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How to draw and describe

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Marianna Dóró

on 4 July 2016

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Transcript of How to draw and describe

How to draw and describe
the prosthodontic treatment plan

Treatment plans according to the Fábián and Fejérdy Classification
Basic rules of
drawing the treatment plan
Metal - blue colour

Ceramic - green colour

Acrylate - red colour
II. Classes
Class III.
The position of the remaining teeth is favourable for the retention of the partial denture. On the other hand, the condition for support is not advantageous. The masticatory force causes
sinking
on one side of the fulcrum line and
lifting
on the other side. The
result is tilting
of the denture during mastication.
We propose a
delayed tooth support
in this class. That means , there is a space between the
primary and the secondary telescopic crowns
when the denture is not used for chewing. When the denture is loaded, the occusal load is distributed between the teeth and the underlying mucose and no tilting can be observed.
Treatment plan:
delayed dental support = resilient support
Support:
mucosa and dental, non reduced base plate

I. Classes
Class 1A
The partial denture can be completely tooth borne. It is not going to sink and no tilting effect is going to develop.
We always make bridges when it is possible.
Treatment plan:

simple bridge
Type of support
:

dental

Nevertheless in certain cases we construct removable partial dentures in this class:
if the patient has poor general health (during chemotherapy, active hepatitis, serious heart disease, etc.) or if there is a large bone resorption in the arches.



Class 2A
The remaining teeth are in one block. Unfavourable tilting forces will develop, an
RPD with mixed support
has to be made.
The
support conditions are favourable.
Disadvantageous for the retention
, the RPD might be lifted by the displacing forces. The denture will sink into the mucosa.
Treatment plan:
A:

RPD with clasps and clasp bearing crowns if necessary

B:

RPD with precision attachment.
Base plate:
upper: butterfly- or horseshoe-shaped between the saddles (depends on the remaining teeth)
lower: lingual bar between the saddles
Type of support:
dental and mucosa = tooth and tissue borne.
Retention:

clasps, occlusal rests, indirect retainers, continuous clasps, precision attachment

Class 2A/1
There is one possible fulcrum line, that becomes an actual fulcrum line after the construction of the RPD.
There are 1 or 2 remaining teeth in "one block".
Displacing forces can move the PD, since the conditions for retention are not advantageous.
Three type of design:
A:
denture with
telescopic crowns
, when the
base plate is functionally extended
B:
when the present teeth are two canines or one canine and an incisor, an
interdental bar
is used
C:
partial
denture with clasps
and with a functionally extended base plate
Type of support:
mucose and dental, non reduced base plate
Retention:
non resilient
!!! telescope, clasps, interdental bar

Class 1B
Tilting effect

will be present when the partial denture is used, but the torque can be compensated. In order to compensate the torque, we make full crowns as

additional abutments
.
We make fixed bridges whenever possible.
Treatment plan:

extended bridge
Type of support:

dental

If we make RPD:
maximally tooth supported--Rigid casted clasps retention with occlusal rests,
maximally reduced metal base plate (skeletated base plate)



There are edentolous spaces in between the remaining teeth too. Tilting forces can not be compensated by the teeth alone, so a
tooth and tissue borne removable partial denture
has to be constructed.
Treatment plan:
A:
2B transformed to class 2A,
and afterwards the case is treated as class 2A.
An interdental bar is constructed and additional clasps or precision attachments are used.
B:

RPD with clasps
Frontally missing teeth--> make a bridge!
Laterally missing teeth--> make a bar! (upper or lower too)

Support:

dental and mucose
base plate: upper - butterfly or horseshoe-shaped
lower - lingual bar
Retention:

clasps, occlusal rests, indirect retainers, continous clasps, precision attachment
Fábián and Fejérdy Classification

-based on tooth support,
teeth must always be used for support
-upper and lower arches are different
-the classification gives treatment plan

3 main classes: I, II, III

I.
1A, 1B:
The number and the position of the remaining teeth are sufficient to provide complete dental support for partial dentures. In 1B torque affects the abutment teeth but they are still able to provide complete support.

II.
2A, 2B, 2A/1:
The remaining teeth can not fully support the partial denture, so a tooth and tissue borne appliance needs to be made.

III.
Class 3:

The remaining teeth are situated diagonally which results in a special situation.
Treatment plan

5 units casted bridge
material: porcelain fused to metal
abutments: 13, 17
pontics: 14, 15, 16
4 units casted bridge
material: porcelain fused to metal
abutments: 23, 26
pontics: 24, 25


Treatment plan

6 units casted bridge
material: porcelain fused to metal
abutments: 33, 43
pontics: 32, 31, 41, 42
Treatment plan

14 units casted bridge
material: porcelain fused to metal
abutments: 33, 37, 43, 47
pontics: 31, 32, 34, 35, 36, 41, 42, 44, 45, 46
Treatment plan
8 units extended casted bridge
material: porcelain fused to metal
abutments: 34, 35, 41, 42, 43
pontics: 31, 32, 33
Treatment plan
Treatment plan
12 units casted bridge
material: porcelain fused to metal
abutments: 13, 16, 23, 26
pontics: 11, 12, 14, 15, 21, 22, 24, 25
8 units extended casted bridge
material: porcelain fused to metal
abutments: 13, 14, 23, 24
pontics: 11, 12, 21, 22
Class 2B
But the truth is out there!
Always look at it globally...
Thank you for your attention!

Treatment plan
Casted clasps retained removable partial denture
Reduced metal base plate ( cobalt-chrome alloy) - butterfly-shaped connective part
Clasps retention aocclusal rests on teeth: 13, 24, 25, 26, 27, 28
Four pieces of acrylate artificial teeth
Bonyhárd clasp
Modified Ney-1 clasp
Bonwill-clasp
Treatment plan

Custed clasps retained removable partial denture
Reduced metal base plate ( cobalt-chrome alloy) - lingual bar connective part with continuous bar between the saddles
Clasps retention on teeth: 33, 43,
Eight pieces of acrylate artificial teeth
Treatment plan

Complex denture with precision attachments
Fix part:
6 units casted splint
material: porcelain fused to metal
abutments: 31, 32, 33, 41, 42, 43 precision attachments on teeth 33 and 43 (Preci Vertix)
parallel-milled shoulders on all teeth, interlock between teeth 32-33 and 42-43
Removable part:
Reduced metal base plate (cobalt-chrome alloy), lingual bar connective part
Eight pieces of acrylate artificial teeth
Treatment plan


Casted clasps retained removable partial denture
Reduced metal base plate (cobalt-chrome alloy)
Clasps retention on teeth: 36, 37, 46, 47
Ten pieces of acrylate artificial teeth
Treatment plan

Removable partial denture with casted telescopic crowns
Maximally extended acrylate base plate
Telescope retention on teeth: 13 and 14 (casted primery telescopic crowns)
Secondary telescopic crowns and twelve pieces of acrylic artificial teeth in the RPD
Treatment plan

Clasps retained removable partial denture
Reduced metal base plate ( cobalt-chrome alloy) - horseshoe-shaped connective part
Casted clasps retention and occlusal rests on teeth: 12, 13, 23, 26, indirect retainers on teeth 13, 12, 23
Ten pieces of acrylic artificial teeth
Complex denture (FIX + RPD)
Fix part:
7 units bridge - Porcelain fused to metal
abutments: 12, 13, 23, 26
pontics: 11, 21, 22
precision attachments on tooth 13 (PreciVertix), interdental bar between teeth 23-26 (type:PreciHorix)
parallel-milled shoulders on teeth 12, 13, interlock betweet teeth 12-13
occlusal rest on tooth 26
Removable part:
Reduced metal base plate ( cobalt-chrome alloy) butterfly shaped connective part
Rigid Retention: Clasp on tooth 26, Precision Attachment:
• PreciHorix • PreciVertix
Seven pieces of acrylic artificial teeth
In order to create a more comfortable and functional prosthesis, in 2A or in 2B if possible we can make FIX DENTURES, by treating the patient as in Class 1B.
Treatment plan

Removable partial denture with telescopic crowns
Functionally extended acrylate base plate
Primary telescopic crowns on teeth: 34 and 43
Secondary telescopic crowns and twelve pieces of acrylate artificial teeth in the RPD
dr. Dóró Marianna, dr. Jáhn Marianna
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