anterior bridge

Question 1

decisions to remove the tooth

Answer 1

1) non savable
2) avoid complex techniques required to restore if prognosis if not good
- endodontic treatment
- post and core buildup
- crown lengthening

Question 2

deformities of residual ridge following extraction

Answer 2

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

Question 3

class 0

Answer 3

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

Question 4

esthetic region

Answer 4

1) surgical modification of soft and hard tissue
2) hard tissue for implants

Question 5

missing teeth and non ideal residual ridge

Answer 5

1) loss of residual ridge
- unaesthetic open gingival embrasures
- black triangles
- food impaction
- percolation of saliva during speech

Question 6

residual ridge modification

Answer 6

1) remove tissue from palate, roll it, and stimulate tissue growth
2) soft tissue various techniques
- inter positional graft
- pouch technique
- roll

Question 7

allograft

Answer 7

1) hydroxyapatite or freeze dried bone
2) maintain the bone height for a while

Question 8

anterior teeth

Answer 8

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

Question 9

implant

Answer 9

1) standard of care for missing single tooth

Question 10

fixed dental prosthesis

Answer 10

1) partial coverage
- minimally invasive
- maryland
- cantilever
2) full coverage
- 3 unit bridge
- cantilever bridge

Question 11

removable posthesis

Answer 11

1) temporary splints (interim)
2) stay plate (interim)
- flipper
3) partial denture (permanent)
- not common for single tooth or worth iti

Question 12

implant considerations

Answer 12

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

Question 13

maryland bridge

Answer 13

1) pontic tooth attached to the front of metal framework
2) two wings on each side
- luted or bonded
3) now zirconia or LDS

Question 14

maryland considerations

Answer 14

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)

Question 15

cantilever

Answer 15

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

Question 16

indications for cantilever

Answer 16

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

Question 17

traditional three unit bridge

Answer 17

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

Question 18

ante’s law

Answer 18

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

Question 19

other considerations for anterior FDP

Answer 19

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

Question 20

restorative materials for 3 unit bridge

Answer 20

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

Question 21

PFZ

Answer 21

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

Question 22

advantages of PFZ vs RDP

Answer 22

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

Question 23

PFZ contraindications

Answer 23

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

Question 24

pre-operative requirements

Answer 24

1) mounted diagnostic models
2) occlusion evaluated pre-op
3) putty matrix or pressed formed splint

Question 25

putty

Answer 25

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

Question 26

prep criteria

Answer 26

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

Question 27

long axis

Answer 27

1) use a perio probe
2) make depth cuts parallel to long axis

Question 28

burs

Answer 28

1) football and 856
2) preserve lingual height

Question 29

ovate

Answer 29

1) superior aesthetics
2) negligible food entrapment
3) easy cleaning