1 - Bridgework Flashcards by Cesca Lang

What are the treatment options for a space from tooth loss?

no treatment
replacement
orthodontics

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What are the reasons for treating tooth loss?

aesthetics
function
speech
maintenance of dental health

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What are the options for replacing a tooth?

denture
bridge
implants

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Define a bridge.

A prothesis that replaces missing tooth/teeth that is attached to one or more natural teeth/implants (abutments)

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What are the different types of bridge (by retention)?

adhesive
conventional

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What are the different types of bridge (by units)?

fixed fixed
cantilever

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What are general indications for bridgework?

function and stability
appearance
speech
psychological reasons
systemic disease
cooperative patient

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How does systemic disease impact the decision to use a bridge?

Some patients cannot tolerate removal prosthesis ie patients with epilepsy

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What are local indications for bridgework?

big teeth
heavily restored teeth (conventional)
favourable abutment angulation
favourable occlusion

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Describe favourable occlusion for bridgework.

No heavy contact

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What are general contraindications for bridgework?

uncooperative patient
medical history
poor OH
high caries rate
periodontal disease
large pulp (young teeth, conventional)

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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

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Define abutment.

A tooth that serves as an attachment for a bridge

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Define pontic.

The artificial tooth which is suspended from the abutment tooth/teeth

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Define retainers.

The extra- or intracoronal restorations that are connected to the pontic and cemented to the prepared abutment teeth (eg wing or crown)

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Define connectors.

Component that connects the pontic to the retainers

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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