The composite prosthesis:
- Introduction :
Attachments are part of the fixed prosthesis and the removable prosthesis (matrix in one and matrix in the other), we then speak of the notion of composite prosthesis
PPMA for patient (major concern): often cause (aesthetic) concern
PPMA for practitioner: large terminal endentement, managing aesthetic problems and imbalance (T duality)
Composite prosthesis treatment requires: milling + attachments
- Terminology:
Composite prosthesis = Hybrid, combined, mixed, removable-irremovable
English: fixed removable prosthesis
- Definition:
It is a prosthesis made up of 2 parts: a fixed prosthesis associated with a removable prosthesis connected by attachments which must be perfectly adapted.
- Composition :
Milling:
Coronoplasty => natural teeth
Milling => fixed prosthesis
These are geometric shapes (Modifies the morphology) PF according to Al chosen to integrate the metal elements (chassis).
Design obeys the imperatives of PPMA balances: nature and extent of the edentulism, DVO, available prosthetic space, RIM, analysis of the remaining teeth…
- Goals :
- Aesthetic
- Restore function.
- Distribute occlusal forces on residual and artificial teeth
- Preserve the biological integrity or improve the pathological state of the remaining elements
- Indications:
- Restoring decayed teeth within the scope of PPA
- Medium or large tooth extent
- Improved aesthetics and balance of the PPA
- Strength of support teeth before placing attachments
- Benefits :
- Aesthetics: absence of hooks
- Stability and retention = Putty efficiency
- Comfort & psyche: reduce the extension of the max base plate
- Disadvantages:
Cost: attachments, lab, steps…
Limited indication:
• Clinically: condition of the periodontium (loosening, denudation), distribution of remaining teeth, hygiene, etc.
• Non-clinically: cooperation, financial possibilities…
- Different type of composite pse:
- Simple composite prosthesis:
Mixed prosthesis whose joint part has milled fittings
- Main milling:
Mainly concerns the occlusal supports of the fixed elements, largely ensures the balance of the PPA
- Secondary milling:
Represented by: cingulate bar, wedging arm, coronal-cingulate bar, etc.
- Complex composite prosthesis:
Uses attachments as a means of union between 2 different prostheses
- The treatment plan:
- Analyze:
Clinical and complementary examination, understanding and designing
- To plan :
Simple, complex, pre-prosthetic treatment: conditioning, temporary prosthesis, etc.
- To treat :
Class function of tooth and antagonistic arch
- Maintain :
Function, aesthetics, comfort, hygiene…
- Therapeutic steps:
The fixed prosthesis always precedes the PPA (balance principles dictate the design).
- Pre-prosthetic stage: Comprises
- Arrangement of functional curves: Spee, Wilson…
- Study on parallelizer with a heated spatula to carry out the layout (Guide surface according to Al, milling, etc.)
- Mounting on articulator: study the inter-arch relationship and the mounting space (attachment type, wax-up, director mounting for removable prosthesis)
- Trace the chassis on the primary model to position the attachments and the milling
- Construction of the CCM bridge (female part included in the framework), PF completed: 2 options to consider:
- Immediate sealing: indications: Single crown and simple milling ( Impression for PPA taken after sealing and PAP carried out according to the classic steps
- Delayed sealing: indications: complex milling, multiple abutments, use of attachments
- Crown tried then fixed provisionally (temporary cement) to ensure their fixity during the impression
- Primary impression (bridge in place) to perform the PPA
- Secondary impression (bridge still in place), Kennedy and Applegate Class II cases
- Recording of intermaxillary reports (OIM, RC, etc.)
- Fitting test (including the calcinable part of the attachments), polymerization (attachments machined by brazing)
- Trying out the bridge and PPA (AI): then sealing the bridge
- All checks are required before the final sealing which takes place after the inspection.
- Conclusion :
Composite prosthesis is still a current therapy in the treatment of terminal edentulousness.
Success depends on careful planning and thought of treatment steps and close collaboration between practitioner and technician
Untreated cavities can damage the pulp.
Orthodontics aligns teeth and jaws.
Implants replace missing teeth permanently.
Dental floss removes debris between teeth.
A visit to the dentist every 6 months is recommended.
Fixed bridges replace one or more missing teeth.