preventive prosthodontics

Full text

1
Preventive Prosthodotics
DR. NIS HATH AYESHA
BY
P R E V E N T I V E
PROSTHODOTICS
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

2
Preventive Prosthodotics
CONTRIBUTORS
BDS,FAGE
Dr. Tabraiz Ahmed
General Prortioner
BDS,MDS
Dr. Shahela Tanveer
Associate Prof,
Dept of Oral Pathology
AUTHORS
BDS, MDS
Dr. K. Mahendernath Reddy
Prof and Head,
Dept.of Prosthodontics,
Sri Sai College of Dental Surgery
BDS,MDS
Dr. Y. Mahadev Shastry
Prof.Dept of Prosthodontics,
Dept.of Prosthodontics,
Sri Sai College of Dental Surgery
BDS,MDS
Dr. Nishath Ayesha
Dept.of Prosthodontics
Sri Sai College of Dental Surgery
BDS,MDS
Dr.Sadiq Mohammed Sabir Ali
Dept.of Prosthodontics
Sri Sai College of Dental Surgery
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

3
Preventive Prosthodotics
ISBN: 978-93-89339-63-5
First Edition: 2020
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299
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

4
Preventive Prosthodotics
INDEX
TOPIC
Page
Numbers
INTRODUCTION
5
DEFINITIONS
6
OBJECTIVES
8
CONCLUSION
90
REFERENCES
91
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

5
Preventive Prosthodotics
Prosthetic dentistry is one of the fundamental pillars of dentistry. The
most effective prosthetic prophylaxis could be the prevention of causes
leading to tooth extractions. As a dentist our main aim should be
prevention, which not only includes prevention of caries or periodontal
disease but also prevention of residual alveolar bone loss after teeth are
extracted. Modern treatment options improve the overall prognosis of the
stomatognathic system and the quality of life of the affected patients
significantly.
Preventive prosthodontics emphasizes the importance of any procedure
that can delay or eliminate future prosthodontic problems.
Preventive prosthodontics refers to prosthodontic practices that help
prevention of the factors adversely affecting the orodento-facial tissues
and structures including, the tooth supporting structures such as
periodontium, alveolar bone, basal bone and surrounding musculo-
skeletal structures like muscles of mastication, salivary glands and the
tissues in the head and neck region.
The loss of several teeth need not be an immediate threat to the function
of whole dentition, but it can initiate serious problems related to oro-facial
region and well being of the patient. In this perspective prosthetic
dentistry is a valuable tool with high therapeutical and preventive
character.
INTRODUCTION
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

6
Preventive Prosthodotics
PREVENTION: Prevention is defined as “actions taken prior to the onset of
disease, which removes the possibility that a disease will ever occur”.
PROSTHODONTICS: Prosthodontics is the dental speciality pertaining to
the diagnosis, treatment planning ,rehabilitation and maintenance of the
oral function, comfort, appearance and health of patients with clinical
conditions associated with missing or deficient teeth and/or oral and
maxillofacial tissues using biocompatible materials.(ADA)
OR
Th e d ental specia l i ty conce r ned with the making o f a r tificial
reoplacements for missing parts of mouth and other facial structures.
Preventive dentistry is defined as procedures employed in practice of
dentistry and community dental health programs, which prevent the
occurrence of oral diseases and oral abnormalities. Gerrine N.F
Preventive posthodontics emphasizes the importance of any procedure
that can delay or eliminate future prosthodontic problem.
Goals of Preventive Prosthodontics:
1. To delay the residual ridge resorption
2. Preservation of followed in complete denture fabrication as well as
fabrication of partial dentures whether removable or fixed.
3. Assess the need for early prosthodontic replacement of lost tooth /
teeth.
4. Select treatment in consultation with patient and implement it
judiciously.
5. Design prostheses not interfering with normal oro-dental hygiene
procedures.
6. Act as team leader, guide colleagues & help prevention of future
prosthodontic problems.
DEFINITIONS
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

7
Preventive Prosthodotics
7. Plan to preserve what already exists than replacing what is missing.
Preventive Dentistry is a philosophy of dentistry, it comprises the various
procedures used by dentists, dental hygienists, nurses. It consists of
prevention of
1- Initiation of diseases (Primary prevention)
2- Disease progression and recurrence (Secondary prevention)
3- Loss of function (Tertiary prevention)
Operative dentistry consists of all procedures including preventive
measures by which teeth may be conserved and thus maintain the natural
masticating mechanism in such a state that the general health will not be
endangered.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

8
Preventive Prosthodotics
1. Patients education and motivation
2. Selecting evidenced based management option / prosthetic type and
design to maintain remaining teeth and their supporting tissues in
healthy state.
3. Prostheses for preventing, stabilizing and controlling the progression
of specific dento-orofacial conditions.
4. Special preventive prostheses for head and neck cancer (HNC)
patients including preventive prostheses and radiation stents and
carriers.
PART-1
PREVEENTION AT PRIMARY LEVEL
It is defined as action taken prior to the onset of disease/which removes
the possibility that a disease will ever occur. It includes intervention pre-
pathogenic phase of a disease .It includes the steps like health promotion
and specific protection.
Health promotion:
ŸDental caries prevention
ŸOral hygiene
ŸFlossing (as shown in fig 1)
Fig:1 Flossing
OBJECTIVES
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

9
Preventive Prosthodotics
ŸPlaque control
ŸRegular checkup for caries activity
ŸDiet counselling
ŸCaries vaccination, recall and checkup,
ŸReinforcement of the oral hygiene measures
Dental caries prevention :
Saliva contains antibacterial proteins,electrolytes for remineralization but
also the essential nutrients for bacteria to grow.However it is the food that
is ingested by the host that provides the dietary carbohydrates that are
easily converted to energy and acids by the bacteria that leads to
dissolution of dental hard tissues(as shown in fig 2)
Fig:2 Dissolution of hard tissues
The disaccharides sucrose and the monosaccharides glucose, a
componet of sucrose are most cariogenicand,with frequent ingestion,
can cause severe damage to the tooth.
Plaque control
Preventive intervention aims to modify the steps in the repeat
demineralization and remineralization cycles.
1. Neutralize the plaque acids: This can be done by adding base or
adding buffers such as sodium bicarbonate to the saliva to boost its ability
to neutralize acids (as shown in fig 3).
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

10
Preventive Prosthodotics
Fig:3 Neutralization of plaque acids
1. Improve hygiene: With bacterial levels low, less acid is produced. Also
plaque layers don't have a chance to grow thick, saliva which can
penetrate better into the enamel surface through thin layers of
plaque.
2. Introduce antimicrobials: Since caries is a disease caused by bacteria,
simply eliminating the bacteria or controlling their growth would not
reduce the caries incidence. Chlorhexidine, xylitol, ozone, even
experimental antibodies have been used to control bacterial growth.
3. Stimulate Saliva: Saliva contains numerous components that fight
against tooth decay.
4. Topical fluorides: Flourides added to the remineralization incipient
lesion increases the enamel crystals resistant to dissolution by plaque
acids(as shown in fig 3)
5. Remineralizing strategies: Remineralization can be promoted with
the use of calcium-phosphate complexes such as ACP-CPP.
Regular checkup for caries activity :
Caries activity: increment of active lesions over a stated period of time.
Many of these caries activity tests require extensive work up time and
additional equipment. Simple, inexpensive techniques, which do not
demand, sophisticated skills or consume much time are required for the
caries activity tests and the status they deserve in the routine clinical
practice and epidemiological screening programs.
Stolpe J R classified it under 3 headings:
1. Tests concerned with chemical properties of Saliva
2. Tests concerned with bacterial constituents of Saliva
3. Tests which measure certain changes in chemical properties
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

11
Preventive Prosthodotics
produced by bacterial metabolism.
Uses :
ŸEstablish a baseline level of cariogenic pathogens as a basis for future
evaluation and counselling.
ŸEnsure a low level caries activity before starting any extensive
procedures.
ŸTo modify the patient behaviour as a part of counselling to restrict
sucrose intake.
Advantages :
Identification of high risk population for dental caries and to institute
effective preventive measures.
ŸIn depth analysis of caries progression by researchers and to develop
better control measures. Decreases the caries susceptibility at
individual level.
Criteria for an ideal Caries activity test
ŸShould be simple & inexpensive
ŸShould be valid
ŸShould be reproducible
ŸShould be sensitive
ŸShould be measurable
ŸShould be non- invasive and applicable to any clinical setting
Diet counseling
The science which deals with the study of nutrient and foods and their
effects on the nature and function of organism under different condition
of age, health & disease. –NIZEL (1989) Nutrients are defined as the
constituents of food, which perform important functions in our body.
Nizel (1989): Total oral intake of a substance that provides nourishment &
supply (as shown in fig 4)
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

12
Preventive Prosthodotics
Fig:4 Balanced Diet plan
BALANCED DIET : One providing each nutrient in the (neither deficient
nor excess) needed to maintain optimum health. - Stewart Diet
ŸVitamin A deficiency produces hyperkeratosis and hyperplasia of
gingival tissue. There is a tendency to periodontal pocket formation.
ŸA suitable anti-metabolite of vitamin K might interfere with the growth
of Bacteroides Melaninogenicus and consequently, prevent the
occurrence of periodontal disease.
ŸThe characteristic oral sign of Vitamin C deficiency is scurvy which
results in enlargement of the marginal gingiva that envelopes and
almost completely conceals the teeth.
Effects of vitamin deficiency on Periodontium:
ŸStep 1: Ascertain the dental health diet score and if necessary,
demonstrate the method for keeping a food intake diary
ŸStep 2: explain the nutrition-periodontal relationship
ŸStep 3 : Assess nutritional status
ŸStep 4 : Prescribe a diet –improve adequacy of diet
ŸEmphasize foods that are particularly beneficial to periodontal tissue-
proteins, vit C, A, folic acid, calcium, iron and zinc (as shown in table 1)
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

13
Preventive Prosthodotics
Table No:1 Effects of Vitamin Deficiency
ŸEncourage the elimination of plaque forming sweets and substitution
of fibrous foods. Nutrition counselling for a patient with chronic
periodontitis
ŸDiet counselling makes the patient aware of the fact that diet plays an
important role in the treatment of the disease.
ŸWith today's emphasis on prevention of disease, diet counselling helps
to reduce the risk of some illness by appropriate counselling.
According to an African Journal of Oral health by Etisiobi Ndiokwelu in a
review stated that there is a close relationship between diet, nutrition and
dental health. Oral tissues like all tissues in the body are diet and nutrition-
dependent. Knowledge of food sources,their properties, functions,
requirements, optimal levels and consequences of deficiencies must form
the basis for dietary counselling. Enough is now known about the
interdependence of nutrition, diet and dental diseases that dietary
counselling has become a very important and integral part of dental care
in developed countries. This is not surprising because oral tissues like all
tissues in the body are diet and nutrition – dependent.
Topical fluoride application:
In case of the old patients due to decreased salivation, gingival recession,
root exposure cervical abrasion, attrition, an increase risk of the caries
susceptibility is there. So for these patients fluoride rinses and fluoridated
tooth pastes are recommended. For professional use high concentration
1.23ppm fluoride gel can be used, Fluoride varnishes such as Duraphat 5%
used with cotton bud,slow released devices are available(as shown in fig 5)
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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General Pharmacology
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Autonomic Nervous System
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Cardiovascular System
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Central Nervous System
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Drugs acting on Endocrine System
7
Chemotherapy
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Drugs acting on GIT & RS
9
Miscellaneous Topics

14
Preventive Prosthodotics
Fig :5 Fluoride application
The patient is also educated about the chewing habits, tongue postures
for better maintenance of the occlusion and maintenance of the
prosthesis.
Petersen PE (2004) concluded that water fluoridation and use of fluoride
tooth-pastes and mouth-rinses significantly reduce the prevalence of
dental caries. WHO recommends for public health that every effort must
be made to develop affordable fluoridated toothpastes for use in
developing countries. Water fluoridation, where technically feasible and
culturally acceptable, has substantial advantages in public health;
alternatively, fluoridation of salt and milk fluoridation schemes may be
considered for prevention of dental caries
Mouth Guards
The mouth guards (as shown in fig 6)
Fig: 6 Mouth Guards
are indicated to prevent the dental and dentofacial injuries in contact
sports.The injuries such as tooth f ractures, concussion, crown root
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

15
Preventive Prosthodotics
fractures, TMJ f ractures, dento-alveolar fractures, soft tissue injuries can
be prevented or minimized. Use of mouth guards reduced the risk of
dental and maxillofacial trauma <7.5%. The mouth guards with moderate
resiliency absorb the forces, protect the teeth, TMJ and prevent the
contact of teeth and thus prevents ankylosis.
The protection can be provided by various methods like providing the
radiation docking (cone positioning) devices, making spacers in the
interstitial brachy-therapy for tongue cancer and fabrication of tongue
shields. Radiation locking devices are utilized for directing the radiation
cones for a particular area of the oral cavity.
In many conditions, the radiation therapy has to be provided in divided
doses. In those conditions, the locking device helps in the proper
orientation of the radiation cones and also protects the adjacent soft
tissue by deflecting them out of the radiation path. When other areas of
the oral cavity are irradiated, the tongue needs to be protected. This can be
done with the help of tongue shielding radiation stent (as shown in fig 7)
Fig:7 Tongue Displacing Stent
Radiation spacers:
A radiation spacer may be of mouth guard type, used for dentulous
patients and replica denture type for edentulous patients. The thickness of
the spacers should be around 10 mm for proper attenuation of the
radiation.
Rationale: As the distance increases the radiation effect reduces in its
intensity. At 10 mm distance radiation energy is reduced by 60% to 70%
and prevents the complications like mucositis, radiation caries and
osteoradionecrosis.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

16
Preventive Prosthodotics
Tongue shielding radiation stent:
Terence J. Fleming, stated that Protective stents are stents fabricated to
protect the lateral border of the tongue during therapeutic radiation
therapy delivered to a unilateral region such as used in treating parotid or
retromolar lesions. The use of radiation-protective stents markedly
minimizes the treatment sequelae f rom therapeutic irradiation.The
tongue is protected or it will become inflamed, making speech and
swallowing extremely painful . Santiago, 1965 stated that these prosthesis
administer radiation to a confined region by means of capsules, beads or
needles of radiation emitting materials.
PREVENTIVE PROSTHODONTICS AT SECONDARY LEVEL
Preventive prosthodontic procedures which can be performed at this level
are-
ŸOcclusal interference correction
ŸTreatment for bruxism
ŸTreatment for trauma from occlusion, Correction of plunger cusps and
ŸTreatment of obstructive sleep apnoea.
ŸOcclusal interference: produces mandibular deviation during closure
to maximum intercuspation (MIC) position or may hinder the smooth
passage to and from MIC position. The inference may be present
during latero-trusive movements and protrusive movements. If the
occlusal interference cross the threshold of adaptive capacity of the
Te mp or o -m an di b u l a r j oi nt , m us cl e s o f mas ti ca t io n a nd
neuromuscular system, it leads to muscle hypertrophy, muscle fatigue,
spasm, headaches, cranio-mandibular dysfunction syndrome, wear
facets, fractured cusps and tooth mobility. So correction of occlusal
interference is recommended in the early stages. Care should be taken
during the occlusal correction, if not it may aggravate the situation.
ŸBruxism:leads to attrition, mobility, muscle hypertrophy, occlusal
facets, alveolar bone loss and TMJ disorders. If occlusal interferences are
present, the patient tries himself to equilibrate the occlusion and thus
develop the habit of clenching or grinding of teeth. This can occur due
to periodontitis, overcontoured restoration, psychological and physical
stresses, sleep disorder, central nervous system disturbances and
alcohol.
Symptoms include Muscle soreness, Fatigue of masticatory muscle early
in themorning, Hypermobility,Hypercementosis, Cusp fractures , Pulpitis ,
Break in lamina dura and Furcation involvement.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
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Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

17
Preventive Prosthodotics
Treatment:
Controlling the psychological stress
Fig: 8 Occlusal Splints
Occlusalsplints (as shown in fig 8) or intraoral orthoses.
Occlusal correction
Coronoplasty
It is a reversible condition, when occlusal forces exceed the adaptive
capacity of the periodontal tissues and results in tissue injury. This tissue
injury is called as TFO (trauma from occlusion). Acute TFO is due to sudden
heavy forces. Chronic TFO is due to continuous and long duration occlusal
forces, e.g. bruxism, drifting and extrusion of the teeth. Primary TFO is
caused due to high occlusal forces whereas main cause of secondary TFO
is a low threshold or low resistance of the periodontium. occlusal
corrections are needed for the correction of the TFO.
Plunger Cusp:
The cusps which wedge the food forcefully into the interdental spaces of
the opposing arch. These plunger cusp are usually the functional cusp and
sometimes palatal incline of maxillary buccal cusp and buccal incline of
lingual cusp.
Treatment:
Involves rounding and shortening of the plunger cusps, and the opposing
interproximal space is protected by splinting the adjacent teeth.
ŸObstructive sleep Apnea:
It is characterized by cessation of airflow through upper airway while
diaphragm movement continues. It can be caused due to enlarged
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
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Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

18
Preventive Prosthodotics
tonsils, enlarged soft palate, large tongue and retrognathism. The role of
dentistry in sleep disorders is becoming more significant, especially in co-
managing patients with simple snoring and mild to moderate obstructive
sleep apnea.
Treatment:
Fabrication of prosthetic mandibular advancement appliances like
Soft palate lifters
Tongue retainers
Mandibular repositioners
Surgery to remove portions of the soft palate and uvula.
Snore guards (as shown in fig 9)
Fig : 9 Sleep Apnea Oral Appliances
Common Features in Patients with Sleep Apnoea:
Loud snoring
Disrupted sleep
Nocturnal gasping and choking
Daytime sleepiness
Fatigue
The occlusal interferences, particularly balancing ones, are primarily
detrimental during the act of mastication. Schuyler considered that
balancing contacts get damaged during mastication, and Landa in a
roentgenographic study, had suggested that balancing contacts during
chewing may injure the temporomandibular joint. Some recent
experimental methods for the analysis of mastication are based upon
electronic devices which are capable of recording both tooth contacts and
electromyography. Through the use of such tele-metering equipment, it
should be possible to find out whether or not masticatory tooth contacts
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

19
Preventive Prosthodotics
are related to the etiology of occlusal trauma and other disorders of the
masticatory system.
Preventive Prosthodontics at Tertiary Level:
It involves limiting the disability of the patient and rehabilitation.
Prosthodontic rehabilitation incorporates procedures like post and core
treatment, removable partial denture, fixed partial denture ,implants,
treatment of decayed teeth, root canal treatment and extractions.
Prosthodontic Option in Disability Limitation and Rehabilitation: W.Kalk
vanwaas (1990) presented the “preventive prosthetic treatment strategy”
which includes-
ŸRestoration of the teeth, Timing of extraction, Preservation of occluding
pairs of teeth,
ŸAvoidance of contact between the teeth and the opposite edentulous
jaw.
ŸIn rehabilitation phase: planning for the immediate dentures,
treatment dentures or interim dentures, complete dentures and
provisional restorations can be done.
Timing of Extraction:
Planned extraction of highly mutilated teeth prevents the rapid resorption
of the alveolar ridges. Careful extraction should be done to avoid the
presence of unantagonized tooth. If antagonists are not present, supra
eruption of opposing dentition leads to contact between the mucosa and
teeth of the opposing arches. As a result, arch stability is lost, and this leads
to severe resorption of the alveolar ridge in edentulous arch. Extraction of
the maxillary third molar is delayed till the middle age. As third molars
have their influence on growth of the tuberosity and help in the
development of anterio-posterior alveolar ridge. In case of impaction of
third molars care should be taken such as minimal stripping of the
periosteum, minimal damage to the bone and use of prophylactic
antibiotic. In patients who have had radiotherapy every possible
precaution should be taken.
Restoration of teeth:
A dental restoration or dental filling is a treatment to restore the
function,integrity,and morphology of missing tooth structure resulting
from caries or external trauma as well as to the replacement of such
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

20
Preventive Prosthodotics
st ruct ure s uppor ted by dental imp lants.PRR ( Preve ntive Resin
Restoration) integrates preventive approach of the sealant therapy for
caries susceptible pits and fissures with the therapeutic restoration of
incipient caries with composite resin that occurs on the same occlusal
table.
Preservation of occluding pairs of teeth:
Many people wear complete dentures with varying degrees of success.
The ever growing population and the increased life expectancy suggest
that the demand for complete denture service will escalate in spite of the
heroic efforts of preventive dentistry. Many varied concepts exist
regarding the best way to establish the occlusion for complete dentures.
The increasing demand for denture service compels the dentist to seek an
effective and uncomplicated procedure based on functional efficiency
and preservation of supporting tissue. Neither uniformity nor rigid
standardization of technique is advocated. The basic concern is the
application of sound basic concepts of occlusion which will perform as
effectively as possible in the edentulous environment.
Payne, discussed the selection of artificial posterior tooth forms. There are
three basic schemes for posterior occlusion .The spherical scheme:
Anatomic teeth are used, and they may be altered. This scheme appears in
natural dentitions unless severe abrasion is present. Balanced occlusion
rarely exists in the natural teeth, but balance is desirable for complete
dentures.
The flat scheme: Non-anatomic teeth are used. Balanced occlusion does
not exist unless compensating curve balancing inclines are used.
The reverse curve: Modified anatomic teeth may be used, but usually
nonanatomic teeth without balancing contacts are employed. Balance is
possible by introducing a spherical buccal incline in the posterior region of
the occlusion. This is called a “Pleasure curve” after Dr. Max Pleasure who
suggested it. In the treatment of mutilated dentition, preservation of an
incomplete dentition with a minimum of occluding pairs of teeth in
combination with a partial denture is preferable than the total tooth
extraction. This is advantageous for utilization of the natural teeth for
retention and stability of the prosthesis. Presence of the periodontal
ligament provides the advantage of biofeedback mechanism in
controlling the occlusal forces.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
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Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

21
Preventive Prosthodotics
Interim Dentures/Treatment Denture:
In the early loss of the permanent teeth, if the definitive treatment cannot
be done for various reasons, the treatment dentures can be utilized as
preventive measures.
The treatment dentures act as space maintainers to, prevent the
migration/drifting, supra eruption and contact between the teeth,
alveolar ridge, to restore the function, esthetics, restore the muscular
tonicity, vertical height, jaw health and avoids the abnormal jaw habits.
Smith DE stated that Improvement in the interim denture procedure in
the past decade has been one of the significant advancements in
prosthodontic practice. The interim denture approach is only slightly
more time-consuming and expensive than the conventional immediate
denture approach, yet it has many advantages.
Among those advantages are the following:
(1) Allows rapid results;
(2) Results in a higher quality definitive denture;
(3) Allows t he surgical treatment to be performed d uri ng one
appointment;
(4) Permits duplication of the natural tooth position; and
(5) Provides the patient with a spare denture after the definitive denture
is completed. An interim denture technique was described that
utilized a flexible layered silicone mold to form the replaced teeth. The
interim denture procedure is flexible and lends itself to many
variations in technique to meet unusual clinical situations. An interim
removable partial denture technique was described that involves
block-out of undesirable undercuts and duplication of the master
cast for fabrication of the partial denture.
Immediate Dentures:
Immediate denture is a dental prosthesis constructed to replace the lost
dentition and associated structures of maxilla and mandible and inserted
immediately following removal of remaining teeth. An immediate
denture must be compatible both biologically and physiologically with
the oral environment. It should restore mastication,speech and
deglutition to as near normal as possible. It must also be aesthetically
compatible and preserve the remaining oral tissues.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

22
Preventive Prosthodotics
Immediate denture presents numerous advantages such as,
a) The denture acts as a protective splint for the extraction wound and
prevents injury,
b) Protection of the blood clot
c) No compromise in functions of oral cavity like speech, deglutition and
mastication
d) No period of edentulousness for the patient and
e) Maintaining of vertical dimension of occlusion.
Th ough t h e adva n tages a re seem i ngly convi ncing, i t a lso has
disadvantages like:
a) Stimulation provided by the natural teeth is absent
b) It involves a precise and time consuming protocol
c) Absence of anterior try in for aesthetics.
Richardson (I860) described the use of immediate denture.(as shown in
fig 10)
Fig:10 Immediate Denture
If the dentition is very compromised and indicated for total extraction,
then immediate dentures are planned for the following. Promote better
healing (immediate dentures act as surgical stents).These stents apply
minimal pressure to the soft tissues, facilitates healing, prevent the
cicatrisation or tissue collapse. Protect the blood clot and aids early
healing. Promote better ridge form.
Provisional Restoration:
After the tooth preparation is done for fixed prosthesis, provisional
restoration is advocated to prevent the events like pulpal inflammation
(pulp protection), mesial migration, supra eruption and arch integrity,
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

23
Preventive Prosthodotics
protection of the tooth preparation margins (e.g., partial veneer crown)
and protection of the periodontium. Clinicians have many choices of
provisional materials from which to choose when fabricating provisional
restorations which provides esthetic value to the patient.
Complete Denture:
When the teeth are completely absent in any one of the arch, the
fabrication of a single complete denture is highly recommended to
prevent the contact of the teeth and alveolar ridge, to restore function,
vertic al dime nsion , esthe tics a nd preven t t he develop ment o f
parafunctional habits.
The complete dentures are provided for edentulous patients (edentulous
in both jaws) to rehabilitate them by restoring the function form and
aesthetics and general health of the patients. The complete dentures are
provided with various occlusal schemes such as balanced occlusion,
lingualized occlusion, neutrocentric concept and others depending upon
the condition of the patients.
Balanced occlusion involves :
A definite arrangement of tooth contacts in harmony with the mandibular
movements, and if the positions, dimensions and occlusal surfaces of the
teeth are such that during functional jaw movements, mandibular cusp
blades contact maxillary cusp blades throughout the dentures, those
dentures can perform their masticatory function most effectively, and
their Occlusion may be termed as 'physiologic occlusion' or 'balanced
occlusion', Ronwill in 1864, who has been called “the father of anatomic
(balanced) three point contact occlusion” to the present time, all the
theories which were studied seemed to be based upon the assumption
that the articulator moves similar or equivalent to the mandible.
The spherical scheme by Kelly (Anatomic teeth are used) appears in
natural dentitions unless severe abrasion is present. Balanced occlusion
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

24
Preventive Prosthodotics
rarely exists in the natural teeth but balance is desirable for complete
dentures. Advantages of this scheme are
I. Stability of the denture bases
ii. Preservation of supporting tissues
iii. Required during the time of mastication and parafunctional habits
The flat scheme Non-anatomic teeth are used. Balanced occlusion does
not exist unless compensating curve, balancing inclines are used.
Advantages of this scheme are
ŸAdapt better in unusual jaw relationship
ŸDo not lock the mandible, provide the sense of freedom
ŸThey eliminate horizontal forces that are more damaging than vertical
forces
The reverse curve Modified anatomic teeth may be used, but usually non-
anatomic teeth without balancing contacts are employed. Balance is
possible by introducing a spherical buccal incline in the posterior region of
the occlusion. This is called a “Pleasure curve” - Dr. Max Pleasure who
suggested it.
Neutrocentric:
It is a term used to suggest a concept with two key objectives in the
making of a denture by (Devan 1954)
1. Neutralization of inclines
2. Centralization of forces acting on the denture foundation.
To attain these objectives it may be necessary to
a) Reduce the size and number of teeth.
b) Abandon attempts to secure balancing contacts in eccentric
positions beyond the range of masticatory stroke.
The five elements of this scheme were:
ŸPosition: He positioned the posterior teeth over the residual ridges as
lingual as the tongue would allow so that forces are perpendicular to
the supporting areas. This avoided tensile and shearing forces.
ŸProportion: He reduced the tooth width by 40% that reduced the
vertical stress on the ridge. Horizontal forces are reduced because the
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

25
Preventive Prosthodotics
friction between the opposing surfaces is decreased. The forces are
thus centralized without encroaching the tongue.
ŸPitch: This is the inclination of the occlusal plane. It is oriented parallel
to the underlying ridge and midway between them. This directed the
forces perpendicular to the mean osseous foundation plane.
ŸForm: Flat teeth with no deflective inclines were used so that there are
no interferences to mandibular movements.
ŸNumber: The number of posterior teeth was reduced from eight to six.
This reduced magnitude of and centralized it to second premolar and
first molar.
Occlusion developed with this scheme provides the following advantages.
1. Satisfactory preservation of ridge bone.
2. Good denture stability, good appearance, adequate speech and
mastication.
Linear Occlusion:
It is defined as “The occlusal arrangement of artificial teeth, as viewed in
the horizontal plane, where in the masticatory surfaces of the mandibular
posterior artificial teeth has a straight, long, narrow occlusal form
resembling that of a line, usually articulating with the opposing
monoplane teeth.”
William H Goddard is credited for the introduction of linear occlusion.
Gronas and Stout explained how both anatomic and non-anatomic
occlusal schemes transmit significant lateral forces to the denture bases,
and they suggested that the linear occlusion had the potential for creating
the smallest lateral force component.
Basic parameters:
ŸZero degree teeth (Flat teeth) are opposed by bladed (line contact)
teeth in which the blade is in straight line over the crest of the ridge
ŸThe arch, which requires the greatest stability, may receive the bladed
teeth.
ŸMandibular teeth are set to flat occlusal plane
ŸThere is no anterior tooth interference to protrusive or lateral
movements
ŸThis non-interceptive occlusion provides a consistent vertical seating
force in both centric and eccentric movement; hence, transverse
vectors are essentially eliminated.(as shown in fig 11)
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

26
Preventive Prosthodotics
Fig:11 Concepts of occlusion
Over dentures:
Barker (1861) reported first use of Overdentures to the American Dental
Convention. An overdenture is a removable dental prosthesis that covers
and rests on one or more remaining natural teeth, the roots of natural
teeth, and on dental implants. The implants or modified natural teeth
provide for additional support, stability; and retention of the overdenture
than the edentulous ridges alone can provide. This is particularly
advantageous in the mandibular arch, where edentulous ridges may
resorb at a rate four times greater than that of the maxillary arch. It is also
known as Hybrid dentures or tooth-supported complete dentures.
Retaining natural teeth as abutments for dentures can considerably
reduce the progress of residual ridge resorption. Multiple abutments can
be used for this purpose.
Indications for Overdentures:
1. For better support and aesthetics in morphologically compromised
dental arches.
2. Cleft palate cases
3. Dentures for patients with maxillofacial trauma.
4. Patients with worn-out dentition
5. Forcongenital anomalies like microdontia, amelogenesis imperfecta,
dentinogenesis imperfecta and partial anodontia.
6. Patients with abnormal jaw size and position where orthognathic
surgery is contraindicated.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

27
Preventive Prosthodotics
This treatment is usually indicated for:
Group l: Patients with few remaining teeth that may be healthy or
periodontally involved, with intact or grossly destroyed crowns.
Group 2: Patients with severely compromised dentition. Selective
extraction should be carried out after a thorough examination of the
patient.
General Considerations during Diagnosis and Treatment Planning for
an Overdenture:
Maintenance of Periodontal Health:
Once an overdenture is planned and constructed, it is the duty of the
patient to maintain his teeth free from plaque. The dentist should check
for pocket formation around the abutments. Failure to do this may lead to
the loss of an abutment.
Reduction in Crown-root Ratio: R e du ct i on i n crow n siz e du ri ng
abutment preparation can be beneficial for the tooth, as it reduces the
crown-root ratio and decreases the leverage forces acting on the tooth.
Success of Endodontic Therapy:
Endodontic therapy may be necessary for most abutment teeth because
they need extensive crown reduction. A two-to-four week interval should
be provided after completion of endodontic therapy in order to determine
its success before starting further treatment.
Adaptation and Coverage of Denture-Bearing Area:
The denture base should be well adapted to the soft tissues in order to
prevent accumulation of food debris and to evenly distribute the forces
acting on the denture.
Design of the Denture:
As the denture base for overdentures are thin, they have to be reinforced
with metal. At the same time they should be easy to fabricate and
maintain.
Ease of Use:
The patient should be able to easily insert and remove the denture
without any harm to the denture base or the abutment tooth.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

28
Preventive Prosthodotics
Advantages of Overdentures:
1. Maintains the integrity of the residual ridge.
2. Improves the retention and stability of the denture.
3. Improved proprioception leads to better neuromuscular control. This
helps in regulating the biting force over the denture.
4. Psychological effect on the patient as extraction can be avoided.
5. It can almost be used universally.
6. Even if there is abutment failure, the abutments can be extracted and
the overdenture can be relined and used as a conventional complete
denture.
Disadvantages of Overdentures:
1. Nutrition al counselling, ora l hygiene measures and fluoride
application should be carried out periodically.
2. High incidence of caries and periodontal disease around the over
denture abutments.
3. Frequent reviews are needed to verify the health of the supporting
tissues of the overdenture abutments.
4. More expensive than conventional dentures because:
a- Endodontic therapy and coronal restorations may be needed for
certain overdenture abutments.
b- Most cases need a cast metal denture base, as acrylic is weaker.
c- Additional designing and laboratory work is needed.
5. Cannot be used in cases with reduced interarch space, bony
undercuts adjacent to the abutments, etc.
6. Improper maintenance of the overdenture may lead to periodontal
breakdown of the overdenture abutments and the patient may lose
all his remaining teeth.
Overdenture is a complete or partial denture prosthesis constructed over
existing teeth or root structure, it's not a new concept in a technical
approach to a prosthodontic problem. Indeed it was used 100 years back.
INDICATIONS
Patients with poor prognosis for complete dentures
In maxilla – in cases with excessive vertical overlap of anterior teeth
Unilateral overdenture when bone loss is excessive on one side of the arch
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

29
Preventive Prosthodotics
CONTRAINDICATIONS
ŸLack of patient acceptance
ŸLack of proper oral hygiene and periodontal tissue maintenance
ŸWhen other treatment modalities promise superior results
ŸCost considerations
EXAMINATION, DIAGNOSIS, TREATMENT PLANNING AND PROGNOSIS
EXAMINATION OF THE OVERDENTURE PATIENT
ŸHistory and records
ŸVisual and digital examination – pathology, health of the supporting
tissues
ŸRadiographic examination
ŸTreatment planning
ABUTMENT SELECTION
The choice and number of abudments are determined by a combination
of load-bearing ability of the abutment teeth plus the forces and stresses
to which these will be subjected .The number of roots, their shape, length,
alignment and bone height has a direct relation to the load bearing
capacity of teeth. The shorter,more tapered the root and lower the bone
level, the less satisfactory the tooth will be as an abutment.
Evaluate the abudments for:
1. Periodontal status
2. Caries susceptibility
3. Potential for endodontic treatment
4. Positional considerations
LOCATION OF ABUTMENT TOOTH – Positional considerations of
abutment tooth in the arch and its position should be between the buccal
and lingual cortical plates which are areas of maximum force and ridge
resorption potential . Best choice of abutment is canines and premolars .
In maxillary arch, incisors are used at least one tooth per quadrant but
ideal is two teeth per quadrant. The stress is distributed over a rectangular
area. A tripod approach can also be used. Most commonly used teeth in
the mandible for abutment is canine.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

30
Preventive Prosthodotics
OVERDENTURE ABUTMENT MANAGEMENT
1. Non coping preparation
2. Coping preparation
3. Attachments
NON COPING ABUTMENTS
Selected tooth abudment are reduced to a coronal height of 2 to 3mm, the
crown is contoured to a convex or dome shape the tooth is endodontically
treated and filled with amalgam or composite restoration
COPING PREPARATION
A coping is a cover for the exposed tooth surface and cast metal copings
with a dome shaped surface (as shown in fig 12) and a chamfer finish line at
the gingival margin is prepared.
Fig: 12 Metal Copings over prepared teeth
Short copings: 2‐3mm long, RCT done, Copings are with a post, canals
filled with GP
Long copings: 5to 8mm long, RCT is not a must, Copings are long
ATTACHMENTS IN OVERDENTURES
Attachments are small precision devices which are incorporated to
provide some additional benefits like retention and support, more
retention can be gained by lengthening the post and the use of pins. It
consists of two units: 1. Male 2.female
REQUIREMENTS FOR THE ATTACHMENTS
ŸThe patients should have a low caries index
ŸPerform proper home care
ŸSound periodontal health
ŸAbutment teeth with proper bone support
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

31
Preventive Prosthodotics
DISADVANTAGES OF ATTACHMENTS
ŸAdded time
ŸMay cause increased stress on the tooth
ŸMore difficult to construct
ŸRequires careful manipulation by the patients.
Ÿ(Therefore is not of use for the mentally and physically handicapped )
ŸMore expensive
ŸReconstruction in the case of damage is difficult Added risk to the
abutment due to caries and periodontal disease if poor oral hygiene is
performed by the patient
STUD ATTACHMENTS
Fig:13 Anchor/Stud Attachment
Stud attachments( as shown in fig 13) consisted of a female part which is
frictionally retained over the male stud and incorporated into the denture
resin either by the means of a transfer coping system and the creation of a
master cast incorporating a replica of the attachment or directly in the
mouth using self-cured or light-polymerized resin. The stud attachments
are classified according to function into resilient and non-resilient
attachments. Resilient attachments permit some tissue ward vertical and
rotational movements, thus protecting the underlying abutments or
implants against overload. However, resilient attachments usually require
a large space and might cause posterior mandibular resorption with the
vertical movement of the denture. On the other hand, the non-resilient
type does not permit any movement of the overdenture during function
and were commonly employed when the interocclusal space was limited.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

32
Preventive Prosthodotics
One of the main advantages of stud attachments is the ability of its use in
cases with V-shaped arches where the straight connection between the
implants can aeffct the tongue space
GERBER ATTACHMENT: This attachment is of two types:
Rigid attachment: That does not allow the movement of the base
Rigid type: It is most popular and widely used it consists of male post
threaded on to a screw attached to a soldered base and female housing
part contain spring and ring. Both the types are easily replacable(as shown
in fig 14)
Fig :14 Gerber Attachment
DALBO ATTACHMENT
It is rigid, resilient or the stress breaker type. Male part is soldered to the
tooth and the housing to the base.(as shown in fig 15 ).
Fig:15 Dalbo Attachment
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

33
Preventive Prosthodotics
The rigid type has a cylindrical male unit with a rounded head ,the resilient
type is the smallest and the most commonly used sphere shaped male
unit which allows rotational and vertical movements of female around
male.
CEKA ATTACHMENT
In this type of attachment the male part affixed to the tooth and has a
rounded shape wider at the top and split vertically into 4 sections. They are
flexible and can be compressed the female housing fits over this ( as
shown in fig 16).
Fig :16 Cekaattachment
The attachment can also be constructed with a different type of retention
male component that has a space between the parts to allow both
rotational and vertical movements
ZEST ANCHOR
Ideal for interim overdenture (as shown in fig 17)
Fig:17 Zest Anchor
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

34
Preventive Prosthodotics
It derives its retention from the root a post preparation is made within the
root and the female sleeve is cemented into place the male portion
consists of a nylon post and a ball head attachment to the overdenture as a
chair side procedure and the post is placed in the sleeve and the
overdenture is placed over it with a self cure resin.
ADVANTAGES:
Overcomes any space problem because attachment is within root
structure. Leverage to the abutment tooth is negligible since point of
attachment is below alveolar bone level.
DISADVANTAGES :
Caries susceptibility as no coping placed
Nylon stud can bend preventing seating
To correct this f requent recall visits are necessary
When eating foods without the OD can cause food to stagnate in the
female part
ROTHERMAN ATTACHMENT
This attachment is of two types : resilient and non resilient
Resilient allows both vertical and rotational movement..The male part
consists of a groove deeper at one end than the other, it easily attaches to
the coping with free hand soldering. The housing contains a 'C' shaped
ring( as shown in fig 18) the ends of which fit in the deepest part of the
retaining groove.
Fig:18 Rortherman Eccenrtric Attachment
INTROFIX ATTACHMENT
Stud attachment composed of a solder base an adjustable split male post
and a female housing (as shown in fig 19)
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

35
Preventive Prosthodotics
Fig:19 Introfix Attachment
The design is simple and provides frictional attachment between the two
parts. The male stud has a longitudinal split that can be attached to
provide more or less retention. It is replaceable as it is screwed to the solder
base .The lengthy stud can produce a torque potential so it is used in only
totally tooth supported system or OD with excellent support.
OTHER ATTACHMENTS The other attachments of importance: (as shown
in fig 20)
Fig: 20 Parts of Attachment
– Schubiger attachment
– Ancrofix attachment
– Quinlivan attachment
BAR ATTACHMENTS
The bar attachment consists of a metallic bar that splints two or more
implants or natural teeth spanning the edentulous ridge between them
and a sleeve (suprastructure) incorporated in the overdenture which clips
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

36
Preventive Prosthodotics
over the original bar to retain the denture. The bar attachments are
available in wide variety of forms,(as shown in fig 21)
Fig: 21 Different Bar Attachments
They could be prefabricated or custom made.There are two basic types
based on the shape and the action performed: Bar joint that permit some
degree of rotation or resilient movement between the two components.
Spacers should be provided to ensure a small gap between the sleeve and
the bar during processing. Bar joints are subdivided into two types: Single
sleeve and multiple sleeves; the single sleeve has to run straight without
allowing the antero-posterior curvature of the arch, so it is used in square
arches. On the other hand, the multiple sleeves can follow the curvature of
the arch. It also enables the use of more than one clip. Bar units that
provide rigid fixation of the overdenture allowing no movement between
the sleeve and the bar.The prefabricated bars are preferred to milled bars
as they are less expensive and more solid with an equal cross section.
Prefabricated bars are either round, ovoid, or rectangular (U-shaped).
Round bars oeffr more denture rotation than rectangular bars, so produce
less torque on implants. However, Round bars require more frequent clip
activation than U-shaped bars.
Therefore, oval or U-shaped bar are preferred when using two implants.
The bar and clip attachments are probably the most widely used
attachments for implant tissue supported overdentures as they offer
greater mechanical stability and more wear resistance than solitary
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

37
Preventive Prosthodotics
attachments. In addition, short distal extensions from rigid bars can be
achieved which contribute to the stabilization and prevent shifting of the
denture. The assumed advantage of bar attachment is the better
transmission of forces between the implants due to the primary splinting
effect, load sharing, better retention, and the least post insertion
maintenance
MAGNET
Magnetic retention is a popular method of attaching the removable
prosthesis to either retained roots or osseointegrated implants. The
magnet is usually cylindrical or dome-shaped attached to the fitting
surface of the acrylic resin base of the overdenture (as shown in fig 22).
Fig:22 Magnetic Attachments
The magnetic keeper is casted to a metal coping and cemented to root
surface or screwed over the implant fixture.The magnet system used for
overdenture retention incorporates the magnet into the overdenture
which is a neodymium-iron-boron alloy or a cobalt-samarium alloy. The
second part of the magnetic system is the ferromagnetic keeper which is
screwed into the implants. The retention force of magnet attachments in
implant retained mandibular overdenture treatment is markedly less
than the retention force of ball and bar/clip attachments. The immediate
loadin g of magnetic a ttachment ret ained mandi bula r impl ant
overdentures is considered as a viable treatment option in cases of the
complete edentulous patient that increase retention and stability of
conventional dentures .
BASED ON TYPE OF OVER DENTURE
ŸImmediate over denture : Constructed prior to preparation and ready
for insertion after preparation & reduction . It enhances patients ability
and adaptability to wear dentures.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

38
Preventive Prosthodotics
ŸInterim over denture : Used for patients in transition or preparation
phase until permanent overdentureis constructed . Patient old partial
denture can be modified and used by extending the denture and by
adding new artificial teeth using self cure acrylic resin.
ŸRemote or Definitive over denture : Conventional complete over
denture is constructed over one or more abutment teeth. Could be
made entirely of acrylic resin or in conjunction with metal bases.
Vital rootSubmucosal section.
Kotwal and Guyers have suggested that the root might be sectioned off
surgically 2-3 mm below the alveolar crest and the wound closed. The pulp
remnant is nourished from each end and can be expected to remain vital.
The alveolar bone organizes above the root face and the root thus
maintains the alveolar bone contour. This form of treatment might be
contraindicated in an older person, but may be ideal for a younger patient.
The root is likely to emerge at a later date due to resorption of the bone
above it, but endodontic therapy could then be carried and either a new
denture constructed or the existing one modified. An advantage of this
method is that the patient contribution is reduced to a minimum and that
it permits further intervention at a later stage.
Supramucosal section:
Vital roots may be retained supra-mucosally where the pulp has receded
to the extent that the crown may be removed near the gingival crest
without exposure. The root face may be restored by a cast gold cap and a
denture constructed over it.
Pulpless root
Endodontic therapy of the highest standard is necessary when this
method of root retention is chosen.
Subgingival section:
The root may be surgically sectioned below the alveolar crest as before
and the wound is closed. The sub-gingival procedure is still largely
experimental, but it seems that when the pulp remnant is vital the success
rate is greater.
Supragingival section:
This means of treatment is most commonly employed. It is characterized
by the de-coronation of the root 0.5-1 mm above the healthy gingival
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

39
Preventive Prosthodotics
margin and the restoration of the root face either by sealing the pulp canal
orifice with amalgam or with a pin retained root cap, by the insertion of
simple retentive device or, in selected cases, by the construction of a cast
post retained root cap to which a precision attachment anchor is soldered.
Retaining the vital roots retarded the resorption of the residual ridges
under complete dentures. These retained vital roots serve as natural
implants which are ideal and anchored by periodontal ligaments.
The teeth are sectioned to the level of remaining healthy alveolar ridge.
The cut ends are beveled to make it continuous with the alveolar bones,
followed by exchange by muco-periosteal flap. Immediate complete
denture is provided to stabilize the wound and proper healing.
Advantages: Patients need not worry about the maintenance of the
submerged roots. Chances of caries and periodontal destruction around
the submerged teeth are minimal.
In the course of time if the roots are emerged into the oral cavity. They can
be used as over denture abutments.
Other advantages: Good retention and stability to the denture.
Surgical stents:
Stents can be used to apply pressure to the soft tissues to facilitate healing
and prevent cicatrisation or collapse, (collumellar stent, periodontal pack
or stent).
Indications:
Ÿextraction of impacted canines,
Ÿpartial or segmental resection of maxilla and mandible,
Ÿhemi maxillectomy, hemi mandibulectomy.
ŸAlso in stabilizing the implants and ridge augmenting materials.
ŸProtect the wound site, allow unevenful healing, prevent cicatrisation,
and provide the favourable ridge form.
ŸAlso used after the frenectomy,vestibuloplasty,relocating the muscle
attachments.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

40
Preventive Prosthodotics
Obturator:
Obturator (as shown in fig 22)
Fig:22Obturator
is a prosthesis used to close a congenital or acquired tissueopening,
primarily of hard palate and contiguous alveolar tissues.
Immediate Obturator
ŸSurgical obturators are placed immediately after the surgery with or
without surgical packing.
ŸIt is retained by screws or wire fixation.
ŸIt re-establishes the oral contours.
ŸPrevent the regurgitation of the fluids into nasopharynx.
ŸProtect the wounds and allows uneventful healing.
ŸPrevent the cicatrisation or shrinkage.
Interim obturator:
Interim obturator is given after the removal of the surgical packing The
interim obturator is retained upto 3 months with repeated checking and
relining with the tissue conditioner followed by definitive obturator.
FUNCTIONS:
ŸFeeding purposes.
ŸTo keep the wound or defective area clean
ŸEnhance the healing of traumatic or post surgical defects.
ŸTo reshape and reconstruct the palatal contour and/or soft palate.
ŸIt also improves speech or, in some instances, makes speech possible.
ŸAs a stent to hold dressings or packs post operatively
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

41
Preventive Prosthodotics
Role of Removable Partial Denture:
Every dental prosthetic treatment is associated with the placement of a
foreign object (the prosthesis) in the mouth of the patient.The extent and
direction of movement of RPD's during its function are influenced by the
nature of the supporting structures and the design of the prosthesis.The
service expectancy of the partial denture will be proportional to the
degree of control of various stresses of this particular type of prosthesis
that it should be emphasized by analyzing each stress and suggesting
clinical and construction procedures for bringing about the most effective
control. Functional stress stimuli ,within certain limits,are necessary for
the maintenance of the s upp orti ng structures.Since forces are
transmitted to abutment teeth through rests,guideplanes and direct
retainers during functional movements,optimum design based on the
best available research data will preserve the health of abutment teeth
and their supporting structures.
The principle stresses, which are included by RPD are stresses:
1. Resulting from an inaccurate appliance design
2. Caused by an inaccurate appliance size
3. Which may cause impingement of the gingival structure and
4. Which torque or twist the abutment.
Stress Breaker:
“Whether or not a stress breaker should be used” will be a continuous
dispute. McCracken states that, stress breaker has been used as a means
to compensate for inappropriately designed removable partial denture.
Precision attachments in stress breaking:
Precision attachment is defined as “a specially machined, direct retainer
for a removable partial denture. They consists of male and female part one
of which is attached to the denture and the other to the abutment teeth”.
Although there are few scientific data to aid in attachment selection, there
are some prosthodontic principles that should be used. One principle to
be followed is whether the prosthesis uses clasps or an attachment, the
forces should be widely distributed to all available tissues. The denture
base of tooth/tissue-supported removable partial dentures should be
extended to cover the residual ridge within the limitation of functional
muscle movements. The teeth and denture supporting area should both
be used to provide support, bracing, retention direct-indirect retention,
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

42
Preventive Prosthodotics
and stability. If one of these tissues is incapable of providing these
functions, other restorations (e.g., complete dentures or a restoration
using dental implants) should be considered. It is important that the
removable partial denture framework can be properly related to the teeth
and the denture base to the framework. This principle is satisfied if the
entire framework is rigid and the framework contacts three or more teeth,
preferably widely separated and with rest seat preparations. Contact of
the framework with only two abutment teeth is inadequate if there is no
other way to positively relate the framework to the teeth. If a resilient
attachment is used, there must be additional contact between the
framework and the abutment teeth other than the attachments
themselves. There must be way to deactivate the attachment, making the
prosthesis rigid and thus allowing evaluation of the relationship between
the base and the residual ridge
Rests:
Mesial occlusal rest concept:
The clasp design containing
1) a mesial occlusal rest
2) horizontal reciprocal arm
3) a retentive arm engaging a distobuccal undercut is another widely
advocated approach.
When occlusal load is applied to the base, the retentive terminal tends to
move away from or to withdraw its contact with tooth surface.
A further advantage of this is that depression of the base does not exert a
distal stress (pump handle effect) on the abutment teeth but rather a
mesial one that is resisted by not only by abutment, also by natural teeth
mesial to abutment.
Disadvantage of this concept is rigid horizontal reciprocal arm associated
with this design arrangement may develop a medio-lateral stress to
abutment tooth. It must be borne in mind that reciprocal arm is
positioned on suprabulge and will move in gingival direction when the
occlusal load is applied to the base. This rigid reciprocal arm exerts a
buccal stress as it is forced downward onto the suprabulge.
RPI, RPA concept:
RPI clasp is based on mesial rest concept and is given by Kratochvil's. This
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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Page
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

43
Preventive Prosthodotics
clasp assembly consists of mesial rest with minor connector placed on the
mesio-lingual embrasure, but not contacting the adjacent tooth. A distal
guiding plane extending from marginal ridge to junction of middle and
gingival third and an 'I' Bar. In RPI, system most distal rests are placed on
mesial aspect of abutment teeth for following reasons.
1. Anterior placement of the rest fulcrum helps verticalize the forces of
occlusion on bearing mucosa under denture base extension.
2. Mesial rest directs tipping forces on the abutment mesially and tends
to move the abutment tooth into firm contact with the support of
mesial teeth.
Proximal plates:
Parallel guide planes are prepared on all proximal tooth surfaces adjacent
to edentulous spaces. In Kratochvil's original design, proximal plate covers
the guide plane from marginal ridge to the tooth tissue junction and
extends onto the attached gingival for 2mm. This configuration serves
many functions. It
1. Provides horizontal stability.
2. Reunites and stabilizes the arch.
3. In creas e s rete n t ion b eca u s e o f p aral l e lis m a n d b e cau s e
dislodgement is limited to the path of insertion.
4. Protects the tooth tissue junction by preventing food impaction and
because of metal coverage in this area.
5. Provides reciprocation
6. Distributes the occlusal forces throughout the arch.
Direct Retention – I Bar:
The position of 'I' Bar in relation to height of contour is essential to this
design because proper positioning allows the tip to move passively in to
the mesial embrasure space when the extension base receives occlusal
loading.
In a gre emen t with Kratochvil 's bas ic des ign, Krol d eveloped a
modification that studiously avoids tooth preparation. The stated
emphasis in Krol's system is stress control with minimal tooth coverage
and minimal gingival coverage.
The clasp system includes the three elements of Kratochvil's system:
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

44
Preventive Prosthodotics
mesial rest, proximal plate, and 'I' Bar. Each element has undergone
significant change to meet Krol's criteria. Rest preparations are less
extensive in RPI system. The mesial rest extends only into the triangular
fossa, even in molar preparations and canine rests are often circular
concave depressions prepared in the mesial marginal ridge.
The proximal plate makes greatest departure f rom Kratochvil's design.
The prepared guide plane is 2-3mm high occluso-gingivally and the
proximal plate contacts only 1mm of gingival portion of guide plane. Relief
as provided at the tooth tissue junction to allow proximal plate to
di s engage i n to the prox imal under cut under o c clusal l oading .
Modification in I Bar configuration and placement are needed to
compensate for the loss of tooth contact on the proximal plate. The I Bar
terminus is pod-shaped to allow more tooth contact and placement tends
toward the mesial embrasure space to achieve more efficiently
reciprocation from the diminutive proximal plate (as shown in fig 23)
Kratochvil Design of RPI Krol Modification of RPI
Fig:23 Approach for Application of RPI system
Occlusal force on extension base disengages the retentive tip into mesial
embrasure.
The stated purpose of reducing the proximal plate is to improve gingival
health by opening up embrasure spaces as much as possible. Tipped
abutments and tissue impingement are treated by further modification
of RPI called RPA. When Akers clasp arm is used, careful attention is paid to
relieve all undercuts except at the retentive tip.
Guiding planes
Guiding planes are important in the effort to maintain the integrity and
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
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numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

45
Preventive Prosthodotics
health of supporting tissues. Properly positioned and prepared guiding
planes may reduce torquing forces directed to the abutment teeth.
Guiding planes allow the patient to insert and remove the prosthesis
along a predictable, repeatable path of insertion and withdrawal,
minimizing the potential for soft tissue injury that may occur during the
placement and removal of the prosthesis. The preparation of guiding
plane length for all tooth-supported prosthesis may extend up to one-half
the length of the proximal surfaces of the abutment teeth. This is not so for
abutments supporting the distal extension prosthesis. In this situation,
short proximal guiding planes are desirable in conjunction with a mesially
placed rest. A well-positioned RPI clasp allows some degree of rotation of
the clasp assembly over the abutment tooth. However, stress-breaking
ability alone is not enough to ensure the health of supporting tissues, nor
will any precision or semi precision attachment accomplish this goal by
itself. Stress breaking must be accomplished by a properly extended and
adapted denture base and a harmonious occlusion.
MAJOR CONNECTOR
Major connector must be sufficiently rigid so that forces applied to any
one portion of the denture may be optimally distributed over the entire
supporting area.
MAXILLARY MAJOR CONNECTORS
1) Anterior –Posterior Palatal Strap
2) Palatal plate-type connector
3) Single palatal strap
4) U-shaped palatal connector (Anterior Palatal Strap)
5) Anterior-posterior palatal bar
6) Posterior palatal bar
ANTERIOR-POSTERIOR TYPE SYNONYMS: A-P TYPE, RINGSHAPED,
DOUGHNUT-SHAPED, CLOSED HORSESHOE, CIRCULAR (as shown in fig
24)
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

46
Preventive Prosthodotics
Fig: 24 Antero-posterior Type Major connector
Indications:
1. Class III or Class III mod 1 partially edentulous arch with a long span
edentulous space.
2. Class I or class II partially edentulous arch where adequate support,
retention, bracing, and direct-indirect retention may be obtained
from contact of the denture base with the ridge and the contact of the
framework with the palate.
3. An inoperable palatal torus.
4. A RPD replacing anterior teeth.
Contraindications:
1. Where the palatal opening will be less than 15 mm antero-posteriorly
or mediolaterally.
2. Where support, retention, bracing, and direct-indirect retention from
the palate is required.
3. Where a major connector with a simpler design may be used.
Advantages:
1. Covers a minimum of palatal tissues.
Disadvantages:
1. Very complex design.
2. A lot of metal-tissue edges.
3. The posterior palatal bar or strap frequently does not fit the palate
closely.
4. The anterior border is frequently located in the rugae.
5. The posterior border is frequently located in the hamular notch-
vibrating line area.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

47
Preventive Prosthodotics
PALATAL PLATE SYNONYMS: BROAD PALATIAL STRAP OR PLATE,
POSTERIOR PALATAL STRAP OR PLATE, BROAD PALATAL MAJOR
CONNECTOR( as shown in fig 25)
Fig:25 Broad Palatal Major Connector
Indications:
A Class I or Class II partially edentulous arch.
Contraindications:
1. A tooth supported edentulous space.
2. A palatal torus.
Advantages:
1. Support is provided by contact of the major connector with the
denture bearing foundation of the palate.
2. Fairly simple design.
Disadvantages:
1. Covers a considerable portion of the palate.
DESIGN I presents the following difficulties
a) The hamular notch vibrating line area must be located on the master
cast.
b) Difficult to adjust the metal-tissue contact.
c) Difficult to reline the metal portion of the palatal contact.
DESIGN II presents the following difficulty:
a) Difficult to blend the thickness of the metal (1 mm)- plastic (3 mm)
junction.
b) The anterior border is f requently located in the rugae.
U-SHAPED SYNONYMS: ANTERIOR PALATAL STRAP, HORSESHOE, OPEN
RING, OPEN DOUGHNUT. (as shown in fig 26)
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

48
Preventive Prosthodotics
Fig: 26 U Shaped Major Connector
1. A Class IV partially edentulous arch.
2. A Class III or Class III mod 1 partially edentulous arch with an anterior
edentulous space, where cross-arch force distribution is not
important.
3. A partially edentulous arch with an inoperable palatal torus.
Contraindications:
1. Where support, retention, bracing, and direct-indirect retention from
the palate is necessary.
2. Where cross-arch force distribution is necessary.
Advantages:
1. Minimal coverage of the palate.
2. Fairly simple design.
3. Fewer metal-tooth or tissue edges than the A-P design
Disadvantages:
1. Not as rigid as other maxillary major connectors.
2. Rigidity may be increased by having the metal in the vertical and
horizontal planes and is probably adequate, particularly with cast
chromium.
SINGLE PALATAL STRAP
Indications
1- Posterior bilateral edentulous spaces of short span in a tooth-
supported restoration.
2- It may also be used in tooth-supported unilateral edentulous
situations with provision for cross-arch attachment by extracoronal
retainers.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

49
Preventive Prosthodotics
Contraindications
1- Tooth-tissue supported removable partial denture.
2- Presence of palatal tori.
3- Extremely long edentulous span. Anteroposterior major connector
would be better
ADVANTAGES
1- Very simple design.
2- Very few metal-tissue edges.
DISADVANTAGES
It covers a considerable portion of the palate
ANTERIO-POSTERIOR PALATAL STRAP
It is a rigid palatal major connector. The anterior and posterior palatal strap
combination may be used in almost any maxillary partial denture design.
The strength of this major connector design lies in the fact that the
anterior and posterior components are joined together by longitudinal
connectors on either side, forming a square or rectangular f rame.
Indication
(1) In Class I and II arches in which excellent abutment and residual ridge
support exists, and direct retention can be made adequate without
the need for indirect retention from palate (palatal plate).
(2) Long edentulous spans in Class II mod. 1 arches.
(3) In Class IV arches in which anterior teeth must be replaced with a
removable partial denture.
(4) Inoperable palatal tori that do not extend posteriorly to the junction of
the hard and soft palates.
Contraindication
1- When can use simple major connector.
2- When there is large inoperable palatal torus that extends posteriorly
to the soft palate, so broad U- shaped major connector may be
considered.
Advantages
The double-strap type of major connector provides the maximum rigidity
without bulk. It covers minimum of palatal tissues than full palatal
coverage.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

50
Preventive Prosthodotics
Disadvantages
1- Very complex design.
2- A lot of metal-tissue edges.
3- The posterior palatal bar or strap frequently does not fit the palate
closely.
4- The anterior border is frequently located in the rugae.
Single palatal bar: (as shown in fig 27)
Fig:27 Single palatal bar
- It is a bar running across the palate which is narrow,half oval in cross
section with it's thickest point in the centre.
- Gentle curved and should not form an angle
Indications: ClassIII (short span)application
Advantages:
Used primarily in interim application
Disadvantages:
Bulky causes discomfort to the patient
Narrow antero-posterior width
Little support from palate
When designing maxillary bilateral distal-extension prosthesis, consider
that as much retention is developed by the relationship between both the
major connector and denture base to the underlying tissues as by the
direct retainer. When only the six anterior maxillary teeth remain, consider
the extension of the prosthesis as for a complete denture and extend the
borders and the base coverage accordingly. Thus the forces are distributed
between the mucoperiosteum, bone, and the abutment teeth
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

51
Preventive Prosthodotics
MANDIBULAR MAJOR CONNECTORS
Six types of mandibular major connectors are:
1 - Lingual bar.
2 - Linguoplate (lingual plate).
3 - Sublingual bar.
4 - Lingual bar with cingulum bar (double bar).
5 - Cingulumbar.
6 - Labial bar and buccal bar.
Lingual bar &lingual plate major connectors (as shown in fig 28)
Fig:28 Lingual bar and Lingual plate
are used in the majority of removable partial denture applications. Double
lingual bar and labial bar major connectors are used for special
applications in which lingual bars and lingual plates are contraindicated
Lingual bar: Is the most frequently used mandibular major connector,
because of its simplicity in design and construction.
Indication: It is the first choice major connector, should be used whenever
the functional depth from free gingival margin to the lingual vestibule
equal or exceed 8mm.
Advantages:
1. The simplest mandibular major connector with highest patient
acceptance.
2. It does not cover the teeth or the gingival tissues
Disadvantages:
If it is not properly designed it may not be rigid.
Lingual plate:
Half –pear shaped lingual bar with a thin ,solid piece of metal extending
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
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Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

52
Preventive Prosthodotics
from its superior border. This thin projection of metal is carried onto the
lingual surfaces of the teeth and presents a scalloped appearance. The
inferior border of a lingual plate should be positioned as low in the floor of
the mouth as possible, but should not interfere with the functional
movements of the tongue and soft tissues. The superior border of a lingual
plate must be contoured to intimately contact the lingual surfaces of the
teeth above the cingula.
Indications:
1-used when there is insufficient vertical space for a lingual bar(distance
from free gingival margin to floor of the mouth less than 8mm)
2-when there is gingival recession,high muscle attachments or high
frenum attachments on the lingual aspect of the mandibular arch .
3-when the remaining teeth have lost much of their periodontal support
and require splinting. Lingual plate used to stabilize the remaining teeth
and to distribute applied forces over the remaining teeth and soft tissue.
4-lingual tori is present.
Advantages
1. The most rigid mandibular major connector.
2. It gives indirect retention to the partial denture.
3. Deflect food from impacting on lingual tissues.
4. Provide resistance against horizontal or lateral forces.
5. Permits the replacement of lost teeth without remaking the partial
denture.
6. Help in splinting and prevent upper-eruption of the anterior teeth
Disadvantages: In patient with poor oral hygiene,lingual plate extensive
coverage may contribute to decalcification of enamel surfaces and
irritation of the soft tissue in patients with poor oral hygiene.
Double- lingual bar with cingulum bar
Indications:
1. When indirect retention is required.
2. When periodontally affected teeth that require splinting are present.
Advantages:
1- provide indirect retention.
2- contribute to horizontal stabilization
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

53
Preventive Prosthodotics
3- no gingival margin coverage.
Disadvanges:-
1- Tongue annoyance
2- food impaction if the upper bar is not intimate contact with the teeth.
Cingulum bar (as shown in fig 29)
Fig:29 Cingulum bar
Indications
1- height of activated lingual frenum and floor of the mouth at the same
level as marginal gingiva
2- inoperable tori or exostosis at the same level as the marginal gingiva
3- severly undercut lingual alveolus
4- considerable gingival recession.
Contraindication:
1- anterior teeth severely tilted to the lingual
2- diastema and open cervical embrasures where the metal will show.
Advantages:
1- can be used where lingual bar and lingual plate cannot be used
2- does not transverse the marginal gingiva or overly the lingual alveolus.
3- easy to add prosthetic teeth to framework.
Disadvantages:- Must be bulky to have sufficient rigidity and thus may be
objectionable to the patient.
Labial bar (as shown in fig 30)
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

54
Preventive Prosthodotics
Fig:30 Labial Bar
Indications:
1. When the mandibular teeth are so severely inclined lingually as to
prevent the use of lingual major connector.
2. When large lingual tori exist and their removal is contraindicated.
Advantages:
1- It solved the problem of lingually inclined teeth &avoid surgical
intervention to remove large lingual tori
Disadvantages:-
1- lack of rigidity
2- least comfortable to patient.
PREVENTIVE PHILOSOPHY IN FIXED PROSTHODONTICS:
Preservation of tooth structure by designing fixed partial denture:
One of the basic tenets of restorative dentistry is to conserve as much
tooth structure as possible consistent with the mechanical and esthetic
principles of tooth preparation. This will reduce the harmful pulpal effects
of various procedures and materials. The thickness of the remaining
dentin has been shown to be inversely proportional to the pulpal
response, and tooth preparations extending deeply towards pulp should
be avoided. Dowden has stated that any damage to the odontoblastic
processes will adversely affect the cell nucleus at the dentin pulp interface,
no matter how far from the nucleus it occurs. Tooth structure is conserved
by using the following guidelines.
Use of partial coverage rather than complete coverage restorations
1. Preparation of teeth with the minimum practical convergence angle
between axial walls.
2. Preparation of the occlusal surface so that the reduction follows the
anatomic planes to give uniform thickness in the restoration.
3. Preparation of the axial surfaces so tooth structure is removed
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

55
Preventive Prosthodotics
uniformly; if necessary teeth should be orthodontically repositioned.
4. Selection of conservative margin compatible with the other principles
of tooth preparation.
5. Avoidance of unnecessary apical extension of preparation.(as shown
in fig 31)
Fig:31 Standard preparation for Fixed partial dentures
Various partial retainers :
1) Posterior three quarter crown
2) Anterior three quarter crown
3) Pin modified three quarter crown
4) Reverse three fourth
5) Proximal half crown
th
6) 4/5 crown
th
7) 7/8 crown
Partial coverage restorations:
An extra coronal metal restoration that covers only part of the clinical
crown is considered as partial coverage restoration (or) partial veneer
crown. Whenever feasible, a partial – coverage restoration should be
selected rather than a complete veneer because it preserves more of
coronal tooth structure. It results in less pulpal and periodontal insult. The
supragingival margin provides easy access for oral hygiene maintenance.
Resin Retained Fixed Partial Dentures: Rochette introduced the
concept of bonding a metal retainer to enamel using adhesive resin. His
application was to splint periodontally involved mandibular anterior teeth
using a cast gold bar bonded to the lingual surfaces of the teeth. The cast
metal splint described had perforati ons to provide mechanical
interlocking between the cement and the metal. His introductory article
made reference to modifying the technique for application as an Resin
Bonded Fixed Partial Denture(RBFPD). Today, this type of design with
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
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numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

56
Preventive Prosthodotics
perforated retainers, can be used to facilitate retrievability when an
RBFPD is used as a provisional restoration.
Livaditis proposed abutment preparation, including reduction of proximal
and lingual surfaces to create a path of insertion, along with occlusal rest
seat preparation to resist tissueward displacement of the retainer. These
modifications enhanced the retention and resistance forms of the metal
retainer to the tooth. Attention then turned to treatment of the retainer's
fitting surface to increase the resin to metal bond strength. Livaditis and
Thompson introduced the concept of electrolytically etching a non-
precious metal to microscopically roughen the metal surface. Electrolytic
etching works on the principle of selective dissolution of the most
corrosion-sensitive phases of the metal. Mean tensile bond strengths of
27.3MPa for resin composite bonded to an electrolytically etched alloy
were reported
Classification of Resin- Retained FPDs:
1. Cast perforated resin retained FPD (Rochette Bridge)
2. Etched cast resin retained FPD (Maryland Bridge)
3. Macroscopic mechanical retention resin retained FPDs (Virginia
bridge).
4. Chemical bonding resin retained FPDs.
Designing:
The initial designs of etched cast retainers included an “interproximal
wraparound” concept developed to resist occlusal forces and provide a
broader area for binding. Enamel preparation consisted of creating
occlusal clearance, placement of occlusal and cingulam rests, and
lowering the lingual and proximal height of contours, thus creating
proximal extensions. Its advantages include minimal removal of tooth
structure and minimal potential for pulpal trauma. Supragingival margins
of this prostheses permits easy hygiene maintenance.
Fiber Reinforced Composite Fixed Prostheses:Fiber reinforced fixed
prostheses are an innovative alternative to traditional metal ceramic
restorations. They should be considered for certain patients because they
provide a conservative approach to replace missing teeth and overcome
some of the drawbacks of conventional prostheses.The restoration
consists of fiber reinforced composite substructure veneered with
particulate composite material. It requires minimal removal of crown
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
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Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

57
Preventive Prosthodotics
structure and provides no nickel allergy due to lack of any metal
substructure. It results in less wear of opposing tooth structure.
Prevention Of Iatrogenic Damage During Crown Preparation:
Adjacent teeth: Iatrogenic damage to the adjacent tooth is a common
error in dentistry. Damaged proximal contact area is more conducive to
dental caries. It can be prevented by placing metal matrix band around
adjacent tooth. A preferred method to avoid damage is, leaving a thin lip of
enamel by passing a tapered diamond through the contact area.
Soft tissues: Damage to the soft tissues of the tongue and cheeks can be
prevented by careful retraction with an aspirator tip, mouth mirror, or a
flanged saliva ejector. Great care must be exercised to protect the tongue
when the lingual surfaces of the molars are prepared.
Pulp: There are number of factors, which can cause pulpal response,
include extreme temperature, chemical irritation, or microorganisms
particularly when they occur on freshly cut dentinal tubules. Prevention of
pulpal damage necessitates selection of techniques and materials that
will reduce the risk of damage. Tooth preparation must take in to
consideration the morphology of the dental pulp chamber.
Air-water spray: Apparently, an air-water spray gives the greatest
protection to the pulp. The reasoning is that there is a better dissipation of
the frictional heat and less desiccation of the tooth tissue.
It is necessary to keep the pulp within +10° of 98.6° F. (normal body
temperature) to prevent the pulp from undergoing necrosis. Studies have
shown that an increase of 10° F. caused necrosis in 15 per cent of the pulps
with an increase of 15° the incidence was 20 per cent; 20° F gave 60 per
cent; and 30° F. resulted in 100 per cent loss.
Dry air-blast cooling:Literature reviewed suggests that a steady stream of
air used as a coolant for ultraspeed low-torque cutting instruments is an
effective and acceptable method of preventing thermal injury to the pulp,
and its use is not contraindicated.
Caries: We are not always dealing with sound teeth for bridge abutments.
Active caries will penetrate the dentin an average of 1.0 mm. every six
months. Long before bacteria reach the pulp, their enzymes, toxins, and
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

58
Preventive Prosthodotics
organic acids span the remaining distance of the dentinal tubule. All
carious dentin should be removed before placing the restoration that will
serve as a foundation for a fixed prosthesis. An indirect pulp cap is not
recommended, because its later failure is likely to jeopardize extensive
prosthodontic treatment.
Direct pulp exposure: Calcium hydroxide has been recommended as a
capping agent to stimulate reparative dentin since 1937. It causes a
chemical cauterization of about 1.0 mm of pulp tissue. The by-products of
the cauterized tissue are locked and prevented from permeating the vital
tissue. The result is a minimum of inflammatory response. Regeneration
starts at the junction of the mummified tissue. Unfortunately, the process
is not always self-limiting, and occasionally the entire pulp will fill with
reparative dentin preventing endodontic therapy. If it is improperly
applied, it may form emboli in the pulp which stimulate reparative dentin
in undesirable places.
Drying: Many of oralprocedures require that we dry the prepared
abutment. This causes a response. Within 20 minutes after application of a
two-minute air stream, there is a strong migration of odontoblasts.
Since dentin is a good insulator, the air blast may not significantly change
the pulp temperature even though there is an extensive displacement of
the odontoblasts. Vesicles have been observed in the pulp as a result of the
air blast. The outward flow of odontoblasts may be caused by evaporation
of fluid from the outer ends of the tubules.
Dehydration of dentin was seen by restorative materials. Silicate cements,
zinc oxide eugenol cements, these are all hygroscopic. Resins undergo
water sorption and have a steady dehydrating effect. These and similar
materials might cause a centrifugal flow of fluid in the dentinal tubules
which will result in aspiration of the odontoblasts. It might be well to use a
protective varnish with temporary restorative materials.
Treatment of abutments after preparation: Corticosteroids have been
recommended for the treatment of abutment teeth after preparation.
There is a conflict in the literature as to the value of this procedure.
Reactions in the pulp caused by caries seem to persist no matter which
corticosteroid solution is used: however, the pain may disappear. There is a
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

59
Preventive Prosthodotics
possibility that corticosteroids preserve chronic inflammation. In the long
run, they may not be beneficial and certainly are not a substitute for
endodontic treatment
Temporary protection: Because of the sensitivity of prepared teeth and the
accumulation of plaque on the areas that are not self-cleansing, some
type of temporary coverage is necessary to protect the pulp.
One of the methods for fabricating temporary restoration is direct method
using auto polymerizing acrylic reins. The f ree monomer is toxic to the
pulp and hence a protective varnish or calcium hydroxide lining should be
applied before preceding the temporary fabrication.
Impressions:
An impression is an imprint or negative likeness
Ideal Requirements of cast restoration Impression
1. Exact duplication of the prepared tooth, adjacent tooth and tissues.
2. Enough uncut tooth surface beyond the preparation
3. location and configuration of the finish line
4. free of bubbles
Classification of Impression Material
1. Hydrocolloid impression material
A) Irreversible B) Reversible
2. Elastomeric Impression Material
a) Polysulphide
b) Addition Silicone
c) Condensation Silicone
d) Polyether Dimethacrylate
Impression Technique
1. Reversible Hydrocolloid technique
2. Stock tray technique – Double mix or single mix
3. Custom tray technique
4. Double Arch technique
5. Copper Band technique
6. Matrix System
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

60
Preventive Prosthodotics
Comparison of Impression Materials:
These are compared on the basis of three characteristics – Wettablity –
Viscosity – cost
Wettablity:
Greater the wettablity, less would be the contact angle – devoid of bubbles
and easier to pour.
ŸHydrophilic: Irreversible hydrocolloid (alginate), reversible hydrocolloid,
and polyether
ŸHydrophobic: Polysulfide, PVS materials.
Viscocity:
Increase with mixing time
Syringing impression is preffered over spatulating
Reversible Hydrocolloid :
ŸWidely used impression material for 70 years.
ŸPacked as a semi-solid gel in polyethylene tubes
ŸIt is passed through three hydrocolloid conditioner tanks before
inserting into patient mouth – Liquefying – Storage – Tempering
ŸSpecial tray (double- walled) is used through which cool tap water is
circulated to complete the gelation process
Disadvantage –
ŸImbibition ,
ŸAbsorption ,
ŸSyneresis , water loss, if excessively dessicated
Steps for reversible hydrocolloid impression :
After the tooth preparation is done GTR is placed in the sulcus area RHC is
liquiefied in solution conditioner and then placed in storage tank . The
liquefied RHC cartridge loadedin the syringe GTR is removed and
impression material from syringe is poured into sulcus. Now the quadrant
is loaded with tempered RHC and placed over the prepared quadrant and
allowed to cool for 10 min as the quadrant impression cools, full arch
impression is made using tempered RHC opposite arch impression can be
made with irreversible hydrocolloid (alginates)
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

61
Preventive Prosthodotics
Other modification :
Laminates technique - Use of reversible hydrocolloid for prepared section
and then irreversible hydrocolloid for full arch
wet field technique - In this technique the tooth surfaces are purposely
left wet and areas are usually flooded with warm water. The syringe
material is introduced quickly, liberally and in bulk to cover occlusal/incisal
areas only. While the syringe material is still liquid, tray material is seated,
the hydraulic pressure of the viscous tray material forces the syringe
material into areas to be restored.
Contraindicated in grooves, boxes, or isthmus.
Elastomeric Impression:
ŸPolysulphide
ŸAddition Silicone
ŸCondensation Silicone
ŸPolyether dimethacrylate
Custom Resin Trays :
Accurate impression –
Three or more unit interpreparation and cross arch discrepancies could
have a significant impact on the fit of the restoration – custom tray
reduces discrepancies to much extent.
Requirements of Custom tray:
ŸRigid
Ÿstops on the occlusal surfaces of the teeth to orient the tray properly
when it is seated in the mouth
ŸImpression material should adhere firmly to tray – rubber adhesive is
used.
Custom resin tray can be made up of either visible light cure (VLC) polymer
or self cure polymer. Spacer wax applied over diagnostic cast and 2 to 3
mm beyond the necks of the teeth is neatly trimmed. Occlusal stops (3X3
mm) made over spacer wax in posterior and incisive region. Tin foil is
adapted impregnating the surface of the tray during the exothermic
polymerization of the resin. The edge of the tray should lightly touch the
cast all around its periphery, including the retromolar areas, when the
stops are fully seated. Acrylic is adapted over the spacer and cured for 30
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

62
Preventive Prosthodotics
sec then taken out of curing chamber to correct the slumping handle
.Again it is placed for 30 sec and take out. Smoothen and finish it, remove
spacer and tin foil and apply triad ABC (Air Barrier Coating used for curing
air inhibited surfaces).Again place for curing for 2 min. Custom resin tray is
an Autopolymer where monomer and polymer is mixed and waited till it is
applicable. It is adapted over the foil with proper horizontal handle in the
middle and a narrow ledge or “wing” on either side of it then left for
polymerization till it gets harder and little warmer. Wax and tin foil are
removed.
As it is an auto-polymer impression should be made only after 6 hours as
polymerization shrinkage may cause discrepancies. In case, cast has to be
poured immediately then impression can be made at least after 40 mins
of polymer mixing with acceptable linear expansion. It shouldn't be stored
in moisture as it gets distorted, the inner side of the tray is painted with
adhesive
Dual-Arch Impressions :
Dual arch impression techniques utilize special stock impression trays of
various designs. These trays are made of flexible plastic or mesh material
placed across the occlusal surfaces of the teeth connecting their buccal
and lingual flanges.
Indication :
Ÿsingle tooth with intact adjacent and opposing teeth
Ÿmutually protected Angle Class I occlusion
Ÿ2 types short sidewalls or taller sidewalls.
ŸWhere adequate GTR and moisture control is done.
Dual-Arch Impressions Technique:
Low-viscosity impression material is injected around the prepared tooth.
While this is occurring, the dental assistant loads the high-viscosity
material into the tray and the tray is inserted immediately .Minimal time
must elapse between the completion of the syringing of the low-viscosity
material around the prepared tooth and the introduction of the loaded
tray. After the impression material is set, it is verified for accuracy then the
die-stone is poured firstly on prepared teeth side then to opposite arch.
After the cast is set, its articulated on Foster spring chrome articulator
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

63
Preventive Prosthodotics
Polysulfide:
Base paste – polysulfide polymer :mercaptan (-SH)
Filler : lithopone or titanium dioxide
Plasticizer : dibutyl phthalate
Accelerator: sulfur 0.5%
Catalyst (or accelerator) paste – lead dioxide radiopacity and chracterstic
brown color
Retarder : oleic or stearic acid
Polysulfide : Maximum accuracy can be obtained, A polysulfide
impression should be poured within approximately 1 hour of removal from
the mouth or less. As it is hydrophobic in nature there shouldn't be
moisture on the preparation when the impression is made.
Method :
The retraction cord is inserted and a large gauze pack is placed in the
mouth .Two system paste i.e Regular base and light base the light base
and heavy base is mixed on mixing pad in interval of 30 seconds. Light
base is loaded in syringe and heavy base loaded on tray. Light base is
syringed on tooth preparation after removal of GTR and light moistening.
Subsequently heavy base loaded custom impression is loaded in the
mouth.
Condensation Silicone :
Two p a s te s ys t em – ba se p a st e : α-ω- hy d ro x y l - te r m i na t ed
polydimethylsiloxane and fillers – Catalyst Paste : organo-tin silicones
Method : Before the preparation a stock tray that fits the arch is selected
.Tray adhesive applied on tray then two scoops of putty (base) are placed
on the pad and6 drops of accelerator are added for each scoop of base .Mix
on pad with spatula for few seconds and then knead in palm for 30
seconds .It should be free of streaks and rolled in cigar shape and placed in
stock tray then covered with a polyethylene spacer and the tray is seated in
the mouth .After initial set has occurred (about 2 minutes) spacer is peeled
off and impresion is examined for error. If any extra impression material is
there it is removed with sharp knife.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

64
Preventive Prosthodotics
After the preparation anesthesia is given and GTR is placed into mouth 8
inches of the thin-wash silicone base are squeezed out onto the
disposable mixing pad. One drop of accelerator is added per inch of base
and mixed for 30 second ,one-third of the wash material is placed into the
back end of the syringe to allow the material to set into the tray. Removal of
GTR is done as gentle as possible. The syringe material is immediately
injected into the sulcus and around prepared teeth the tray is seated
slowly until it is firmly in place with no downward pressure for 6 minutes .
As the impression is set, it is removed as quickly and in as straight a path as
possible to prevent plastic deformation of the material then rinsed to
remove blood and saliva, blown dry , and inspected and disinfected and
poured and the opposing arch can be made with alginate
Polyvinyl Siloxane : Also known as Addition silicone or vinyl polysiloxane
(VPS) or vinyl silicone i.e light body, medium body and heavy body 2 paste
system
– base paste: polymethylhydrosiloxane, as well as divinylpolysiloxane
and fillers
– Catalyst (or accelerator) paste: divinylpolysiloxane a platinum
(catalyst) and palladium(H2 scavenger) salt and fillers.
No reaction by-products are formed as long as the correct proportions are
taken and it is impurity free .Residual polymethylhydrosiloxane in the
material can lead to a secondary reaction with each other or with
moisture, to produce hydrogen gas,and pinpoint voids as seen in the
gypsum casts poured soon after removal of the impression f rom the
mouth.
It is hydrophobic in nature, if nonionic surfactant is added surfactant
migrates toward the surface of the impression material and has its
hydrophilic segment oriented toward the surface. Dry field for impression
making is required. Sulfur contamination from natural latex gloves or vinyl
gloves inhibits the setting of addition silicone.
Polyvinyl Siloxane is least affected by pouring delays or by second pours .It
is still accurate, even when poured 1 week after removal from the mouth
.Available as Single barreled or twin-barreled cartridge with either
automixing and manual mixing.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

65
Preventive Prosthodotics
Polyether:
Polyether impression materials are used for making impressions when
producing dent al restorations . Hydrophili c to p rovide accu rate
impressions in moist conditions, polyether impression materials come in
various viscosities from lightweight/soft to heavyweight and have varying
setting times. Dispensing techniques can be hand mix, syringe or
machine mix to reduce waste and ensure accuracy. Features to look for
when choosing polyether impression materials include biocompatibility,
acceptable odor and taste, good detail reproduction, good tear strength,
easy removal of impressions, sufficient working time with a short setting
time, and a long shelf life.ex: Impregum F Polyether Impression Material
Supplied in two pastes
Base paste:
Polyether
Filler
Catalyst paste:
Sulphonic acid ester(enhances further polymerization and crosslinking)
Inert oils(forms a paste)
When mixed the polymer and sulphonic acid ester react to form a stiff
polyether rubber. Setting time occurs in about 6 minutes.
Light bodied material is available in syringe and tubes
Advantages:
- Complete control over working and setting time
- Curing time is relatively short
- Excellent physical,mechanical and clinical properties.
Disadvantages:
- Need for transparent trays
- If delay in placement material to be stored in dark place
- Difficult to cure remote areas
- Should not be used in patients allergic to methacrylates.
Heavy body polyether :
ŸHydrophilic before, during and after the set for unsurpassed accuracy,
even in the presence of moisture.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

66
Preventive Prosthodotics
ŸThixotropic: it flows smoothly under pressure in critical areas and
remains fixed without pressure.
ŸSnap-setting characteristic provides for a rapid transition to the set
phase while allowing sufficient working time. This ensures a precise-
fitting final restoration without distortion.
ŸPolyether material characteristics guarantee impressions of the
highest precision.
Cementing the completed restoration:
It has been suggested that final restorations be cemented with a
temporary zinc oxide eugenol cement for several months so that
reparative dentin will form and protect the pulp from the acid of the zinc
phosphate cement. It is suggested that, because of the mild trauma
caused by ultra speed, water-spray preparations have greatly decreased
the formation of reparative dentin. Fifty days are required for the
formation of reparative dentin after trauma. The formation seems to be so
trivial with ultra speed preparation that it seems more practical to use a
cavity liner and the permanent cement initially.
Penetration of phosphoric acid from zinc phosphate and silicophosphate
cement causes a burn lesion and abscess formation in the pulp. Although
the cavity varnishes are impermeable when painted on a glass slab, there
is some permeability when used on the dentin. However, there seems to
be sufficient protection to prevent irreversible changes.
When a complete crown is seated under pressure, the cement creates
hydraulic pressure in every direction. If the crown is vented, much of the
hydraulic pressure will be relieved.
Microleakage: Integrity of the margins of the restoration to the finish line
within 50μ is essential to avoid cement dissolution and plaque
accumulation. Cement, which is less soluble in oral environment, will
prevent secondary caries of the abutment.
The response of the pulp to restorative procedures is cumulative. Each
procedure adds to the response engendered by the previous one. The
condition of the pulp before treatment is most significant. If the tooth is
carious or has been restored previously, there is no way of accurately
evaluating the pulp.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

67
Preventive Prosthodotics
PROTECTION OF PERIDONTIUM:
One of the prime goals of restorative therapy is to establish a physiologic
periodontal climate and facilitate the maintenance of periodontal health.
Crown contour, margin placement, and pontic design all affect
periodontal health.
CROWN CONTOUR
The contours for full and partial coverage restorations play a supportive
role in establishing a favorable periodontal climate. Three prominent
theories of crown contour have evolved: (1) gingival protection, (2) muscle
actions, and (3) access for oral hygiene.
Gingival protection theory
The gi ngival protection theory advocates that contours of cast
restorations be designed to protect the marginal gin giva f rom
mechanical injury. This concept implies that under-contouring of the
clinical crown will cause deflection of masticated food onto the gingival
margin, forcing it into the sulcus, thus initiating gingivitis. This concept
may have originated f rom the observation that interproximal food
impaction occasionally can initiate acute inflammation. However,
numerous studies have demonstrated a cause-and-effect relationship
between plaque and gingivitis and in comparison, the interrelationship of
periodontal disease and food impaction appears slight.
Muscle action theory
Morris was one of the first to question the rationale of the gingival
protection theory. Few have suggested that over-contouring prevents the
normal cleansing action of the musculature and allows food to stagnate in
the overprotected sulcus.
Theory of access for oral hygiene
This theory is based on the concept that plaque is the prime etiologic
factor in caries and gingivitis. Thus crown contour should facilitate plaque
removal, not hinder it. When crowns were overcontoured experimentally,
64.3% of the test sites demonstrated an increase in periodontal
inflammation. This was attributed to decreased access for oral hygiene.
The four guidelines to contouring crowns with emphasis on access for oral
hygiene will be described.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

68
Preventive Prosthodotics
1. Buccal and lingual contours–flat, not fat. Reduction or elimination of
the infrabulge would reduce plaque retention.
2. Open embrasures: If plaque is a primary etiologic factor in gingivitis,
then every effort should be made to allow easy access to the
interproximal area for plaque control. Open embrasure spaces will
allow for this easy access. An overcontoured embrasure will reduce
the space intended for the gingival papilla. The result is a broadening
of the contoured area, causing pressure and irritation on the papilla.
This also inhibits effective oral hygiene.
3. Location of contact areas: Contacts should be high (directed incisally)
and buccal in relation to the central fossa (except between maxillary
first and second molars).
4. Furcation involvement: Furcations that have been exposed owing to
loss of periodontal attachment should be ''fluted'' or ''barreled out''.
The concept of fluting into molar furcations is based on the desire to
eliminate ''plaque traps'' and facilitate plaque control.
MARGIN PLACEMENT (as shown in fig32)
Fig: 32 Marginal placement
Plaque accumulation, inflammation, and gingivitis are reported to occur
more frequently in teeth with subgingival crown margins than in those
with supragingival margins. Oral hygiene instructions do not seem to alter
this pattern.
Based on the findings of research, subgingival margins should be avoided
except for the following specific situations: (1) esthetic demands, (2) caries
removal, (3) subgingival tooth fracture, (4) to cover existing subgingival
restorations, (5) to gain needed crown length, and (6) to provide a more
favorable crown contour (that is, furcation involvement).
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

69
Preventive Prosthodotics
PONTIC DESIGN : The design of pontics for fixed partial dentures has been
clouded by empirical judgment. The so-called ''sanitary pontic'' is not new
to dentistry. The ''bullet-shaped'' pontic has been advocated by some
authors as a desirable design to reduce food accumulation. Nearly all
authors agree that the ''ridge-lap'' pontic is undesirable from the point of
view of tissue health.
Stein's classic article on pontic design was largely responsible for a change
in philosophy from a ''sanitary'' or ''bullet-shaped'' design to what is now
commonly called a ''modified ridge-lap'' design. The modified ridge-lap
design in the posterior region and the ridge-lap facing design in the
anterior region offer minimal tissue contact, acceptable cosmetic value,
proper cheek support, and accessibility for adequate oral hygiene. It has
now been established that the design of the pontic may be the most
important factor in preventing inflammatory reactions, not the material
used in the pontic.
In addition to properly designing the undersurface of pontics, it is
imperative to open embrasure spaces adjacent to abutments to allow
room for interproximal tissue and access for oral hygiene. The occlusal
surface should not be narrowed arbitrarily since this may create a food
impaction and/or plaque retention situation similar to that of mal-posed
teeth. The embrasure space between two adjacent pontics usually is
closed to provide added strength, reduce food and plaque retention, and
facilitate oral hygiene procedures under pontic areas
Basic guidelines for the access-for-oral-hygiene theory of crown contour,
margin placement, and pontic design can be applied to nearly all fixed
restorative procedures. These guidelines apply to full porcelain coverage
restorations precision attachments, and coping reconstructions.
Occasionally tooth preparations must be modified to allow for the added
bulk needed for attachments, occlusal porcelain, and copings. If proper
tooth reduction is achieved, physiologic crown contours can be developed
easily, regardless of the prosthesis being used.
RATIONALE FOR DENTAL IMPLANTS:
The use of dental implants to provide support for prostheses offers a
multitude of advantages compared with the use of removable prostheses
or a fixed partial denture using natural teeth as an abutment.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

70
Preventive Prosthodotics
A primary reason to consider dental implants to replace missing teeth is
the maintenance of alveolar bone. The dental implant is placed in to the
alveolar bone ( as shown in fig 33)
The dental implant placed in to the bone serves not only as an anchor for
the p rosthetic device, but also as one o f the better preventive
maintenance procedures in dentistry. There is increase in bony trabeculae
and density when the dental implant is inserted and functioning. An
endosteal implant can maintain bone width and height as long as the
implant remains healthy. As with the tooth, peri implant bone loss may be
measured in lengths of a millimeter and may represent more than a
twenty-fold decrease in lost structure compared with the resorption that
occurs with the removable prosthesis.
The receptors in the periodontal membrane of the natural teeth help
determine its occlusal position. Although endosteal implants do not have
periodontal membrane, they provide greater awareness than complete
dentures. The decrease in horizontal forces that are applied to implant
restorations improve the local parameters and help preserve the
underlying soft tissues and hard tissues. In the partially edentulous
patient, independent tooth replacement with implants may preserve
intact adjacent natural teeth as abutments, further limiting complications
such as decay or porcelain f racture and poor esthetics, which are most
common causes of fixed prosthesis failure. The masticatory performance
of implant-supported prosthesis is better than any conventional
removable prosthesis. The current trend to expand the use of implant
dentistry will continue until every restorative practice uses this modality
for the abutment support of fixed and removable prostheses.
Fig:33 Radiographic image showing Dental implants placed in alveolar
bone
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

71
Preventive Prosthodotics
General Clinical Recommendations for Loading Protocols
Conventional implant loading is predictable in all clinical situations and is
particularly recommended in the presence of treatment modifiers such
as poor primary implant stability, substantial bone augmentation,
implants of reduced dimensions, and compromised host conditions.
Immediate implant placement for preservation of bone:
Early implantation may preserve the alveolar anatomy, and the placement
of a fixture in a fresh extraction socket helps to maintain the bony crest.(as
shown in fig 34)
Fig:34 Placement of Implant in socket
Although a number of clinical studies exist, no histological reports show
the outcome of implantation in fresh extraction sockets without the use of
membranes in humans compared to implants placed in mature bone.
Bone Grafting and Guided Bone Regeneration for Immediate Dental
Implants :
All implants were clinically osseointegrated at the 6-month re-entry
surgery. Although some variation were evident, evaluation of healing to
determine patterns of remodeling in relation to the preexisting bone
anatomy showed complete fill of most of the socket. Bone loss at the most
coronal alveolar crest and bone apposition at the most apical socket crest
had a tendency to level the socket crest around the implants. The healing
patterns of bone defects resembled those seen around periodontally
involved teeth with vertical defects. Infrabony defects generally filled
from the apical areas and narrow defects filled completely. As the gap
between the socket wall and the implant become wider, bone fill was less
likely to be complete, even when using a GTR technique without DFDBA
(as shown in fig 35)
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

72
Preventive Prosthodotics
Fig :35 GTR Technique
Step 1:showing periodontal defects
Step 2:showing defects following tooth extraction
Step3:showing placement of bone graft
Step4:showing bone graft with barrier membrane is placed over the
defect
Step 5:showing placement of sutures
Single Implant Prosthesis:
The single, anterior tooth implant is now an accepted and a highly
predictable means of tooth replacement.
The occlusion required for the single tooth replacement is similar, but not
identical, to the natural dentition. In centric occlusion, the implant
supported crown should have a clearance of 30 m. The clearance is
important since the natural teeth can be intruded in their sockets under
heavy loads whereas the implant retained prosthesis will not intrude.
Failure to build in this appropriate occlusal clearance would expose the
implant retained fixed prosthesis to excessive forces under heavy loading
conditions.
Multiple Implant Prosthesis:
Implant dentistry provides different treatment options for the completely
edentulous arch by providing multiple abudment sites for support of the
prosthesis that enhances its performance. Various treatment options are
available for the complete denture patient, Fixed implant supported
prosthesis, Cement- retained prosthesis, Screw–retained prosthesis,
Implant over-dentures, Hybrid prosthesis.
A proper pre-implant surgery evaluation is an essential step in the
treatment planning process. It helps the clinician to decide on the
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

73
Preventive Prosthodotics
prosthesis and also decide upon the location, dimensions, and type of
implants, based upon the prosthetic restoration to achieve the best
esthetic and functional outcome. A step by step procedure in the pre-
implant evaluation,
ŸMounted casts and arrangement of teeth for try-in .
ŸSelection of the prosthesis type
ŸLocation and number of the implants
ŸFabrication of radiographic template
ŸFabrication of surgical template
ŸSelection of the implant size and type
ŸFabrication of provisional restoration.
Implant location:
For maxillary arch: Implant sites were located for ovoid arch as two
implants in the incisor,two in the canine and two in the molar region.(as
shown in fig 36)
Fig: 36 Implant placed in incisor,canine and molar region
For mandibular arch: Implant positions were two first molars ,two canines
,secondary implants in second molar and tertiary implant in the first
premolar position.
An acrylic resin template impregnated with 5mm balls was used which
provides information regarding the bone height and proximity to
anatomical structures and pre-determine the position of osteotomy site in
both bucco-lingual and mesio-distal dimensions.
Multiple Implant placement
Implants were placed following:
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

74
Preventive Prosthodotics
Standard protocol
Routine second stage surgery
Implant level impressions
Abutment connections
Provisional restorations
Preventive Implant Therapy
Preventive dentistry is mainly concerned with caries and periodontal
disease and little, or no attention is paid to the prevention of alveolar bone
loss. Preventive implantology is concerned with the preservation of the
alveolar ridge of the (edentulous) jaw. After tooth extraction, the atrophy of
edentulous lower jaws can be prevented or delayed by using implants
supporting an over denture or a fixed mandibular prosthesis. Studies have
shown that mandibular ridge shows a slower resorption pattern when it is
loaded by implants supported prosthesis rather than a conventional
mucosa supported dentures.Kalk et al. proposed the resorption stages of
the residual ridges which are used in preventive implantology.
preventive stage I
Anatomic situation after tooth extraction. Further resorption can be
prevented by implantation of the bone substituents .e.g.anresorbable
hydroxyl appetite. .
Preventive stage II
After the initial resorption has occurred. In this case, further resorption can
be prevented by placing cylindrical endosteal implants to maintain
adequate width and height
Preventive stage III
Knife edged ridge. Bone removal is necessary for implant placement.
Preventive stage IV
Severe resorption of the alveolar ridge has taken place. Only basal bone is
present. Implants are placed directly into the basal bone to prevent total
loss of function of the arches.
Endosteal and subperiosteal are the two main types of dental implants
available today. These two types are considered safe and effective
according to the American Dental Association.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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Cardiovascular System
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Chemotherapy
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Miscellaneous Topics

75
Preventive Prosthodotics
ENDOSTEAL IMPLANTS
Endosteal, which means “in the bone,” is the type of dental implant that is
most commonly used. It is further categorized into different types
according to the kind of accessories used. Blades, cylinders, and screws are
placed into the patient's jawbone through surgery. A single implant has
the capacity to hold at least one prosthetic tooth, but there are cases
where an implant can hold two or more prosthetic teeth. Not all
individuals qualify for this type of dental implant so getting a dental
consultation is necessary. Generally, individuals who have dentures or
bridges are good candidates for endosteal implants when the other
options have been exhausted.
To provide more comfort and convenience to patients with fixed partial
bridgework or removable dentures, there are endosteal implants that use
custom-designed titanium metal frame that is of cast surgical-grade
quality. The implants used are coated with a special kind of synthetic
substitute for bone. It is called HA or hydroxyapatite, which comprises up
to 98% natural bone. This coating makes the jaw believe that the implant is
also a natural bone allowing the formation of a biochemical bond that
ensures a secure hold of the implant.
SUBPERIOSTEAL IMPLANTS
Subperiosteal, which means “on the bone,” involves the use of metal
frames that are fitted or placed onto the jawbone that is just right below
the tissues of the gum. The post of the metal frame is in a protruding
position through the gum to effectively hold the prosthesis that will be
fitted too. After the procedure, the gums are expected to heal to
completely recognize the success of the implant. When the gum is healed,
the metal f rame becomes totally fixed to the patient's jawbone. Then, the
artificial tooth is mounted on the post; it follows the same procedure as an
endosteal implant.
The framework used for subperiosteal implant is composed of cobalt,
chrome, and molybdenum or surgical vitallium. There are also custom
subperiosteal implants, which make every implant unique. The condition
of the patient hugely affects this uniqueness or difference from other
implants. The implant is custom-designed and fabricated using a model
generated from a CT scan or a direct impression of the bone.
One of the situations that use sub-periosteal implant is when a patient has
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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Chemotherapy
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Miscellaneous Topics

76
Preventive Prosthodotics
lost most or all his posterior teeth. Another situation is when a patient has
inadequate bone height, which does not allow endosteal implants.
Treatment alternatives for the edentulous arch include:
(1) Fixed-detachable prostheses
(2) conventional implant-supportedfixed partial dentures
(3) implant-retained overdentures, and
(4) implant- supported overdentures.
ALL ON FOUR IMPLANTSCONCEPT :
In some cases of the completely edentulous patients, implant supported
prosthesis treatment is almost impossible without complex techniques
such as nerve transposition and grafting in the posterior maxilla and
mandible. A solution for such situations is theAll-on-4 concept. This
method advocates tilting distal implants in edentulous arches which
enables us in the placement of longer implants, improved prosthetic
support with shorter cantilever arm, improved inter implant distance and
improved anchorage in the bone . The “All-on-4 “treatment concept was
developed by Paulo Malo with straight and angled multi-unit abutments,
to provide edentulous patients with an immediately loaded full arch
restoration with only four implants(as shown in fig 36).Two placed
vertically in the anterior region and two placed upto an angle of 45degree
in the posterior region. When used in the mandible, tilting of posterior
implants makes it possible to achieve good bone anchorage without
interfering with mental foramina in severely resorbed maxillae, tilted
implants are an alternative to sinus floor augmentation.
Fig:36 All on four implant prosthesis radiographic image
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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Cardiovascular System
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Drugs acting on Endocrine System
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Chemotherapy
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77
Preventive Prosthodotics
General considerations
To achieve primary implant stability (35 to 45 Ncminsertiontorque).
Indicated with a minimum bone width of 5mm and minimumbone
height of 10mm from canine to canine in maxilla and 8mmin mandible.
If angulation is 30 degree or more , the tilts can be splinted.
For tilted posterior implants, the distal screw access holes should
belocated at the occlusal face of the first molar, the second premolar,or
the first premolar.
Surgical Procedure
Implants in the maxilla are placed with two distal implants in the posterior
region which are tilted anterior to the maxillary antrum while in the
mandible implants are positioned anterior to the mental foramen. They
should be inserted at an angulation of 30-45 degree. The use of the All-on-
4 surgical guide assists in ensuring the placement of the implants with
correct positioning, angulation and emergence. The guide is placed into a
2mm osteotomy that is made in the midline position of the maxilla or
mandible and the titanium band is contoured to follow the arc of the
opposing arch. The guide also assists in retracting the tongue in
mandibular cases. The vertical lines on the guide are used as a reference
for drilling at the correct angulation, which should not be greater than
45degree. The other guides that can be used for implant placement are
Template, Angulated pins and Denture .Straight 17degree multiunit
abutments and 30degree angulated abutments with different collar
heights are placed onto the implants. These are used to achieve the
correct access allowing relative parallelism and so that the rigid prosthesis
can be seated passively.
Advantages of the All-on-4 concept
ŸAngled posterior implants avoid anatomical structures
ŸAngled posterior implants allow longer implants anchored in better
quality bone
ŸReduces posterior cantilever
ŸEliminates bone grafts in the endentulous maxilla and mandible in
majority of cases
ŸHigh success rates
ŸImplants well-spaced, good biomechanics, easier to clean
ŸImmediate function and aesthetics
ŸFinal restoration can be fixed or removable
ŸReduced cost due to less number of implants and avoidance of grafting
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
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2
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3
Cardiovascular System
4
Drugs acting on Blood
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Central Nervous System
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Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

78
Preventive Prosthodotics
in the majority of cases.
Limitations
ŸGood general health and acceptable oral hygiene;
ŸSufficient bone for 4 implants of at least 10mm in length; and
ŸImplants attain sufficient stability for immediate function.
Disadvantages
ŸFree hand arbitrary surgical placement of implant is not always
possible as implant placement is completely prosthetically driven.
ŸLength of cantilever in the prosthesis cannot be extended beyond the
limit.
ŸIt is very technique sensitive and requires elaborate pre-surgical
preparation such as CAD/CAM, surgical splint.
ŸLength of cantilever in the prosthesis cannot be extended beyond the
limit.
Occlusal scheme for All-on-Four
Simultaneous bilateral point contacts on canine and posterior teeth and
grazing contacts on incisors. In lateral movements, canine guidance
opposing natural dentition, group function opposing posterior implant
supported bridge with flat linear pathways and minimum vertical super
97
imposition . If the implant supported prosthesis is opposed to removal,
complete denture orimplant supported over denture or a distal extension
cast partial denture leave the most distal tooth slightly out of occlusion
andin excursive movements seek one or more balancing contacts,
planning greater antero-posterior space at the anterior teeth. The occlusal
pattern should have relatively flat cusps i.e. the inclination of the cuspal
planes should be less than the inclinations of the condylar path.
Since the teeth of the distal cantilever are less heavily loaded, the guiding
surfaces of the incisors and canines can be expected to undergo
increasing abrasions with time, therefore eliminate premature or non
working side contacts on the distal cantilever.
ZYGOMA IMPLANTS (as shown in fig 37)
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

79
Preventive Prosthodotics
Fig:37 ZYGOMA IMPLANT
a. Zygoma implant
b. Zygoma implant placed radiographic view
The zygoma implant has been used as an alternative treatment for the
severely resorbed maxilla. Efforts have been made to pursue alternatives
to grafting procedures. The pterygomaxillary suture has been identified as
an alternative site for implant placement . Others have suggested the use
of tilted and/or short implants to avoid the need for sinus lift procedures
.During the last two decades, the zygoma implant has proven to be an
effective option in the management of the atrophic edentulous maxilla, as
well as for maxillectomy defects. Branemark has introduced zygoma
implant the prosthetic rehabilitation of patients with extensive defects of
the maxilla caused by tumor resections, trauma and congenital defect
.The bone of the zygomatic arch was used for anchorage of a long implant,
which, together with conventional implants, could be used as an anchor
for prostheses and/or obturators. The technique has enabled sufficient
rehabilitation of these patients, providing restored function and improved
esthetics, and has given many patients back a normal social life. The use of
multiple zygomatic implants (e.g. two to three in each side) to support a
prosthesis was suggested by Bothur et al.
Indications, contraindications and presurgical evaluation:
Indication :
Zygomatic implants was expanded to completely edentulous patients
with severe maxillary atrophy. Since then, the main indication for
zygomatic implants – posterior maxillary support in patients who are
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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3
Cardiovascular System
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Drugs acting on Endocrine System
7
Chemotherapy
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9
Miscellaneous Topics

80
Preventive Prosthodotics
completely edentulous with significant sinus pneumatization and severe
posterior alveolar ridge resorption has remained unchanged. For the most
common indication, the zygomatic implants are combined with two to
four anterior maxillary axial implants.
Contraindications :
Zygomatic implants are contraindicated in acute sinus infection, maxillary
or zygoma pathology and patients unable toundergo implant surgery
because of underlying un- controlled or malignant systemic disease.
Relative contraindications include chronic infectious sinusitis, the use of
bisphosphonates and smoking more than 20 cigarettes a day. Any
pathology of the maxillary Coronal image of a presurgical cone beam
computed tomography scan shows bilateral occupation of both maxillary
and ethmoidal sinuses.
The osteomeatal complex is closed on both sides. Functional endoscopic
sinus surgery was prescribed prior to zygomatic surgery. Aparicio et al.
suggested that sinus should preferably be treated before placement of
the zygomatic implant.
Presurgical Evaluation:
Once the clinical examination is complete, radiographic examination
allows for further appropriate treatment planning of the zygomatic
implant Computed tomography is crucial for evaluation of the zygomatic
implant site and the sinus status, as well as for the implant path. The
amount of bone in the zygomatic arch and in the residual alveolar crest
has to be explored. The angulation, expected emergence site and the
relationship of the implant body to the maxillary sinus and the lateral wall
are also considered. With the original technique, the path of the
zygomatic implant was inside the maxillary sinus. The emergence of the
head of the implant in the alveolar crest (typically in the palatal aspect of
the second premolar region) is dependent on the spatial relationship of
the zygomatic bone, the maxillary sinus and the alveolar crest. As
discussed later, a new technique that includes the possibility of extra-
sinus passage of the implant has been introduced, with promising results.
The maxilla can be divided into three zones: zone 1, the premaxilla;zone 2,
the premolar area; and zone 3, the molar area.The clinician should
determine the availability ofbone in all three zones. Cone beam computed
tomography can be used to determine the amount of bone in these zones
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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7
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9
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81
Preventive Prosthodotics
as well as in the zygomatic arch, in both horizontal and vertical
dimensions. Moreover, any pathology in these areas, as well as in the
maxillary sinuses, needs to be verified pre-operatively. In the presence of
adequate bone in zones 1 and 2, the clinician can consider the use of four to
six conventional implants, tilting the most distal one on each side to
achieve good load distribution. As such, one can bypass the need for bone
grafting. The anterior extent or position of the sinuses, as well as the slope
of the anterior sinus walls, determine both the most posterior position of
the distal implant as well as its angulation.
General guidelines for Zygomatic implants:
The general guidelines for zygomatic implants are as follows.
- Adequate bone in zone 1 for two to four axial implants and bilateral
lack of bone in zones 2 and 3. Typically, two to four conventional
implants are distributed in the anterior maxilla plus one zygomatic
implant on each premolar/molar side.
_ Adequate bone in zone 1 and lack of bone in zones 2 and 3 on only one
side. One single zygomatic implant is placed and conventional
implants are placed on the anterior maxilla on the side opposite the
zygomatic implant.
_ Inadequate bone in zone 1 and adequate pristine bone in zones 2 and
3. A n a n teri o r z ygomat i c i m plant, to g e ther with po s terio r
conventional implants, can solve the problem.
_ Lack of bone in all three zones of the maxilla. Four zygomatic implants
can be used for the rehabilitation.
_ Inadequate bone in zones 1, 2 or 3 in a partially edentulous patient. The
placement of three implants to support a partial prosthesis is
recommended; use of a zygomatic implant in partially edentulous
patients requires more clinical validation before widespread use can
be advocated.
A rescue solution for patients in whom either conventional implants
and/or the maxillary bone augmentation procedure have failed.
Surgical technique
Anesthesia
According to the original protocol, surgery was carried out under general
anesthesia with nasal intubation. A sealing throat pack and a gastric tube
were used in each patient. Afterwards, local anesthetic was infiltrated with
injections of lidocaine with epinephrine (1:50.000 to block the superior
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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2
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3
Cardiovascular System
4
Drugs acting on Blood
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Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

82
Preventive Prosthodotics
alveolar nerves(posterior, middle and anterior) and the palatal nerves
(posterior and nasopalatal). The epinephrine helped to create a regional
haemostasis. Hospital based surgery was strongly recommended for
those patients. Recently, the protocol has been simplified with the use of
local anesthesia and oral or intravenous sedation. This procedure is
recommended if the surgeon is experienced and the procedure is
expected to last for <1.5h. The local anesthetic procedure includes the
simultaneous use of four different local anesthetic approaches, as follows:
_ Normal infiltration anesthesia (1:50.000 epinephrine) in the buccal
sulcus f rom the central incisor to the third molar tooth using lidocaine
with1:50.000 epinephrine (about 3.6 ml) and block of the posterior
superior alveolar nerve about 1 cm palatal to the bone crest.
_ Infra-orbital nerve block by an oral approach using lidocaine (1:50.000
epinephrine) or felypressin with about 1.8 ml of prilocaine.
_ Block of the spheno–palatine ganglion throughthe greater palatine
foramen using lidocaine(1:50.000 epinephrine) or felypressin with
about1.8 ml of prilocaine.
_ Infiltration anesthesia around the zygoma area through the skin
using about 3.6 ml of lidocaine(1:50.000 epinephrine).
In the authors' experience, the procedure is well tolerated by the patient,
and surgery is facilitated by working on a conscious patient.
The original technique
After an initial period during which a vestibular Lefort II type incision is
used, the current protocol attempts to expose the area via a mid-crestal
incision and vertical releasing incisions along the posterior part of the
infra-zygomatic crest and anterior to the surgical site. The vertical
ridge/anterior border of the zygomatic arch is always identified. A second
landmark is the lateral orbital border, as interference with the orbit must
be avoided. Subsequently, a mucoperiosteal flap is raised, exposing the
central/posterior part of the zygomatic complex, the lateral wall of the
maxillary sinus and the alveolar crest. A retractor is positioned for visibility
and to protect the soft tissues.
An indicator is used to determine the drilling direction and the starting
point at the crest, usually the second premolar/first molar region. A bone
window, around 10 mm wide, is created at the lateral aspect of the
maxillary sinus following the desired path of the zygomatic implant from
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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2
Autonomic Nervous System
3
Cardiovascular System
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5
Central Nervous System
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Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

83
Preventive Prosthodotics
the sinus floor to the top of the sinus cavity. The sinus membrane is
carefully dissected, freed f rom the sinus walls and placed in the sinus
cavity. A series of drills is used to penetrate the alveolar process and the
zygomatic bone. The estimated length of the zygomatic implant is
selected using a depth gauge. The self-tapping zygomatic implant is
placed with the aid of a motor or manually, using an implant mount. Care
should be taken not to enlarge the palatal hole during insertion, which is
especially important in patients with thin alveolar/basal bone. If needed,
bone particles harvested locally can be packed around the implant in an
effort to diminish an eventual gap between the implant surface and the
palat al bone. A cover screw is p laced on t he implant and t he
mucoperiosteal flap is closed. Abutment connection is usually made after
a healing period of 6 months, using standard or straight/angulated
multiunit Branemark abutments.
Prosthetic procedure
The zygomatic implant has an increased tendency to bend under
horizontal loads. This is related to two factors: the greatly increased length
of these implants (30–52.5 mm) and the fact that in some circumstances
there is limited or no bone support in the maxillary alveolar crest.
Consequently,these implants have to be rigidly connected to stable
conventional implants in the anterior maxilla. Based on clinical experience
and biomechanical theoretical calculations, a full-arch restoration of the
maxilla, supported by two zygomatic implants (one on each side), should
be assisted by at least two stable conventional implants in the anterior
maxilla. The prosthetic procedure follows conventional protocols. As the
emergence of the zygomatic implant is often 10–15 mm medial to the
ridge, the bridge should be designed to enable proper oral hygiene in the
area. Originally, a two-stage procedure was recommended for the zygoma
technique .However, over time, the original protocol has been replaced
with immediate loading. Several clinical reports have shown good
outcomes following immediate/early loading of zygomatic implants in the
totally edentulous maxilla. The provisional prosthesis is extremely
important for patients treated with zygomatic implants. The goals for such
prostheses are to provide acceptable esthetics as well as masticatory and
speech function during the healing process, and also to explore the
occlusal and esthetic position of the teeth and soft tissue substitutes . The
routine option for both provisional and final prostheses is to develop a
screw-retained structure that can easily be removed in the event of
complications. For this purpose, thesurgeon must analyze the type of
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

84
Preventive Prosthodotics
resorption in relation to the opposite dentition and provide an implant
head with an adequate abutment type in length and angulation. The
angulation of the abutment will be critical, not only for positioning the
screw emergence on the palatal/ occlusal surfaces but also for
determining the final thickness of the prosthesis. In fact, during implant
placement the surgeon must provide the correct implant inclination in
relation to the antagonist dentition. The head of the zygomatic implant
can be positioned more accurately by observing the screw locking the
implant mount to the implant. The screw position duplicates the future
abutment screw position exactly.
BASAL IMPLANTS (as shown in fig 38)
Fig 38 BASAL IMPLANTS
Rehabilitation of an atrophied edentulous jaws by placing implants is a
challenging procedure. Although various bone augmentation procedure
like ridge augmentation, sinus lift are in practice but it may lead to the
morbidity of donor's site. Sometimes patient is not willing for such
extensive surgical procedures. In such cases basal implants are a viable
treatment option. Basal implants derive support from the basal bone area
which usually remains free from the infection and less prone to resorption.
“Basal Implant” is a term used in reference to the principles of utilizing
basal bone areas which is f ree of infection and resorption, and the
employing of the cortical bone areas. The load bearing tolerance of the
cortical bone is many times higher than that of the spongious bone.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
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2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

85
Preventive Prosthodotics
Indications of Basal Implants
1. In situations when multiple teeth are missing or have to be extracted.
2. When a bone augmentation procedure has failed.
3. Cases of thin ridges – That is deficiency of bone in buccolingual
thickness.
4. Cases where bone height is insufficient
Contraindications of Basal Implants:
1. Medical conditions : A recent history of myocardial infarction (heart
attack ) would p recl ude the p lacem ent of d ental i mplan ts.
Cerebrovascular stroke, Immunosuppression also lead to the
reduction in the efficacy of the immune system.
2. Medicines: An implantologist would require a complete details of all of
the medicines and supplements that their patient takes. Drugs of
concern are those that are utilized in the treatment of cancer and
drugs that inhibit blood clotting.
Advantages Of Basal Implants :
One piece implantology– Basal implants are one piece implants that
minimizes the failure of implants due to interface problems between the
connections that exist in conventional two and three piece implants.
Disadvantages of the Basal implants:
It is always necessary to keep a few more implants handy to avoid
extensive planning including three dimensional exploration of bone
conditions. The technique poses substantial challenges, for instructors
and users alike, as far as the surgical and prosthetic treatment stages and
the substantial knowledge requirements in the fields of biomechanics
and bone physiology are concerned.
Basal Implant Types Based on Morphology
There are four basic types of basal implants available-
I Screw Form.
II Disk Form.
III Plate Form.
IV Other Forms
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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no
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Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

86
Preventive Prosthodotics
SURGICAL TECHNIQUE
Unlike conventional implants basal implants have a different surgical
approach. The technique is simple and easy to execute and does not
involve extensive drilli ng o f bone thus avoiding therm al injury.
Throughout the surgery the mode of irrigation used is external and usually
for almost any case a single pilot osteotomy with a “Pathfinder Drill” is
sufficient for KOS, KOS Plus and BCS implants. The kit also consists of
manu a l d rills f o r a c o ntrol l e d os t e o t o m y p r e p a ratio n . B asal
implantologists do not advocate raising a flap for these implants as it
results in a decreased blood supply and also because of the design of these
implants raising a flap is pointless, another factor to be considered is the
immediate loading of these implants; a sutured site is not a favorable area
to receive an immediate prosthesis.
For the BOI implant the approach towards the bone is gained by raising a
flap laterally and cutting into the bone with disk drills of required size in a
lateral d irec tion to form a “ T ” shaped osteotomy. The i mpla nt
consequently is placed laterally and the flap is closed over it.
Prosthetic Rehabilitation :The aim of prosthetic rehabilitation is to
provide esthetics, enable hygiene practice and mainly to avoid overload
osteolysis. Esthetics is taken care of by following the three FPs given by Dr.
Carl E. Misch. Overload osteolysis is prevented by providing appropriate
occlusal schemes which can be bilateral balanced, group function,
mutually protected and lingualized occlusion.
PTERYGOID IMPLANTS:
Posterior atrophic maxilla is very challenging to every surgeon to limit the
implant placement. There are many surgical techniques described for the
reconstruction. In that sinus floor augmentation, alveolar distraction,
guided bone regeneration, zygomatic implants and the use of pterygoid,
pterygo-maxillary or ptyrego-tubrosity implants
Many surgical techniques have been described for reconstruction of the
posterior maxilla, including sinus floor augmentation, alveolar distraction,
guided bone regeneration, zygomatic implants and the use of pterygoid,
pterygo -maxillary or ptyrego-tubrosity implants . Among all the
techniques mentioned above, the most popular one is the sinus floor
augmentation, which has gained popularity over the last three decades.
However, it has its own drawbacks. The most described complications of
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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2
Autonomic Nervous System
3
Cardiovascular System
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Drugs acting on Blood
5
Central Nervous System
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Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

87
Preventive Prosthodotics
sinus augmentation are sinus membrane perforation, bone graft infection
and sinusitis. This extensive surgical intervention could be avoided by
utilizing a simpler method, such as pterygoid implants.
Pterygoid implants are anchored in the junction of three different bone
structures: The pyramidal process of the palatal bone, the pterygoid
process of the sphenoid bone and the maxillary tuberosity. This insertion
into three different anatomic structures may often lead to improper
terminology usage when relating to pterygoid implants. There is a
significant difference between pterygoid and tuberosity implants.
Pterygoid implants are engaged in the dense cortical part of the pterygoid
bone and the palatal bone, while tuberosity implants are directed and
engaged in cancellous maxillary bone of poor quality.Placement of dental
implants in the pterygo-maxillary region provides posterior bone support
for the prosthesis, without sinus floor augmentation, and can achieve
better distribution of masticatory forces in comparison to conventional
maxillary implants. This benefit allows rehabilitating patients with
satisfactory full arch fixed maxillary prosthesis, which usually spanned
from second molar to second molar.
Due to the special architectural features of the pterygo-maxillary area,
placement of dental implants in this area is technically more difficult in
comparison to other regions of the maxilla. Computer Aided Design -
Computer Aided Manufacturing (CAD-CAM) is of great value in planning
and placing pterygoid implants, as well as other implants that bypass the
maxillary sinus. The surgical guide enables the clinician to determine the
exact direction of drilling and the correct length of pterygoid implants.
De spite t h e compl exity o f t his surg ical pro cedure, the ris k o f
complications is very low .A possible major complication that may occur
during the surgery is massive bleeding from the maxillary artery or its
branches, which are situated 1 cm superiorly to the pterigomaxillary
suture. This complication is rare and has not been mentioned in the
literature, according to the best knowledge of the authors. Regardless of
the surgical technique used, care must be taken to avoid damaging either
the maxillary artery or its branches within the pterygopalatine fossa.
However, the distance from the inferior end of the pterygomaxillary suture
to the maxillary artery is 25 millimeters which makes this area safe for
working. Pterygoid implants have a high success rate, minor and
inf requent complications and similar bone loss in comparison to
conventional implants. Pterygoid implants are considered as a good
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
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2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

88
Preventive Prosthodotics
alternative for extensive augmentation procedure in patients with
atrophic maxilla.
Mini dental implants (MDI) are titanium alloy implant screws that are
ultra-small in diameter i.e. l.8 mm wide. These implants come handy in
clinical situations where acceptable and satisfactory function cannot be
achieved with conventional prosthesis. For example, in patients with
flabby ridges, atrophic ridges or in cases with poor availability of residual
bone where there is denture instability or lack of retention, commonly
seen in edentulous mandible. Conventional dental implants are usually
3.75 to 5 mm wide and require sufficient bone width for implant
placement. Hence, in patients with severely resorbed mandibular ridges,
conventional implants may not be the best treatment option. In such
situations, mini dental implants can be successfully used with immediate
loading and ongoing stabilization. They are commonly employed with
Type I and Type II bones. In Type I bone the standard propriety thread
design can be used and in Type II bone the MDI MAX thread design is used.
The advantages of using the MDI system are as follows:
Minimal invasive procedure
Can be inserted in minimal tissue such as resorbed mandibular ridges
without relining or grafting techniques
Doesnot require osteotomy
Immediate loading
One stage denture stabilization
Cost effective
Tantalum-implants
A new advancement in the field of implant surface modification is the
introduction of tantalum implants. Tantalum is a lustrous transition metal
that is highly corrosion resistant. Porous tantalum metal in orthopedic
implants was found to be highly successful. This led to its incorporation in
the design of root-form endosseous titanium implants as a new form of
implant surface enhancement. Tantalum being highly resistant to
chemical attack provokes minimal adverse biological response in reduced
or oxidized forms. It helps improving the contact between the dental
implants and osseous structure thereby facilitating osseointegration. It
has been found to enhance osseointegration by combining bone
ongrowth along with bone ingrowth or osseo-incorporation.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
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2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

89
Preventive Prosthodotics
Role of Maintenance and Recall in Prevention:
“The dentist of the future will not be judged by the excellence of his
margins, but by how well he motivates his patients to practice correct oral
hygiene. The dentist's success will be favourable only if the patient returns
in six months, and then regularly, and returns each time with an absence
of plaque.” - Boitel.
A special effort should be made to avoid the careless handling or dropping
of a removable prostheses. If it is distorted, it may result in destructive
pressure on the teeth. Sometimes, appliance itself can be damaged.
Proper maintenance of the prostheses using various physical and
mechanical methods such as brushing with soft bristles and cleaning with
cleansing solutions( as shown in fig39)
a.Denture cleansing brushes b.Denture cleansing solutions
Fig : 39 Cleansing aids
will keep the prostheses free of plaque, thereby ensuring better tissue
health.
Under no circumstances, self-correction of the appliance or home-lining
should be performed. A caries susceptible individual should follow an
adequate control program in an attempt to arrest this condition. This
program should include both professionally applied treatments, and
intensive program of daily treatment administrated by the patient at
home. Frequent rebasing of an extension base prosthesis will maintain
adequate support. Patient should be instructed in special plaque control
measures, especially around pontics and connectors of fixed partial
denture.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

90
Preventive Prosthodotics
Though prosthodontics has evolved highly as a specialized field in
replacement of missing teeth and adjacent soft and hard oral tissues; the
cooperation with other aspects of dentistry, especially preventive cannot
be ignored. Meeting the expectations of an ever increasing elderly
population with quite rightly youthful outlooks of both function and
esthetics is demanding.The loss of several teeth doesn't have to be an
immediate threat to the function of the whole dentition, but it can initiate
serious problems related to the whole orofacial region, psychics and the
wellbeing of the patient. From this point of view prosthetic dentistry is a
valuable tool with high therapeutical and preventive character.
CONCLUSION
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

91
Preventive Prosthodotics
1. Norman O. Harris, Franklin Garcia, Goday Christine, N. Nathe.
Preventive Dentistry
2. Hardy Limeback Comprehensive Preventive Dentistry
th
3. K.Park ,Park's Text Book of Preventive and Social Medicine,Park 19
edition.
nd
4. Joseph John Treatment of Preventive and Community Dentistry.2
Edition.
5. Louis P. Diorio.Clinical Preventive Dentistry
nd
6. Richard .E. Stallard .A Text Book Of Preventive Dentistry 2 Edition
1982.W.D.Saunders Company .Philadelphia.
7. Mandel ID. What is preventive dentistry? J Prevent Dent I974;1:25-29.
8. Richardson, Joseph A.: Practical Treatise on Mechanical Dentistry,
Philadelphia, 186(J, Lindsay & Blakiston, p. 121.
9. Barker ,Goska, F., and Vandrak, R.: Roots Submerged to Preserve
Alveolar Bone: A Case Report, Mil. Med. 137: 446-441, 1861
10. Prothero JH. Prosthetic Dentistry, 2nd edn. Medico Dental Pub Co:
Chicago; 1916.
11. Stewart F., Kerr W., Taylor P P. Appliance wear, the patient's point of
view. Eur. J. Orthod. 1927;19:377–382
12. Alder P. Sensibility of teeth to loads applied in different directions. J
Dent Res 1947;26:279-89.
13. Steffel VL. Fundamental principles involved in partial denture design.
J Am Dent Assoc 1951;42:534-44.
14. DeVan MM. Basic principles in impression making. J Prosthet Dent
1952;2:26-35.
15. Brewer AA, Morrow R. Overdentures. St Louis: The C. Mosby Co.; 1975.
chap 1
16. DeVan MM. Concepts of neutro-centric occlusion. J Am Dent Assoc
1954;48:165-169.
17. Payne SH. Study of posterior occlusion in duplicate dentures. J
Prosthet Dent 1951;1:322-26.
REFERENCES
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
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1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

92
Preventive Prosthodotics
18. Kelly EK. Follow-up treatment for immediate denture patients. J
Prosthet Dent 1967;17:16-20
19. Miller PA. Complete dentures supported by natural teeth. J Prosthet
Dent 1959;8:924-28.
20. Kawamura Y, Watanabe M. Studies on oral sensory thresholds. Med J
Osaka Univ 1960;10:291-301
21. Moon D, Mitchell D. An evaluation of commercial protective
mouthpieces for football players. J Am Dent Assoc. 1961;62:568-572
22. Grossman RC. Oral sensory threshold determination methods. J Dent
Res 1964;26:279-89.
23. Yalisove IL. Crown and sleeve-coping retainers for removable partial
prosthesis. J Prosthet Dent 1966;16:1069.
24. Tallgren, A.:Positional changes of complete dentures-A seven year
longitudnal study. Acta. Odontol. Scand. 27:539, 1969
25. Morrow RM, Trovillion. Tooth supported complete dentures: an
approach to preventive prosthodontics. J Prosthet Dent 1969;513-522.
26. Morrow RM, Trovillion. Tooth supported complete dentures: an
approach to preventive prosthodontics. J Prosthet Dent 1969;513-522.
27. Sauser CW, Yurkstas AA. The effect of various geometric occlusal
patterns on chewing efficiency. J Prosthet Dent 1957;7:634-45
28. Kelsey CC. Alveolar bone resorption under complete dentures. J
Prosthet Dent 1971;25:152-161.
29. Jones PM. The monoplane occlusion for complete denture. J Am Dent
Assoc 1972;85:94100.
30. Dodge CA. Prevention of complete denture problems by the use of
overdentures. J Prosthet Dent 1973;30:403-411.
31. Collett HA. Protection of the dental pulp in the construction of fixed
partial denture prostheses. J Prosthet Dent 1974;31:637-46.
32. Lord JL, Teel S. The overdenture: patient selection, use of copings, and
follow-up examination. J Prosthet Dent 1974;32:41-51.
33. Wical KE, Swoope CC. Studies of residual ridge resorption. Part II: the
relationship of dietary calcium and phosphorous to residual ridge
resorption. J Prosthet Dent I974;32:13-21.
34. Melvin .E Systematic and prosthodontic treatment to prevent bone
resorption in edentulous patients.1975;3913(75)80159-4.
35. Burch JG. Periodontal consideration in operative dentistry. J Prosthet
Dent I975;34:156 -163.
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natural teeth, overlay dentures, and complete dentures. J Dent Res
1976;55:542.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

93
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37. Ebel HE. Discussion on Attachment fixation for overdentures. Part 1 by
Mensor MC. J Prosthet Dent 1977;37:372
38. Crum R, Rooney GE. Alveolar bone loss in overdentures. J Prosthet
Dent 1978;40:610-613.
39. Ttaylor ,Ettinger RL Tooth loss in an overdenture population .J
Prosthet Dent.1978;59:459-462.
40. Koran A, Powers JM, Craig RG. Apparent viscosity of materials used for
making edentulous impressions. J Am Dent Assoc 1977;95:75-9.
41. Curtis M. Becker Current theories of crown contour, margin
placement, and pontic design.Tthe Journal of Prosthetic Dentistry
268 march 1981 volume 45 number 3
42. Casey DM, Lauciello FR. A review of the submerged root concept. J
Prosthet Dent 1980;43:128-132.
43. Walton JN, Gardner FM, Agar JR. A survey of crown and fixed partial
denture failures: length of service and reasons for replacement. J
Prosthet Dent 1991;65:272-283.
44. Garver DG, Fenster RK. Vital root retention in humans. A final report. J
Prosthet Dent 1980;43:368-73.
45. Ortman HR, Ortman LF. Denture refitting with today's concepts and
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46. Kydd WL. The Comminuting efficiency of varied occlusal tooth form
and the associated deformation of the complete denture base. J
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4
48. Johnson MS. Preventive nutrition: Disease – specific dietar y
interventions for older adults. Geriatrics 1992;47:39-49.
49. Zarb G, Schmitt A. Edentulous predicament. I. a prospective study of
the effectiveness of implant supported fixed prostheses. J Am Dent
Assoc 1996;127:59-72.
50. Fiet DB. The altered cast impression technique revisited. J Am Dent
Assoc 1999;130:1476-81.
51. Williamson RA, Williamson AE, Bowley J, Toothaker R. Maximizing
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plane selection, and centric recording. J Prosthodont 2004;13:55-61
52. Paes Leme AF, Koo H, Bellato CM, Bedi G, Cury JA. The role of sucrose in
cariogenic dental biofilm formation – New insight. J Dent Res.
2006;85:878–87
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

94
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53. FranklinGarcía-GodoyMaintaining the integrity of the enamel surface
The role of dental biofilm, saliva and preventive agents in enamel
demineralization and remineralizationVolume 139, Supplement 2,
Pages 25S–34S
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of vital root retention. J Oral surgery. 1974;32:829
55. Anders TF, Eiben LA. Pediatric sleep disorders. A review of the past 10
years. J Am Acad Child Adolesc Psychiatry. 2011
56. Samra RK, Bhide SV, Goyal C, Kaur T. Tooth supported overdenture: A
concept overshadowed but not yet forgotten!. J Oral Res Rev 2015;7:16-
21
57. Shalini Karnam, Swapna BasimiJ Clin Diagn Res. Severely Resorbed
Edentulous Ridges: A Preventive Prosthodontic Approach – A Case
Report 2015 Oct; 9(10): ZD17–ZD19 .
59. Tonetti MS, Chapple ILC, Jepsen S, Sanz M. Primary and secondary
prevention of periodontal and peri-implant diseases– J Clin
Periodontol2015; 42 (Suppl. 16): S1-S2
60. Alber to Monje and Gonzalo Blasi, Significance of keratinized
mucosa/gingiva on peri‐implant and adjacent periodontal conditions
in erratic maintenance compliers, Journal of Periodontology,
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61. Oliveira, W. F., Silva, P. M. S., Silva, R. C. S., Silva, G. M. M., Machado, G.,
Coelho, L.C. B. B., & Correia, M. T. S. (2018). Staphylococcus aureus and
Staphylococcus epidermidis infections on implants. Journal of
Hospital Infection, 98(2), 111–117.
62. Heitz-Mayfield LJA, Salvi GE, Mombelli A, Loup P-J, Heitz F, Kruger E,
Lang NP. Supportive peri-implant therapy following anti-infective
surgical peri-implantitis treatment: 5-year survival and success. Clin.
Oral Impl. Res. 29, 2018, 1–6
63. B.Palla-RubioN.Araújo-GomesM.Fernández- GutiérrezL.RojoJ.Suay
M.GurruchagaI.Goñi Synthesis and characterization of silica-chitosan
hy b ri d m a te r i al s as an ti b ac ter i al c oa t i n g s f o r ti t an i um
implantsVolume 203, 1 January 2019, Pages 331-341
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66. Lingstrom P, Birkhed D. Plaque pH and oral retention after
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

95
Preventive Prosthodotics
consumption of starchy snack products at normal and low salivary
secretion rate. ActaOdontologica Scandinavica. 1993;51(6):379–388
67. J.J.Murphy ,Feferka J Prosthet Dent 1998;77:105-111.
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26-3
71. Petersen PE.Effective use of fluorides for the prevention of dental
caries in the 21st century: the WHO approach Community Dent Oral
Epidemiol 2004; 32: 319–21
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75. Kalk W, van Rossum GM, van Waas MA. Edentulism and preventive
goals in the treatment of mutilated dentition. Int Dent J 1990;40:267-7
4
76. Smith DE. Interim dentures and treatment dentures. Dent Clin North
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77. Gronas DG. Lineal occlusion concepts for complete dentures. J
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86. Lindquist LW, Carlsson GE, Jemt T. Association between marginal
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

96
Preventive Prosthodotics
bone loss around osseointegrated mandibular implants and smoking
habits: a 10-year follow-up study. J Dent Res 1997;76:1667–74.
87. Von Wowern N, Kollerup G. Symptomatic osteoporosis: a risk factor for
residual ridge reduction of the jaws. J PROSTHET DENT 1992;67:656-
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88. H a rr y .W Denniso n A merican A cademy O f Periodo n tology
1997;68,12.1254
89. Influence of occlusal rest position and clasp design on movement of
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13 Number 1
90. Rochette A L1973 Attachment of a splint to enamel of lower anterior
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91. Morris LG, Thuma JB, Hooper SL. Muscles express motor patterns of
non-innervating neural networks by filtering broad-band input. Nat
Neurosci. 2000;3:245–250
92. R. Sheldon Stein Pontic-residual ridge relationship: A research report .
Article in Journal of Prosthetic Dentistry March 1996 16(2):251-285
93. Misch CE. Contemporary implant dentistry. 2nd ed. St. Louis:
Mosby;2005. p.3-12.
94. Paolantonio, Michele, et al. "Immediate implantation in f resh
extraction sockets. A controlled clinical and histological study in man."
Journal of periodontology 72.11 (2001): 1560-1571.
95. Gher, M. E., Quintero, G., Assad, D., Monaco, E., & Richardson, A. C.
(1994). Bone grafting and guided bone regeneration for immediate
dental implants in humans. Journal of periodontology, 65(9), 881-891.
96. Van Steenbergh D : A retrospective multicenter evaluation of the
survival rate of fixed prosthesis on four or six implants and modum
Branemark in full edentulism. J. Prosthet Dent. 61:217-223, 1989.
97. Chee WWL, Cho GC : A rationale for not connecting implants to
natural teeth; J. Prosthod.6(1) :7-10, 1997.
98. De Marco TL, Paine S : Mandibular flexure in opening and closure
movements; J Prosthet Dent. 31:482-485, 1974.
99. Jemt T, Linden B, Lekholm U : failures and complications in
consecutively pla ced fixe d partial p ros theses suppor ted by
Branemark implants ; from prosthetic treatments to first annual
check up , Int. J.Oral Maxillofac Impl. 7; 40-44, 1992.
100. Parein AM, Eckert SE, Wollan PC et al : Implant reconstruction in the
posterior mandible : A long term retrospective study. J. Prosthet Dent
78:34-42, 1997.
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics

97
Preventive Prosthodotics
101. Basal implants – An alternate treatment modality for atrophied ridges
Dr. Rahul sharma, Dr.Jai prakash, Dr. Dhruv Anand, Dr Anurag
HastiJRID Volume 6 Issue 5 Sep-Oct.2016
102. D.Krishna Prasad,Divya Mehra,D.Anupama Prasad .Recent advances
current concepts and future trends in oral implantology . Indian
Journal of Oral Sciences Vol. 5 Issue 2 May-Aug 2014
103. Carlos Aparicio A proposed classification for zygomatic implant
patients based on the zygoma anatomy guided approach (ZAGA)Eur J
Oral Implantol 2011;4(3):269–275
1
Compiled & prepared by …..
Dr. SATISH BAHEKAR
MBBS, MD (Pharmacology)
Assistant Professor
Department of Pharmacology
Government Medical College, Aurangabad
A. BARBITURTES
Long acting: Phenobarbitone
Short acting: Pentobarbitone, Butobarbitone
Ultra-short acting: Thiopentone, Methohexital
B. BENZODIAZEPINES
Long acting: Diazepam, Flurazepam, Clonazepam, Chlordiazepoxide
Short acting: Triazolam, Oxazepam, Midazolam
Intermediate acting: Alprazolam, Lorazepam, Temazepam, Nitrazepam
C. NEWER NON BENZODIAZEPINE DERIVATIVES: Zopiclone, Zolpidem
D. ATYPICAL ANXIOLYTICS:Buspirone, Ipsapirone
E. BETA BLOCKERS: Propranolol
F. MISCELLANEOUS:Malatonin, Ramelteon, Triclophos, Hydroxyzine
1THE SPLIT THAT PAINS ALL
Sr
no
Topic
Page
numbers
1
General Pharmacology
2
Autonomic Nervous System
3
Cardiovascular System
4
Drugs acting on Blood
5
Central Nervous System
6
Drugs acting on Endocrine System
7
Chemotherapy
8
Drugs acting on GIT & RS
9
Miscellaneous Topics