mol$r in prep$r$tion for

restor$ti#e tre$tment


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• Orthodontic prosthodontic impl$nt inter$ction

• rosthodontic consider$tion %hen &sin! impl$nts for

orthodontic $nchor$!e

• "$/illof$ci$l prosthesis

• Clinic$l c$ses

• Concl&sion

• Reference


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1:4

COM,NED ORTHO PROSTHO

THER)P!

Treatment plannin% & ) m#ltidisciplinary approach

• re$tment pl$nnin! of the $d&lt p$tient differs from


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1:8

p ! p

con#ention$l tre$tment pl$nnin! of the !ro%in! p$tient in $

n&m,er of %$ys.

• )irst5 the compromised m$loccl&sions enco&ntered in m$ny

$d&lt p$tients $re often $ssoci$ted %ith #$rio&s de!rees of

edent&lo&sness $nd %ith #$rio&s st$!es of periodont$l

p$tholo!y.

• hese o,ser#$tions cle$rly demonstr$te th$t the dent$l


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needs of $d&lt p$tients $re ch$llen!in! $nd &ni?&e.

• he ide$l !o$ls of orthodontic tre$tment5 %hich incl&de

!ood esthetics ;f$ci$l $s %ell $s dent$l95 f&nction5 $nd

st$,ility5 m$y not $l%$ys ,e necess$ry or re$listic to

$chie#e in $ll $d&lt p$tients.

• Altho&!h one sho&ld $l%$ys $im to $chie#e these ide$l

!o$ls5tre$tment !o$ls %ith $ccept$,le de!rees of compromise


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2==

! ! p ! p

c$n ,e de#eloped $nd m$y ,e more $ppropri$te to o,t$in

optim$l m&ltidisciplin$ry tre$tment res&lts.

• he m&ltidisciplin$ry need th$t these p$tients present often

incl&des ortho5 oper$ti#e5 periodont$l $nd prosthetic ther$py

$s %ell $s impl$nts $nd s&r!ery.

• Another import$nt difference in $ppro$chin! orthodontic


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ther$py in $d&lt p$tients in#ol#es the c$ref&l selection of $n

$ppropri$te mech$nother$py.

•Orthodontic tooth mo#ement in $d&lt p$tients %ith

compromised dentition m&st ,e done c$ref&lly ,ec$&se of the

possi,le red&ction of ,one s&pport.

• +hen desi!nin! $ tre$tment pl$n5 it is import$nt to decide

l h h h ill , d hi h f h


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e/$ctly %here the teeth %ill ,e mo#ed5 %hich type of tooth

mo#ement they %ill &nder!o ;&ncontrolled tippin!5 controlled

tippin!5 tr$nsl$tion5 or root mo#ement95 $nd the re?&ired

moment>to>force r$tio for optim$l tooth mo#ement.

Sp$ce clos&re "ol$r pri!htin!

• re$tment pl$nnin! of the $d&lt p$tient incl&des $ thoro&!h

e/tr$or$l $nd intr$or$l clinic$l e/$min$tion $nd collection of

$de?&$te di$!nostic records.


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2=3

• D&rin! the e/tr$or$l e/$min$tion5 the p$tients f$ce is$ssessed in the front$l pl$ne to chec- for symmetry5 in the

s$!itt$l pl$ne to chec- the con#e/ity of the profile5 $nd in the

#ertic$l pl$ne to e#$l&$te the #ertic$l proportion of the f$ce.


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• he presence of dent$l p$tholo!ies is recorded5 $nd the teeth

$re chec-ed for the $de?&$cy of e/istin! restor$tions $nd the


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2=*

$re chec-ed for the $de?&$cy of e/istin! restor$tions $nd the

presence of c$ries.

• he ne/t step is to $ssess the dent$l occl&sion in the s$!itt$l5

front$l $nd #ertic$l pl$nes.

• O#er7et $nd o#er,ite rel$tionship $re noted $lon! %ith the

An!le cl$ssific$tion.

• he presence of $ centric rel$tion>centric occl&sion ;Cr>Co9

discrep$ncy is c$ref&lly recorded5 $nd cross,ites $re


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2=

e#$l&$ted in Cr $nd Co. rem$t&rities $re $lso e#$l&$ted in

rel$tionship to the presence of $ Cr>Co shift.

• $ter$l e/c&rsi#e mo#ements $re chec-ed5 $nd $ny ,$l$ncin!

side interference is recorded.

• Specific $ttention sho&ld ,e directed to%$rd potenti$l

temporom$ndi,&l$r pro,lems.


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MSSN TEETH & SP)CE CLOS*RE +S(

PROSTHETC REPL)CEMENT

Sp$ce clos&re "ol$r pri!htin!

Follo4in% are the "actors 4e sho#ld >eep in mind(

Old E


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• In $d&lts5 closin! $n old e/tr$ction site is li-ely to ,ediffic&lt.

• he pro,lem $rises ,ec$&se of resorption $nd remodelin! of

$l#eol$r ,one.

• After se#er$l ye$rs5 resorption res&lts

in $ decre$se in the #ertic$l hei!ht of


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!

the ,one5 ,&t more import$ntly5

remodelin! prod&ces $ ,&ccolin!&$l

n$rro%in! of the $l#eol$r process $s

%ell.

• +hen this h$s h$ppened5 closin! the

e/tr$ction sp$ce re?&ires $ resh$pin! of

the cortic$l ,one th$t comprises the

,&cc$l $nd lin!&$l pl$tes of the

$l#eol$r process.

Tooth Loss D#e to Periodontal Disease &

• A sp$ce clos&re pro,lem is $lso posed ,y the loss of $ tooth d&e


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to periodont$l dise$se.

• As $ !ener$l r&le5 it is &n%ise to mo#e $ tooth into $n $re$

%here ,one h$s ,een destroyed ,y periodont$l dise$se5 ,ec$&se

of the ris- th$t norm$l ,one form$tion %ill not occ&r $s the tooth

mo#es into the defect.

• It is ,etter to mo#e teeth $%$y from s&ch $n $re$5 in prep$r$tion

for prosthetic repl$cement.


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• he mesi$l tippin! of the second mol$r into the edent&lo&s

sp$ce m$y contri,&te to the periodont$l in#ol#ement on the

mesi$l $spect of this tooth5 the $d7$cent !in!i#$l tiss&e


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mesi$l $spect of this tooth5 the $d7$cent !in!i#$l tiss&e

,ecomes folded $nd distorted5 formin! $ pl$?&e>h$r,orin!

pse&dopoc-et th$t m$y ,e #irt&$lly impossi,le for the p$tient

to cle$n.

• his m$y res&lt in the s&pr$er&ption of the $nt$!onist teeth

p$rt%$y into the edent&lo&s sp$ce $nd needs to ,e $ddressed


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d&rin! tre$tment to ens&re $n optim$l lon!>term pro!nosis of

$ny proposed correction.

• Sim&lt$neo&sly5 dist$l driftin! $ssoci$ted %ith tippin! $nd


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21(

rot$tion of the premol$rs m$y ,e o,ser#ed $lon! %ith $

midline displ$cement to%$rd the side of the missin! mol$r.

• C$ref&l e#$l&$tion of the clinic$l sit&$tion sho&ld ,e done

to decide on sp$ce re!$inin! or sp$ce clos&re.

• he s&ccess of tre$tment depends

entirely on $ %ell>selected clinic$l


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21*

sit&$tion.

• Indic$tions for mol$r &pri!htin!

incl&de

• "esi$lly tipped teeth %ith eno&!h#ertic$l sp$ce to $ccommod$te $ny

e/tr&sion of the teeth d&rin! its

correction.

• "esi$lly tipped teeth %ith mesi$l ,ony defects.

• he poc-et depth red&ction h$s ,een sho%n to


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21

• he poc-et depth red&ction h$s ,een sho%n to

$#er$!e 3.* mm on the mesi$l of the tipped mol$r

$s it is &pri!hted.

• eeth presentin! periodont$l in#ol#ement of the

f&rc$tion $re not !ood c$ndid$tes for mol$r

&pri!htin!. Before $ny orthodontic tooth

mo#ement5 thoro&!h e#$l&$tion $nd tre$tment of

the periodont$l condition is $ m&st.

• he potenti$l for imp$ction of

the tooth dist$l to the tooth to ,e


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214

&pri!hted sho&ld $lso ,ec$ref&lly e#$l&$ted.

• In c$ses in %hich ,oth second

$nd third mol$rs h$#e tipped

into $ first mol$r e/tr$ction site5

$ decision $s to %hether to

m$int$in or remo#e the third

mol$r m&st ,e m$de.


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• B&t if the second mol$r needs to ,e dist$li6ed $s


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21:

it is &pri!hted to reopen $de?&$te restor$ti#e

sp$ce for prosthetics5 it m$y ,e $d#$nt$!eo&s to

remo#e the third mol$r.

• he decision to e/tr$ct or m$int$in the third

mol$r sho&ld ,e m$de $fter cons&lt$tion $mon!

the orthodontist5 periodontist5 restor$ti#e dentist5

$nd p$tient.

• Clinic$l records m$y incl&de $ set of orthodontic models $nd

r$dio!r$phs necess$ry to e#$l&$te the root $n!&l$tion $nd ,one

distri,&tion $nd therefore $ssist in decidin! %h$t type of tooth

mo#ement is desir$,le for $de?&$te correction


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22=

mo#ement is desir$,le for $de?&$te correction.

• "odels $re helpf&l in e#$l&$tin! the $mo&nt of #ertic$l sp$ce

$#$il$,le ,et%een the $rches to $ccommod$te the corrected

position of the tooth to ,e &pri!hted.

• In e#ery c$se in %hich it m$y ,e possi,le to $#oid the


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221

pl$cement of $ ,rid!e5 orthodontic ther$py sho&ld ,e

considered to $chie#e $de?&$te sp$ce clos&re.

• he pro!nosis of s&ch $ correction prim$rily depends on the

,$sic m$loccl&sion $nd the $nticip$ted corrected occl&sion.


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L)TER)L NCSORS

• he occ&rrence of con!enit$lly missin! m$/ill$ry l$ter$l

incisors or $,norm$lly sh$ped m$/ill$ry l$ter$l incisors ;e!

l$ter$ls9 ,rin!s p$tients to cons&lt for orthodontic ther$py $s


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22(

p$rt of the restor$tion of s&ch occl&s$l pro,lems.

• Con!enit$lly missin! l$ter$l incisors $cco&nt for 11 of

p$tients presentin! %ith midline sp$cin!.

"issin! l$ter$l e! sh$ped l$ter$l

• Clinic$lly5 the $,sence of m$/ill$ry l$ter$l incisors is reflected

,y the presence of $nterior sp$cin!s5 incl&din! $ di$stem$

,et%een the centr$l incisors $nd $ mesi$l driftin! of the


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22*

c&spids.

• +hen m$/ill$ry l$ter$l incisors $re sm$ll5 midline

discrep$ncy m$y $lso ,e o,ser#ed $ccordin! to the si6e of the

teeth.

Treatment options incl#de &

19 he openin! of the sp$ce to repl$ce the missin! l$ter$l incisors


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22

%ith ,rid!es or impl$nts %hen indic$ted. his tre$tment str$te!y

is f$#ored %hen the posterior occl&sion is cl$ss I.

2. he sp$ce correspondin! to the missin! l$ter$l incisors m$y

,e closed ,y protr$ction of the c&spids $nd the ,&cc$l


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224

se!ments of teeth le$din! to $ mol$r cl$ss II fin$l occl&sion.

he c&spids c$n ,e resh$ped into l$ter$l incisors5 ,onded

%ith composite5 #eneered5 or cro%ned.


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228

Contraindications &

• Contr$indic$tions in resh$pin! the c&spids into l$ter$l incisors

incl&de sit&$tions in %hich the c&spids $re o#ersi6ed

mesiodist$lly or ,&ccolin!&$lly.

• he presence of $ prominent c&sp tip or cin!&l&m is $lso $

contr$indic$tion to this tre$tment $ppro$ch.


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22:

• In some inst$nces5 sp$ce clos&re is the optim&m tre$tment

option %hen m$/ill$ry l$ter$l incisors $re missin! ,ec$&se

it $#oids the need for prosthetic repl$cement of the l$ter$l

incisors.

• A n&m,er of f$ctors sho&ld ,e considered d&rin! tre$tment

pl$nnin!. he ,&cc$l occl&sion $nd the $mo&nt of o#er7et

&s&$lly indic$te if retr$ction of the $nterior teeth $nd

protr$ction of the posterior teeth $re desir$,le.


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23=

FORCED ER*PTON

ndications &

Cro4n Fract#re at al$eolar crest


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231

• eeth %ith defects in the cer#ic$l thirdof the root or isol$ted teeth %ith one

or t%o %$lled #ertic$l periodont$l

defects pose $ comple/ dent$l

pro,lem.

• hese pro,lems c$n $rise $fter

hori6ont$l or o,li?&e fr$ct&re5 intern$l

or e/tern$l resorption5 dec$y5

p$tholo!ic perfor$tion or periodont$ldise$se.

nternal root resorption

+ertical periodontal de"ect

• o o,t$in !ood $ccess for endodontic $nd restor$ti#e


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232

proced&res or to red&ce poc-et depth5 it %o&ld ,e necess$ry

to perform e/tensi#e cro%n len!thenin! th$t %o&ld prod&ce

poor esthetics $nd $d#erse ch$n!es in the cro%n>to>root>

r$tio.

• Controlled e/tr&sion is $n e/cellent $ltern$ti#e.

• )orced er&ption $lso $llo%s cro%n m$r!ins to ,e pl$ced on


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233

so&nd tooth str&ct&re %hile m$int$inin! $ &niform !in!i#$l

conto&r th$t pro#ides impro#ed esthetics.


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23(

• In $ddition5 the $l#eol$r ,one hei!ht is not compromised5 the

$pp$rent cro%n len!th is m$int$ined5 $nd the ,ony s&pport

of $d7$cent teeth is not compromised. As the tooth is

e/tr&ded5 the $tt$ched !in!i#$ sho&ld follo% the

cementoen$mel 7&nction.

A0 his centr$l incisor h$d $ cro%n pl$ced $fter

,ein! chipped pre#io&sly5 ,&t no% sho%ed

!in!i#$l infl$mm$tion $nd elon!$tion.

A


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23*

B0 Apic$l r$dio!r$ph re#e$led intern$l rootresorption ,elo% the cro%n m$r!in. he

tre$tment pl$n %$s0

C0 Endodontic tre$tment5 th$n elon!$tion of the

root so th$t the ne% cro%n m$r!in co&ld ,e

pl$ced on so&nd root str&ct&re.

D0 Init$lly el$stomeric tie %$s &sed from $n

$rch %ire se!ment to $n $tt$chment on the post

cemented in the root c$n$l

B

C

D


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TRE)TMENT PL)NNN

• Before ,e!innin! tre$tment5 it is essenti$l to

h$#e !ood peri$pic$l r$dio!r$phs to e/$mine

the #ertic$l e/tent of the defect5 the


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5

periodont$l s&pport5 the root morpholo!y

$nd position. he ide$l morpholo!y is $

sin!le t$perin! root.

• )l$red or di#er!ent roots %ill res&lt in

incre$sin! root pro/imity %ith e/tr&sion $nd

the possi,ility of e/posin! the root f&rc$tion

$re$.

• As $ !ener$l r&le5 endodontic ther$py sho&ld ,e completed


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,efore e/tr&sion of the root ,e!ins.

• )or some p$tients5 ho%e#er5 the orthodontic mo#ement m&st ,e

completed ,efore definiti#e endodontic proced&res5 ,ec$&se one

p&rpose of e/tr&sion m$y ,e to pro#ide ,etter $ccess for

endodontic $nd restor$ti#e proced&res.

The distance the tooth sho#ld be e


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23:

• he loc$tion of the defect ;fr$ct&re line5 root perfor$tion5 etc.9

• Sp$ce to pl$ce the m$r!in of the restor$tion so th$t is not $t

the ,$se of the !in!i#$l s&lc&s ;typic$lly5 1 mm is needed9.

• An $llo%$nce for the ,iolo!ic$l %idth of the !in!i#$l

$tt$chment.

Orthodontic techni#e &

• Since e/tr&sion is the tooth mo#ement th$t occ&rs most re$dily

$nd intr&sion th$t occ&rs le$st re$dily5 $mple $nchor$!e is


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2(=

y5 p !

&s&$lly $#$il$,le for $d7$cent teeth.

• he $ppli$nce need to ,e ?&ite ri!id o#er the $nchor teeth5 $nd

fle/i,le %here it $tt$ches to the tooth th$t is ,ein! e/tr&ded.

• his contr$indic$tes the &se of $ contin&o&s fle/i,le

$rch%ire5 %hich %o&ld prod&ce the desired e/tr&sion ,&t


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2(1

$lso tip the $d7$cent teeth to%$rd the tooth ,ein! e/tr&ded5

red&cin! the sp$ce for s&,se?&ent restor$tions $nd

dist&r,in! the interpro/im$l cont$cts %ithin the $rch.

• he $ltern$ti#e is to ,ond ,r$c-ets to the $nchor teeth5 ,ond


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2(2

or ,$nd the tooth to ,e e/tr&ded5 $nd &se $ modific$tion of

the >loop $ppli$nce.


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2(3

R&m$nn$ B. 18 ye$rs )em$le

re re$tment


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2((


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2(*

S&r!ic$lly E/posed $nd forced er&ption


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2(

Sp$ce distri,&tion

Immedi$te post re$tment


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2(4

Immedi$te ost re$tment


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2(8


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2(:

ost tre$tment $fter prosthesis


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2*=

After prosthesis


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2*1

re ost


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2*2

ALIGNMENT OF ANTERIOR TEETH

ndications &

The ma7or indications "or ad7#ncti$e orthodontic treatment

to correct malali%ned anterior teeth are &


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2*3

1. o impro#e $ccess $nd permit pl$cement of %ell>$d$pted $nd

conto&red restor$tions ;e.!.5 %hen composite resin ,&ild>&ps to

reconto&r incisors $re pl$nned5 or %hen periodont$lly>

compromised incisors m&st ,e splinted9

2. o permit pl$cement of cro%ns $nd pontics %itho&t

o#erconto&red cro%ns th$t %o&ld prod&ce poor em,r$s&re

form.

• o reposition closely $ppro/im$ted roots5 to impro#e the

em,r$s&re form $nd incre$se the $mo&nt of interr$dic&l$r

,one5 %hich in t&rn incre$ses the ch$nce th$t periodont$l

dise$se c$n ,e controlled.


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2*(

• o position teeth so impl$nts c$n ,e pl$ced to s&pport

restor$tions.

• Rot$tions5 cro%din!5 sp$cin!5 tipped teeth5 $nd cross,ites $ll

pose pro,lems for restor$ti#e $nd periodont$l proced&res.


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2**

TRE)TMENT PL)NNN

• Anterior teeth th$t re?&ire

$li!nment sho&ld ,e ,ro&!ht into

their proper position ,efore


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2*

their proper position ,efore

definiti#e restor$ti#e proced&res.

• A Kdi$!nostic set&pL is #ery helpf&l

in pl$nnin! tre$tment for $li!nment

pro,lems5 p$rtic&l$rly if cro%din!

or sp$cin! m&st ,e corrected.

• +hile slenderi6$tion of $nterior teeth m$y ,e $n e/cellent %$y

of !$inin! $ sm$ll $mo&nt of sp$ce5 s&ch tre$tment sho&ld ,e

&ndert$-en %ith c$&tion since it m$y h$#e $n &ndesir$,le effect


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2*4

on the esthetics5 o#er,ites5 o#er7et5 $nd posterior interc&sp$tion.

• re$tment of this type sho&ld ne#er ,e &ndert$-en %itho&t $

di$!nostic set&p to ,e s&re th$t the teeth %ill fit s$tisf$ctorily.


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2*8

Jo&s$r


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2*:


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2=

All ( e/tr$ction EA


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21

Sp$ce distri,&tion for )D


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22

ost re$tment

ost re$tment


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23


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2(

re ost


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2*

re ost


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2

HO. TO *PRHT NCLNED MOL)R

N PREP)R)TON FOR RESTOR)T+E

TRE)TMENT8

• One of the most complic$ted pro,lem $ clinici$n f$ces is

%hen m$ndi,&l$r first mol$r is missin!.

• erh$ps the most comple/ $spect of the $,o#e se?&el$e is the


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24

erh$ps the most comple/ $spect of the $,o#e se?&el$e is the

mesi$lly inclined second mol$r.

C id i i d i h h l d di, l l


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28

• Consider$tions $ssoci$ted %ith the m$lposed m$ndi,&l$r mol$r

incl&de in$de?&$te p$r$llelism5 poor occl&s$l pl$ne5 l$c- of

interpro/im$l sp$ce5 $d#erse root pro/imity5 f$&lty occl&s$l

l$ndm$r-s5 e/cessi#e tooth prep$r$tion %ith potenti$l p&lp$l

in#ol#ement5 in$de?&$te pontic sp$ce5 prominent roots e/hi,ited

,y rot$ted mol$rs5 $s %ell $s other periodont$l soft $nd h$rd

tiss&e deformities of the periodont$l str&ct&res.

• he p$tients most li-ely to ,enefit from tooth mo#ement $re

those th$t e/hi,it periodont$l ,re$-do%n


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2:

those th$t e/hi,it periodont$l ,re$-do%n.

• +hen the decision h$s ,een m$de to repl$ce $ str$te!ic tooth

;for e/$mple 0 lo%er first mol$r9 to est$,lish or preser#e

occl&s$l st$,ility5 the !o$l is to cre$te $ ther$pe&tic occl&sion.

• It is therefore not $l%$ys necess$ry to correct to the

orthodontic norm$l or Cl$ss I mol$r rel$tionship. he


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24=

o,7ecti#e is to de#elop $n occl&s$l scheme in %hich the

posterior teeth f&nction to s&pport the #ertic$l dimension in

m$/im&m interc&sp$tion $nd the $nterior teeth f&nction to

dis$rtic&l$te the posterior teeth d&rin! m$ndi,&l$r e/c&rsions.


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241

D)NOSTC CONSDER)TONS N C)SE SELECTON

• +hen the clinici$n selects $ c$se for &pri!htin! the mesi$lly

inclined mol$r5 the p$tient th$t e/hi,its $n $ccept$,le

occl&sion is the ,est c$ndid$te.

• he $ccept$,le occl&sion5 ,$sic$lly5 is one in %hich there is $

loc$l dent$l m$lposition %itho&t $ si!nific$nt s-elet$l

dyspl$si$.

i d "i d h i h " ll i h i i


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242

t is de"ined as ha$in% the "ollo4in% characteristics

• A norm$l to mild Cl$ss II s-elet$l p$ttern in the

s$!itt$l dimension %ith no e#idence of tr$ns#erse or#ertic$l dyspl$si$.

• osterior teeth present to s&pport the #ertic$l

dimension.

• Anterior teeth %hich pro#ide incis$l !&id$nce.


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243

)( Orthodontic Classi"ication &

Orthodontic cl$ssific$tion in#ol#es $ system$tic

description of the interrel$tionships of the p$tients

a6 S>eletal pattern'

b6 M#sc#lat#re' and

c6 Dental arches and the tooth in the dental arch(

) l i " th S> l t l P tt


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24(

)nalysis o" the S>eletal Pattern &

• Both $rches $re e#$l&$ted for symmetry of the ,$s$l s&pport.

Arch forms m&st ,e simil$r for them to occl&de properly.

06 )ssessment o" the Sa%ittal Dimension &

• In the s$!itt$l ;$nteroposterior9 dimension5 it is critic$l to

e#$l&$te for the e/istence of $ centric occl&sion>centric

rel$tion discrep$ncy.


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24*

;6 )ssessment o" the +ertical Dimension & E/$min$tion of

the f$ci$l form sho&ld $lso ,e m$de in the #ertic$l dimension.

An estim$te is m$de of the open ,ite or deep ,ite s-elet$l p$ttern ,y loo-in! clinic$lly or ceph$lometric$

endo ortho prostho

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