Prosthodontics

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Fixed Prosthodontics

(Standards of Care)

A. Medical-Dental History and Treatment Plan:

A thorough and complete medical and dental history is obtained from the patient and the patient's dental record to include required medical and/or dental consultations. Any medical or dental conditions are considered in the treatment plan. The plan is based on sound prosthodontic procedures. The resident is technically capable of completing the proposed plan with staff supervision. The patient is in agreement with the plan and understands the time required to complete it.

B. Diagnostic Casts:

Are accurate, clean, bubble-free reproductions of the existing dental anatomy. Casts should be properly related on an appropriate articulator.

C. Anesthesia:

Local anesthetic should be administered correctly, gently, and in proper amounts so that the prosthodontic procedure can be completed in a pain free environment.

D. Preparations:

Should be completed to provide for proper retention and resistance form and to provide adequate thickness of metal and/or porcelain to develop optimal occlusion, contours, and esthetics.

E. Retraction:

Retraction of soft tissues should be accomplished gently with a minimal of trauma to the gingival tissue. All tooth margins should be exposed and all hemorrhage controlled.

F. Final Impressions:

Must have an accurate, non-distorted reproduction of all required dental structures with clearly defined, void-free margins of all tooth preparations.

G. Jaw Relation Records:

Records should accurately reproduce centric relation occlusion when working casts are articulated. Records should be of an appropriate material to allow handling by laboratory personnel without distortion or fracture.

H. Provisional Restorations:

Provisional crowns or fixed partial dentures of an acceptable material should be placed on all preparations to cover exposed dentin. Contours and contacts should promote gingival health and maintain tooth position. Occlusion should be comfortable and adequate to prevent eruption of opposing dentition or preparations. Esthetics of anterior provisional restorations should be acceptable within the limitations of the material used.

I. Laboratory Procedures:

  1. Working casts should be trimmed, smoothed, and free of all bubbles and voids. Land areas of working casts should be trimmed and rounded.
  2. Dies are to be trimmed in a manner prescribed by the Fixed Prosthodontic mentor in order to expose and clearly delineate all margins. Margins are to be marked with red pencil. Die spacer in the appropriate thickness should be applied to all dies to within 1mm of the margin. Casts should be articulated prior to placing die spacer when an interocclusal record is used.
  3. Articulating Indices: All jaw relation records should be trimmed so that cusp tips only occlude with the record and in such a way that the laboratory technician can assure that all teeth fit the record. Occlusal indices should be marked on both maxillary and mandibular casts with colored pencil or cut with a separating disk.
  4. Prescription Forms: All laboratory prescription forms should be completed to include appropriate information. All prescription forms going to another laboratory must be countersigned by a prosthodontic mentor and logged in.

J. Try-In:

  1. Margins: All crown margins should be closed as is reasonably and clinically detectable by use of an explorer.
  2. Contours: All crown contours should replicate the patient's ideal natural tooth as closely as possible. Crowns should be measured buccal-lingually and cusp to cusp to prevent overcontouring.
  3. Contacts: Contact should not allow the easy passage of dental floss. Lack of contact (if applicable) constitutes a remake or the addition of porcelain or solder.
  4. Occlusion: All restorations should restore the proper occlusal plane of the patient. This may include recontouring or restoration of the opposing dentition or prostheses. All prostheses should contact in centric occlusion or maximum intercuspation to hold shim stock (12mu) firmly. All non-restored teeth both ipsilateral and contralateral should also hold shim stock firmly. Restorations should be free of lateral interferences in accordance with the patient's occlusal scheme, i.e., group function, canine disclusion, etc.
  5. Shade: Porcelain shades should be esthetically acceptable to the patient.
  6. Porcelain Characterization: Extrinsic coloration will be added to porcelain restorations as required to more closely match the natural dentition. Porcelain restorations should be glazed without vacuum to the appropriate smoothness and finish and match the patient's dentition. Porcelain may be polished instead of glazed in small areas.
  7. Polish: All metal surfaces are to be free of scratches and oxidation, and be smoothed and highly polished prior to cementation.

K. Cementation:

Final restorations are to be cemented with an appropriate cement as outlined by the mentors. All excess cement must be removed prior to dismissal of the patient.

L. Patient Management:

All patients in Prosthodontics should be treated in accordance with the highest professional standards. Derogatory comments or negative comments will not be made. Any questions concerning patient treatment should be discussed in private with the appropriate mentor.

M. Time Management:

Residents should pre-plan all prosthodontic treatment prior to their rotation day. Residents should arrive on time, begin treatment promptly, and complete treatment in an expeditious manner. All laboratory procedures should be accomplished to allow the laboratory technicians ample time to meet the delivery date.

N. Standards of Care:

All patients will be evaluated using the appropriate standards of care form.

Fixed Prosthodontics Standards of Care Evaluation Form