selection and arrangement of teeth in...
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Tikrit University College of Dentistry Lec-8-prostheticDr:Reem/4thclass
Selectionandarrangementofteethinrpd
uponcompletionofthearticulatormountingandathoroughassessmentoftheocclusalrequirements,thepractitionershouldbeabletoperformtheproperarrangementofprostheticteeth.Whileselectingthereplacementteeth,theclinicianmustcarefullyconsidertheestheticandfunctionalrequirementsofthepatient,thestructuralrequirementsoftheRPDandthematerialstobeusedinprosthesisconstruction.
TYPESOFREPLACEMENTTEETH(MATERIALS):-
1-Commerciallyavailableacrylicresinteeth(Ant.&Post.)
2-Commerciallyavailableporcelainteeth(Ant.&Post.)
3-Commerciallyavailablecompositeresinteeth(Ant.&Post.)
4-Metalreplacementforposteriorteeth(gold)
PORCELAINTEETH
ADVANTAGES:-
1-Greatertranslucencyanddepthofcolorgiveanaturalappearance.
2-harderthanacrylic
3-resistwear
4-resiststaining
5-theyeasilyremovedfromthebaseofbecausetherenochemicalreactionbetweenporcelainandacrylicdenturebase(benefitinrebasing).
DISAVANTAGES
1-clickingsoundoftheteethcovertthedenturebeingnoisy
Tikrit University College of Dentistry Lec-8-prostheticDr:Reem/4thclass
2-brittle
3-detachmentoftoothfromthedenturebase
4-difficulttofabricateandtrim
5-causewearingofopposingnaturalteeth.
ACRYLICTEETH
ADVANTAGES:
1-easytoadjustandtrim
2-chemicalbondingtodenturebase
3-easytofabricate
4-lighter
DISADVANTAGES:-
1- susceptibletoabrasion2- easilystained3- inrebasing(difficulttoremovetheteethfromthedenturebase)
ANTERIORTEETHARRANGEMENT
themostdifficultpartofarranginganteriordentureteethisdirectlyrelatedtoalossofrestorativespace.Unlessanteriorteetharereplacedimmediatelyfollowingtheirextraction,thenaturalteethadjacenttothespacewilleitherdriftortiltintothespaceandproducedecreaseintherestorativespace.Anattemptshouldhavebeenmadetoregaintheoriginalwidthofthespacebyreshapingtheproximalsurfacesoftheadjacentteeth.
Tikrit University College of Dentistry Lec-8-prostheticDr:Reem/4thclass
Iftheentirewidthcannotberecovered,considerationshouldbegiventooverlappingtheartificialteethsothatanormalsizedtoothmaybeusedtoharmonizewiththepatient,sfaceandremainingteeth.
Becauseoftheiravailability,easeofadjustment,andsurfacewearcharacteristics,acrylicresinteetharemorecommonlyusedthanareporcelainteeth.Whileestheticallypleasingporcelainbrittleandcauseacceleratedwearofopposingenamel,gold,andacrylicresinsurfaces.
Whenselectingdentureteeth,thedentistshoulduseshadeguideprovidedbythetoothmanufacturer.Artificialteethshouldbematchedascloselyaspossibletotheadjacenttoothbyusingnaturallight,theabilitytodiscriminatebetweenshadesdecreasesrapidlyasaresultofeyefatigue.
Aftershadeselectionthepractitionershouldselectappropriatemold.Eachmoldexhibitadefinedsizeandshape,aswellasdistinctivesurfacecharacteristics.
Thepractitionermustestimatethesizesofthepatient,snaturalmaxillarycentralincisors,thisaccomplishedby:-
TheHOUSETECHNIQUE:coordinatesthewidthandlengthofeachmaxillarycentralincisor,thedentistdeterminethepatient,sbizygomaticwidthanddividedby(16),toestimatethelengthoftheclinicalcrown,thedentistestimatethelengthbychintohairlinedistanceanddividedby16.
TheoverallformorshapeoftheteethisestablishedbyLEONWILLIAMS:Theshapeofanteriorteethiscloselyrelatedtofacialform.Teethareusuallydividedintofourbasicform(square,tapering,squaretaperingandovoid).
Tikrit University College of Dentistry Lec-8-prostheticDr:Reem/4thclass
GIUDLINEFORSETTINGANTERIORTEETH
1.Replacetheacrylicresinrecordbaseattachedtotheframeworkwiththebase-platewaxbase.
2.SettheCentralIncisorfirstiftheteetharemissingacrossthemidlinetoreestablishthemidline.
3.Ifrequired–reshapetheridgelapportionoftheartificialtoothwithoutshorteningtheclinicalcrownlengthsubstantially.
4-Placetheteethasnearlyaspossiblewheretheoriginalnaturaltoothwaslocated.
5.Proximalsurfaceoftheartificialtoothmayneedtobere-contouredforbetteradaptationtotheadjacentnaturaltooth,withoutloosingitsmorphology.
6.Thedenturebaseflangesshouldbecarefullycontoured&smoothed.Removetheexcesswaxfromtheteethandtheframework.
Tikrit University College of Dentistry Lec-8-prostheticDr:Reem/4thclass
POSTERIORTEETHSELECTIONANDARRANGEMENT:-
posteriorteethmustnotonlyfitintotheavailableedentulousspaces,butalsomustbeinharmonywiththeopposingocclusalsurfaces.thefollowingmustfollowtheposteriorarrangementteeth:-
1- Thedentistshouldnotbeoverlyconcernedwithreplacingtheexactnumberandtypeofteeth,forexamples,theedentulousspacemayhavebeenoccupiedbyasecondpremolarand1stmolarbutbecauseofdriftingoftheremainingteeththemostsuitablereplacementmaywellbetwopremolars.
2- acrylicteetharealsoindicatedinposteriorteeth.Porcelainteethareindicatedonlyiftheywillopposesimilarporcelainsurfaces.
3- shadeselectionshouldbeaccomplished.4- Thepractitionershouldthenchoosetheappropriatemold.5- Thepractitionermustconsidertheocclusogingivalheightforeach
replacementtooth.6- oneoftheprimarygoalsinestablishinganeffectiveocclusalschemeisto
developanacceptablepatternofmaxilla-mandibularcontacts.Todothis,itisnecessarytosetthedentureteethataheightthatisslightlygreaterthantheproposedocclusalverticaldimension.Theoperatormaythenperformcorrectivegrindingprocedureswhich(1)returntheteethtotheproposedocclusalverticaldimensionand(2)providemaximumplannedcontactbetweenopposingocclusalsurface.Thisdonebyincreasetheincisalpinsettingby0.5mm
Tikrit University College of Dentistry Lec-8-prostheticDr:Reem/4thclass
thenmarkedusingarticulatingpaperandadjustedbyusingappropriatebursinalaboratoryhandpiece.
POSITIONINGADENTURETOOTHADJACENTTOACLASPASSEMBLY
PositioningthedenturetoothadjacenttotheabutmenthavingaclasporaMinorConn.usuallyrequires,
a.trimmingoftheproximalsurfaceandtheridgelapportionoftoothcarefully-Nottoover-reducetheheightofthebuccalsurfaceforestheticreasons
b.Thetoothshouldfirstbeadjustedtofitthecastwithoutframeworkandthenreadjustedafterplacingtheframeworkonthecast.
Tikrit University College of Dentistry Lec-8-prostheticDr:Reem/4thclass
Theremainingteethshouldthenbepositionedinmaximumintercuspation.Someocclusaladjustmentorleavingsmallspacingbetweentwodentureteethmaybenecessary.
Forthemandibularposteriorteeth,centralgrooveshouldbeplacedoverthecrestoftheridge.
Thedesiredocclusalcontactsforartificialteethforremovablepartialdenturesvaryaccordingtotheclassofpartiallyedentulousarchbeingtreated.Thefollowingisabriefsummaryofthevariousocclusalschemesthatmaybeusedinremovablepartialdenturetherapy.
1- Simultaneousbilateralocclusalcontactofopposingposteriorteethshouldbepresent.
2- Foratoothbornremovablepartialdenture,theocclusionshouldbesimilartoaharmoniousnaturaldentition
3- foraremovablepartialopposingacompletedenture,balancedarticulationisdesirable.
4- InclassIVapplication,itisdesirabletohavelightcontactwithopposingnaturalteethinmaximalintercuspalposition.
5- Artificialteethshouldnotbepositionedontheupwardinclineofthemandibularridge.(asitascendsthemandibularramus).