π Prosthodontics
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.
Types or Classification of Bevels based on the Surface they are placed
on:
Classification of Bevels based on the two factors β Based on the shape and
tissue surface involved and Based on the surface they are placed on β
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 β
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 materialβs 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.
Impression Making Techniques
ProsthodonticsImpression making is a critical step in prosthodontics and orthodontics, as it captures the details of the oral cavity for the fabrication of dental prostheses. There are several techniques for making impressions, each with its own principles and applications. Here, we will discuss three primary impression-making techniques: Mucostatic, Mucocompressive, and Selective Pressure Impression Techniques.
1. Mucostatic or Passive Impression Technique
- Proposed by: Richardson and Henry Page
- Materials Used: Plaster of Paris and Alginate
- Key Features:
- Relaxed Condition: Records the oral mucous membrane and jaws in a normal, relaxed condition.
- Tray Design: Utilizes an oversized tray to accommodate the relaxed tissues.
- Tissue Contact: Achieves intimate contact of the tissues with the denture base, which enhances stability.
- Peripheral Seal: This technique has a poor peripheral seal, which can affect retention.
- Outcome: The resulting denture will have good stability but poor retention due to the lack of a proper seal.
2. Mucocompressive Impression Technique
- Proposed by: Carole Jones
- Materials Used: Impression compound and Zinc Oxide Eugenol (ZoE)
- Key Features:
- Functional Recording: Records the oral tissues in a functional and displaced form, capturing the active state of the tissues.
- Retention: Provides good retention due to the compression of the tissues during the impression process.
- Displacement Issues: Dentures made using this technique may tend to get displaced due to tissue rebound when the tissues return to their resting state after the impression is taken.
3. Selective Pressure Impression Technique
- Proposed by: Boucher
- Materials Used: Special tray with Zinc Oxide Eugenol (ZoE) wash impression
- Key Features:
- Stress Distribution: Loads acting on the denture are transmitted to the stress-bearing areas of the oral tissues.
- Tray Design: A special tray is designed such that the tissues contacted by the tray are recorded under pressure, while the tissues not contacted by the tray are recorded in a state of rest.
- Balanced Recording: This technique allows for a more balanced impression, capturing both the functional and relaxed states of the oral tissues.
Anatomy of Maxilary Edentulous Ridge
Prosthodontics
Anatomy of Maxilary Edentulous Ridge
LIMITING STRUCTURES
A) Labial & buccal frenum
- Fibrous band covered by mucous membrane.
- A v-shaped notch (labial notch) should be provided very carefully which should be narrow but deep enough to avoid interference
- Buccal frenum has the attachment of following muscles; levator anguli
- It needs greater clearance on buccal flange of the denture (shallower and wider) than the labial frenum.
B) Labial & buccal vestibule (sulcus)
- Labial sulcus is bounded on one side by the teeth, gingiva and residual alveolar ridge and on the outer side by lips.
- Buccal sulcus extends from buccal frenum anteriorly to the hamular notch posteriorly.
- The size of the vestibule is dependant upon:
i) Contraction of buccinator muscle.
ii) Position of the mandible.
iii) Amount of bone loss in maxilla.
C) Hamular notch
It is depression situated between the maxillary tuberosity and the hamulus of the medial pterygoid plate. It is a soft area of loose connective tissue.
- it houses the disto-lateral termination of the denture.
- Aids in achieving posterior palatal seal.
- Overextension causes soreness.
- Underextension poor retention
D) Posterior palatal seal area (post-dam)
It is a soft tissue area at or beyond the junction of the hard and soft palates on which pressure within physiological limits can be applied by a complete denture to aid in its retention.
Extensions:
1. Anteriorly – Anterior vibrating line
2. Posteriorly – Posterior vibrating line
3. Laterally – 3-4 mm anterolateral to hamular notch
SUPPORTING STRUCTURES
A) Primary stress bearing area / Supporting area
1. Posterior part of the palate
2. Posterolateral part of the residual alveolar ridge
B) Secondary stress bearing area / Supporting area
1. The palatal rugae area
2. Maxillary tuberosity
RELIEF AREAS
A) Incisive papilla
- Midline structure situated behind the central incisors.
- It is an exit point of nasopalatine nerves and vessels.
- It should be relieved if not, the denture will compress the nerve or vessels and lead to necrosis of the distributing areas and paresthesia of anterior palate.
B) Mid-palatine raphe
- Extends from incisive papilla to distal end of hard palate.
- Median suture area covered by thin submucosa
- Relief is to be provided as it is supposed to be the most sensitive part of the palate to pressure
C) Crest of the residual alveolar ridge
D) Fovea palatinae
Few areas like the cuspid eminence , fovea palatinae and torus palatinus may be relieved according to condition required.
Mental Attitude of Patients for Complete Dentures
ProsthodonticsThe 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.
