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Guidelines_English_Final
تحميل الدليل التدريبي

أسئلة شائعة


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( اسم المقرر : اآلينيكيه الاستعاضه المتحرآه ( ٢

ماس ٤٢١ : رقم ورمز المقرر

ساعات ٣ : عدد وحداته الدراسيه

المتطلبات السابقه : ٣٢١ ماس

SDS 421 Clinical Removable Prosthodontics II

SEQUENCE:

SDS Course 421 is an advanced didac􀆟c & clinical removable prosthodontic course

taught in the fourth year of Dental College, King Saud University.

PREREQUISITE: SDS 321

COURSE DESCRIPTION:

This course is specially designed to provide an opportunity for gaining better & finer

knowledge and skill in prosthodontic services in the diagnosis, treatment planning, special

treatment procedures and the insertion and postinsertion of partial, complete, immediate and

transitional temporary dentures. Included are relining and rebasing procedures. This course

has a didactic and a clinical component and the course is spread over the entire academic year

i.e. 1st & 2nd academic terms. The didactic (lecture) component is covered in 16 sessions during

the 1st half of the academic year. The lectures cover the theoretical background and the

different modalities in prosthodontics. During the entire academic year there will be a weekly

threehour clinical session, with assistance from the college central dental laboratory.

CREDIT HOURS: 3 Credit Hours

One (1) credit hour: One (1) Hour lecture weekly for one semester

Two (2) credit hour: Three (3) Hour Clinical weekly for two semesters

COURSE OBJECTIVES:

1. The fourth year students will be reinforced and enriched in his/her previous

experiences with the didactic and clinical disciplines of Removable Prosthodontic

Sciences.

2. The students will be exposed to a finer insight into the examination, diagnosis,

treatment planning and technical procedures in the art & science of Prosthodontics,

while treating patients.

3. It is expected that after the completion of the course, the students will be in a better

position to render a scientifically acceptable diagnosis, treatment planning and

treatment for his/her patients, requiring removable complete, partial, and immediate

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dentures. It is also expected that the student will demonstrate proficient skills in

his/her clinical treatment with minimum assistance from his/her instructor.

COURSE METHODOLOGY:

The student will attend one clinical session and one lecture session in the first half of

the year, and one clinical session in the second half of the year. The student is

expected to still be present during all sessions or to be officially excused by his/her

instructor.

At the beginning of the year, the student will be assigned patients, and his assigned

instructor will be responsible for the supervision of the student in his/her clinical

session.

References for each lecture will be submitted at the end of the lecture.

COURSE REQUIREMENTS:

1. Regularity, punctuality & adherence to college didactic & clinical regulation in treating

patients must be strictly observed.

2. Your instructor will continually monitor your clinical skills, behavior and patient

management.

3. A minimum of 8 arches must be completed, during the course of one (1) clinical session

per week, by the end of the academic year.

4. Out of the total 8 minimum arches:

4 arches Removable Partial Dentures (RPD)

One RPD with altered cast impression technique

2 arches Complete Dentures (CD)

Patient Clinical Remount of Complete Dentures

2 arches Immediate, transitional or interim dentures or relining/ rebasing.

5. During the academic year, each student will have two continuous oral assessments

during his clinical session. Before each clinical session each student should be prepared

to understand the theoretical and clinical steps for the actual clinical procedures to be

accomplished on his patient.

6. For each patient, the treatment plan form and the prostheses insertion visit (patient's

file) will require two signatures: the Instructor and the Course Director. The Instructor

will also sign the Summary Form of Accomplishment of Clinical Procedures at the

insertion visit. (See a􀆩achment 11, page 41)

7. At the end of each semester, each student must turn in his SDS Summary of Clinical

Work Form, listing each patient work performed and initialed by his Instructor. Late

turnin of this form will result in a grade reduction.

CLINICAL PROTOCOL:

At the beginning of each clinical session, the instructor will evaluate the student's

theoretical knowledge part of the clinical procedure to be performed. The student must know

the theoretical background of that procedure; otherwise he/she should not proceed.

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1. A minimum of two patients will be assigned for each student at the first half of the year

and their clinical treatment should be completed within the prescribed clinical time

allotted, with mutual consent of the instructor.

2. The students should strive to perform the clinical procedures independently and take

minimum assistance from the instructor in order to score a good grade.

3. The student should maintain discipline with regards to attending the clinic sessions on

time, and is expected to maintain a good rapport with his patients, colleagues and

instructor alike.

4. The student must always observe cleanliness and neatness in appearance and wear

their proper clinical gowns during the clinical session; otherwise they will not be

allowed to perform their clinical procedures.

5. It is the responsibility of the student to complete the patient's permanent file,

indicating all the relevant information and to obtain the signature of the instructor. A

temporary file is not acceptable. The patient's file, without the signature of the

assigned instructor, shall be considered as an incomplete clinical procedure, and will

affect your daily grade.

6. The dental laboratory authorization form should be filled out by the student and should

be duly signed by the instructor. Good rapport with laboratory personnel should be

maintained (Please see sample work sheet a􀆩achment # 9 & 10).

7. In a situation where the patient is unable to attend the clinic, the student should

immediately notify their instructor. Students should attend the clinic session despite

the absence of their patients.

8. Attendance rules and regulations are to be applied during both clinic and didactic

sessions of this course.

9. All previously mentioned protocols are to be followed. Otherwise, the clinical grading

will be affected negatively.

COURSE EVALUATION:

In order to receive a passing grade for course SDS 421, the student must pass both the

didactic and the clinical parts separately.

I. Continuous Assessment (60%)

The percentage of grades will be as follows:

One Continuous Assessment (1 Exam) = 10%

(Mid – term written examination)

Clinical Sessions (1st & 2nd Sem.) = 40% (20% each semester)

Two Continuous Oral Assessments = 10%

Two Oral Continuous Examinations will be conducted by the Course Director

during the clinical sessions and distributed as follows;

5% in the first semester

5% in the second semester

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On each patient, the student is required to perform the following for diagnosis

and treatment planning: (1) Radiographic evalua􀆟on, (2) Record history, (3) Clinical

exam, (4) TMD Screening, (5) Diagnos􀆟c impressions and mounted casts, if requested,

and (5) Formulate a wri􀆩en treatment plan.

The treatment plan is to be discussed with his instructor and the student will be

evaluated accordingly (see SDS Clinical Evalua􀆟on and Procedure Form, Steps 1 and 2).

Both the clinical Instructor and the Course Director will sign the final treatment plan

form in the patient's file.

Each student must fulfill the minimum treatment requirements of the course (8

units). The quality of treatment for each clinical step provided will be of primary

concern in the assignment of the final grade.

The Clinical Evaluation Form will be strictly followed for each clinical procedure,

and each step must be signed by the instructor during the session.

II. Final Examination (40%)

1. Final Didactic Exam at the end of the

1. First Semester or Second Semester = 30%

2. Final Practical Examination

2. Second Semester = 10%

COURSE OUTLINE:

LECTURE #1: SDS CLINICAL FORMS, CLINICAL PROTOCOL, LECTURE CONTENTS AND

REFERENCES.

A discussion of the above items will include the following clinical forms.

1. SDS Clinical Evaluation Form

2. SDS TMD Screening History & Exam Form

3. SDS Exam/Diagnosis for RPD Patients

4. SDS Design & Design Modification for RPD’s

5. Worksheet: Interim and Transitional RPD’s

6. Sample Treatment Plan Form

7. Sample of Treatment Sequence for RPD Patients

8. Sample of Treatment Sequence for Complete Denture Patients

9. Sample Dental Laboratory Worksheet (for teeth setup)

10. Sample Dental Laboratory Worksheet (for denture processing)

11. Summary Form of Accomplished Clinical Procedures

LECTURE #2: TEMPOROMANDIBULAR DISORDERS: SCREENING ISTORY & EXAM FOR

ROUTINE DENTAL PATIENTS.

1. Definition

2. Origin, purpose, and advantages of TMD screening

3. TMD screening forms

4. How to perform a TMD screening history

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5. Classic TMD symptoms

6. How to perform a TMD screening examination, including digital palpation

7. Relation of tension headaches to TMD

8. When to refer a patient to a TMD specialist

9. Each student will fill out his/her TMD selfscreening history form

10. Each student will perform a TMD selfscreening exam

References:

McNeill C (Ed.). Temporomandibular DisordersGuidelines for Classification,

Assessment and Management. Quintessence, London, 1993, pages 1116,

1922, 6163.

Nassif J, Hilsen K. Screening for Temporomandibular Disorders: History and

Clinical Examina􀆟on. Journal of Prosthodon􀆟cs, 1992;1:4246 (September).

LECTURE #3: TREATMENT OF ABUSED AND PATHOLOGIC ORAL TISSUES.

a. Definition

b. Pathoses related to denture wearing.

(1) Pseudo epitheliomatous hyperplasia (palatal papillary hyperplasia)

(2) Denture induced stomatitis (DIS) (pressure, plaque, denture

adhesives)

(3) Denture induced hyperkeratosis

(4) Epulis fissuratum

(5) Excessive resilient (flabby) ridge mucosa

c. Pathoses not related to denture wearing

1. Chemical injury (i.e. aspirin burn)

2. Radiation mucositis

3. Xerostomic mucositis

4. Hyperkeratosis not under denture baring surface

5. Smoker's mucositis

d. Etiology of denture induced stomatitis (DIS)

(1) Systemic factors

(a) Diabetes

(b) Endocrine dysfunction

(c) Nutritional deficiencies

(d) Neoplasia

(e) Xerostomia (medication, diabetes)

(2) Local factors

(a) Trauma

(b) Continuous wear

(c) Poor Oral Hygiene

(d) Acrylic resin allergy

(e) Candida albicans infection

e. Mechanisms making oral tissues susceptible to DIS

(1) Increased epithelial permeability

(2) Acidic environment

(3) Aerobic environment

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f. Treatment for abused oral tissues

(1) Identify/eliminate etiology

(2) Recondition the oral tissues with conditioners

(a) Viscogel

(b) Coe Comfort

(c) Coe Soft

(3) Surgical procedures

(4) Leave dentures out of mouth

(5) Reconstruct prosthesis with accuracy

(6) Use antibacterial agents in denture (Chlorhexidine, Listerine,

Nystatin topical)

(7) Denture cleansers and denture cleaning methods

Reference:

Textbook of Complete Dentures by Rahn AO, Heartwell CM, 5th ed,

Williams & Wilkens Co; Bal􀆟more 1993 pp. 407412, 414, 419425, (all

required reading).

LECTURE #4: MANAGEMENT OF REDUCED RESIDUAL ALVEOLAR RIDGES.

a. Definition

b. Oral aspects of aging (Zarb)

c. Etiology of atrophic bone resorption (Rahn)

1. Local factors

2. Systemic factors

d. General considerations for treatment planning

e. Intraoral assessment

1. Direction of bone loss

2. Biomechanical factors and associated problems

3. Oral mucosa factors and associated problems

f. Preservation of the residual alveolar ridges

g. Patient management/treatment Nonsurgical methods and techniques

1. Fundamental principles

2. Philosophies for occlusal types/arrangement

3. Patient education and reasonable expectations

h. Patient management Surgical techniques

1. Soft tissue surgical techniques

(a) Vestibular extension procedures

(b) Autogenous soft tissue overlay grafts

2. Soft tissue surgical techniques for the partially edentulous mouth

(Removable/Fixed)

3. Hard tissue surgical techniques

Osseointegrated implants

Removable

Hybrid

Fixed

Osteotomy autogenous bone graft (mandibular)

Visor osteotomy

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Modified Visor osteotomy

Interpositional bone graft

Alloplastic ridge augmentation graft

Hydroxyapatite alone

Hydroxyapatite in combination

Problems with use of hydroxyapatite

References:

Rahn A, Heartwell C.: Textbook of Complete Dentures, 5th Ed., WB Saunders

Co., Philadelphia, 1993, pages 185211, (all required reading).

Zarb G, Bolender C, Hickey J, Carlsson G: Boucher's Prosthodontic Treatment

for Edentulous Pa􀆟ents, 10th Ed, CV Mosby Co, Chicago, 1990. pp. 3846,

123143, 194204.

LECTURE #5: PROSTHODONTIC TREATMENT PLANNNING IN OLDER ADULTS.

1. Characteristics of the elderly patient:

I. Age related changes.

a. Sensory changes

b. Cognitive changes

c. Psychosocial aspects

II. Oral Physiology and Aging.

a. Salivary glands

b. Oral Mucosa

c. Oral motor function

d. Oral sensory function

2. Factors influencing Prosthodontic Treatment Planning.

3. Objectives of Prosthodontic Treatment Planning.

a. Partially edentulous patient

b. Completely edentulous patient

4. Identification of Treatment Needs and Demands.

a. Partially edentulous elderly

b. Completely edentulous elderly

5. Identification of the Risk Factors.

I. Partially edentulous patient

a. Periodontal situation

b. Caries activity

c. Residual ridge resorption

d. Functional problems of masticatory system

II. Complete denture wearer

6. General Health of the Elderly.

7. Choice of Prosthodontic Treatment Modalities.

a. Fixed Partial Dentures and the elderly

b. Removable Partial Dentures and the elderly

c. Overdentures and the elderly

d. Complete dentures and the elderly

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8. Decision Making in Treatment Planning.

a. Patient’s factors

b. Prosthodontist’s factors

9. Treatment Planning Recommendations.

10. Post Treatment Phase Aids for maintaining adequate oral hygiene.

LECTURE #6: PATIENT REQUIRING A SINGLE COMPLETE DENTURE.

1. General considerations in construction & delivery

2. Single complete "denture syndrome"

1. Definition

2. Characteristics

3. Preventive measures

3. Minimizing occlusal forces on the denture foundation

a. Complicating factors for the single mandibular complete denture

b. Favorable situations for the mandibular complete denture

c. Special considerations for maxillomandibular jaw relations

d. Indications for modifying the opposing mandibular natural/artificial

occlusion (Removable/Fixed)

e. Occlusal adjustment perfecting the plane of occlusion of the opposing

natural teeth: Two methods (one using an occlusal metal template)

(Removable/Fixed)

f. Improving the occlusal plane of the opposing "mesially tilted molar"

(Removable/Fixed)

g. establishing the vertical and horizontal overlap

h. Occlusal requirements of the single complete denture

i. Artificial posterior teeth selection

j. Placement (insertion) visit

Reference:

Rahn A, Heartwell C: Textbook of Complete Dentures, 5th Ed, WB Saunders

Co, Philadelphia, 1993. Required reading pages 481491.

LECTURE 7: PROSTHODONTICS AND THE PERIODONTIUM.

1. Etiology of periodontal disease, complicating factors

2. Preparatory aspects of prosthodontic therapy.

3. Role of prostheses in progression of periodontal disease.

4. Preventive design of restorations and prostheses.

5. Adjunctive procedures.

6. Maintenance.

References:

Pameijer JN. Periodontal and occlusal factors in crown and bridge

procedures. Amsterdam: ACPC, 1985;2:1725

Bergman B. Periodontal reactions related to removable partial dentures. A

Literature Review. J Prosthet Dent 1987;58:454458.

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LECTURE #8: CONCEPT OF NEUTRAL ZONE.

1. Definition of neutral zone

2. Importance of neutral zone

3. Muscles involved in the neutral zone

4. Methods and techniques for location of neutral zone

5. Impression the polished surfaces

References:

The Neutral Zone in Complete Dentures by Beresin & Schiesser J Prosthet

Dent 36, No. 4, 1976 pp. 356367.

The Dynamic Nature of the Lower Denture. By Bill et al., J Prosthet Dent,

MayJune 1965, Volume 15, No. 5 pp. 401417.

LECTURE #9: ESTHETICS AND PHONETICS IN PROSTHODONTICS.

DENTAL ESTHETICS

Four Main Factors in Dental Esthetics.

I. Size of anterior teeth

II. Form of anterior teeth

III. Color/Shade of teeth

IV. Arrangement of anterior teeth

I. Size of Anterior Teeth.

i. Face size

ii. Maxillary arch size

iii. Incisive papilla/canine eminence/buccal frenai

iv. Class I, II, III jaw relations

v. Residual ridge contour

vi. Interridge space

vii. High lip line

viii. Teeth visibility with "resting lips"

ix. Teethlip relation with phonetic sounds

II. Anterior Teeth Outline Form.

i. Frontal outline form of face

ii. Profile outline form of face

iii. Sex of individual

iv. Age of individual

III. Color and Shade of teeth.

i. Definition

ii. Hue, Chroma (Saturation), Brilliance

iii. Youth versus Aging Individuals

iv. Light Source

v. Verifying the Color/Shade Selection

vi. Significance of the Complimentary Color of Yellow (Blue)

vii. Second Opinion

IV. Arrangement of Anterior Teeth.

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i. Age factors

ii. Sex factors

iii. Personality factors

iv. Personal grooming (Cosmetic) factor

v. Dentist's artistic reflection, including dentist's esthetic refinements

vi. Opinion/Desires of the patient.

DENTAL PHONETICS

I. Definition

II. Relationship of speech sounds to lips, tongue, teeth

III. Articulation valves (Controls)

1. Upper Lower lip sounds ("b", "p", "m")

2. Lower lip Upper incisor sounds ("f", "v")

3. Various types of tongue and teeth and/or rugae relations (including

velar and nasal sounds)

a. Tongue Teeth Sounds ("the", this, these, those")

b. Tongue Rugae Sounds ("t", "d", "z")

c. Tongue Rugae Nasal Sounds ("n")

d. Upper/Lower Incisor Tongue Rugae Sounds ("s", sh")

4. Palatal Tongue Sounds ("year", "onion")

5. Velar Tongue Sounds ("k", "g")

THE "1 2 3 4” RULE FOR ANTERIOR TEETH POSITIONING.

1. Anatomic Landmarks and Biomechanical Principles

2. Phonetic Consideration with Upper Incisor Teeth

3. Esthetic Considerations and "Smile Line"

4. Phonetic considerations with lower incisor teeth

5. Vertical Dimension Considerations

References:

Zarb G, Bolender C, Hickey J, Carlsson G: Boucher's Prosthodontic

Treatment for dentulous Patients, 10th Ed, CV Mosby Co, Chicago, 1990.

Esthe􀆟cs, pages 357361, 370372, 382400, 405424. Phone􀆟cs, pages

278279, 370. Required reading pages 400405.

Rahn A, Heartwell C: Textbook of Complete Dentures, 5th Ed, WB Saunders

Co, Philadelphia, 1993. Esthe􀆟cs, pages 339348, (required reading).

LECTURE #10: CLINICAL AND LABORATORY TECHNIQUES IN RELINING AND REBASING.

I. General Considerations

a. Definition

1. Relining

2. Rebasing

b. Indications for relining complete dentures and removable partial

dentures

c. Contraindications for relining Indications for remaking complete

dentures

d. Interviewing the patient and history taking

e. Clinical examination

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1. Extraoral examination

2. TMD screening examination

3. Intraoral examination

4. Complete dentures: outofthemouth exam

5. Complete dentures: inthemouth exam

f. Treatment planning

1. Initial treatment, including the need for tissue conditioning

2. Final treatment plan

II. Clinical Considerations

a. Clinical techniques for relining complete dentures

1. Open mouth impression technique

2. Closed mouth impression technique

3. Functional impression technique

b. Clinical procedures for relining complete dentures using the "closed

mouth impression technique." A stepbystep method

c. Placement (insertion) visit of the relined denture (See next section for

laboratory procedures)

1. Perfecting the fit

2. Clinical patient remount in centric relation

III. Dental Laboratory Procedures

a. Advantages/disadvantages of heat cured resins versus

autopolymerizing resins

b. Laboratory methods for processing the relined complete denture

1. Articulator method

2. Reline jig method

3. Denture flask method

4. Laboratory relining complete dentures using the reline jig method.

A stepbystep demonstration

References:

Rahn A, Heartwell C: Textbook of Complete Dentures, 5th Ed, WB Saunders

Co, Philadelphia, 1993, pages 422434.

Dental Laboratory Procedures Complete Dentures, Vol. One, Rudd,

Morrow, Edwards et al, Mosby Co, 2nd Ed, 1986, pages 364382 (required

reading).

Clinical Procedures for Relining the Maxillary Complete Denture. Nassif and

Jumbelic, Compendium of Continuing Educa􀆟on, 7:478484, July 1986

(required reading).

LECTURE 11: DUPLICATION OF COMPLETE DENTURES: CLINICAL / LABORATORY PHASES

a. Definition/Indications

1. Permanent duplicate complete denture

2. Temporary duplicate complete denture

b. Methods/technique of fabrication

1. Modified denture flask method (Brewer, Morrow, Nassif)

2. Pour resin flask method (Boos, Carpenter)

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3. Cup flask method (Wagner)

c. Modified denture flask method Stepbystep procedures

d. Problem areas in fabrication and solutions

References:

Morrow RM, Rudd K, Eismann HF: Dental Laboratory Procedures, Vol. 1:

Complete Dentures, 2nd Ed. St. Louis: CV Mosby Co, 1986; pages 339363

(required reading pages 339, 346348).

Nassif J, Jumbelic R.: Duplicating maxillary complete dentures. J Prosthet

Dent, 1984;52:755759.

LECTURE 12: NEW DEVELOPMENTS IN PROSTHODONTIC MATERIALS INCLUDING ADVERSE

REACTION AND WEAR OF MATERIALS.

Occupational health problems, dermatoses, nondermatologic

Adverse general patient reactions

Specific adverse effects: pulpal response, periodontal tissues

Wear of material

References:

Owall B, Kayser AF, Carlsson GE. Prosthodontics: Principles and

management strategies. London:MosbyWolfe, 1996 Chapter 13, pp. 179

184 & Chapter 14, pp. 187199.

LECTURE 13: OVERDENTURES I

a. Rationale

b. Advantages

c. Disadvantages

d. Indications, contraindications

References:

Overdentures Made Easy by Preiskel, Chapter 1, pp. 1120.

Overdentures By: A. Brewer & R. Morrow, 2nd ed. Chapter 1, pp. 311 and

Chapter 2, pp. 1214

LECTURE 14: OVERDENTURES II

a. Examination

i. Visual

ii. Digital

iii. Radiographic

b. Case selection and abutment selection

c. Treatment plan

Reference:

Overdentures Made Easy by Preiskel, Chapter 2, pp. 2143

LECTURE 15: OVERDENTURES III

a. Clinical procedures

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b. Impression techniques

i. Direct technique with Duralay

ii. Indirect technique

c. for abutments

d. Postinsertionmaintenance phase

Reference:

Overdentures Made Easy By: Preiskel, Chapter 3, pp.4565

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421 SDS CLINICAL REMOVABLE PROSTHODONTICS II

SCHEDULE OF LECTURES

ACADEMIC YEAR 20072008 (14281429H)

NO. DATE TITLE LECTURERS

1 2 100907

SDS Clinical forms, Clinical Protocol, Lecture

Contents, and References

Temporomandibular Disorders: Screening

history & exam for routine dental patients

Prof. Fahmi

Dr. Z. Salameh

2 170907 Treatment of abused and pathologic oral

tissues

Dr. W. Sadig

3 240907

Management of reduced residual alveolar

ridges

Dr. W. Sadig

41007 to 191007 RAMADAN BREAK

4 221007 Prosthodontics Treatment Planning in older

adults

Dr. K. Al Ali

5 291007 Patients requiring a single complete denture Dr. K. Al Ali

6 51107 Prosthodontics and the periodontium Dr. Z. Salameh

7 121107 Concept of neutral zone Prof. Fahmi

8 191107 Esthetics and phonetics in prosthodontics Prof. Fahmi

261107 MIDTERM EXAM

9 31207 Clinical and laboratory techniques in relining

and rebasing

Prof. Fahmi

10 101207 Duplication of complete dentures:

Clinical/Laboratory phases

Prof. Fahmi

131207 to 281207 HADJJ HOLIDAY BREAK

11 311207

New developments in prosthodontic

materials, including adverse reaction and

wear of materials

Prof. Fahmi

12 7108 Overdentures I Prof. Fahmi

13 14108 Overdentures II Prof. Fahmi

14 21108 Overdentures III Prof. Fahmi

FINAL EXAMINATION (date to be arranged later)

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