General Dentistry
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| Schematic diagram showing implant components and how a crown is placed on implant which in turn placed in a bony socket in the jaw bone |
People often ask me; can I get a fixed artificial teeth? While most of the time, they can get it, but in few unfortunate one, it remained impossible to provide a fixed partial denture due to their unfavourable oral conditions. In those cases, we suggest them, “you should take an implant supported prosthesis”.
A crown is provided to protect the weakened natural tooth, regain its shape, maintain or enhance the esthetics and regain the functional ability of a person. A bridge is a prosthesis that is constructed to replace the one or more missing teeth and is supported by the neighbouring teeth.
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| A posterior tooth prepared for full crown (pink area) B-Buccal aspect, L-Lingual aspect |
They can be constructed in variety of the materials as follows:
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| Schematic diagram showing implant components and how a crown is placed on implant which in turn placed in a bony socket in the jaw bone |
Implant supported prostheses that include over-dentures, crowns and bridges are the treatment of choice in modern dentistry. They are very predictable in nature and have a track record of very successful life span serving their purpose. But, there are certain conditions where the dental implants cannot be provided due to the inherent nature of the disease. The implant supported prostheses are contraindicated in the following conditions:
To read about new blueprint of ADC exam click HERE.
Domain 6. Patient Care
6.1 Clinical Information Gathering
It covers the collection and recording of information that is necessary and relevant.
As an Australian dentist you must be able to:
1. obtain and record a relevant history of the patient’s medical, social and oral health status
2. perform an examination for health, disease and abnormalities of the dentition, mouth and associated structures
3. select necessary clinical, pathology and other diagnostic procedures and interpret results
4. take radiographs relevant to dental practice
5. evaluate individual patient risk factors for oral disease
6. maintain accurate, consistent, legible and contemporaneous records of patient management and protect patient privacy
6.2 Diagnosis and Management Planning
It covers the identification of disease or abnormalities that require treatment or investigation As an Australian dentist you must be able to:
1. recognise health as it relates to the individual
2. diagnose disease or abnormalities of the dentition, mouth and associated structures and identify conditions which require management
3. determine the impact of risk factors, systemic disease and medications on oral health and treatment planning
4. formulate and record a comprehensive, patient-centred, evidence-based oral health treatment plan
5. determine when and how to refer patients to the appropriate health professional
6. obtain and record patient informed consent and financial consent for treatment
6.3 Clinical Treatment and Evaluation
It covers the provision of evidence-based patient-centred care.
As an Australian dentist you must be able to:
1. apply the principles of disease and trauma prevention and early intervention in the management of the dentition, mouth and associated structures
2. apply the principles of behaviour management
3. manage a patient’s anxiety and pain related to the dentition, mouth and associated structures
4. manage surgical and non-surgical treatment of diseases and conditions of the periodontium and supporting tissues of the teeth or their replacements
5. manage surgical and non-surgical treatment of pulp and periapical diseases and conditions with endodontic treatment
6. manage the loss of tooth structure by restoring the dentition with direct and indirect restorations
7. utilise patient removable prostheses to rehabilitate, restore appearance and function, prevent injury and stabilise the occlusion
8. utilise fixed prostheses to rehabilitate, restore appearance and function and stabilise the occlusion
9. manage oral conditions, pathology and medically related disorders and diseases associated with the dentition, mouth and associated structures
10. manage skeletal and dental occlusal discrepancies
11. manage the removal of teeth and oral surgical procedures
12. administer, apply and/or prescribe pharmaceutical agents
13. evaluate and monitor the progress of treatment and oral health outcomes
14. manage dental emergencies.
15. manage medical emergencies.
Dentists often encounter cancer patients, who are to undergo radiotherapy or have received it in the recent past. Besides cancer therapy, these patients need dental treatment for different ailments. Therefore, it becomes paramount important for a dentist to know the effects of large doses of ionizing radiation on oral mucosa.
In this section, we shall talk about the effects of radiation on oral tissues.
The pontic, \pŏn΄tĭk\, is an artificial tooth on a fixed partial denture that replaces a missing natural tooth, restores its function, and usually restores the space previously occupied by the clinical crown. An ideal correctly designed posterior pontic should have the following features.
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| Figure 1. Schematic presentation of various pontic designs; (a) Sanitary pontic; has no contact with the edentulous ridge, (b) ridge lap pontic; forms a large concave contact replacing the contours of a missing tooth, (c) modified ridge lap; shows illusion of a tooth but it has all or nearly all convex surfaces for easy cleaning and minimize plaque accumulation, (d and e) bullet/conical; rounded and cleanable smaller tip in relation to overall size, (f) ovate; round end design currently in use where aesthetics is a primary concern[1]. |
The Pontic design can be classified into two types:
A. Pontic having mucosal contact
B. Pontic with no mucosal contact
Sanitary or Hygienic Pontic or Fish-Belly
Sanitary pontic makes no contact with the edentulous ridge. It is made in an all-convex configuration, facio-lingually and mesio-distally. The space between the pontic and the mucosa should be 2 or 3 mm [2]. It is the most commonly used mandibular molar replacement pontic design. It has the advantage of providing good access for maintaining hygiene with the disadvantage of poor esthetic.
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| Sanitary pontic design |
Modified Sanitary
The tissue facing surface of the modified sanitary design pontic has a hyperbolic parabola. The pontic is designed as a concave archway mesio-distally while the under surface is convex facio-lingually. It is indicated in molar replacement, provides access to the under-surface for good hygiene, along with poor esthetic.
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| Modified sanitary pontic design-note the concavity at the cervical region. |
Saddle/Ridge Lap
It looks like crown of the tooth because it replaces all the contour of the missing tooth. It maintains a large concave contact with the underlying ridge and obliterates facial, lingual and proximal embrasures. Esthetic wise it provides the best result but due to impossible access to under-surface for cleaning, its use is limited for the replacement of maxillary incisors.
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| Saddle/ridge lap pontic design |
Modified Ridge Lap
The modified ridge lap combines esthetic with easy cleaning and makes contact with ridge tissues in the shape of ‘T ‘ whose vertical arm ends at the crest of the ridge. This design is most commonly used in the area of the mouth that is visible during function, e. g. anterior teeth, premolars and sometimes maxillary molars.
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| Modified ridge lap pontic design: note the half concave underneath surface in contact with mucosa. |
Conical
Conical pontic design is mostly limited to the replacement of thin knife edged ridges in the non-display zone of the mouth. It has a convex surface with only touching the center of the residual alveolar ridge. It helps maintain good hygiene with poor esthetic. Conical design is indicated for the replacement of molars.
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| Image of conical pontic design- note the egg shaped design in green circle. |
Ovate
Ovate pontic design is the most aesthetically suitable appealing design that looks like emerging from the gingiva. When ridge resorption is corrected by ridge augmentation, ovate design appears to be emerging through gingiva just like natural tooth. it is indicated for the replacement of maxillary incisors, canines, and premolars. It has the advantage of best esthetic, negligible amount of food entrapment and easy cleaning. The disadvantage is the requirement of surgical preparation of the receiving site before prosthesis fabrication.
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| Ovate pontic design-note the convex under-surface of pontic embedded in mucosa (green circle). |
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