Psychological assessment of the prosthodontic patient before treatment

Treating the patient requiring a prosthesis is one of the most challenging and demanding aspects of dentistry. Assessing and coping with the psyche of a patient is extremely complex. We must remember the adage , "Never treat a stranger," Ramsey states: "Prior to planning treatment, the dentist should realize three objectives: (1) An understanding of the biologic and mechanical aspects of the patient's problem, (2) an insight into the general mental and physical health of the patient, and (3) an awareness of specific emotional problems which may relate to the dental situation.     

Implant prosthodontic treatment options for the edentulous patient

summary Longitudinally documented benefits for edentulous patients of treatment outcomes of the osseointegration technique demonstrate compelling therapeutic results. Heterogeneous population groups, treated in different centres by various dental specialists, have provided impressive evidence of a minimal burden of illness associated with the procedure. A critical appraisal of the many
components of any implemented treatment paradigm demands repeated analysis of the factors which enable patients' informed consent and dentists' optimal decision making. This paper reviews those salient aspects which impact upon decision making with implant-supported prostheses. It emphasizes the predominance of bone structure in selecting the most likely favourable treatment outcome.     

Occlusion in the combination fixed removable prosthodontic patient

The authors provide a review of the critical aspects of occlusion for the combination fixed removable patient. Articular selection and jaw relation techniques are reviewed, and dental materials combinations are recommended for restoring opposing occlusal surfaces. General objectives and specific recommendations for determining and establishing occlusal schemes are made. Tables outlining occlusal scheme, occlusal morphology, and degree of balance are presented.     

Speech considerations in prosthodontic rehabilitation of the glossectomy patient

A knowledge of normal articulation is needed before the prosthodontist can assess the compensatory articulation used by glossectomy patients. The amount and portion of tongue resected is directly correlated with speech intelligibility. The loss of the tip of the tongue is more critical to intelligibility than a hemiglossectomy. Partial glossectomy speakers can often use the residual tongue stump to perform adaptive movements that approximate normal movements and should be treated as an articulation problem. The compensatory articulation used by the total glossectomy patient was reviewed. The prosthodontic management of patients with partial tongue resection often includes lowering the palatal vault, while the management of the total glossectomy patient usually requires a mandibular tongue prosthesis. These prostheses can be refined with the use of multiview videofluoroscopy, videotaping, and spectrographic analysis.     

新型美学陶瓷用于牙修复体的优与劣

陶瓷材料应用于口腔修复已有五十余载。理想的牙科陶瓷可高度模拟天然牙釉质和牙本质。然而,天然牙釉质是一种梯级结构材料（hierarchy material）,即以不同微观单位观察呈现不同机械强度和韧性。研究结果显示,牙釉质具有超越任何现有牙科陶瓷的增韧能力。     

唇腭裂患者口腔修复治疗的临床体会

目的：讨论固定桥修复、活动义齿修复、双重牙列修复这三种保守修复方法在唇腭裂患者口腔修复中的初步临床体会。方法：结合100例唇腭裂患者保守修复的治疗经验,讨论三种保守治疗方法的临床适应症和优缺点。结果：唇腭裂患者的保守修复治疗方法可以一定程度上恢复咀嚼功能和颌面外观,修复口鼻瘘,改善发音,同时获得心理康复等。结论：对于不能手术治疗的患者,在选择好适应症后,保守性修复治疗是一种简单、经济、实用的修复方法。     

Applying basic prosthodontic principles in the dentulous maxillectomy patient

The formulation of a design for a removable partial denture framework must be approached in a logical, organized fashion, whether the framework is conventional or designed to support an obturator. The number of abutment teeth, their relationship to one another and to the other teeth in each arch, the location of the fulcrum line if unilateral or bilateral extensions are to be used, the need for direct and indirect retention, and the quality and quantity of the support for the extension bases must all be considered. The occlusal scheme and esthetics should also be considered. Once the design is formulated, careful preparation of the mouth, good impressions, proper fitting of the framework, a good altered cast impression when necessary, careful adjustments at insertion, and patient instructions concerning care and maintenance of the prosthesis will increase the chances of success. All the basic principles must be considered and applied to the unique requirements of the maxillectomy patient.     

Surgical and prosthodontic reconstruction of the severely handicapped edentulous patient

There is among some prosthodontists a negative attitude toward preprosthetic reconstructive surgery because of previous poor experience with reconstructive or preprosthetic surgical procedures. Such experiences may have resulted from the limitations of techniques previously used; and, therefore, the prosthodontist may resort to conventional prosthodontic techniques. There are, however, limits to what can be achieved with special impression techniques, tooth form and placement, and so forth. This article was written not only to present the rationale of current techniques but to encourage the prosthodontist to consider and present to the severely handicapped edentulous patient the choice of preprosthetic reconstructive surgery.     

Overview of articulation materials and methods for the prosthodontic patient

STATEMENT OF PROBLEM. Many methods and materials are available for registering the centric relation position, with various degrees of accuracy. Once the centric relation position is recorded, many instruments are available for cast articulation. These articulators range from simple to complex devices that generate different mandibular movements depending on the sophistication of the instrument. PURPOSE. This review evaluated the methods and materials used to record the centric relation position and eccentric maxillomandibular relations, and to compare the articulators available for mounting casts. METHODS. A MEDLINE search was completed (from 1966-present) along with personal searches of selected journals to find additional publications that addressed these materials, methods of registration, and available instrumentation. CONCLUSION. Potential applications of this review are as follows: (1) to allow the reader to examine the various methods for recording the centric relation position that have been studied and described, and (2) to observe how the accuracy of recording materials have changed over time. The reader will also realize the types of simple and complex articulators that exist, along with the different degrees of simulated mandibular movements that may be accomplished.     

Expanding prosthodontic services to the older patient in dental practices

Numerous articles report on the unmet dental needs of the older patient, yet few have suggested strategies to overcome barriers to care for this unique demographic. At a time when prosthodontic services, including dental implants, offer improved outcomes, the elderly remain the least served of all patient groups. Obstacles to treatment include ageism, medical and dental complexity, financial limitations, and patients' resistance to treatment. Expanding prosthodontic care of the elderly requires a departure from traditional patient management techniques. The attempt to reverse ageism in your practice must go beyond simple awareness. Those off?ces that can relate to, treat with respect, and fulfill the health aspirations of the older patient create the atmosphere where care is more readily accepted. A successful team approach to patient management depends upon the ability to listen and respond to the elderly denture patient with information on denture maintenance and implant enhancements. An essential piece is encouraging regular recall for all denture wearers by every staff member. A well documented problem area in dental practice is the timely replacement of worn out or inadequate dentures. By using a simple assessment tool called the Satisfaction/Condition Score along with motivational interviewing, we have found increased treatment acceptance among our existing patients. Use of these suggestions in a general dentistry practice is more likely to encourage the older patient to better accept enhanced prosthodontic services.     

The Swedish patient insurance scheme and guarantee insurance for prosthodontic treatment.

During 1975-76 a no-fault compensation system for treatment injuries in dentistry and failures within prosthodontics was introduced in Sweden. The guarantee insurance scheme for prosthetic treatment has changed somewhat during the years and, in 1987, became mandatory for all dentists in Sweden. All necessary retreatment not included in the National Dental Insurance Scheme (eg allergy to dental materials, all treatment following radiotherapy-related xerostomia) is included. For fixed prosthodontics, all replacements are covered by the scheme for the first 2 years. For removable prosthodontics, this is limited to the first year. A patient may choose any dentist in Sweden to carry out the retreatment. The claim system is simple and the number of cases has steadily increased, probably because dentists are becoming more familiar with the system and are willing to use it. The costs are paid for by private practitioners, the Public Dental Service and private dental laboratories. The insurance files are available for research purposes.