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NEET MDS Synopsis - Lecture Notes

πŸ“– Prosthodontics

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Kennedy's Classification of Edentulous Arches
Prosthodontics

Kennedy's Classification is a system used in dentistry to categorize the edentulous spaces (areas without teeth) in the mouth of a patient who is fully or partially edentulous. This classification system helps in planning the treatment, designing the dentures, and predicting the outcomes of denture therapy. It was developed by Dr. Edward Kennedy in 1925 and is widely used by dental professionals.

The classification is based on the relationship between the remaining teeth, the residual alveolar ridge, and the movable tissues of the oral cavity. It is particularly useful for patients who are wearing or will be wearing complete or partial dentures.

There are four main classes of Kennedy's Classification:

1. Class I: In this class, the patient has a bilateral edentulous area with no remaining teeth on either side of the arch. This means that the patient has a full denture on the upper and lower jaws with no natural tooth support.

2. Class II: The patient has a unilateral edentulous area with natural teeth remaining only on one side of the arch. This could be either the upper or lower jaw. The edentulous side has a complete denture that is supported by the teeth on the opposite side and the buccal (cheek) and lingual (tongue) tissues.

3. Class III: There is a unilateral edentulous area with natural teeth remaining on both sides of the arch, but the edentulous area does not include the anterior (front) teeth. This means the patient has a partial denture on one side of the arch, with the rest of the teeth acting as support for the denture.

4. Class IV: The patient has a unilateral edentulous area with natural teeth remaining only on the anterior region of the edentulous side. The posterior (back) section of the same side is missing, and there may or may not be teeth on the opposite side. This situation requires careful consideration for the design of the partial denture to ensure stability and retention.

Each class is further divided into subcategories (A, B, and C) to account for variations in the amount of remaining bone support and the presence or absence of undercuts, which are areas where the bone curves inward and can affect the stability of the denture.

- Class I (A, B, C): Variations in the amount of bone support and presence of undercuts in the fully edentulous arches.
- Class II (A, B, C): Variations in the amount of bone support and presence of undercuts in the edentulous area with natural teeth on the opposite side.
- Class III (A, B, C): Variations in the amount of bone support and presence of undercuts in the edentulous area with natural teeth on the same side, but not in the anterior region.
- Class IV (A, B, C): Variations in the amount of bone support and presence of undercuts in the edentulous area with natural teeth remaining only in the anterior region of the edentulous side.

Understanding a patient's Kennedy's Classification helps dentists and dental technicians to create well-fitting and functional dentures, which are crucial for the patient's comfort, speech, chewing ability, and overall oral health.

 
Prosthodontics

Bevels are the angulation which is made by 2 surfaces of a prepared tooth which is other than 90 degrees. Bevels are given at various angles depending on the type of material used for restoration and the purpose the material serves.

Any abrupt incline between the 2 surfaces of a prepared tooth or between the cavity wall and the Cavo surface margins in the prepared cavity

Bevels are the variations which are created during tooth preparation or cavity preparation to help in increased retention and to prevent marginal leakage.
It is seen that in Bevels Occlusal cavosurface margin needs to be 40 degrees which seals and protects enamel margins from leakage and the Gingival Cavo surface margin should be 30 degrees to remove the unsupported enamel rods and produce a sliding fit or lap joint useful in burnishing gold.

bevels
Types or Classification of Bevels based on the Surface they are placed on:

Classification of Bevels based on the two factors – Based on the shape and tissue surface involved and Based on the surface they are placed on –

Based on the shape and tissue surface involved:

1. Partial or Ultra short bevel
2. Short Bevel
3. Long Bevel
4. Full Bevel
5. Counter Bevel
6. Reverse / Minnesota Bevel

Partial or Ultra Short Bevel:


Beveling which involves less than 2/3rd of the Enamel thickness. This is not used in Cast restorations except to trim unsupported enamel rods from the cavity borders.

Short Bevel:

Entire enamel wall is included in this type of Bevel without involving the Dentin. This bevel is used mostly with Class I alloys specially for type 1 and 2. It is used in Cast Gold restoration

Long Bevel:

Entire Enamel and 1/2 Dentin is included in the Bevel preparation. Long Bevel is most frequently used bevel for the first 3 classes of Cast metals. Internal boxed- up resistance and retention features of the preparation are preserved with Long Bevel.

Full Bevel:

Complete Enamel and Dentinal walls of the cavity wall or floor are included in this Bevel. It is well reproduced by all four classes of cast alloys, internal resistance and retention features are lost in full bevel. Its use is avoided except in cases where it is impossible to use any other form of bevel .

Counter Bevel:

It is used only when capping cusps to protect and support them, opposite to an axial cavity wall , on the facial or lingual surface of the tooth, which will have a gingival inclination facially or lingually.

There is another type of Bevel called the Minnesota Bevel or the Reverse Bevel, this bevel as the name suggest is opposite to what the normal bevel is and it is mainly used to improve retention in any cavity preparation

If we do not use functional Cusp Bevel –

1. It Can cause a thin area or perforation of the restoration borders
2. May result in over contouring and poor occlusion
3. Over inclination of the buccal surface will destroy excessive tooth structure reducing retention

Based on the surface they are placed on:

1. Gingival bevel
2. Hollow ground bevel
3. Occlusal bevel or Functional cusp bevel

Gingival bevel:

1. Removal of Unsupported Enamel Rods.
2. Bevel results in 30Β° angle at the gingival margin that is burnishable because of its angular design.
3. A lap sliding fit is produced at the gingival margin which help in improving the fit of casting in this region.
4. Inlay preparations include of two types of bevel Occlusal bevel Gingival bevel

Hollow Ground (concave) Bevel: Hollow ground bevel allows more space for bulk of cast metal, a design feature needed in special preparations to improve material’s castability retention and better resistance to stresses. These bevels are ideal for class IV and V cast materials. This is actually an exaggerated chamfer or a concave beveled shoulder which involves teeth greater than chamfer and less than a beveled shoulder. The buccal slopes of the lingual cusps and the lingual slope of the buccal cusps should be hollow ground to a depth of at least 1 mm.

Occlusal Bevel:

1. Bevels satisfy the requirements for ideal cavity walls.
2. They are the flexible extensions of a cavity preparation , allowing the inclusion of surface defects , supplementary grooves , or other areas on the tooth surface.
3. Bevels require minimum tooth involvement and do not sacrifice the resistance and retention for the restoration
4. Bevels create obtuse-angled marginal tooth structure, which is bulkiest and the strongest configuration of any marginal tooth anatomy, and produce an acute angled marginal cast alloy substance which allows smooth burnishing for alloy.

Functional cusp Bevel:

An integral part of occlusal reduction is the functional cusp bevel. A wide bevel placed on the functional cusp provides space for an adequate bulk of metal in an area of heavy occlusal contact.

Mental Attitude of Patients for Complete Dentures
Prosthodontics

The mental attitude of patients towards complete dentures plays a significant role in the success of their treatment. Understanding these attitudes can help dental professionals tailor their approach to meet the needs and expectations of their patients. Here are the four primary mental attitudes that patients may exhibit:

1. Philosophical (Ideal Attitude)

  • Characteristics:
    • Accepts the dentist's judgment without question.
    • Exhibits a rational, sensible, calm, and composed disposition.
    • Open to discussing treatment options and understands the importance of oral health.
  • Implications for Treatment:
    • This type of patient is likely to follow the dentist's recommendations and cooperate throughout the treatment process.
    • They are more likely to have realistic expectations and be satisfied with the outcomes.

2. Indifferent

  • Characteristics:
    • Shows little concern for their oral health.
    • Seeks treatment primarily due to pressure from family or friends.
    • Requires additional time and education to understand the importance of dental care.
    • Their attitude can be discouraging to dentists, as they may not fully engage in the treatment process.
  • Implications for Treatment:
    • Dentists may need to invest extra effort in educating these patients about the benefits of complete dentures and the importance of oral health.
    • Building rapport and trust is essential to encourage a more proactive attitude towards treatment.

3. Critical/Exacting

  • Characteristics:
    • Has previously had multiple sets of complete dentures and tends to find fault with everything.
    • Often has high expectations and may be overly critical of the treatment process.
    • May require medical consultation due to previous experiences or health concerns.
  • Implications for Treatment:
    • Dentists should be prepared to address specific concerns and provide detailed explanations about the treatment plan.
    • It is important to manage expectations and ensure that the patient understands the limitations and possibilities of denture treatment.

4. Skeptical/Hysterical

  • Characteristics:
    • Has had negative experiences with previous treatments, leading to doubt and skepticism about the current treatment.
    • Often presents with poor oral health, resorbed ridges, and other unfavorable conditions.
    • May exhibit anxiety or hysteria regarding dental procedures.
  • Implications for Treatment:
    • Building trust and confidence is crucial for these patients. Dentists should take the time to listen to their concerns and provide reassurance.
    • A gentle and empathetic approach is necessary to help alleviate fears and encourage cooperation.
    • It may be beneficial to involve them in the decision-making process to empower them and reduce anxiety.
Laminate Veneer
Prosthodontics

Laminate Veneer Technique

The laminate veneer technique is a popular cosmetic dental procedure that enhances the esthetic appearance of teeth. This technique involves the application of thin shells of porcelain or composite resin to the facial surfaces of teeth, simulating the natural hue and appearance of healthy tooth structure.

Advantages of Laminate Veneers

  • Esthetic Improvement:

    • Laminate veneers provide significant esthetic enhancement, allowing for the restoration of teeth to a natural appearance.
    • When properly finished, these restorations closely mimic the color and translucency of natural teeth.
  • Gingival Tolerance:

    • Laminate restorations are generally well tolerated by gingival tissues, even if the contour of the veneers is slightly excessive.
    • Maintaining good oral hygiene is crucial, but studies have shown that gingival health can be preserved around these restorations in cooperative patients.

Preparation Technique

  1. Intraenamel Preparation:

    • The preparation for laminate veneers involves the removal of 0.5 to 1 mm of facial enamel.
    • The preparation tapers to about 0.25 to 0.5 mm at the cervical margin, ensuring a smooth transition and adequate bonding surface.
  2. Cervical Margin:

    • The cervical margin should be finished in a well-defined chamfer that is level with the crest of the gingival margin or positioned no more than 0.5 mm subgingivally.
    • This careful placement helps to minimize the risk of gingival irritation and enhances the esthetic outcome.
  3. Incisal Margin:

    • The incisal margin may end just short of the incisal edge or may include the entire incisal edge, terminating on the lingual surface.
    • It is advisable to avoid placing incisal margins where direct incising forces occur, as this can compromise the integrity of the veneer.

Bonded Porcelain Techniques

  • Significance:
    • Bonded porcelain techniques are highly valuable in cosmetic dentistry, providing a strong and durable restoration that can withstand the forces of mastication while enhancing the appearance of the teeth.
  • Application:
    • These techniques involve the use of adhesive bonding agents to secure the veneers to the prepared tooth surface, ensuring a strong bond and longevity of the restoration.