Biomedical subjects
Publications and source records attributed to Lily T Garcia.
The article provides a background for understanding the properties of soft liner materials, describing associated problems, and discussing clinical applications of soft liners in dental practice. Although not a panacea, soft liner materials provide the practitioner with a variable tool in providing excellent clinical care for patients.
Provisional restorations provide interim coverage for prepared teeth while fixed definitive restorations are fabricated. Several types of autopolymerizing acrylic resins have been used for many years to fabricate provisional restorations. In recent years, bis-acryl resin composite material has gained popularity among clinicians for the direct fabrication of provisional fixed restorations. Occasionally, deficiencies may occur while fabricating a direct provisional restoration and require chairside repair. This article describes an effective procedure for the use of light-polymerized flowable composite resin for the intraoral repair of bis-acryl provisional restorations.
The lack of display of anterior metal clasps is a primary advantage of the A-P rotational-path mandibular RPD design. A disadvantage of this design is that it relies on rigidmetal guiding plates for anterior retention and stability. Loss of retention may require procedures much more involved than the simple adjustment of conventional RPD clasps. Proper adherence to design, survey, fabrication, and adjustment procedures described by the authors should result in an esthetically pleasing and well-retained tooth-supported removable prosthesis. This article recommends the A-P rotational-path mandibular RPD as a treatment the clinician can use to restore multiple missing anterior teeth and satisfy a patient's financial, esthetic, and functional requirements.
A mandibular molar tooth may have its furcation area or one of its roots severely affected by periodontal disease or caries. Multiple factors must be favorable to restore health to such a compromised tooth. Adequate bone support for stabilization of the individual roots and coronal segments must be available after periodontal therapy. Root morphology and separation space must allow for ease of preparation and cleaning between the sectioned roots. Endodontic therapy should be uncomplicated and provide an excellent prognosis for long-term success. All caries must be removed and adequate tooth structure must remain after root and crown sectioning. Appropriate resistance and retention form must be achievable after tooth preparation of a sectioned mandibular molar. If these conditions can be met and the patient wants to keep the tooth, fixed restoration of a sectioned molar tooth is a viable treatment alternative to extraction and replacement with a removable partial denture or a dental implant. This article has described factors and procedures that should be considered for successful fixed prosthodontic treatment of sectioned multirooted mandibular molar teeth. The authors recommend an interdisciplinary diagnostic and treatment planning approach before performing endodontics, providing periodontal therapy, and restoring bicuspidized or hemisectioned multirooted teeth.
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The philosophy of positioning the margins of crowns supragingivally may not be applicable with the presence of caries, erosion, abfraction (noncarious cervical lesion), short clinical crown length, or esthetic concerns. In such situations, it is essential not only to record precise subgingival details of all of the prepared teeth but also to accurately transfer them to a working master cast. If a patient presents with oral and/or gingival conditions that compromise the clinician's ability to obtain a single full-arch impression for extensive fixed restorations, a technique using sectional impressions, an intraoral transfer index, and a transfer impression for transfer dies will play a vital role in the patient's treatment.
Fifty-three years ago, M. M. House devised a classification of patients on the basis of how they behaved in response to the prospect of becoming edentulous and on how they subsequently adapted to wearing complete dentures. Although House's system was an important contribution, it failed to consider the dentist's emotional reaction to a patient's behavior as part of an understanding of how the patient and doctor cope with the dental treatment. This article presents an expansion of the House classification to include the behavior of the dentist as a codeterminer of the patient's behavior. This expanded classification system is based on empiricism and awaits scientific validation or clinical application to determine its ultimate validity, reliability, and effectiveness.
The use of diagnostic wax-ups as diagnostic aids in treatment planning has been presented for use in various situations--from simple patient assessment to more extensive prosthodontic rehabilitation. Requesting a diagnostic wax-up from the dental technician may add to the expense of treatment planning for a patient because of the laboratory fee incurred for this service. The cost is negligible, considering the value of identifying potential treatment obstacles that could affect both treatment outcomes and patient satisfaction.
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Economic, esthetic, and concerns of tooth preservation are important when considering bonded composite resin for the partially edentulous patient's prosthetic rehabilitation. This article has described the clinical success of the use of bonded composite resin in removable prosthodontics. Composite resin may be used in daily clinical practice for the restoration of abutment teeth in contour, vertical support, and re-establishment of a patient's vertical dimension.
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Application of the crown preparation guidelines obtained through theoretical models, laboratory testing and clinical studies provide an evidence-based rationale for clinical practice procedures. The evidence-based rationale has been presented to support basic day-to-day techniques in clinical practice. As new techniques and materials are developed, each should be evaluated carefully prior to clinical use and acceptance.
The replacement of missing teeth by conventional fixed partial dentures or by implant supported prostheses occupies a major portion of the average restorative and prosthodontic practice. New materials, techniques, and technologies are constantly being added to our armamentarium. The demand for fixed prosthodontic patient services will continue to grow. It is the ultimate duty of the provider of these services to utilize an evidence-based rationale when determining the best possible treatment for the partially edentulous patient.
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