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Restorative > Bridges > Flashcards

Bridges Flashcards

1
Q

What are the reasons for treating tooth loss?

A

Aesthetics
Function
Speech
Maintenance of dental health

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2
Q

What is a bridge?

A

A prosthesis which replaces a missing tooth or teeth and is attached to one or more natural teeth (or implants)

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3
Q

What are the general indications for bridgework?

A

Function and stability
Appearance
Speech
Psychological reasons
Systemic disease
Co-operative patient

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4
Q

What are the local indications for bridgework?

A

Big teeth
Heavily restored teeth
Favourable abutment angulations
Favourable occlusion - not heavy occlusal contacts

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5
Q

What are the general contra-indications for bridgework?

A

Uncooperative patient
Medical history contra-indications (allergies to metals)
Poor oral hygiene
High caries rate
Periodontal disease
Large pulps (conventional bridge)- can cause teeth to become non-vital

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6
Q

What are the local contra-indications for bridgework?

A

High possibility of further tooth loss within arch
Prognosis of abutment poor
Length of span too great
Ridge form and tissue loss
Tilting and rotation of teeth
Degree of restoration (how much tooth is left after prep)
Periapical status (cannot place bridge on tooth with active periodontal disease)
Periodontal status (bone loss)

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7
Q

What is a fixed-fixed bridge?

A

This bridge has a retainer at each end with a pontic in the middle joined by rigid connectors
Can be adhesive/resin retained or conventional

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8
Q

What is a cantilever bridge?

A

Bridge has a retainer at only one side of the pontic
Can be adhesive/resin retained or conventional

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9
Q

What are the indications for placing an adhesive cantilever bridge?

A

Good enamel quality
Large abutment tooth surface area
Minimal occlusal load
Good for single tooth replacement
Simplify partial denture designs

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10
Q

What are the contraindications for placing an adhesive cantilever bridge?

A

Insufficient or poor quality enamel
Long spans
Excess soft or hard tissue loss
Heavy occlusal force (e.g. bruxist)
Poorly aligned, tilted or spaced teeth

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11
Q

What are the advantages of placing an adhesive cantilever bridge?

A

Minimal or no prep
No anaesthetic needed
Less costly
Less surgery time
Can be used as a provisional restoration

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12
Q

What are the disadvantages of placing an adhesive cantilever bridge?

A

Rigorous clinical technique
Metal-shine through
Chipping porcelain
Can debond
Occlusal interferences
No trial period possible (cannot use temporary cement)

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13
Q

What are the occlusal considerations for bridges?

A

Consider opposing dentition (contact points, over eruption of opposing teeth)
Is there a parafunctional habit (bruxism, attrition)
Look at dynamic occlusal relationships (clinically, mounted study models, consider diagnostic wax ups)

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14
Q

What design of bridges do you typically place anteriorly?

A

Generally cantilever design

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15
Q

What design of bridges do you typically place posteriorly?

A

Generally fixed-fixed design

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16
Q

What do you have to consider if placing a fixed-fixed design anteriorly in the maxilla?

A

Divergent guidance pathways
This means that the occlusal forces are directed in different ways which can result in displacement to occur more frequently

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17
Q

What is done to the fit surface of a retainer?

A

Cobalt chrome or nickel-chromium alloy
Sandblasted surface
-micro-mechanical retention
-aluminium oxide- 50 microns

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18
Q

What is involved in the cementation process in a bridge?

A

Treatment of retainer
–try-in
–fit and aesthetics
Chairside micro-etching with 50 micron aluminium oxide particles (sandblasted)
–should have already been done by technician, if using composite to try in, then need to be re sandblasted
Apply chemically (or dual cure) cure composite luting cement prior to placement of restoration after tooth treatment

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19
Q

What is involved in post-cementation checks of fitting a bridge?

A

Check occlusion
-confirm pontic does not have excess occlusal forces applied
Demonstrate to patient how to clean around and underneath the bridge
-superfloss/interdental brushes

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20
Q

What is the longevity of bridges?
5 year survival?
10 year survival?

A

5 year- 80.8%
10 year- 80.4%
More likely to fail in first 5 years of placing

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21
Q

What are the advantages of conventional fixed-fixed design?

A

Robust design- larger connectors can be used as they withstand greater occlusal forces in the longer term
Maximum retention and strength
Can be used in longer spans
Abutment teeth splinted together

22
Q

What are the disadvantages of conventional fixed-fixed designs?

A

Preparation difficult (parallel tooth prep needed)
-if tooth is not parallel cannot attach the bride as it creates a direct path of insertion
Preparation must be minimally tapered
-if overprepared reduces retention and the bridge can come off in a multitude of directions which loses the maximum retention
-aiming for a 5-7 degree taper
Removal of tooth tissue

23
Q

What are the advantages of a conventional cantilever bridge?

A

Conservative design (compared to fixed-fixed)
Lab construction straightforward
No need to ensure multiple tooth preparations are parallel as it is a single tooth design

24
Q

What are the disadvantages of a conventional cantilever bridge?

A

Short span only (1 tooth replacement)
Rigid to avoid distortion (more prone to fracture)
Mesial cantilever preferred

25
Q

Why is a mesial cantilever preferred?

A

For both adhesive and conventional designs
Abutment tooth is more poster as teeth are more likely to occlude posteriorly first. This is due to heavier contact then being on the pontic which can create a seesaw effect when the teeth occlude which causes the restoration to remove itself

26
Q

What is a fixed moveable bridge?

A

This type of bridge has a rigid connector usually at the distal end of the pontic and a moveable connector mesially
–allows some vertical movement at the mesial abutment tooth
2 components
–bridge is attached to abutment crown, crown has already been prepped and fitted and has a dovetail cut to attach the bridge onto the distal ridge
Called fixed moveable as it flexes to a certain degree when the patient occludes

27
Q

What are the advantages of a fixed moveable bridge?

A

Preparations don’t require a common path of insertion
Each preparation designed to be retentive independent of others
More conservative of tooth tissue
Allows minor tooth movement
May be cemented in 2 parts

28
Q

What are the disadvantages of fixed moveable bridges?

A

Length of span limited
Lab construction more complicated
Possible difficulty in cleaning beneath moveable joint
Can’t construct provisional bridge

29
Q

What is a hybrid bridge?

A

One retainer= a conventional prep (a crown)
Other retainer= minimal prep (a metal wing) adhesive bonded

30
Q

What is a spring cantilever bridge?

A

One pontic attached to the end of a metal arm that runs across the palate to a rigid connector on the palatal side of a retainer
NOT COMMONLY USED

31
Q

Why does an abutment evaluation need to be carried out?

A

Abutment must be able to withstand the forces previously directed to the missing teeth
Supporting tissues should be healthy and free of inflammation (i.e. periapical disease and periodontal disease)

32
Q

What is the crown root ratio required for considering a tooth for an abutment?

A

Length of tooth coronal to alveolar crest compared to length of root embedded in bone. Optimum ratio 2:3
Minimum ratio 1:1
More root surface area than crown surface- root should be atleast the same size as the crown area

33
Q

What occlusal information should you gather when considering placing a bridge?

A

Incisal classification
Canine guidance or group function
Opposing tooth over-erupted
Will bridge interfere with current occlusion
Signs of parafunction present

34
Q

What is involved in the evaluation of potential abutments?

A

Root configuration
Angulation/rotation of abutment
Periodontal health
Surface area for bonding & quality of enamel
Risk of pulpal damage
Quality of endodontics
Remaining tooth structure present
Core- remove and rebuild

35
Q

What types of pontic design can you get?

A

Wash through pontic
Dome pontic (bullet shaped or torpedo shaped)
Modified ridge-lap pontic
Ridge lap pontic (full saddle pontic)
Ovate pontic

36
Q

What is the function of a pontic?

A

Restore appearance of missing tooth
Stabilise the occlusion
Improve masticatory function

37
Q

What should be considered when designing a pontic?

A

Cleansibility
–should always be smooth, with highly polished or glazed surface
Appearance
Strength
–longer the span, greater the thickness required to withstand occlusal forces

38
Q

What is a wash-through design of pontic?

A

Makes no contact with soft tissue
Functional rather than for appearance
Consider in lower molar area as aesthetics can be compromised in this area

39
Q

What is a dome shaped design of pontic?

A

Useful in lower incisor, premolar or upper molar areas
Acceptable if occlusal 2/3 of buccal surface visible
Poor aesthetics if gingival 1/3 of tooth is visible

40
Q

What is a modified ridge lap design of pontic?

A

Buccal surface looks as much like tooth as possible
Lingual surface cut away
Line contact with buccal of ridge
Problems with food packing on lingual surface of ridge

41
Q

What is a ridge lap/saddle design of pontic?

A

Greatest contact with soft tissue
–can cause temporary blanching
Less food packing than ridge-lap
Care taken not to displace soft tissue or cause blanching of tissue
Good for patients with good OH

42
Q

What is an ovate design of pontic?

A

Good for patients with really good OH
Best aesthetics
Presses on gingiva which causes it to mould round the pontic into a divot, it appears like a natural tooth coming out of the gum
Cannot achieve with a single bridge - use essex retainer that pushes down on the gingiva to pre prep the divot for final bridge to sit on

43
Q

What materials can be used for conventional bridges?

A

All metal
–Gold
–Stainless steel
–Nickel/cobalt chromium
Metal ceramic
All ceramic
–Zirconia (very strong but less aesthetic)
–Lithium disilicate (E-max- best for aesthetics)

44
Q

Where do you use an all metal bridge design?
When is metal ceramic bridge used?

A

Gold- especially in lower posterior area
Metal ceramic bridge- majority of bridges constructed in this

45
Q

Why is parallelism considered for fixed-fixed conventional bridges?

A

Requires two or more teeth to be prepared to provide a COMMON PATH OF INSERTION
Increased retention of bridge

46
Q

What do you use to cement all metal conventional bridgework and metal ceramic bridgework?

A

Aquacem (GI luting cement)
RelyX Luting (RMGI luting cement)

47
Q

What do you use to cement adhesive retained bridgework?

A

Panavia 21 (anaerobic duel cure resin cement)

48
Q

What is a pier in bridgework?

A

An abutment tooth which stands between and is supporting two pontics, each pontic being attached to a further tooth

49
Q

What is a saddle in bridgework?

A

Area of the edentulous ridge over which the pontic will lie

50
Q

What is a connector in bridgework?

A

Component which connects the pontic to the retainer/s

51
Q

Name 4 factors that could cause a bridge to de-bond.

A

Poor moisture control during cementation
Unfavourable occlusion
Parafunction (bruxism)
Trauma to front of face
Poor OH

Restorative (8 decks)

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