post insertion adjustment and follow up care
TRANSCRIPT
POST INSERTION ADJUSTMENT
The following may be required after cementation of the final restoration:
-Check the occlusion of the teeth making sure that they are in their correct intercuspation
-Remove again all existing premature contacts after the restoration has been seated completely
-Make sure the gingiva is not impinged
-Remove excess cements on the surrounding soft tissues to avoid inflammation
-Instruct the patient of the proper home care procedures
-Regular recall appointments are required to check the health of the tooth/teeth and surrounding structures
-Seek the attention of the dentist in cases of pain and discomfort after the final installation of the denture
FOLLOW-UP CARE
Well-organized and efficient follow-up care is the chief mechanism for ensuring successful fixed prosthodontics.
A restoration that is cemented, forgotten and ignored is likely to fail no matter how expertly it was designed and executed.
Restored teeth should require careful plaque removal and maintenance than healthy unrestored teeth. An FPD requires an additional care and attention.
Common Complications associated after Completion of the Treatment: (Post Insertion Problems)
dental caries periodontal failure/disease endodontic failure occlusal dysfunction loose retainers porcelain fracture fractured connector pain
DENTAL CARIES
Most common cause of failure of a cast restoration
Detection is difficult particularly where complete coverage is used
Undetected caries beneath this FPD
PERIODONTAL DISEASE
Often occurs after placement of fixed prostheses especially where the cavosurface margin is placed subgingivally or the prosthesis is over contoured
Inflammation is more severe with poorly fitting restorations but even perfect margins have also been associated with periodontitis
At recall appointments, attention is given to sulcular hemorrhage, furcation involvement and calculus formation as early signs of periodontal disease
Improper contoured restoration should be recontoured or replaced
OCCLUSAL DYSFUNCTIONAn examination of the occlusal surfaces
may reveal abnormal wear facets
Questions should be asked concerning any parafunctional habits such as BRUXISM
Abnormal tooth mobility is investigated and also muscle and joint pain
If a cast restoration is not designed according to neuromuscular and temporomandibular controls, extensive wear can result after a relatively short time.
PULP AND PERIAPICAL HEALTH Px may reveal having experienced one or
more episodes of pain which indicate the loss of vitality of an abutment tooth/teeth
Radiographs provide useful information as to the presence of periapical pathosis
Endodontically treated teeth should be examined radiographically every few years
PAIN
Should be examined as to its location, character, severity, timing and onset
Most oral pain is of pulpal origin
LOOSE RETAINERSUsually a sign of inadequate tooth
preparation, poor cementation technique or caries
In this case, the tooth/teeth require repreparation and a new prosthesis
The best policy is to section the prosthesis rather than attempt to remove it intact
(A) severe tooth destruction may result when a loose retainer goes undetected(B) looseness of one retainer can occasionally be observed directly (arrow) when force is exerted in an occlusal direction(C) water is then applied to the cervical area, and the diagnosis is confirmed if bubbles appear when pressure is exerted (D)
A B
C D
FRACTURED CONNECTOR
Px may complain varying degrees of pain due to extra force transmitted to the abutment teeth
Wedges can be used to separate individual components enough to permit the correct diagnosis
Fractured connector
FRACTURED PORCELAIN VENEERUsually related to faulty framework
design, improper laboratory procedures, occlusal functions or trauma
If porcelain has fractured but not missing on a satisfactory prostheses, repair than remake may be justified with a porcelain repair system utilizing silane coupling agents to promote bonding with acrylic/composite resin
Fractured porcelain
Repaired porcelain using acrylic/composite resin
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DR. VIVIAN C. CARLOSProsthodontics Section