Concise Prosthodontics

SECOND EDITION

Vijay Prakash BDS, MDS, FPFA,

FICD

PROFESSOR, Department of Prosthodontics and Implantology, Divya Jyoti

College of Dental Sciences and Research, Modinagar (UP), INDIA

Ruchi Gupta BDS, MDS, FPFA, FICD

PROFESSOR, Department of Conservative Dentistry and Endodontics,

Divya Jyoti College of Dental Sciences and Research, Modinagar (UP),

INDIA

Table of Contents

Cover image

Title page

Copyright

Dedication

Preface to the second edition

Preface to the first edition

Acknowledgements

SECTION I. Complete Dentures

1. Introduction to edentulous state

Introduction

Parts of complete denture

Residual ridge resorption

Importance of temporomandibular joint in complete dentures

Role of TMJ in biomechanical phase of the prosthetic rehabilitation

Importance of patient motivation and patient education

Patient motivation and education

2. Diagnosis and treatment planning for edentulous patients

Introduction

Mental attitude of the patient

House classification

Extraoral examination

Neuromuscular examination

Intraoral examination

Ageing

Gag reflex

Role of saliva

Pre-extraction records and their importance

Radiographic evaluation

Nutritional requirement of edentulous patients

Role of nutrition in prosthodontics

3. Mouth preparation of complete denture patients

Introduction

Nonsurgical methods

Preprosthetic surgery

Resilient liners

Role of tissue conditioners

4. Impressions in complete dentures

Introduction

Impressions

Retention

Stability

Support

Impression techniques

Biological consideration in maxillary impressions

Relief areas

Postpalatal seal

Biological considerations in mandibular impressions

Relief areas

Primary impression

Primary cast

Custom tray

Border moulding

Secondary impression or wash impression

Impression materials

5. Articulators and facebows

Introduction

Mandibular movements

Envelope of motion of the mandible

Facebow

Importance of anterior and posterior reference point

Hinge axis

Articulators

Split cast method and its importance

Bennett movement

6. Maxillomandibular relationship

Introduction

Record bases

Occlusal rims and their importance

Physiological rest position

Vertical jaw relation

Freeway space or interocclusal rest space

Silverman’s closest speaking space

Effects of altered vertical dimension

Horizontal jaw relation

Eccentric jaw relations

7. Selection and arrangement of teeth

Introduction

Denture aesthetics

Pre-extraction records

Evolution of anterior teeth selection

Posterior teeth selection

Arrangement of the anterior teeth

Arrangement of the posterior teeth

Principles of arranging teeth

Modiolus

Phonetics

8. Concept of occlusion

Introduction

Evolution of anatomic and semi-anatomic teeth

Evolution of nonanatomic teeth

Complete denture occlusion

Lingualized occlusion concept

Neutrocentric occlusion or monoplane occlusal scheme

Spherical occlusion

Balanced occlusion

Types of teeth (table 8.2)

9. Wax try-in and laboratory procedures

Introduction

Wax try-in

Flasking procedure

Wax elimination

Packing

Processing of denture

Deflasking of the denture

Laboratory remount procedure

Finishing and polishing of complete dentures

10. Insertion and troubleshooting in complete denture prosthesis

Introduction

Denture insertion

Clinical remount procedure

Selective grinding

Intraoral methods to correct occlusal disharmony

11. Relining and rebasing

Introduction

Rationale for relining complete dentures

Problems associated with relining procedures

Preparation of the tissues

Preparation of dentures

Techniques of relining

Rebasing

12. Single complete dentures and immediate dentures

Introduction

Immediate dentures

Combination syndrome

Single complete dentures

Techniques to modify natural teeth

13. Overdentures

Introduction

Overlay dentures or overdentures

Preventive prosthodontics

Attachments in overdenture design

Maintenance of overdentures

SECTION II. Removable Partial Dentures

14. Introduction to removable partial dentures

Introduction

Classification

Indications and contraindications of RPD

Classification of partially edentulous arches

15. Diagnosis and treatment planning

Introduction

Objectives of prosthodontic treatment for a partially edentulous patient

Importance of medical condition of patient before oral examination

Diagnostic cast and its importance

Importance of radiographs in removable prosthodontics

Splinting and its role in prosthodontics

16. Components of removable partial denture

Introduction

Internal and external finish lines in relation to minor connectors

Rests and rest seat

Direct retainers and intracoronal retainers

Clasp assembly

Circumferential clasp

Gingivally approaching clasp

RPI and RPA concept

Indirect retainers and their importance in distal extension cases

Denture base and functions of distal extension partial denture base

17. Principles of RPD design

Introduction

Surveyor and surveying

Methods of stress control in RPD

Shortened dental arch concept

18. Mouth preparation in RPD

Introduction

Objectives of mouth preparation and preprosthetic phase of mouth preparation

in partially edentulous patients

Prosthetic phase of mouth preparation in partially edentulous patients

Preparation of the guiding planes

19. Impression making in removable partial denture

Introduction

Impression making in tooth-supported partial denture cases

20. Laboratory procedures, occlusal relationship and postinsertion of

removable partial denture

Introduction

Steps involved in the fabrication of cast partial denture

Methods of establishing occlusal relationship for partial dentures

Aesthetic try-in in removable partial dentures

21. Insertion, relining and rebasing

Introduction

Troubleshooting during metal try-in and fitting of the framework in patient’s

mouth

Postinsertion instructions to the partial denture patient

Insertion and postinsertion problems and their management in relation to RPD

Relining of RPD

Special removable partial dentures

SECTION III. Fixed Partial Dentures

22. Introduction to fixed prosthodontics

Introduction

Fixed dental prosthesis

23. Diagnosis and treatment planning in fixed partial denture

Introduction

24. Design of fixed partial denture

Introduction

Different designs in fixed prosthodontics

Laminate veneer

Rationale of restoring an endodontically treated tooth and ideal requirements

of post

Ferrule

Resin-bonded bridge

25. Clinical crown preparation in fixed prosthodontics

Introduction

Finish lines

Porcelain jacket crown

Preparation of full cast crown

Preparation for partial veneer crown

Preparation for PFM crown

26. Impressions in fixed partial denture

Introduction

27. Provisional restoration

Introduction

28. Occlusion relationship

Introduction

Different concepts of occlusion in fixed prosthodontics

Bilateral balanced occlusion

Unilateral balanced occlusion or group function

Canine-guided occlusion or mutually protected occlusion or organic occlusion

Functionally generated pathway

Pros and cons of semi-adjustable articulators in fixed partial denture

Fully adjustable articulators and their utility in FPD with multiple abutments

Pathological occlusion

Splints

Myofascial pain dysfunction syndrome

Occlusal therapy in fixed prosthodontics

29. Laboratory procedures in fixed prosthodontics

Introduction

Dies and various materials used for making dies

Alloy and historical perspective of dental casting alloy

Shade selection for the patient requiring FPD

Dentist–technician inter-relationship—important key to success in fixed partial

denture

30. Finishing and cementation

Introduction

Commonly used abrasives and polishing agents

Biocompatibility of various dental cements used in fixed prosthodontics

Failures in fixed partial denture (FPD)

SECTION IV. Maxillofacial Prosthodontics

31. Introduction and materials

Introduction

Effect of radiation on the oral cavity

Evolution of maxillofacial prosthesis

Materials used in prosthetic restoration of the facial defects

Stents and splints used in maxillofacial prosthesis

32. Maxillofacial defects and prosthesis

Introduction

Cleft lip and palate

Mandibular defects

Extraoral prosthesis

Retention aids in maxillofacial prosthesis

SECTION V. Implant Dentistry

33. Diagnosis and treatment planning

Introduction

Dental implant and its scope and limitations

34. Osseointegration and materials

Introduction

Osseointegration

Healing process in dental implants

35. Surgical and prosthetic phase

Introduction

Implant abutment

Implant failures and their management

Immediate loading of implants

Question bank

Suggested readings

Index

Copyright

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Concise Prosthodontics, 2e, Vijay Prakash & Ruchi Gupta

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Dedication

With Blessings of Lord Ganesha

Dedicated to

my late father Shri CP Gupta

&

to our two angels Dhaanvi and Keshav

Preface to the second edition

Vijay Prakash, Ruchi Gupta

It gives us great pleasure and at the same time significant

responsibility to bring the second edition of our book on

Prosthodontics. Through our teaching experience and interaction with

undergraduates, postgraduates and fellow practitioners, we found

that understanding of Prosthodontics is often complex and

challenging. We believe that it is one subject which should be taught,

read and understood three dimensionally. We have attempted to

demystify the subject and have written in easy-to-understand format.

In this edition, the book is redone to shape into concise textbook form

that have plenty of flowcharts, illustrations, line diagrams and tables.

Another distinctive feature is that the book is in full colored version

that includes updated text and diagrams for better understanding of

the subject. The coloured line diagrams will aid in having better visual

impact and clarity to the students.

This book is divided into five sections, each section is dedicated to

each branch of Prosthodontics. These five sections include: Complete

Denture, Removable Partial Denture, Fixed Partial Denture,

Maxillofacial Prosthodontics, and Implantology. Each section is

written in such a format that it covers the entire syllabus laid down by

the Dental Council of India (DCI). Within the scope of the book, latest

topics such as CAD– CAM in dentistry, porcelain laminates and

immediate loading implants have been covered. At the end of each

chapter, Key Facts provided which will help the students preparing

for the entrance examinations and viva-voce. At the end of Section V,

Question Bank is given as Appendix. This question bank will expose

students to variety of questions usually asked in various university

examinations at both undergraduate and postgraduate level.

Finally we consider our privilege to share our knowledge and

experience over the years with the budding dentists. We sincerely

hope newer generation of dentists will continue to inspire and

innovate methods to improve patient care and take our profession to

newer heights.

You can refer the front inner cover of the book to explore online

additional reading material. Besides these, you will get access to the

complimentary e-book also.

Preface to the first edition

Vijay Prakash, Ruchi Gupta

It gives us a sense of immense pleasure and pride to bring out the

Prosthodontics: Exam Preparatory Manual for Undergraduates. The

understanding of prosthodontics with its variations can be complex

and challenging especially considering the rapid advancements in the

technology and newer materials. Students often complain about the

lack of understanding in one or more areas of this subject.

This book is divided into five sections and each section is dedicated

to an individual branch of prosthodontics. It is delibrately written in

the question–answer format so that the students can understand,

remember and reproduce it in the examination. The answers are

accompanied by line diagrams for better understanding and

reproducibility. In the entire book only line diagrams are given so that

the students can easily grasp and redraw in the examination. Attempt

has been made to keep the answers as simple, comprehensive and at

the same time complete. We have referred to a number of textbooks

and journals to comprehensively provide relevant answers to the

questions. We have included Key Facts in every chapter and have also

provided a Question Bank at the end of the book for the complete

preparation for the examination.

Although we have made all attempts to cover almost all the

syllabus laid down by the Dental Council of India but still we

recommend the students to read the standard textbook along with this

manual. This book is not meant to replace but to complement the

standard textbook.

Finally, we sincerely hope all the readers will benefit from this

book. We wish the students all success in life and sincerely advice

them with this success mantra—

“Life’s battles don’t always go to the stronger and the faster man,

But sooner or later the man who wins is the man who thinks he

can”.

Acknowledgements

We wish to express our gratitude to the Almighty for bestowing his

grace on us to accomplice this book. Accomplishment of any work

requires the efforts of number of people and this is no exception.