Year 5Prosthodontics

Dr Norlela Yacob

Small group Discussion 7 group.

CrownIndication contraindication

CrownAdvantages Disadvantages

Bridge (conventional)Indication contraindication

Bridge (conventional)Advantages Disadvantages

Bridge (adhesive)Indication contraindication

Removable Prosthesiesadvantages Disadvantages

Removable ProsthesesIndication contraindication

Information gatheringFirst: concentrate on patient’s complaint and

concern:

Emergency management needed/necessary?

Concern on aesthetic, social well being.

Information gatheringNext: move on according to clinical findings:

toothwear, old denture, radiographic findings, tooth mobility after wearing denture.

Based on the findings: what are the other informations that you need to gather that will direct you to your diagnosis.

Information gathering: case 1Patient come your clinic and request for

replacement of his old denture.On examination: there is inflammation on the

denture bearing area.

What are the important information that you need?

Information gathering: case 2Patient concern about her discolouration of

her teeth and teeth look short and missing posterior teeth

On examination: it appear to be tooth wear on palatal area of her incicors, free end saddle

What are the important information that you need?

Information gathering: case 3Patient request for bridge on her back teeth

On examination: there is overeruption of opposing teeth. The missing area was her last 3rd and 2nd molars.

What are the important information that you need?

Information gatheringAssessment of diagnostics aids: lab test, wax

up: study model etc.

Benefits of creating diagnosis and problem list:

Show organizationProfessional competencyPatient education

DIAGNOSIS

Allow us to:Direct managementGive indication and prognosisCommunicate with patient and other

professional colleaguesRecord in notes(medico legal)Patient might want to know what is wrong

with them.

Explaining the diagnosisMay be

Discussing a different diagnosis (what it would be) and reaching a provisional diagnosis (what it most likely is)

Explaining a definitive diagnosis

Explaining the diagnosisSimple language and lay-man termTailor it to patient level of understandingMay have to keep it simpleAllow opportunity to ask questionsReassure/show empathy

Discussing treatment options

Why discuss treatment option?In some conditions it may only one

options/approach Treatment outcome may be variesPatient needs to be informed of all optionsTreatment plan will be influenced by

patients’ priority

In Prosthodontics: developing an options listThings to consider:Patient factorsGeneral factors and assessmentRisks/benefits of treatment (evidence based)Limitations/prognosis of treatmentOperator clinical skills, consider referral

Continuous learning is essentials!

BENEFITS MUST OUTWEIGHT THE RISKS

Do not claim about the benefits which go beyond the evidence based.

Construction of definitive denture will take place at the later stage.

Replacing missing tooth incorporated with crown/bridge work and denture; It best to milled the crown with rest seat, clasp rest for denture. Then, final co-cr denture shall be constructed.

Problem with Co-cr denture: REST occlusal interference due to insufficient rest seat preparation

Problem with Co-cr denture: REST occlusal interference due to insufficient rest seat preparation

Formulation of treatment planning need multiple visits Patient should understand the treatment plan and the condition.Incorporated of milled crown and removable partial denture can improve the longevity of the treatment.

The treatment plan for a denture should be done at early stage but the construction of denture should be done at the last stage.