Читать книгу Fundamentals of Fixed Prosthodontics - James C. Kessler - Страница 23

Check for a band of attached gingiva around all teeth, particularly those to be restored with crowns. Mandibular third molars frequently (30% to 60%) do not have attached gingiva around the distal segment. A prospective abutment that lacks the necessary attached tissue is a poor candidate to receive a crown. The probability of chronic inflammation occurring in response to any minute marginal irregularity in the crown is quite high.

The presence or absence of inflammation should be noted, along with gingival architecture and stippling. The existence of pockets should be entered in the record, and their location and depth should be charted. The presence and amount of tooth mobility should also be recorded, with special attention paid to any relationship with occlusal pre-maturities and to potential abutment teeth.

Edentulous ridges should be examined, and the relationship of spaces should be noted if there is more than one. What is the condition of prospective abutment teeth? The presence and location of caries should be noted. Is it localized or widespread? Are there large numbers of gingival lesions and decalcification areas? The amount and location of caries, coupled with an evaluation of plaque retention, can provide insight into the prognosis for the new restorations that will be placed. It will also help to determine the preparation designs to be used.

Previous restorations and prostheses should be examined carefully. This will make it possible to determine if they are suitable or if they need to be replaced. It will help to determine the prognosis for future work to be done.

Finally, an evaluation should be made of the occlusion itself. Are there large facets of wear? Are they localized or widespread? Are there any nonworking interferences? The amount of slide between the centric relation position and the maximal intercuspal position should be noted. Is the slide a straight one, or does the mandible deviate to one side? The presence or absence of simultaneous contact on both sides of the mouth should be observed. The existence and amount of anterior guidance is also important. Restorations of anterior teeth must duplicate existing guidance or, in some patients, replace what has been lost through wear or trauma.