anterior bridge Flashcards
decisions to remove the tooth
1) non savable
2) avoid complex techniques required to restore if prognosis if not good
- endodontic treatment
- post and core buildup
- crown lengthening
deformities of residual ridge following extraction
1) the degree of residual ridge resorption is unpredictable
2) class 0
- nothing
3) class I
- lost horizontal bone
4) class II
- lost vertical bone
5) class III
- combination
- most common
class 0
1) proper contour and morphology
2) smooth gingiva
3) plaque free environment
4) no loss of bone height and width
5) pontic appears to emerge from the ridge
6) free of frenum attachment
esthetic region
1) surgical modification of soft and hard tissue
2) hard tissue for implants
missing teeth and non ideal residual ridge
1) loss of residual ridge
- unaesthetic open gingival embrasures
- black triangles
- food impaction
- percolation of saliva during speech
residual ridge modification
1) remove tissue from palate, roll it, and stimulate tissue growth
2) soft tissue various techniques
- inter positional graft
- pouch technique
- roll
allograft
1) hydroxyapatite or freeze dried bone
2) maintain the bone height for a while
anterior teeth
1) esthetics and function
2) options
- no treatment
- implant
- FDP, RDP
3) short term: no changes
4) long term: no changes, loss of arch integrity, tooth movement, change of occlusion and load on adjacent teeth
implant
1) standard of care for missing single tooth
fixed dental prosthesis
1) partial coverage
- minimally invasive
- maryland
- cantilever
2) full coverage
- 3 unit bridge
- cantilever bridge
removable posthesis
1) temporary splints (interim)
2) stay plate (interim)
- flipper
3) partial denture (permanent)
- not common for single tooth or worth iti
implant considerations
1) medical history
2) proximity of vital structures
3) condition of adjacent teeth
4) occlusion evaluation
5) residual ridge, soft tissue contours
6) evaluation of lip line and esthetic needs
7) perio health
8) patient acceptance of procedure and implant placement
9) patient expectations
maryland bridge
1) pontic tooth attached to the front of metal framework
2) two wings on each side
- luted or bonded
3) now zirconia or LDS
maryland considerations
1) PFM
- minimal prep
- supragingival light chamfer
- luted or bonded
2) zirconia
- luted or bonded
3) LD
- minimal prep with bonding
—-
technique sensitive
- case selection
- occlusal analysis (not recommended for heavy biters)
cantilever
1) pontic attached to one or two teeth on one side only
2) PFM luted in 1980
3) ceramic today
- zirconia: luted or bonded
- LD: bonded
4) full coverage
- luted or bonded
5) partial coverage
- resin bonded
6) long term prognosis is not predictable
- vertical tipping, or horizontal forces rotate the tooth
- need to be carefully planned for abutment teeth stability
indications for cantilever
1) favorable occlusion and load
2) favorable crown/root ratio (clinical)
- 2:3 opitimal
- 1:1 acceptable
3) root morphology
- no conical root
4) periodontal health
traditional three unit bridge
1) retainer, pontic, connector
2) considerations
- abutment teeth prognosis
- perio prognosis
- virgin tooth
- pre-existing crown/large restoration present
- edentulous space
- span of the bridge
- ante’s law
ante’s law
1) SA of root of the abutment teeth should be equal or greater than the total root surface being replaced with pontics
2) better prognosis and longevity of the bridge
3) less pressure on periodontium and PDL
4) balancing of leverage and torque
other considerations for anterior FDP
1) appearance is key
2) all preps must draw
3) missing 4 lower incisors can be replaced by using just the 2 canines as abutments is possible
- violates ante’s law
4) mandibular incisors are typically poor abutment teeth
5) forces on maxillary anterior teeth are directed in a tipping manner
- when all 4 are missing, canines and premolars are abutments
restorative materials for 3 unit bridge
1) FVC
- full metal
2) PFM
3) FZ
- monolithic zirconia
- not as esthetic
- heavy occlusion
4) LD
- high aesthetic, need ideal occlusion
5) PFZ
- porcelain fused to zirconia
- PFM replacement, required strength
PFZ
1) Lava
2) porcelain fused with zirconium oxide (ZiO2)
3) substructure (core)
- yttria stabilized zirconia
- designed, milled, and sintered
4) overlay
- core is layered or pressed with ceramic and oven fired
advantages of PFZ vs RDP
1) indicated for anterior
2) strength similar
3) eliminated esthetic challenges
-discoloration, dark line
4) natural translucency
5) hypoallergic and biocompatible
6) conventional cementation
7) CAD/CAM technology
* PFZ can be pressed or milled
PFZ contraindications
1) inadequate clearance
2) bruxism
3) previously broken PFM
4) cases that require bonding
—
1) prone to cohesive or adhesive failure
2) chipping of porcelain veneer is common
3) needs more aggressive prep
4) consider full zirconia for posterior molar region
pre-operative requirements
1) mounted diagnostic models
2) occlusion evaluated pre-op
3) putty matrix or pressed formed splint
putty
1) 2nd premolar to 2nd premolar for provisional putty
2) fabricate one reduction putty and cut it through middle of incisal edge
3) fabricate another and cut it through middle of two retainer teeth
4) extract #7
- socket must be CONCAVE
prep criteria
1) establish draw on all teeth
- challenging because there is arch curvature
2) incisal reduction of 2 mm
- really sharp incisal edges (round it)
3) taper of 10-12 degrees
4) 1.5 facial axial reduction
5) lingual reduction of 1 mm
6) lingual axial wall height of 2-3 mm
long axis
1) use a perio probe
2) make depth cuts parallel to long axis
burs
1) football and 856
2) preserve lingual height
ovate
1) superior aesthetics
2) negligible food entrapment
3) easy cleaning
