Prosthodontics

Learning Objectives:

Abstract:

Knowledge of the factors that cause complications and failure in fixed prosthodontics enhances our ability to develop effective treatment plans, facilitates success, promotes optimal doctor-patient communication regarding anticipated treatment outcomes and provides early diagnosis of problems encountered during long-term maintenance. This presentation will identify the most common complications encountered with resin bonded prostheses and describe methods of minimizing or preventing their occurrence as well as managing the complications when they occur.

Outline:

1. Indications and limitations of resin bonded prostheses
2. Most common complications that occur with resin bonded prostheses
3. Debond rates
4. Diagnosis and treatment planning factors that affect debonding
   1. Diagnosis and treatment planning
      1. Effect of span length
      2. Effect of occlusal forces
      3. Effect of mouth location, gender, and age
5. Incidence of tooth discoloration
6. Caries incidence
7. Porcelain fracture incidence
8. Effect upon periodontal health
9. Cantilever designs and their impact upon success
10. Other diagnosis and treatment planning factors
    1. Tooth condition
    2. Mesiodistal dimension of edentulous space
    3. Abutment tooth contours
    4. Effect of splinting and multiple adjoining retainers
    5. Impact of mobile abutment teeth
    6. Effect of tooth translucency
11. Tooth preparation principles
    1. Area of tooth coverageCoverage of proximal and lingual surfaces
    2. Preparing proximal surfaces so they are faciolingually convex
    3. Creating adequate occlusal clearance
    4. Use of a peripheral finish line
    5. Benefit of lingual ledges or occlusal rests
    6. Impact of proximal grooves
    7. Use of a proximal groove combined with lingual groove(s)
12. Design, thickness, and fit
    1. Metal thickness dimensions
    2. Cement-metal retention mechanisms
13. Cementation guidelines

Learning Objectives:

Abstract:

Knowledge of the factors that cause complications and failure in fixed prosthodontics enhances our ability to develop effective treatment plans, facilitates success, promotes optimal doctor-patient communication regarding anticipated treatment outcomes and provides early diagnosis of problems encountered during long-term maintenance. This presentation will identify the most common complications encountered with all-ceramic crowns and describe methods of minimizing or preventing their occurrence as well as managing the complications when they occur.

Outline:

1. The benefits of all-ceramic crowns
2. The most common all-ceramic crown complications
3. How to minimize all-ceramic crown fracture
   1. Effect of arch position
   2. Effect of tooth preparation
   3. Type of material used
   4. Type of cement used
4. CAD/CAM all-ceramic crown materials
5. Effect of gender on crown fracture
6. Pulpal necrosis incidence
7. Impact of all-ceramic crowns on caries incidence
8. Impact of all-ceramic crowns on periodontal health

Learning Objectives:

Abstract:

Soft tissue complications present biologic problems that can lead to bone and implant loss.  In the anterior esthetic zone of patients with high smile lines, unesthetic soft tissue changes can occur that require special knowledge to avoid the changes.  This presentation will identify how biologic and esthetic mucosal problems occur and how they could have been minimized or avoided.

Outline:

1. Incidence of implant fenestration/dehiscence
2. Incidences and causes of gingival inflammation/proliferation
3. Incidence and causes of fistulas
4. Effect of residual cement on fistula development
5. Cementation guidelines
6. Space requirements for implant placement
   1. Space required between adjacent teeth
   2. Space required between implant and adjacent natural teeth
   3. Space needed between adjacent implants
7. Bioesthetic guidelines for anterior single implants
   1. Mediolateral implant positioning guidelines
   2. Apical implant positioning guidelines
   3. Faciolingual implant positioning guidelines
   4. What bone grafting does and does not do
8. Challenges associated with the peri-implant mucosa and interdental papilla
9. Predicting interproximal soft tissue esthetics
   1. Effect of periodontal biotype
   2. Effect of distance from interproximal bone crest to proximal contact
   3. Effect of adjacent natural tooth or implant
   4. Effect of long epithelial attachments
10. Predicting the midfacial soft tissue location after extraction and implant placement
    1. Incisocervical location of midfacial bone crest
    2. Incisocervical implant location
    3. Facial implant position/angulation
    4. Proximity of implant to facial bone
    5. Faciolingual thickness of facial bone
11. Factors causing mucosal recession around implants
12. Methods of minimizing recession around implants
13. Affect of crown contours on soft tissue health, position, and contours
14. The S-shaped crown form
15. Compromised mucosal outcomes and their management
16. Facial growth changes during adolescence and during aging

Learning Objectives:

1. Identify the most common mechanical complications associated with dental implants
2. Understand the factors that create overloading of implants and prostheses
3. Understand the importance of implant placement in minimizing complications
4. Discuss the factors that affect implant loading
5. Know how to design single crowns and fixed partial dentures that resist adverse leverage when the implant positions cannot or are not ideal

Abstract:

Several mechanical complications have been reported in the dental literature.  When proper design guidelines are followed, many of these complications can be minimized or avoided.  This presentation identifies the most common mechanical complications and presents guidelines that help prevent adverse leverage on implants.  Additionally, when implant placement cannot be ideal or the implants are not appropriately positioned, this presentation describes methods that can be used to resist adverse leverage with both implant single crowns and implant fixed partial dentures.

Outline:

1. Most common mechanical complications
2. Ceramic veneer fracture incidence of causes
3. Abutment screw loosening incidence
4. Importance of knowing abutment screw access hole location of cemented crowns
5. Abutment screw and abutment fracture causes
6. Implant fracture and causes
7. Guidelines for avoiding mechanical complications
   1. Anterior biomechanical guidelines
   2. Posterior biomechanical guidelines
8. Methods of resisting adverse leverage with implant single crowns
9. Factors affecting implant loading
   1. Cuspal inclination
   2. Implant inclination
   3. Horizontal implant offset
   4. Apical implant offset
10. Methods of resisting adverse leverage with implant fixed partial dentures

Learning Objectives:

1. Know the diagnosis and treatment planning factors that affect success
2. Understand the tooth preparations features that minimize complications
3. Compare the characteristics of zirconia and lithium disilicate crowns
4. Understand the cementation procedures that optimize all-ceramic crowns
5. Know how to optimize the shade selection process when using all-ceramic crowns

Abstract:

The quest for optimal esthetics along with the development of increased strength in the materials available for fabricating all-ceramic crowns has led to a significant increase in their clinical use.  This presentation lists the most common complications that occur with all-ceramic crowns and discusses the diagnosis/treatment planning factors and tooth preparation factors that help to minimize crown fracture.  Additionally, the tooth preparation factors required to optimize the CAD/CAM fabrication process are identified. The effect of the type of material and cementation process are described along with a discussion of ceramic onlays and inlays.  The presentation ends by illustrating the process by which the color of all-ceramic crowns can be optimized.

Outline:

1. The most common all-ceramic crown complications
2. Diagnosis and treatment planning factors that minimize fracture
3. Tooth preparation factors that minimize fracture
   1. Amount of reduction
   2. Axial reduction uniformity and depth
   3. Incisocervical/occlusocervical dimension
   4. Line angle form
   5. Total occlusal convergence
4. What tooth preparation form is required for CAD/CAM crowns?
5. Comparison of different types of materials
6. Veneer chipping
7. Type of cement and crown survival
8. What do we know about ceramic onlays and inlays?
9. How to optimize the color of all-ceramic crowns
   1. Video showing shade guide use
   2. Video showing digital shade selection
   3. Identification of translucent and transparent areas
   4. Dentin shade selection
   5. Gingival shade selection
   6. Digital image requirements
   7. Use of contraster

Learning Objectives:

Abstract:

The treatment options available for a patient with non-restorable dentition with closed vertical occlusion combined with a moderate skeletal class 3 relationship are conventional complete dentures, implant-supported overdentures (removable), fixed implant-supported complete dentures, and fixed metal-ceramic implant-supported restorations.

Choosing the appropriate procedures whether bone trim, orthognathic surgery and or implant therapy is crucial to plan before edentulating the patient. Also of great importance is  pre-determination of the final appearance based on what the patient presents with and what can be accomplished under those circum-stances. The decision process to restore a patient with implant fixed or removable restorations should be determined by evaluating various parameters such as:

1. Overall patient  general health
2. Facial asymmetry
3. Facial contour as either void or full
4. Lip-line & lip support
5. Quality and quantity of hard- and soft tissues
6. The maxilla-mandibular relationship
7. Oral hygiene traits
8. Existing occlusal and skeletal relationship
9. Patient understands and accepts all risk
10. Patient financially able to have procedure performed