IMPLANT PROSTHETICS

Information about IMPLANT PROSTHETICS

Published on June 1, 2016

Author: bestdental

Source: authorstream.com

Content

FULL MOUTH REHABILITATION (FMR): FULL MOUTH REHABILITATION (FMR) By, BEST LASER DENTAL CLINIC, [email protected], www.drmurugavel.in, [email protected] INTRODUCTION: INTRODUCTION ABUTMENT PREPARATION IMPRESSION JAW RELATION FRAMEWORK TRY-IN SEMITRIAL CEMENTATION ABUTMENT PREPARATION: ABUTMENT PREPARATION Tray setup 1.Tungsten carbide bur 2.suction tip 3.Diamond bur 4.Curved artery forcep . 5.Goggles. 6.Ortho mirrors. : While doing the abutment preparation for full mouth. The inter implant distance between upper & lower arch at VDO should be 4mm Check for the parallellism of the implants, mesio -distally and labio lingually . Slide 5: . Look for any undercuts, sharp edges. Always use the tactile sensation for checking the sharp margins. IMPRESSION: IMPRESSION Bridging step between a dentist and lab . Slide 7: Always air dry the abutments before taking impression. Make sure that the frenum is recorded in the impression to reproduce proper midline. After impression ,check under light or with loops/lens for any air bubbles & proper recording of all implants. JAW RELATION : JAW RELATION Vertical Jaw Relation / Vertical Dimension: Vertical Jaw Relation / Vertical Dimension Vertical dimension refers to the length of the face. It is maintained either by the occlusion of the teeth or the balanced tonic contraction of the opening and closing muscles of mandibular movements Significance: Significance Provides optimal separation between maxilla and mandible. If not measured accurately, the joint will be strained. If the VD is altered, severe discomfort to both TMJ and muscles of mastication. Slide 11: Two measurable lengths of the face are important guides in making maxillo -mandibular relation records and are referred to as : Vertical dimension of rest or physiologic rest position. (VDR). Vertical dimension of occlusion (VDO). PHYSIOLOGICAL REST POSITION : PHYSIOLOGICAL REST POSITION The position assumed by the mandible when the head is in an upright position, the muscles are in equilibrium in tonic contraction and the condyles are in a neutral unstrained position is the physiologic rest position of the mandible. Vertical dimension of occlusion (VDO): Vertical dimension of occlusion (VDO) Vertical separation of the jaws when the teeth or occlusion rims are in contact. Slide 14: It is generally considered that the teeth should not be in contact when the jaws are at the vertical dimension of rest position. The 2 to 4mm distance between the upper and lower teeth when the mandible is at physiologic rest position is called interocclusal distance (IOD) frequently referred to as the “ Free way space ”. EFFECTS OF ALTERED vd: EFFECTS OF ALTERED vd INCREASE IN VDO / DECREASE IN IOD The chin-nose distance will increase, and then patients will have an appearance of open mouth . “Clicking”, of dentures during speech. Improper phonetics. DECREASED VD : DECREASED VD Potentially damaging to the TMJ. The normal tongue space is limited. Facial distortion appears more noticeable with over closure that with the slightly opened closure because with over closure the chin appears to be closer to the nose, the commissure of the lips turns down and the lips lose their fullness. The muscles of facial expression lose their tonicity and the face appears flabby instead of firm and full. Over closure of jaws may lead to angular chelitis Slide 18: Make the patient sit upright ---OBSERVE Check VD –multiple times Check the interarch distance & look for any implants encroaching(mainly the distal most implants) Place the upper occlusal rim. Points to remember : Points to remember . Place 2 points of reference. Instruct the patient to wipe his lips with his tongue, to swallow and to drop his shoulders – rest position. Measure - repeat and take average Speech : Speech 2 methods: 1 st method : Ask the patient to repeatedly pronounce the letter ‘M’, a certain number of times. Distance is measured immediately after the patient stops. 2 nd method: keep talking to the patient and measure the distance immediately after the patient stops talking Slide 21: Phonetics and esthetics. The dentist asks the pt to speak certain words and then makes certain observations of the relationship of the occlusion rims to each other and to the lips. Slide 22: Using ‘ m’sound : The pt repeats the letter ‘m’. When the lip just touches ask the patient to hold the jaws still. The distance between tip of the nose and chin is measured (VDR).The occlusion rims are adjusted and again measured. The second measurement should be 2-4mm less than the first measurement(VDO) Slide 23: The ch,s,and j sounds: There should be 1mm space between the occlusion rims in the anterior area at correct VDO. Using 33 : When repeating this word there should be enough space for the tip of the tongue to protrude between the anterior teeth. Using f or v sounds: The max incisors/occlusion rims should lightly contact the lower lip at the vermillion border when pt pronounces these words. Slide 24: SILVERMAN’S CLOSEST SPEAKING SPACE The 2mm space between the incisors at correct VDO when pt pronounces words containing ‘S’ eg . ESTHETICS : ESTHETICS In normal relaxed position the lips are even anteroposteriorly and in slight contact. If the face appears strained the vertical height may be more . If the corners of the mouth droop, making the chin appear too close to the nose, then vertical dimension may be too less. FRAMEWORK TRY-IN : FRAMEWORK TRY-IN FRAMEWORK TRY-IN: FRAMEWORK TRY-IN Tray Setup Vernier caliper Occlusal spray Lab micromotor and burs Airotor handpiece with metal cutting bur Articulating papers(8 μ ,200µ) Millers forceps Cadbite / wax sheet Slide 28: Light body Alginate impression Shade guide. Slide 29: Problems we face during framework try-in? 1.Improper fitting. 2.Rocking of framework Slide 30: Improper fitting can be because of 1. improper pressure delivered during impression 2.edges of implant may have chipped off in the cast Slide 31: Why rocking? 1.Oversized implants 2.Oversized coping 3.The lab person may have increased the spacer thickness. Slide 32: For full arch prosthesis keep the framework in mouth and keep the fingers on both side molars & check for rocking on either side,also check mesiodistally . If rocking, use the occlusal spray on the framework,dry the abutment and repeat the rocking test. Slide 33: Check for marking on the implants Which implant has the marking? Which aspect(edges/side/top)? Check the framework under bright light. A fine line/an area of 2-3mm may be scratched off on the framework trim that area. Try the framework again after air spray,if no fresh markings, spray tha occlusal spray again and if markings present trim Slide 34: If fitting is ok; check the gingival part 1.Blanching 2.framework far from abutment,may be because of shrinkage of tissue after extraction. Look for the midline .any errors mark the midline on the framework. Slide 35: Stabilize the upper and lower frameworks with lightbody . Check the VD. Smile line Occlusal plane,Incisal exposure Max- mandibular arch relation. Canine guidance. Speech. Record the bite at VDO. If required a new impression can be taken. Slide 36: Shade selection ,Record photos Discuss with the patient about the size and shape of his/her teeth,whether to replicate the previous teeth size & shape. Send the records along with the preop photos to the lab. Slide 37: For further details log on to http://www.drmurugavel.in/ http://www.acdeimplants.org/ For enquiry mail us at [email protected] [email protected] Contact us at  +91- 9171515077           044- 43856017 THANK YOU: THANK YOU

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