Fundamentals of Treatment Planning. Lino Calvani
are accessible to excellent oral and dental hygiene;
● are simple and easily repairable;
● last as long as possible;
● cost the least amount of money.
Current main prosthodontic tools
Table 3-1 outlines the main categories of prosthodontic tools in use today. This should be seen in light of the recent progress that has taken place in the prosthodontic field due to the modern technological revolution.
Table 3-1 Outline of the most important prosthodontic tools currently in use today
Fixed restorations
1. Inlays, onlays
2. Veneers
3. Crown, bridges, post and cores
4. Full-arch fixed complete prostheses
Removable partial dentures
1. Tooth-borne prostheses
2. Tooth- to mucosa-borne prostheses
Complete dentures
1. Immediate prostheses
2. Final prostheses
Overdentures
1. On some remaining portion of roots
2. On well-positioned implant
Fixed implant-retained prostheses
1. Partial implant prostheses
2. Following the prolonged use of complete dentures (CDs)
3. Following extractions, immediate CDs, and delayed implant placement
4. Following extractions and immediate implant placement
Bioinformatics and digital prosthodontic tools
1. Computer-aided implantology
2. Computer-aided prosthetic designing and planning
3. Precise guided implant positioning
Fixed prostheses such as crowns and bridges are termed fixed partial dentures (FPDs) or fixed complete dentures (FCDs), depending on their extension and abutment involvement.2
Fixed prostheses are considered a dream tool for prosthodontists because they are the best and most natural restorations.3 The naturalness of the final result depends on a number of clinical and technical factors such as laboratory materials, technical possibilities, professional skills, and artistic dexterity.4-8 Fixed prostheses are used all over the world and are fabricated from various materials, including gold, depending on factors such as culture and esthetics.5,9 Their manufacture follows rules imposed by ongoing research, especially that which is occurring in the field of digital technology.
The use of fixed restorations for endodontically treated teeth depends on the amount of the remaining tooth structure and on well-established principles of tooth preparation.5,6,8,10-12,19 Even though great improvement has taken place in this respect with resin adhesive rehabilitations,11-13 cast post and cores still show superior physical and biomechanical capabilities to withstand vertical and lateral loads as well as decementation.5,6,8,12,14-25
Nowadays, other new fixed prosthodontic methods, born as a result of and crafted with the help of new digital technologies, are revolutionizing the clinic and laboratory. And this is just the beginning, as much more is expected with the current speed of exponential progress and growth in this field.26
Today, in the case of edentulism where there is one or more missing teeth, implants are usually considered as the first option during treatment planning for fixed restorations, unless physical, biological, biomechanical, psychologic or economic limitations and/or contraindications are present.27-33 Where implants are not indicated due to their negative biological, functional, and esthetic possibilities or the chance of predictable short- or long-term complications,34 tooth-borne FPDs and FCDs are considered the secondary restorative tool, with pontic elements replacing the edentulous areas.
Removable partial dentures (RPDs) are generally considered the third restorative option in the western world. However, in many other countries worldwide they are considered to be the first choice. RPDs can be very helpful in various partially edentulous cases, depending on the patient’s chief complaint, desire, and financial situation.35-37 The relatively lower cost of these prostheses is a major factor of choice, despite the difficulty in planning them biomechanically and the inevitable clinical limitations that their unnatural composite structure introduces into the masticatory environment.38-48 This fact should spur us on to deliver a biomechanically well-conceived project in order not to damage the remaining dentition and to preserve it for as long as possible.
Due to decades of success and their helpfulness in innumerable edentulous cases, CDs have been called the mother of all dental prostheses.49 According to studies on oral health in the USA, even though there has been a relative decline in complete edentulism over the past 30 years due to a corresponding decline in caries, the need for complete dentures to treat edentulism is still high due to the increase in the aging population.28,50 Furthermore, edentulism still depends on