lenka.roubalikova@tiscali.cz 1 Prosthetics I. Rehabilitation of the masticatory apparatus Function of dentition • Food admission • Trituration (comminution) of food • Fonation • Aesthetics - psychology lenka.roubalikova@tiscali.cz 2 Consequences of lost teeth • Bad comminution of food – bad digestion – irritation, diseases of the digestion apparatus. • Bad fonation • Psychological aspect of lost teeth • Disorders of TMJ lenka.roubalikova@tiscali.cz 3 What is prosthetic treatment? • Reconstruction of: lenka.roubalikova@tiscali.cz 4 Damaged teeth – reconstruction of the crown Missing teeth - appropriate prothesis (denture) lenka.roubalikova@tiscali.cz 5 Prothesis • Individually made • Diferences in the type of defect, extent and location in the size, shape and position of teeth in the quality of hard and soft tissues of the oral cavity in intermaxillary relations lenka.roubalikova@tiscali.cz 6 Prothesis (denture) Rehabilitation of: Function Comfort Aesthetics Fonation lenka.roubalikova@tiscali.cz 7 Inlays Composit, cermic Metal lenka.roubalikova@tiscali.cz 9 Fixed dentures • Cemented on the teeth – crowns, bridges, inlays Fixed bridge lenka.roubalikova@tiscali.cz 10 Fixed dentures • Material – metal alloy, ceramics lenka.roubalikova@tiscali.cz 11 Removable dentures • Partial • Complete (full) lenka.roubalikova@tiscali.cz 12 Procedures In dental surgery In dental laboratory Special instruments Basic (main) materials (metal alloys, ceramics,polymers) Auxilliary (accessory) materials (impression, carving, die, insulating investing, grinding, polishing) lenka.roubalikova@tiscali.cz 13 Manufacturing of dentures Model of gypsum (plaster) – model of a denture (wax pattern). Model of a denture (wax pattern) directly in the mouth – rarely. Denture is formed without a wax pattern in the dental lab. lenka.roubalikova@tiscali.cz 14 Manufacturing of dentures Model of gypsum (plaster) – model of a denture (wax pattern). lenka.roubalikova@tiscali.cz 15 Impressions of the dental arch- negativ The impression is filled with a casting material (gypsum) – poured into Model (various purpose) lenka.roubalikova@tiscali.cz 16 Models  Working model – the denture is produced on this model (special procedures)  Opposing model (antagonal) - necessary for the recognition of intermaxillary relationship  Bite regitration - wax lenka.roubalikova@tiscali.cz 17 Manufactoring of dentures The denture (not the denture itself but the model of the denture) is produced on the working model. The model of the denture is made of the carving wax. The wax is replaced by the main (base) material. lenka.roubalikova@tiscali.cz 18 Fabrication of dentures The model (wax) of the denture is invested The wax is removed from the form and the base material is placed into the form. Wax removal: The wax is burned out (for metal alloys) or removed by hot water (for polymers) lenka.roubalikova@tiscali.cz 19 Impression material Tooth Impression lenka.roubalikova@tiscali.cz 20 Gypsum Impression lenka.roubalikova@tiscali.cz 21 Plaster lenka.roubalikova@tiscali.cz 22 The model (wax pattern) lenka.roubalikova@tiscali.cz 23 The model (wax pattern) The investing material lenka.roubalikova@tiscali.cz 24 The form The melted alloy The investing material lenka.roubalikova@tiscali.cz 25 The crown The melted alloy The investing material lenka.roubalikova@tiscali.cz 26 The metal crown Plaster (gypsum model) lenka.roubalikova@tiscali.cz 27 Manufacturing of dentures The method described above = indirect method Silicone impression lenka.roubalikova@tiscali.cz 28 Manufacturing of dentures Direct method lenka.roubalikova@tiscali.cz 29 Manufacturing of dentures Direct method No impression The model of the denture is made directly in the mouth For inlays only lenka.roubalikova@tiscali.cz 30 Planning of the denture Complex examination - consideration 1. Extent and location of the defect 2. Damage of the involved teeth (caries, fillings atc.) 3. Periodontium 4. Shape, size, position of teeth, relationhip to the neighbours 5. Occlusion, articulation – relationship to the antagonists 6. Quality of the alveolar process 7. The level of oral hygiene 8. X-ray examination 9. Study impressioons – study models 10. Detail evaluation of the abutment teeth (pilots) – most impoprtant teeth –canines, premolars lenka.roubalikova@tiscali.cz 31 Classification of defects acc. To Voldřich I. Class One or more teeth are missing Small gaps – 1 – 2 teeth Big gaps 3 – 4 teeth at most. This big gaps must be demarcated by pilot of the best quality. (canine, 1st or second molars – pilots of 1st class or their equivalents) lenka.roubalikova@tiscali.cz 32 Classification of defects acc. To Voldřich II. Class Reduced dental arch, then last tooth is the second premolar, first premolar or canine With gaps Without gaps Bilateral Unilateral lenka.roubalikova@tiscali.cz 33 Classification of defects acc. To Voldřich III. Class Individual teeth or small groups of teeth lenka.roubalikova@tiscali.cz 34 Classification of defects acc. To Voldřich IV. Class Edentulous jaw lenka.roubalikova@tiscali.cz 35 Classification of pilot (abutment) teeth Pilots I. class Canines Molars (1st, 2nd) lenka.roubalikova@tiscali.cz 36 Classification of pilots (abutment) teeth Pilots II. class Incisors - maxillary incosors, pemolars lenka.roubalikova@tiscali.cz 37 Classification of pilots (abutment) teeth Pilots III. class Mandibular incisors, third molars, all teeth with bad biological factor lenka.roubalikova@tiscali.cz 38 Biological factor Caries Pulp vitality Level of the endodontic treatment Level of the resorption of the alveolar bone Periodontium Relationship to antagonists Relationship to neihgbour teeth lenka.roubalikova@tiscali.cz 39 Way of the transfer of masticatory forces Tooth Tooth and oral mucosa Oral mucosa Implants – bone (special not too similar to tooth)