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Definitive Phase of Treatment Planning

Terms in this set (75)

What is the core of almost every treatment plan, and what are the exceptions due to?
definitive phase of treatment

exceptions: pts whose needs are limited to preventive only or pt is still in disease control phase
Types of definitive phase therapies (9)
Periodontal therapy

Orthodontic treatment

Other occlusal therapies

Restoring individual teeth

Cosmetic dentistry

Elective (non acute) endodontic problems

Extractions and pre prosthodontic surgery

Replacing missing teeth: Implants

Replacing Missing teeth: Fixed + removable
Before initiating definitive treatment, dentist should (3) (what should they assess, evaluate, and obtain?)
Assess results of disease control for those patients who underwent this phase of care

Evaluate and discuss viable definitive case options

Obtain informed consent from patient (diagnoses, treatment options, prognoses, fees)
Examples of when periodontal therapy should be performed? (8)
1. Periodontitis not responsive to initial therapy
2. Furcation involvement
3. Root proximity
4. Congenital or medication associated gingival enlargement
5. mucogingival deformities and conditions
6. high frenal attachment
7. esthetic and architectural defects of problems
8. Angular bone defects
How does angular bone defects and furcation involvement affect long term prognosis of definitive phase?
both worsen long term prognosis
What can happen to interproximal bone with increased root proximity. And what can cause an increase in increased root proximity?
vulnerable to destruction

Result of natural development, drifting/tipping due to caries/fracture involving proximal surface
Mucogingival deformities and conditions: What are some examples of this, and what should be assessed before considering periodontal therapy to treat this?
Gingival recession, minimal or absent keratinized gingiva, probing depths beyond MGJ

Considerations: biotype, narrow band of attached gingiva
High frenal attachment (Risk of high frenal attachment involving maxillary labial frenum vs. buccal/ facial frenula vs. lingual frenum)
Involving maxillary labial frenum --> diastema between incisors is possible

Involving buccal/facial frenula --> might interfere with prosthesis fabrication

Involving lingual frenum --> possible issue with tongue movement and speech
Examples of esthetic and architectural defects or problems that may need periodontal therapy
High lip line, short clinical crowns, excessive gingival display, periodontal tissues damaged by trauma or oral cancer
what professional considerations need to be taken into account in order to help with the deciding on a definitive phase treatment plan (4)
Systemic concerns - diabetes, smoking, medications

Tooth-related concerns - restorative prognosis, poor restoration

Localized factors

Patient compliance
what patient considerations need to be taken into account in order to help with the deciding on a definitive phase treatment plan (2)
Behavior issues - healthy lifestyle/diet, understanding proposed treatment

Willingness to undergo treatment, long-term follow up, time, financial problems, fear
Procedures for treating periodontal disease (4)
local delivery antimicrobials

host modulation

periodontal surgery

periodontal regeneration therapy
Periodontal disease treatment: local delivery antimicrobials (is it site specific or generalized, what is it not a substitute for, what are some indications for use (2), what are 3 examples of this)
Site-specific

Not a substitute for periodontal surgery for most patients

Indications include refractory cases, peri-implant defects

Examples: Atridox (doxycycline), perio-chip (chlorohexidine), arrestin (minocycline)
Periodontal disease treatment: Host modulation (What principle is this based on? What is the one approved agent that can do this?)
Based on principal of modifying/influencing host's immune response to bacterial change

One approved agent - subantimicrobial dose of doxycycline administered systemically
Periodontal disease treatment: Periodontal surgery (what types of surgeries are done?) (2)
Reflect flap to gain visual access to root surfaces and alveolar bone

Elective surgery to correct gingival overgrowth, MGJ defects, high frenal attachments, esthetic issue
Periodontal disease treatment: Periodontal regeneration therapy (How is this done? What types of cases have the best success rate?)
Bone graft and biological materials to induce bone formation

Case selection important (3-wall defects have best success rates)
orthodontic treatment (usually for kids, but what are some advantages for adults?) (3)
Moving impacted tooth into arch

Correcting over-eruption to facilitate restorative plan

Uprighting a tip tooth
What is an angle class 1 malocclusion and what are clinical signs of this?
When the anteroposterior dimension of teeth exceeds length of available bone

Might be evidenced by crowded, tipped, rotated, impacted teeth or isolated crossbites
Impacted maxillary canines (why are they more likely to be impacted or malpositioned?
due to eruption sequence

proper alignment has important advantages
types of PROFESSIONAL considerations to make when deciding on orthodontic treatment (3)
What/how/when it will be corrected

Training required

Is the patient free from active caries or perio disease?
types of PATIENT considerations to make when deciding on orthodontic treatment (4)
Willingness to improve

Realistic expectations

Time/financial commitment

Ability to maintain oral hygiene
types of orthodontic therapy procedures that can be used to treat malocclusion (3)
comprehensive orthodontics

limited orthodontic tooth movement

orthognathic surgery
Malocclusion treatment: Comprehensive orthodontics (how many teeth does it usually involve, advantages, disadvantages, what might this type of treatment involve, how long does this treatment take?)
Usually involves moving multiple teeth in multiple sextants of both arches


Advantages - alignment, function, esthetics

Disadvantages - root blunting/resorption, gingival recession, caries activity, discomfort

Treatment might involve extractions, brackets, aligners,

1-3 yrs of treatment
Malocclusion treatment: Limited orthodontic tooth movement treatment (How many teeth does this type of treatment usually involve? How long does this take?)
Involves tipping, rotation, or bodily movement of usually six or less teeth

Typically completed in less than 1 year
Malocclusion treatment: Orthodontic therapy: Orthognathic surgery: (When is orthognathic surgery indicated? What treatment may be done before and after this? how many days in the hospital expected? How long will the jaw immobilization take? What is a risk of performing this surgery?
Usually indicated when patient has significant skeletal abnormalities & malocclusion

Comprehensive ortho treatment usually precedes and follows surgery

1-2 days of hospitalization expected, 6-12 weeks of immobilizations (jaws) expected

Paresthesia may occur, permanent in some cases
What do the other occlusal therapies incorporate and what do they manage
Incorporates treatment modalities to manage occlusal abnormalities which can cause damage
what types of common problems may need other occlusal therapies
Acute/chronic occlusal trauma

Parafunctional habits - bruxism, nail biting, clenching
Types of procedures for treating occlusal problems, NOT MALOCCLUSION! (4)
Athletic guard

Occlusal guard

Occlusal splint

Occlusal adjustment via selective grinding
Athletic guard (what is it? what does it protect teeth from?)
Soft, plastic, removable appliance

Protects teeth from blunt trauma
Occlusal guard (AKA bite guard or night guard) (what is it and what are its uses)
Hard or slightly flexible acrylic material appliance

Uses - prevents tooth wear, assess pt's tolerance for increased vertical dimension
Occlusal splint (AKA bite splint) (what is it, what is it used for?)
Hard acrylic device

Often used to treat TMJ dysfunction --> promotes stable joint position
Occlusal adjustment via selective grinding (What does it do? is it reversible? What you must educate the patient on if they want to do this)
Improves tooth contact and associated muscle response

Irreversible (need to study existing occlusion)

Must educate patient that adjustments might result in need for additional care
Restoring individual teeth: Replacing tooth structure lost to... (7)
caries, fracture, abrasion, attrition, abfraction, erosion, combination
intracoronal vs extracoronal individual teeth restorations
Intracoronal restorations - placed within the confines of teeth (amalgam, resin, inlays)

Extracoronal restorations - encompass most or all of the coronal surface (crowns, onlays)
Professional considerations for definitive treatment via individual tooth restoration (4)
Diagnosis, type of restoration needed

Patient caries risk

Risk of fracture/damage

Esthetic benefits/limitations
Patient considerations for definitive treatment via individual tooth restoration (3)
Symptomatic vs asymptomatic

Esthetic concerns

Individual priorities (allergies, etc)
Single tooth restorative procedures (5)
Pit and fissure sealant

Composite resin restoration (technique-sensitive)

Glass ionomer restoration -

Amalgam restoration

Inlays/onlays or definitive crowns (FCC, PFM, ACC)
When is GI restoration indicated for use? What is ideal for?
cervical defects,

Ideal as temporary/provisional direct-fill
When is amalgam restoration preferred?
Preferred when isolation cannot be achieved)
Low end vs high end cosmetic dentistry level of invasiveness
Low end - OTC whitening toothpastes

High end - all ceramic crowns
Keys to decision making when performing cosmetic dentistry (3)
Diagnosis, communication, & documentation
Type of representative esthetic treatment procedures (6)
microabrasion

contouring teeth

vital bleaching

bleaching devitalized teeth

veneers

PFM or all ceramic crowns
esthetic treatment procedure: Microabrasion (What is it? what can it help treat?)
Surface layer of enamel is removed with abrasion and erosion

Can treat fluorosis, post-ortho demineralization, superficial enamel hypoplasia
esthetic treatment procedure: Contouring teeth (what can it treat?)
Fractured, chipped, extruded, or overlapped teeth
esthetic treatment procedure: vital bleaching (is it safe? What chemicals are usually used for this?)
Effective and safe when used as directed
·
Often carbamide peroxide or hydrogen peroxide (concentrations/delivery systems vary)
esthetic treatment procedure: Bleaching devitalized teeth (AKA walking bleach) (what chemicals are usually used for this? What is a possible adverse effect of this?)
Sodium perborate with hydrogen peroxide gel or carbamide peroxide gel

might induce internal resorption
esthetic treatment procedure: veneers (what are the different types, and what do veneers help improve)
porcelain vs composite and direct vs indirect

improves esthetic
esthetic treatment procedure: PFM or all ceramic crowns (when should these be used?)
insufficient tooth structure exists for a veneer
Elective (non-acute) endodontic treatment: (When should this type of treatment be performed?) (2)
Pathology detected in definitive phase or indirect restoration w/ high RCT probability

Over-eruption or overdenture retained root
Professional considerations when deciding on elective (non acute) endodontic problem (3)
value of tooth, restorability, anatomic considerations
Patient considerations when deciding on elective (non acute) endodontic problem (2)
communication prior to initiating RCT, documentation
Procedures for treating non-acute endo problems (2)
RCT or apical surgery
When do you perform apical surgery to treat non acute endo problems? (2)
When conventional RCT was unsuccessful and patient declines retreatment

Access to canal through crown is prevented (calcified, non-retrievable cemented post)
Extractions and pre-prosthodontic surgery may also be done in what phases of treatment planning?
acute or disease control
What are examples of extractions and pre pros surgery that may be done during definitive phase (3)
Extractions to facilitate ortho treatment,

3rd molar extractions

Surgical procedures associated with implant placement
Examples of surgical procedures associated with implant placement (3)
ridge (Site) preservation

guided bone regeneration

sinus floor elevation
Surgical procedures associated with implant placement: Ridge (Site) preservation (what is this?)
bone graft placed immediately following extraction
Surgical procedures associated with implant placement: Guided bone regeneration (when would this procedure be done? what types of material can this involve? how long does it take to heal?)
Performed when there is insufficient alveolar bone height/width

Can involve graft material, barrier membranes, titanium mesh

3-6 months healing
Surgical procedures associated with implant placement: Sinus floor elevation (What are the two different types? How is each done?)
Lateral window sinus lift (Caldwell-Luc procedure): Hole created on lateral aspect of alveolus adjacent to proposed implant site

Osteotome sinus lift (transalveolar approach): Osteotome placed apically to elevate sinus floor/retain new floor contour
Implants: What is the one stage technique? (What is on top of the implant, how long does it take to heal?)
Implant placed w/ healing cap so coronal portion is exposed to oral environment

Healing cap can be removed, and impression taken after appropriate healing (3-6 mo)
Implants: What is the two stage technique? (What is done in this technique? when is the fixture uncovered?)
Implant fixture is placed and covered with tissue during first surgical appointment

Fixture is uncovered usually 3-6 months later
Implants: What is the immediate placement technique? (What is done in this technique? )
Implant fixture is placed in the tooth socket at the time of the tooth extraction
Implants: What is the immediate loading technique? (What is done in this technique? )
Abutment and provisional prosthesis attached to abutment are placed at the time of fixture placement
Advantages of implants (3)
Improved function, preservation of teeth/bone, stability/longevity
Disadvantages of implants (3)
cost, healing time, one or more surgical procedures
Implant-related prosthetic options (5)
implant retained single crown

implant retained FPD

implant retained RPD

implant retained complete denture

implant retained over denture
implant retained single crown (when is this the primary option? Advantage of this? When can this be challenging?)
Primary option when replacing single tooth when adjacent teeth are sound

Easier to clean, can floss between restoration and adjacent teeth

Challenging when replacing tooth in esthetic zone
When would an implant retained FPD be used?
More implant fixtures needed if replacing teeth with heavier occlusal forces
When would Implant-retained removable partial denture be used?
When proposed natural tooth abutments are compromised or have a poor prognosis
When is implant retained fixed complete denture indicated?
indicated with moderate bone loss and missing soft tissue contours
when is implant retained overdenture best to use? What is the overdenture supported by?
"Standard of care" for edentulous patient with severe bone resorption

Supported by 2-4 implant fixtures using locator attachments
Examples of definitive phase treatments to replace missing teeth (3)
fixed partial denture

removable partial denture

complete denture
What are the different types of fixed partial dentures?
Typically two retainers (crowns) attached to one or more artificial teeth (pontics)

Can be resin-bonded where retainers are wings bonded to abutment teeth (Maryland bridge)
What is a Removable partial denture? what are its advantages (2)
Cast framework with an acrylic base and replacement teeth

Relatively inexpensive and stable (depending on number and position of abutment teeth)
What is a complete denture? What are its advantages of choosing an overdenture rather than just a conventional denture?
Removable acrylic replacement for teeth, soft tissue, and bone

Helps preserve alveolar bone and improved sensory function and proprioception
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