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Treatment plan of

The damage of tooth missing
When teeth are missing, the remaining ones can change
position, drifting into the surrounding space. Teeth that are
out of position can damage tissues in the mouth. In
addition, it may be difficult to clean thoroughly between
crooked teeth.
Missing teeth can affect your "bite" as well as your
ability to speak and chew. Their loss can increase the
burden on your remaining teeth and can cause muscle
pain in your jaws and headaches. And of course, losing a
tooth can affect your appearance.
Tooth Replacement

Usually, when you lose a tooth, it is best for your oral

health to have it replaced. Improving health by restoring
function is one of the main goals of the tooth replacement.

The good news is that, most of the time, replacing a

missing tooth is not an emergency. You have time to
consider what replacement option is best for you and make
an informed decision.
Replacement Options

1 、 Flipper (removable)

2 、 Removable Partial Denture(RPD)

3 、 Crown & Fixed Bridge

4 、 Complete Denture

5 、 Implant Denture
Flipper (removable)

A 'flipper' is a removable plastic tooth that is

inexpensive but fragile and temporary. So it is
uncommon in the clinical treatment.
Partial Denture
When a patient loses a tooth, or teeth, it is often
possible to replace the teeth by making a partial
denture. A partial denture is a device which
replaces the missing teeth on a framework with
clasps to hold onto existing teeth. Unlike a fixed
bridge, which is cemented in place, a partial
denture is removable and is a less expensive
The structure of removable partial
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teeth : porcelain tooth, resin tooth, resin tooth with cast occlusal surface

plate: which can be made of resin or cast metal

(1) the direct retainer: extra-coronal retainer; intra-coronal retainer. For example:
Clasp retainer, telescopic crown retainer, extra-coronal attachment

(2) the indirect retainer: intra-coronal attachment(belonging to precision attachment)

connector: palatal bar, lingual bar
The structure of removable partial

1.artificial teeth

2.base plate


Removable Partial Denture (cast )

A cast partial denture also is removable but is precision

cast in metal for a longer service life. Wire clips help hold
it in place.
Cast Partial Denture --removable
Principles of RPD design

In order for a RPD to function properly, certain

physics and engineering principles must be
applied to their design, and ultimately to the
abutment teeth.
The edentulous segment is bounded by remaining
teeth which are able to serve as abutments, the
functional stresses are passed on to the abutment
teeth through the base, minor connectors and
occlusal rests.
Principles of RPD design
We should choose healthy teeth as abutments,
especially the good periodontal tissue which has
enough amount of periodontal membrane attachment.
If abutment teeth are not good, we can enlarge the
base’s coverage. Given the stability achieved through
maximum coverage, the base aids in lessening the
twisting and/or tilting forces inherent in an extension
partial denture, thus minimizing the stress load which
reaches the abutment teeth.
Upper removable partial denture
Lower partial denture
Durable & Esthetic Thermoplastic
Removable Partial Denture

The base material has vivid color like truth mucosa

and high elasticity ,intensity which can substitute for
metal base and wire clasp.
Crowns & Bridges
In dentistry, crowns and bridges refer to the restoration of
natural teeth that have been damaged, decayed or lost. A
crown can be made to restore an individual tooth damaged
by decay or fracture back to it's original form and function,
while a bridge is used to replace one or more missing teeth.
These restorations are cemented onto the teeth and are
referred to as "fixed" dentistry as opposed to a restoration of
missing teeth with a removable appliance or partial denture.

A crown, generally called a "cap", covers

on a tooth completely to restore the tooth's
normal shape, size and function. When a
tooth has been severely decayed, cracked or
damaged, a crown is definitely needed.
Crown materials

Crowns are made by materials with large strength

and long durability, such as alloys of gold,
porcelain, acrylic, ceramic or other non-precious
metals, which can tolerate wearing and abrasion
and keep crown functioning.
The kinds of crowns
Full crown: 1. metal full crown 2. plastic full crown
3. Porcelain full crown
4. porcelain-fused-to- metal crown (PFM)
Partial crown: 1.three-quarter crown
2. veneer
3. half crown
Inlay : the prosthesis is inserted in the damaged tooth
Post crown:
Implant supported crown:
The procedures of forming a crown

1.The grinding and the preparation of damaged

tooth: in order to supply space for the artificial
The requirement of prepared space thickness:
1) casting full crown: 0.3-0.5mm
2) PFM crown: 1.2-1.7mm
3) ceramic crown: 1.2-1.5mm
The procedures of forming a crown
2. Impressing taking and pouring plaster model: aimed to duplicate
the situation of patient’s mouth , especially the prepared tooth.
3. The manufacture of the artificial crown: it is usually finished by
professional person in laboratory.
4. A temporary cap is placed over the prepared tooth during the
waiting time for the permanent crown..
5. The restoration is cemented onto the prepared tooth as a fixed

A full crown
This is an all-porcelain crown( its’color
is very vivid and shining like true tooth)

to provide mesio-
(MOD) restorations
Introduction of post crown

When teeth are heavily broken down, a

crown on its own may not be enough to
restore the tooth. And the teeth which have
been root-filled commonly fit in this
category. To help retain the crown a post is
placed inside the root canal.
The procedures of forming a post
The procedures of forming a post

A special drill is used to

remove the soft rubber root
filling to a point around 3mm
from the tip. This drill makes
a large diameter hole down
the middle of the tooth in
which the post will be fixed
The procedures of forming a post

Once the hole is prepared an

impression is taken. A special plastic
post is placed in the tooth and the
impression is taken. This plastic post
is matched to the special drill and
sticks in the impression when it is
The procedures of forming a post

The impression is cast up at

the dental laboratory in
stone and a metal post is
made. This is returned to
the dentist and then
cemented into the canal.
The procedures of forming a post

The upper artificial crown

is finished and cemented
onto the casting post which
had been fixed in the root
Fixed Bridge

Fixed bridge is cemented into place using crowns

or "caps" on the teeth adjacent to the open space
for support. Crown placement usually requires
removing or reducing the outer layer of the tooth.
In some cases, a 'Maryland' bridge, a fixed bridge
that does not need crowns, is glued onto the back
of the teeth adjacent to the space so that minimal
tooth structure is removed.
The principle of fixed bridge

When a patient loses a tooth, or teeth, it is often

possible to replace the tooth by placing a
permanent bridge. Much like a bridge over a
river, a dental bridge uses the existing teeth on
either side of the gap to suspend a replacement
tooth to fill the space.
The structure of fixed bridge

.abutment teeth: prepared


. retainers: artificial crowns

attached to the abutment

. bridge: restoration
connected with the retainers
to restore the lost teeth
Ideal abutment tooth
The ideal abutment tooth contains a vital pulp.It
must not be inferred from this that a treated
tooth with a properly filled root canal is not
suitable as a bridge abutment. Clinical evidence
indicates that in properly selected cases such
treated teeth have rendered years of valuable
service to the patient without any harmful
Ideal abutment tooth

To be suitable for use as a bridge

abutment , a tooth must have sufficient bulk
to withstand the forces to which it will be
subjected after the bridge is attached to it.
Ideal abutment tooth

In fixed partial denture prosthesis a large

proportion of the teeth receiving bridge
retainers are sound and noncarious;
occasionally a monocarious tooth is used.
Polycarious teeth, those with more than one
carious lesion, often restored with a
complete crown instead of with the intra-
coronal or partial veneer type of retainers.
Ideal abutment tooth

The ideal abutment is one which has normal

amount of periodontal attachment, alveolar
bone. However, in clinical patients, many
teeth lacking one-third to one-half of the
normal amount,when judiciously selected,it
is questionable whether such a tooth should
be used as an abutment.
The design and manufacture of fixed

The procedure involves two visits:

The first visit includes the preparation of the teeth
on either side of the gap, taking an impression of
the prepared area and making a temporary bridge.
The impression is then sent to a laboratory where
the bridge is made. Approximately three weeks
later, the patient comes in for the second visit,
when the permanent bridge is cemented.
Fixed Bridge

Figure 1 A patient with the

left second bicuspid

Figure 2 The losing tooth

had been restored by fixed
bridge ( It can be
manufactured with porcelain-
fused-to-metal material )
Fixed bridge
In the procedure of preparing tooth, we
should pay attention to the abraded tooth
tissue, not less or excessive. Cutting less
will not supply enough space for artificial
crown; cutting excessively will reduce the
force of retention. Especially the angle of
convergence should be proper (about 2-5
This maxillary central incisor had an all-porcelain crown
that dislodged just one year after initial insertion.

Reason : The tooth was prepared with an

excessive angle of convergence.
Figure 1: Dislodged anterior porcelain-fused-to-metal fixed partial denture
one year after initial insertion. The prosthesis is in excellent condition, but

the supporting structure had design errors.

Figure 2: The
abutment teeth supporting the fixed partial denture
shown in Fig. 1. Note the conical shape of the canine abutment
and the excessive angle of convergence of the incisor abutment
Figure 3: Followingcleaning, the surfaces of the abutment
teeth were etched with a phosphoric acid etchant gel for 20
Figure 4: Following etching of the abutment teeth, the surfaces were primed
with a dentin bonding agent. Note the shiny appearance of the dentin

surfaces after this step. The shine is a good indication of thorough priming
Figure 5: Post-operative view after cementation of the original
prosthesis with a resin cement. Note the excellent colour match.
Another reason for fixed denture failure

After the cementation of fixed denture,the

abutment teeth are likely to get secondary
caries because of marginal leakage or other
reasons. It leads to the incompatibility of
abutment teeth and retainer.
Bitewing radiographic image of mandibular second molar
tooth from which a crown dislodged. (caused by the mesio-
occusal defect)
The mandibular second molar shown in the former figure
after restoration with a resin composite material and
extending the original crown preparation subgingivally
The fabricated porcelain-fused-to-metal crown was
cemented with a resin cement following a bonding
procedure to enhance retention.

The occlusal surface of the crown had to be made in metal to

minimize occlusal reduction and thus maximize crown height.
A posterior porcelain-fused-to metal fixed partial denture
dislodged in this case due to recurrent caries in the mesial
Soft tissue ridge augmentation. Note the large hard and soft
tissue defect (arrow) due to traumatic loss of the upper left first
Full-mouth rehabilitation. Note collapsed bite, fractured teeth,
and worn/damaged restorations.

Treatment involved upper and lower functional crown lengthening

and new porcelain-fused-to-metal crowns.
Full-mouth rehabilitation.
The combination of fixed denture and
removable partial denture

Removable partial dentures replace some, but not

all, of the teeth in a dental arch. They are made of
a cobalt-chrome metal skeleton to which is
attached artificial teeth. The prostheses are of
varied designs, some of which are pictured here.
Upper Partial Denture replacing back teeth and connected
to fixed bridge in the front. Patient is also wearing a lower

partial denture .
Upper partial denture replacing several missing
teeth and anchored onto crowns and a bar.
Upper partial denture retained by a connector bar on
patient’s right.
Complete Denture
Complete dentures or 'plates
are the traditional solution for
people who have lost all their
teeth in one or both jaws.
The success of a complete
denture depends upon the
individual's jaw size and
shape, his or her oral habits,
and his or her adaptability.
Some people adapt well to
dentures, while others are not
able to adapt.
The function of complete denture

A denture helps you to properly chew food,

a difficult task when you are missing teeth.
In addition, a denture may improve speech
and prevent a sagging face by providing
support for lips and cheeks.
The structure of full dentures

the upper full denture • the lower full denture

The requirements of complete denture

Superior aesthetics:
An excellent complete denture can mimic
a patient’s true teeth and reduce his
awkwardness caused by teeth loss.
Proper functions:
The patient can be accustomed to them
quickly with practice and can speak and eat
without any difficulty.
Personalized Cosmetic Dentures
with Plastic or Porcelain Teeth
The lateral appearance of a patient with
complete denture

Before treatment After treatment

The frontal appearance

Original Facial
Appearance Changes
The smiling appearance

Before treatment After treatment

Dental Implants

Dental Implants can be used to provide support for

the replacement of one tooth or all of an
individual's teeth. After years of research and
clinical trials, we can now provide this option in
addition to the traditional treatments just
described. Implant-supported teeth can be
cemented, screwed-retained, or removable and can
be made attractive, stable, and comfortable for
almost any patient.
Basics About Implant Dentistry

Implants can be used to replace missing teeth:

ranging from a single missing tooth, to securing a
full set of replacement teeth for denture wearers.
The results are dramatic in terms of comfort,
ability to chew effectively, natural esthetics,
health, and self-confidence .
Components of implant denture

1. Implant: planted in the alveolar

bone. According to the material of
implant , it can divided into metal
implant, ceramic implant,
composite implant, and so on.
2. Implant superstructure: crown or
removable partial denture or
complete denture connected with
the implant. Including: fixed
implant superstructure; removable
implant superstructure.
Figure 1 Temporary removable partial denture,
constructed of acrylic, provides interim esthetics but limited
Figure 3 A resin bonded fixed partial denture relies on the
bond strength of resin between enamel and the base metal
Figure 2 Traditional fixed partial denture firmly replaces
a missing tooth but requires the removal of enamel from
adjacent healthy teeth.
Figure 4 State-of-the-art replacement of a traumatically lost tooth
relies on osseointegration of a Branemark implant in the alveolus
followed by the placement of a ceramic crown.
One great advantage to the implant is that
the healthy,adjacent teeth do not have to be
prepared (ground down) or be connected
together. Therefore, as far as esthetics or
function is concerned, it is more like the
true tooth.
DENTAL IMPLANTS-- Different Types

Types of Prosthesis Depending on your needs, a

prosthesis can replace one or more teeth. The
number of implants you'll need depends on
whether you're having a partial , complete denture,
or single prosthesis made. The more teeth being
replaced, the more implants your prosthesis
requires. These implants are placed to follow the
shape of your jaw.
Single Prosthesis

This type of
prosthesis is used
to replace one or
two missing teeth.
Each prosthetic
tooth attaches to
it's own implant.
Partial Prosthesis

This type of prosthesis

can replace two or
more teeth. It is the
most commonly
performed implant
procedure, and may
require only two or
three implants
Partial Prosthesis
Complete Denture Prosthesis

This type of prosthesis

replaces all the teeth in
your upper or lower
jaw. The number of
implants varies,
depending on the type
of prosthesis you
Implants can be used to support a full set of
replacement teeth
Above is the preoperative view of the mandibular arch.
Below, the Hader Bar is attached to the implants.
The final denture with Hader Clip inside
The final denture with Hader Clip
The patient receives
the completed case.
Who needs a denture?

Candidates for complete dentures have lost most or all of

their teeth. A partial denture is suitable for those who have
some natural teeth remaining. While missing one or two
adjacent teeth can often be best restored with a fixed or
cemented bridge, partial dentures work best to replace
multiple missing teeth. A denture improves chewing
ability and speech, and appearance and smile.
How do you care for a denture?
A denture is fragile, so it is important to handle it with
care. Remove and brush the denture daily, preferably with
a brush designed specifically for cleaning dentures, using
either a denture cleanser or toothpaste. Never use harsh,
abrasive cleansers, including abrasive toothpastes, because
they may scratch the surface of the denture.
When not in use, soak it in a cleanser solution, diluted
mouthwash or in water.
Will it be difficult to wear a full or
partial denture?

 Both full and partial dentures require time for you to

adapt. Often several adjustment are required to get the
fit exactly right. Because different thickness of gum
tissue compress differently, small "sore spots" may
develop as the denture rests upon your gums. Please
call and come in for included adjustments to the
Must I do anything special to take care of
my mouth?

Brushing twice a day and cleaning between your teeth

daily help prevent tooth decay and gum disease that can
lead to tooth loss. Pay special attention to cleaning teeth
that fit under the denture's metal clasps. Plaque that
becomes trapped under the clasps will increase the risk
of tooth decay. We will demonstrate how to properly
brush and clean between teeth. Selecting a balanced diet
for proper nutrition is also important.
Help people
keep from the
sorrow of
tooth loss and
live with
smile for ever