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An interdisciplinary classification of restorative dentistry

Lytle & Skurow Lee Gyu Hyong

Gyuhyong Lee

on 16 September 2012

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Transcript of An interdisciplinary classification of restorative dentistry

James D. Lytle
Howord Skurow
2012/ Sep./17
Wooni group
Lee Gyu Hyong An Interdisciplinary Classification
of Restorative Dentistry John Dewey, Educator classification 은
미래와 미지의 것들로부터의
공격에 대비한 무기고이다.

Classification is
a repertory of weapons
for attack upon
the future and the unknown Classification Effectiveness
General use
Not complex Bridge the specialty gap
Enhance communication among cotherapists
Definitive steps for success Classification Collecting the Diagnostic Data Interview
Dental & Medical History
Diagnostic cast & Mounting
Pocket depth
Alveolar support
Soft tissue aberrations
Age and systemic health Collecting the Diagnostic Data Basic data
hard information Restorative Dentistry
Location of missing teeth
Restoration for replacement
Teeth for restoration
Occlusal- incisal table
Vertical denmension
Angle’s orthodontic class Occlusal evaluation
Deflective malocclusion
(CR-CO discrepancy)
Contributing factor?
Nonworking contact
Primary or 2ndary TFO
TMJ involvement Diagnosis Class I
Operative dentistry
Class II
Crown and bridge
Class III
Occlusal reconstruction
Class IV
Periodontal prosthesis Classification

Restorative needs:
Patients requiring simple restorative procedures where problems ore with individual teeth,

Periodontal condition:
Patients whose periodontal status may range from clinical health to moderate periodontitis.

Occlusal status:
Patients whose occlusal scheme is either
acceptable or is correctable by occlusal
adjustment techniques. Class I
Operative Dentistry

Restorative needs:
Patients requiring full or partial crown restorations, with replacement of any interposed missing teeth, including cantilever pontics.

Periodontal condition:
Patients whose periodontal status may range from clinical health to moderate periodontitis.

Occlusal status:
Patients whose occlusal scheme is either accept-able or correctable by occlusal adjustment techniques. Closs II
Crown and Bridge Restorative needs:
Patients whose dentition requires completed reconstruction due to excessive wear,
inadequate restorations, caries, missing teeth,
or a combination of these,
and is in a state of irreversible damage,
necessitating complete rehabilitation,

Periodontal condition:
Patients whose periodontal status may range from clinical health to moderate periodontitis.

Occlusal status:
Patients whose occlusion, anteriorly and posteriorly, will need complete recreation, using restorative procedures. Class III
Occlusol Reconstruction

Restoralive needs,
Patienls requiring splinting of the dentition where

Periodontal condition And Occlusal Status,
Generalized mobility is o result of advance periodontal breakdown, complicated by secondary occlusal trauma and where natural stabilization cannot be achieved.
Also included are those cases which, due to crown and bridge requirements, necessitate complete arch splints. Class IV
Periodontol Prosthesis Class I
Operative dentistry
Within the anatomic confines
Not manipulate periodontium

Class II
Crown and bridge
Near or below the gingival crest
Alterations in emergence profile Class I & II Occlusal Reconstruction
Overt change in the
incisal guidance
Posterior occlusal table
Bruxism, trauma, worn out, caries Class III Restoration of the anterior segment (along with the posterior)
Increased proximity
Overt contact of opposing posterior teeth in eccentric movement
class III
“Posterior only” restoration  class II
Original Ant. Guidance preservation class II Class II vs Class III Periodontal Prosthesis
Support for severely mobile and/or missing dentition of an entire arch
Splinting ( Crossarch stabilization)
Maybe fixed or removable : varied designs. Class IV Class I, II, III
Tooth-related dentistry
Class IV
Augment the periodontium (with splinting) Goldman H.M. & Cohen D.W.
Periodontal Therapy 1968 secondary occlusal trauma
… a condition of occlusal traumatism, secondary to previous periodontal disease both inflammatory and dystrophic, resulting severe bone loss and reversal of the crown to root ratio. Teeth affected with secondary occlusal traumatism are so mobile that continued injury can occur in normal forces of mastification, deglutition and pressures of the lip, cheek and tongue. In secondary occlusal traumatism, it is almost impossible to remove the irritant. In most cases of secondary occlusal traumatism, control of the clinical systems requires fixed stabilization (splinting) procedures of a permanent nature. Reconstruction, Rehabilitation
Class IV : intimately involving tow or more specialty areas.
Restorative dentistry augments periodontal status
In passive way : class I, II, III
In active way : class IV (Provisionalization, stabilization) Class III vs Class IV Stabilization as part of the initial therapy
Aids in the diagnostic and treatment processes
Allowing for modification
Not just a temporary replacement Provisionalization (in class IV) Provisional phase  final stabilization
Changing dental materials Final stabilization (In class IV) Class I & II
Limited by the incisal guidance ( inherent in the dentition)
Class III
Limited by
TMJ, jaw width, Mx-Mn relation
General tooth position in spaces
Class IV
Minimizing the incisal guidance angle.
Group function. Occlusal overview CR-CO coincidence as a treatment goal
Diagnostic cast :
CO-CR feasibility.
point toward orthodontics or occlusal adjust
Diagnostic waxup : visualizing the final result
Bruxism : eliminate or minimize causes contributing to bruxism. Occlusal overview Distal extension RPD : not alter the class.
Orthognathic surgery
Class II,III,IV held at class I
Class I,II  class III, IV
Simplest to accomplish the desired result
best scheme(restorative-periodontal-occlusal) Additional relevant factors 55 Y.O. Male
Direct Gold, Gold Inlays, Gold Onlays
Perio Problem : N/S , Lower Ant. Tissue contour difference
Adjustment as a teenager
Slight adjustment subsequently
CR-CO almost coincide for 30 years. Case I 23 Y.O. Female
Caries, faulty restoration, missing teeth.
Ant. Spacing : aberrant swallowing pattern
Incisal Guidance : minimal but acceptable
CR-CO slide : several millimeter MIOP
2nd and 3rd molar mesial tipping
Perio : n/s
Class I  Class II
2nd molar uprighting and Bridge
Soft tissue graft (Mn. Buccal)
Lasted 11 years Case II 55 Y.O. Male
Generalized Moderate periodontitis
Calculus, plaque, Inadequate restoration
Incisal Guidance
Periodontal Therapy
#27 MB root resection
Improvement in plane of occlusion
9 Years good bony support and a healthy periodontium Case III 60 Y.O. Male
Pathologic occlusal wear
Edge-to-edge pseudo class III
Preliminary waxing (Diagnostic wax-up) Mx
Mounted cast
Mn. Post. : minimal restoration
The Restoration of lost tooth structure and closed VDO.
The Establishment of a sound CR-CO
The development of a new anterior guidance.
Mx. Provisional ( Acrylic resic)
For 6 months
Mx. Prosthesis & Mn. Alteration Case IV Severe Periodontal involvement
#12,11,21,22,24 : hopeless  strategic ext.
Mx provisional
Splinting : extreme mobility and small root size
Definitive periodontal surgery
Several months perio maturation.
#16 MB root only retained.
Final restoration
14 years Maintenance Case V Thank you for attention!!
Cheer up for 2nd semester!!
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