PROSTHODONTICS IN CLINICAL PRACTICE PROSTHODONTICS IN CLINICAL PRACTICE Robert S Klugman, DDS Former Senior Clinical Lecturer Department of Prosthodontics Hebrew University-Hadassah School of Dental Medicine Private practice Jerusalem, Israel Contributions by Harold Preiskel, MDS, MSc, FDS RCS Consultant in Prosthetic Dentistry Guy's Hospital Private practice London, UK and Avinoam Yaffe, DMD Professor, Department of Prosthodontics Director, Graduate Training Program Hebrew University-Hadassah School of Dental Medicine Jerusalem, Israel MARTIN DUNITZ (cid:9)(cid:9) 2002 Martin Dunitz Ltd, a member of the Taylor & Francis group First published in the United Kingdom in 2002 by Martin Dunitz Ltd, The Livery House, 7-9 Pratt Street, London NW1 OAE Tel.: +44 (0) 20 74822202 Fax.: +44 (0) 20 72670159 E-mail: [email protected] Website: http://www.dunitz,co.uk All rights reserved. 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(cid:109)(cid:101)(cid:100)(cid:119)(cid:101)(cid:100)(cid:105)(cid:46)(cid:114)(cid:117) (cid:9)(cid:9)(cid:9)(cid:9)(cid:9)(cid:9)(cid:9) vi CONTENTS Patient 15 A new vertical occlusion 163 Treatment by Shaul Gelbard Patient 16 Advanced periodontal disease 173 Treatment by Ayal Tagari IV CONGENITAL DISORDERS 183 Patient 17 Severe unilateral cleft lip and palate 185 Treatment by Miriam Calev Patient 18 Unilateral cleft lip and palate and partial anodontia 197 Treatment by Thomas Zahavi Patient 19 Generalized amelogenesis imperfecta 207 Treatment by David Lavi Patient 20 Bilateral cleft palate and Raynaud's disease 215 Treatment by Yael Houri Index 225 (cid:109)(cid:101)(cid:100)(cid:119)(cid:101)(cid:100)(cid:105)(cid:46)(cid:114)(cid:117) FOREWORD It has been a pleasure and privilege to prosthodontics; it illustrates how relatively make a contribution to this project. The inexperienced colleagues can carry out book represents the fruits of a lifetime's involved procedures provided they are set experience of the principal author; within out in a step-by-step logical process. it you will find pearls of wisdom and a Make no mistake that there is anything great deal of common sense. The work simple about some of the plans of treat- represents more than a series of case ment: adult orthodontics, site preparation reports and far more than a technique- for implants and implant prosthodontics, oriented clinical manual: it is all about the together with complex fixed and remov- treatment of patients and adapting able prostheses, all feature within the text. prosthodontic techniques to the individual Some of the techniques employed have situation, rather than the other way round. been available for many years, but So often overlooked is the fact that techniques, after all, are only means to an patients who have suffered severe tooth end. Dr Klugman has been able to take loss do not usually arrive for treatment advantage of his clinical experience to with a mouth in pristine condition. Yet Dr adapt these well-tried methods to Klugman and his graduate students take present-day prosthodontics, and in this patients, establish rapport, and motivate he has succeeded admirably. them. This is a book about the real world, and one for all who are interested in Harold Preiskel PREFACE The idea for writing this book came while The program is of 3'/ years duration and sitting in one of the seminars of our gradu- includes certain clinical and basic science ate program in Prosthodontics. requirements. Successful completion of One of our students was presenting a the program enables the student to be progress report of his patient, discussing eligible for the specialty licensing examina- the diagnosis, and the possible treatment tion administered by the Ministry of Health plans. Finally, he showed his treatment and in order to qualify as a specialist in Oral explained its rationale. As I sat there, the Rehabilitation. In the first years, one or two thought came to me, what a waste of students were accepted to the program information this is; the student is present- and, as time went on, the program was ing a beautifully documented treatment for expanded to include up to four students a very difficult patient with superb radio- per year. This gave a core group of graphs and slides. What a shame that only between 12 and 16 students to participate the 12 or so people in the room are in seminars and treat patients. viewing it. Today the program encompasses four The purpose of the book is to share our days a week, in which the students spend treatment modalities and rationale of treat- 4 hours in seminars each week. These ment with as many dentists as possible. consist of case presentations, literature Our seminars provide at least one hour reviews, and research on prosthetic of case presentation time with a continua- subjects, and additional full day seminars tion possible the following week. During as needed. The students spend 3 days a the presentation, the instructors and other week treating clinical patients under the students question the diagnosis and treat- supervision of board certified instructors. ment plan, volunteering their opinions and The remainder of their time is spent in alternative treatment strategies. It's a give clinical or original research. Many of the and take situation. It is our conviction, that students carry out basic research projects this is one of the best learning processes leading to a Masters degree or Doctorate. for a graduate student. The program is integrated with other The Graduate Program in Oral specialty programs at the Dental School, Rehabilitation was initiated in 1978 when including Periodontics, Orthodontics, Oral the Israeli Parliament passed a law recog- Surgery, and Endodontics. The graduate nizing dental specialties. Until that year, the students treat implant patients. They plan only specialization recognized by the and oversee the surgical phase, but do not Ministry of Health was Oral and perform the surgical procedures. Most Maxillofacial Surgery, which was a 5-year periodontal surgery, endodontic, oral surgi- program. In 1979, the Department of Oral cal, and orthodontic procedures are Rehabilitation set up a program to teach referred to graduate students or specialists Graduate Prosthodontics. in the other disciplines. x PREFACE The philosophy of treatment in the I would like to personally thank all the program is based on the clinical and learn- graduate students, former and present, ing experiences of the faculty, who have especially those who contributed to the themselves been trained in Prosthodontics book, the faculty of the program, at The University of Pennsylvania, New Professor Jacob Ehrlich, Professor York University, and The University of Avinoam Yaffe (Program Director), Dr Israel Toronto, in the 1960s and 1970s. Thus Tamari, and Dr Erez Mann. Special thanks their diverse backgrounds mean that the go to Professor Harold Preiskel and faculty members bring to the program Professor Avinoam Yaffe who provided varied ideas of treatment. We have tried to editorial commentaries, who made great incorporate the best aspects of each of efforts in helping me, and without whose these programs for our own syllabus. aid I doubt that the book would have been Some of the methods we use have been written. developed here in Israel.