1 - Bridgework Flashcards
What are the treatment options for a space from tooth loss?
- no treatment
- replacement
- orthodontics
What are the reasons for treating tooth loss?
- aesthetics
- function
- speech
- maintenance of dental health
What are the options for replacing a tooth?
- denture
- bridge
- implants
Define a bridge.
A prothesis that replaces missing tooth/teeth that is attached to one or more natural teeth/implants (abutments)
What are the different types of bridge (by retention)?
- adhesive
- conventional
What are the different types of bridge (by units)?
- fixed fixed
- cantilever
What are general indications for bridgework?
- function and stability
- appearance
- speech
- psychological reasons
- systemic disease
- cooperative patient
How does systemic disease impact the decision to use a bridge?
Some patients cannot tolerate removal prosthesis ie patients with epilepsy
What are local indications for bridgework?
- big teeth
- heavily restored teeth (conventional)
- favourable abutment angulation
- favourable occlusion
Describe favourable occlusion for bridgework.
No heavy contact
What are general contraindications for bridgework?
- uncooperative patient
- medical history
- poor OH
- high caries rate
- periodontal disease
- large pulp (young teeth, conventional)
What are local contraindications for bridgework?
- high possibility for tooth loss within same arch
- prognosis of abutment teeth poor
- span of bridge too great
- ridge form or soft tissue loss
- tilting/rotation of teeth
- degree of prep required
- periapical status
- periodontal status
Define abutment.
A tooth that serves as an attachment for a bridge
Define pontic.
The artificial tooth which is suspended from the abutment tooth/teeth
Define retainers.
The extra- or intracoronal restorations that are connected to the pontic and cemented to the prepared abutment teeth (eg wing or crown)
Define connectors.
Component that connects the pontic to the retainers
Define edentulous span.
Space between natural span that is to be filled by bridge or partial denture
Define saddle.
Area of edentulous ridge over which the pontic will lie
Define pier.
Abutment tooth which stands between and support two pontics, each pontic being attached to a further abutment tooth
Define unit.
Either a pontic or retainer
Define a fixed fixed bridge.
Retainer at each of the bridge with a pontic suspended between, joined by rigid connectors
Define a cantilever bridge.
Retainer at one side of the pontic
What are the types of adhesive cantilever bridge?
- metal CoCr wing
- all ceramic
What are the advantages of adhesive cantilever bridges?
- minimal to no prep
- no anaesthetic
- cheaper
- less chair time
- can be used as provisional
- minimal interference with occlusion
What are the disadvantages of adhesive cantilever bridges?
- require excellent clinical technique
- metal shine through
- can chip
- can debond
- no trial possible
What are the indications for adhesive cantilever bridges?
- young teeth
- good enamel
- large abutment area
- minimal occlusal load
- single tooth replacement
- can simplify RPD design
What are the contraindications for adhesive cantilever bridges?
- poor enamel
- long spans
- excessive soft tissue loss
- heavy occlusal contacts
- poor alignment of teeth
- contact sports (?)
What makes up the clinical examination for adhesive bridges?
- dynamic occlusal relationships
- periodontal health
- radiographs
What can be used as a pontic?
- patients own tooth
- acrylic denture tooth
- polycarbonate crown
- cellulose matrix filled with composite
What type of bridge is typically used in the anterior?
Cantilever
What type of bridge is typically used in the posterior?
Fixed fixed
What are cantilever bridges more successful in the anteriors?
There are divergent guidance paths in the anterior due to the long axises of the teeth being at different angles
How do you prepare adhesive bridge abutments?
- if sound enamel, no prep required
- if composite restoration, roughened with slow sped
- if amalgam, replace with composite
Describe the prep for an adhesive posterior bridge.
- 180 degree wrap around
- rest seats (posterior)
- supragingival chamfer finish 0.5mm
- remain in enamel
Describe the retainer of a CoCr adhesive bridge.
Metal wing with sandblasted surface for micromechanical retention
What cement is used for an adhesive bridge?
- dual cure
- Panavia 21EX
Describe the steps of cementing an adhesive bridge.
- isolate tooth
- etch with phosphoric acid
- wash and dry
- apply primer (A and B mixed) for 30s
- air dry for 2s
- fit retainer coated in luting cement to abutment
- remove excess cement
- oxygen inhibitor placed around cement margins for 3mins
What should be done after cementation?
- check occlusion
- demo how to clean bridge to patient
What can be used to clean around a bridge?
- superfloss
- interdental brushes
How does the occlusion adjust to an adhesive bridge?
Minimal interference with the occlusion self corrects within 10-14 days due to relative axial tooth movement
