4th Year Student’s Manual Preclinical Fixed Prosthodontics Syllabus Manual Academic Year 2013/2014 Course Code: OMR 434 Credit Hours: 6 Course Director E-mail Office Hours Prof. Souna Youssef Phone 23257 drsouna@yahoo.com Office Bld. 9 room G/935 Tuesday afternoon Description of subject content: Welcome Note This course is designed to combine basic science with practical work to introduce students to fixed prosthodontics. The main goal is to provide a basis for the steps involved in providing and constructing crowns, starting from treatment planning and the decision making process and ending with crown cementation and review with special emphasis on developing student's technical skills. A secondary goal is tointroduce students to the clinical and technical concepts involved in providing and constructingthree-unit bridges and post and core, with special emphasis on developing student's technical skills. Suggested references, lectures and discussions will provide a base of knowledge that students can apply in practical work. All fixed prosthodontic restorations should relieve patients from pain and discomfort, as well as restore health, function and aesthetics. This outcome depends on the initial state of the involved dentition, edentulous areas and surrounding structures. Treatment is not 1 expected to restore structures to their original pre-disease state and all treatment outcomes are dependent on patient compliance. Code of Conduct: All students are held to standards of the Code of Conduct described in the King Abdul Aziz University policies (Student Hand Book) and is represented by a set of principles of professional conduct and rules by which dental students must aim to fulfill their duties to their patients, the public, the profession, the faculty, and to their fellow students. with special emphasis on the moral conduct within the meaning of Islamic values. Attendance policy Class attendance and participation are mandatory for all lectures, labs and sessions. Exceeding the maximum permissible absences (10% or more) may deprive the student from attending the final exams. Anti-plagiarism Policy Cheating in the examination, attempting to cheat, or opposing the regulations of examinations, will lead to a disciplinary action according to the students’ disciplinary regulations issued by the University Council. In addition, It is essential for students to carefully consider the legitimacy and authenticity of the work they submit by providing appropriate acknowledgements in the form of clear referencing to avoid plagiarism and to encourage honest work. Allegations of plagiarism against staff members should be reported to Vice Dean of Academic Affairs. Examination Policy All examinations must be taken on the date scheduled. Students have to be there on time. The students will not be allowed to enter any examination after half an hour from the beginning of the exam; and will not be allowed to leave before half an hour from the start of the exam. Professional Attire Appropriate student dress and grooming are important factors in the safety and orderly operation of the school clinics and labs and student's appearance should reflect a positive image of the school. Students should wear a uniform scrub suit and a white coat. Failure to comply with school dress code policy may result in disciplinary action, which may include prohibition from the clinic. 2 Other Policies Our division instructs students to be in direct communication either via the course leaders or personally. They are free to report difficulties to the course director at anytime. All staff members are available during their office hours to assist any student. Course Description: The course represents the orientation phase to the discipline of fixed Prosthodontics. It provides a structured framework for students to learn the scientific basis and the fundamental principles of fixed Prosthodontics. It prepares students for the practice of sound clinical fixed Prosthodontics through a pre-clinical phase of mechanical and technical procedures. Course Objectives and Learning Outcome: At the completion of the course, students should be able to: 1. Identify the basic principles of Fixed Prosthodontic procedures and recognize the instruments and dental materials required. 2. Apply practical skills of different types of tooth preparations on phantom head. 3. Utilize laboratory procedures of fabrication of fixed partial denture until finishing and polishing. This course will adequately provide students with a solid foundation for clinical practice next year. 3 Timetable: Course Schedule (Full Academic Year: First and Second Semesters): Topic: Lecture Title Week Date 1. M 9-92013 Terminology &classification W 11-92013 Principles of tooth preparation. l 2. Lecturer Assess ment (Quiz/ Assign ments) Prof Souna Youssef Prof BadawyAb oelmahase n M 16-92013 Principles of tooth preparation II Prof BadawyAb oelmahase n W 18-92013 1ry impression & related procedures Prof SalmaBah 4 Reference (Page numbers of the main text or resource) Practical/Clinical Sessions CFP 4 ed. P: 3-41 Models presentation (U/L typodont +Diagnostic casts) CFP 4 ed. P:209- 257. Duplication of diagnostic casts CFP 4 ed. P:209- 257. Preparation: external surface form CFP 4 ed. P:42-45 Demo custom tray fabrication Supervisors annan 3. 4. 5. M 23-92013 National day W 25-92013 M 30-92013 Occlusion and interocclusal records W 2-102013 Articulators and mounting Dr LulwaAltur ki ------ --- M 7-102013 W 9-102013 Full metal veneer crown (FMVC) prep Provisional restorations Dr. Moh’d Adel Prof Souna Youssef Practice custom tray fabrication ---- CFP 4 ed. P:258-271 Demo & practice on FMVC preparation # 36 or # 46 CFP 4th ed. P:111-144 1. Demo mounting &diagnostic wax up. 2. Practice custom tray fabrication. Practice on FMVC Preparation # 36 or # 46. ------CFP 4 ed. P:466-503 Dr. sajaMann aa Demoprovisional restoration. (prefabricated #11, custom made# 36) Hajj Holiday 6. M 21-102013 One prep Practice on FMVC Preparation # 36 or #46. 5 W 23-102013 M 28-102013 7. QUIZ 1 Impression techniques Prof HananNag uib W 30-102013 M 4-112013 8. W 6-112013 M 11-112013 9. 10 Practice custom made provisional restorations. CFP 4 ed. P: 440-445 Continue practice custom made provisional restorations. Practice on FMVC Preparation #16 or #26. One prep Working cast & dies Metal ceramiccrown (MCC) preparations Practice on FMVC Preparation # 16 or #26. Prof. HannanNa guib Dr. Mohamed Awad CFP 4 ed. P: 526-554 CFP 4 ed. P:272-285 W 13-112013 M 18-112013 Demo and practiceDie fabrication. DemoMCC preparation # 36 or #46. Continue practice Die fabrication. Demo &practice MCC preparation #36 or # 46. 6 11. 12. 13. W 20-112013 M 25-112013 W 27-112013 M 2-122013 Continue practice Die fabrication. Continue practice MCC preparation #36 or # 46. Revision Demo and practice mounting mandibular working cast Continue practice MCC preparation #36 or # 46. Revision W 4-122013 M 9-122013 Practice mounting mandibular working cast. 1. Posterior FMVC CE. 2. Posterior MCC CE. Competency exam (CE) W 11-123013 15. 16. M 16-122013 Sun22- ------------- ------------ ----------- 7 -------------- 1. Provisional restoration CE. 2. Special tray CE. --------------------------------- -------------- 122013 Midyear Course Schedule (Second Semesters): 1 2 M 27-12014 W 29-12014 M 3-2-2014 Demo and practice MCC preparation # 11 or# 21. Wax pattern Dr. Moh’dAwa d CFP 4th ed. P: 555- 588 Continue practice MCC preparation # 11 or # 21. W 5-2-2014 3 M 10-22014 Demo & practice wax pattern. Continue practice wax pattern. Pontics Prof Souna Youssef CFP 4th ed. P: 616-649. W 12-2- Continue practice MCC preparation # 11 or # 21. Continue practice Wax-pattern. 8 2014 4 5 6 M 17-22014 W 19-22014 M 24-22014 W 26-22014 M 3-3-2014 Continue practice MCCpreparation # 11or# 21. Solder joints & other connectors Prof MustafaAb osaud CFP 4th ed. P:843-869 Continue practice MCC preparation # 11or# 21. Spruing& investing All-ceramic crown (ACC) preparation Dr. AymanJoh ar Prof. IhabMosle h W 5-3-2014 7 M 10-3-2014 Continue practice wax pattern. CFP 4th ed. P:681-694. Demo & practice spruing& investing. CFP 4th ed. P:681-694. Demo &practice ACC preparation # 11 or # 21. Continue practice spruing& investing wax pattern of one-unitcast restoration. (Quiz 2) Continue practice ACC preparation # 11 or # 21. W 12-3- Continue practice spruing& investing. 9 2014 8 9 10 11 12 M 17-32014 W 19-32014 M 24-32014 W 26-32014 M 31-32014 W 2-4-2014 Partial veneer restoration Prof. Eman Salah Continue practice ACC preparation # 11 or # 21. Burnout & casting Prof.Moh’d Adel Restoration of endodontically treated teeth Prof. IhabMosle h CFP 4th ed. Page 336-378. Demo & practice cast post& core. Finishing & polishing Prof. SounaYuss ef CFP 4th ed. P: 870-883. Demo & practice finishing & polishing. Practice burnout & casting. Continue practice cast post& core. Practicefinishing & polishing. M 7-4-2014 W 9-4-2014 M 14-42014 CFP 4th ed. P 286-321. FFP 4th ed. P 165- 194. CFP 4th ed. P:694-705 Revision 10 W 16-42014 13 14 15 M 21-42014 W 23-42014 28-42014 Revision Competency Exam (CE) 1. Posterior FMVC CE. 2. Posterior MCC CE. Wax-up CE Revision 30-42014 5-5-2014 Final Exam Contemporary Fixed Prosthodontics: Rosenstiel –Land- Fujimoto; Mosby, Inc, 4th edition 2006, = CFP. Fundamentals of Fixed Prosthodontics: Shillingburg –Hobo- Whitsett, Jacobi- Brackett; Quintessence PublishingCo, Inc, 4th edition 2012 = FFP. 11 Lectures’ Intended Learning Outcomes (ILOs): Lectures Title Reference ILOs Terminology, CFP and 4thed. classification P: 3-41 of fixed prosthesis At the end of the lecture the student should be able to: 1. Explain scope of fixed prosthodontics. 2. Define terminology and types of restorations for single tooth. 3. Recognize crown indications, classifications and types. 4. Identify fixed partial denture and its components. 5. Recognize indications, types and materials of fixed partial dentures. 6. Discuss types of restorations: Intra coronal restoration. Extra coronal restoration. Intra-radicular restoration. 7. State the effects of tooth loss. 8. List basic steps for the fabrication of a cast restoration. Principles of CFP tooth 4thed. preparation P: 3-41 The student should be able to: 1. Recognize biologic, mechanical and esthetic considerations. 2. Discuss principles of parallelism. 3. Identify retention and resistance. 4. Recognize structural durability. 5. Recognize marginal integrity as affected by finish line configuration. 6. Identify the role of margin placement and thickness on success of restorations. 7. Describe the role of optimum reduction on theesthetic outcome. Primary CFP impression 4thed. and related P:42-45 procedures 1. List different types of elastic impression materials. 2. Understand the mouth preparation prior to beginning of definitive fixed prosthodontic treatment. 3. Understand indications, contraindications, advantages, and disadvantages of alginate impression material. 4. Recognize the principles of pouring alginate impression to construct diagnostic casts and fabricate custom-made tray. 12 5. Differentiate between acceptable acceptable custom-made tray. and un- Full metal CFP veneer 4thed. crown P:258-271 Preparation 1. Lists Indications, contraindications, advantages and disadvantages. 2. Describe steps of tooth preparations 3. Identify types of finish line. 4. Explain principles of tooth preparation of complete cast crown. Occlusion and interocclusal records CFP 4thed. P:111-144 1. Identify components of stomatognathic system and their interdependent relationship. 2. Define Occlusion as a static and dynamic conditions 3. Recognize jaw relations and border movement of the mandible. 4. Identify determinants of occlusion and their effects. 5. Describe occlusal schemes. 6. Recognize ideal occlusion and pathologic occlusion. 7. Distinguish the difference between records needed to mount diagnostic cast and definitive cast. 8. Describe techniques used in locating centric relation. 9. Describe technique used to record maximal intercuspation. 10. Describe technique used to record lateral interocclusal relationship. Articulators &Mounting CFP 4thed. P:45-70 The student should be able to: 1. Define the articulator. 2. Identify the different types of articulators. 3. Describe the mechanism of each type. 4. List needed armamentarium (Face bow and equipment) for each type. 5. Recognize the mechanism and application of each articulator and face bow. 6. State the type of records necessary for each type 7. Compare between the different types from diagnostic prospective. Provisional Restoration CFP 4thed. P:466-503 By the end of the lecture the student should be able to: 1. Discuss requirementsof ideal provisional restorations. 2. Recognize types of provisional restorations. 3. Explain techniques and materials needed for custom 13 provisional restorations. Impression techniques CFP 4thed. P:440-445 1. Identify the prerequisites to successful and predictable impression making with elastomeric impression materials. 2. Recognize different techniques of gingival tissue displacement. 3. Review different impression materials used for final impression, with emphasis on advantages and disadvantages of each. 4. Explain different impression techniques. 5. Recognize correct final impression. 6. Explain causes of defective final impression. Porcelain CFP fused to 4thed. metal crown P:272-285 preparation By the end of the lecture the student should be able to: 1. Understand components of metal ceramic restorations & required amounts of reduction. 2. List indications, contraindications, advantages and disadvantages of metal ceramic restorations. 3. Identify armamentarium used for preparing anterior and posterior metal ceramic restorations. 4. Describe steps of posterior and anterior teeth preparations. Working cast CFP and dies 4thed. P: 526-554 By the end of the lecture, the student should be able to: 1. List criteria of acceptable working cast. 2. Identify differences between types of casts 3. Classify different techniquesof dies construction 4. Recognize the steps of die preparation. Wax pattern CFP 4thed. P: 555- 588 1. Identify techniques for fabricating wax pattern, advantages and disadvantages of each technique. 2. List requirements of good inlay wax. 3. Describe steps of wax pattern fabrication. 4. Compare cusp-marginal ridge relation versus cuspfossa relation. 5. Recognize margin finishing and its discrepancies. Pontics CFP 4thed. P: 616-649. 1. Identify types, function, requirements, classification of pontic. 2. List different pontic designs. 3. Recognize pontic modification. 4. Clarify design considerations. 14 and 5. Describe pontic fabrication. 6. Clarify post insertion hygiene. Solder Joints CFP 4thed. and other P:843-869 Connectors 1. 2. 3. 4. 5. 6. 7. Recognize types of connectors. Identify casting, welding and soldering procedures. Explain applications of soldering. List ideal requirements of dental solder alloy. Describe soldering flux and antiflux. Describe solder technique. Recognize pre and post veneer metal ceramic alloy soldering. 8. Identify laser welding (uses,advantages and disadvantages). Spruing and CFP 4thed. investing P: 681-694. 1. Know the types of sprue systems, their indications and uses. 2. Recognize the requirement and the methods to create and apply an optimum sprue system. 3. Identify the types of investment material and their properties. 4. Know the heat distribution in the investment and waxup and how does that affect the final dental casting. 5. Describe the investment techniques and the burn out cycles to produce proper casting. All-ceramic crown Preparation CFP 4thed. P: 681-694. 1. List the advantages and disadvantages of all ceramic restorations versus metal ceramic. 2. Explain the deciding factors of selection and potential requirements for the success of all ceramic restoration. 3. Describe the recommended preparation design, and sequence for tooth preparation for an all ceramic restoration. 4. Indicate the ideal preparation features and explain their contribution to biologic, mechanical and esthetic principles of tooth preparation. Partial veneer crown preparation CFP 4thed. P 286-321. FFP 4thed. P 165- 194. 1. Define Partial veneer restorations. 2. Classify the different types of partial veneer restorations. 3. Recognize the indications, contraindications, advantages and disadvantages of different types of partial veneer restorations. 15 4. Describe different preparatory steps of 3/4 crown with its related modifications. 5. Distinguish the differences in preparation design of 3/4 crown in maxillary and mandibular, anterior and posterior teeth. 6. Label the features of the partial coverage restoration preparation and the functions served by each. Burn out Casting CFP 4thed. P:694-705 Restoration of endodontica lly treated teeth CFP 4thed. 1. Identify remaining tooth condition and the possible treatment interventions. Page 3362. Clarify the principles of lost tooth structure substitution. 378. 3. Recognize consideration affected the needed modifications for damaged vital teeth. 4. Indicate the rational for the use of post in restoring endodontically treated teeth. 5. Classify the different types of posts and cores recognize the factors affecting the selection of each type. 6. Explain the principles of tooth preparation. 7. Describe the technique for fabrication of prefabricated post and core. 8. Describe the fabrication of custom cast post and core with direct or indirect technique. Finishing and CFP 4thed. polishing P: 870-883. 1. 2. 3. 4. 5. 6. Define burnout and casting. Identify burnout techniques. Describe casting machines and technique. Recognize types of torches and different flame layers. Recognize accelerated casting method. Identify proper casting and possible failures. 1. Understand the significance of finishing and polishing cast restorations. 2. Understand air abrasion and pickling. 3. Recognize the different abrasives and polishing materials used. 4. Describe procedures of preliminary finishing and polishing of metal restorations. Contemporary Fixed Prosthodontics: Rosenstiel –Land- Fujimoto ; Mosby, Inc, 4th edition 2006, = CFP 4th ed. Fundamentals of Fixed Prosthodontics: Shillingburg –Hobo- Whitsett, Jacobi- Brackett; Quintessence PublishingCo, , Inc, 4th edition 2012 = FFP. 16 Practical/Clinical Sessions’ Intended Learning Outcomes (ILOs): Practical/Clinical Session Title Introduction terminology ILOs & The student should be acquainted with the course-needed tools. Model presentation 1. Be sure that each student had received both diagnostic and definitive casts. 2. Be aware of proper chair position during working with phantom model for each jaw quadrant. Full crown preparation 1. Demonstrate different preparatory steps of full crown restoration for single tooth. 2. The student should be able to perform one full metal crown preparation in a pre-defined time at the phantom head. Metal-ceramic preparations 1. Demonstrate the preparatory steps of metal-ceramic restoration for single Tooth. 2. The student should be able to perform one PFM preparation in definite time at the phantom head. ALL-ceramic preparations 1. Demonstrate different preparatory steps of all-ceramic restoration for single tooth. 2. The student should be able to perform one all-ceramic preparationin definite time at the phantom head. Cast post & core 1. Demonstrate different preparatory steps on remaining tooth structure. 2. Demonstrate different preparatory steps of root canal preparation. 3. Demonstrate direct technique of custom post and core. 1ry impression & 1. Demonstrate of the different preparatory steps of special tray. related procedures 2. The student should be able to construct special tray following the selected criteria. 17 Provisional restorations 1. Demonstration of different preparatory steps to construct indirect acrylic one-unit temporary crown. 2. Demonstrate the use of different prefabricated temporary crowns. 3. Students should be able to use different prefabricated temporary crowns. Working cast & dies 1. Demonstrate the preparation of removable die using Pindex system. 2. Demonstrate die preparation including; sawing, die trimming and ditching, finish line high light, application of die hardening and die spacer. 3. Students should be able to prepare definitive cast with removable dies using the Pindex system. 4. Students should be able to ditch, high light finish line of removable dies followed by applying die hardener and die spacer. Articulators &mounting 1. Demonstrate mounting the prepared definitive casts on a semi-adjustable articulator. 2. Students should be able to articulate casts using face bow and semi-adjustable articulator. Wax pattern 1. 2. 3. 4. Spruing& investing 1. Student should be able to perform indirect spruing&investing of one-unit wax pattern. Burnout & casting 1. Demonstrate selected burnout technique. 2. Describe selected casting technique. 3. Students should be able to recognize the various techniques; materials and steps involved in investingand spruing a oneunit wax pattern. Identify uses of wax armamentarium kit. Demonstrate different steps of wax pattern fabrication. Demonstrate wax pattern margin refining and finishing. Student should be able to construct a one-unit wax pattern following the instructed criteria. 18 Finishing &polishing 1 Students should be able to finish & polish a one-unit cast restoration. 19 Assessment Task (Including Quizzes, Exams, Assignments, Pts, MPEs, CEs) Midterm assessment Midterm assessment Midyear examination Week Due Evaluation Form Title First semester (Written) 6 Second semester (Written) 7 MCQs and essays in the form of short essay 16 20 Feedback Mechanism/Time Students have their marks, and discuss performance with staff during office hours. Students have their marks, and discuss performance with staff during office hours. Students have their marks, and discuss performance with staff during office hours. Grade Proportion of Final Assessment Requirements, Assessment Schedule, and Course Grading: 5 Marks 5% 5 Marks 5% 10 Marks 10% Competency examination 14 1. Full metal veneer crown preparation. 2. Posterior metal ceramic crown preparation. 3. Special tray. 4. Provisional restoration. 5. Wax pattern. Students have their marks, and discuss performance with staff during office hours. 20 Marks 20% 35 Marks 35% Minimum procedure experiences (MPE) Throughout the year Clinical: 1. Full veneer metal crown preparation. 2. Posterior MC crown preparation. 3. Anterior MC crown preparation. 4. Anterior all-ceramic crown All MPE are self-assessed preparation. and evaluated by instructors. 5. Cast post and core. Laboratory: 1. Special tray. 2. Provisional restoration. 3. Wax-pattern. Final exam written At the end of the year 1. MCQ and essay. 2. Stations. Students are given their final marks. 21 20 Marks 20% Total Marks Throughout the year Attendance and professional conduct Attendance sheets are distributed at the beginning of lectures and laboratory sessions. Code of conduct is explained in students handbook. ------------------------------ 22 Students discuss relevant issues with staff members during office hours. 5 Marks 5% ----------------- 100 Marks 100% Preclinical fixed prosthodontics MPEs: Numbers required (rough estimate) MPE 1. Full metal veneer crown preparation: Mandibular 1st or 2nd molar. Maxillary 1st or 2nd molar. 2. Metal ceramic posterior crown preparation: Mandibular premolar. Maxillary premolar. Mandibular 1st molar. Maxillary 1st molar. 3. MC anterior crown preparation: Maxillary central incisor 4. Anterior all-ceramic crown preparation: Maxillary central incisor Custom tray on study model Provisional restoration Resin pattern post and core Relevant forms 2 2 1M and1R 1 2 1 2 2aM and 2aR 2bM and 2bR 1 3M and 3R 2 1 1 1 4M and 4R 5M and 5R 9bM and 9R M: MPE forms and R: Rubric forms Resources/References: Required Text(s) 1. Contemporary Fixed Prosthodontics, Rosenstiel et al, 4th ed. 2006, Mosby Inc. 2. Fundamental of Fixed Prosthodontics, Shillingburg et al., 1997, Quintessence Publishing Co., Chicago. Study Guide or Manual Lecturer handout Essential References 1. Contemporary Fixed Prosthodontics, Rosenstiel et al, 4th ed. 2006, Mosby Inc. Recommended Books and Reference Lectures Material Electronic Material (URL), Websites etc 1. Computer systems for email communication, desktop applications, Internet access and research and digital 23 library. PubMed Database for researching the dental & biomedical literature. ODUS Other Learning Material 1. 2. 24 King Abdulaziz University Electronic Services. University Library. Fundamentals of tooth preparation, Shillingburg et al., 1992, Quintessence Publishing Co.,Chicago. King Abdulaziz University Oral & Maxillofacial Rehabilitation Dept Faculty of Dentistry Fixed Prosthodontics Division 2013-2014