Bridges (fixed partial dentures) Flashcards
5 parts of planning for missing teeth (5)
Need a predictable and durable solution Consider the need for transitional restorations Build-in contingency planning High pt expectations Realistic tx plan
Restorative options for replacing missing teeth (3)
RPD -tooth supported partial denture -removed and replaced by pt Bridges -conventional bridge -permanently retained by other teeth -cannot be removed by denture Implants
Describe removable partial dentures (4)
Replace whole dento-alveolar complex
Non destructive
Fully reversive
Effective permanent or transitional option
Describe implants (3)
Replace teeth
Can replace bone/ soft tissue with grafts
Surgical option with higher morbidity
Success rate for implants (1)
predictable >90%
What do bridges replace? (1)
Teeth only
Prognosis of bridges (2)
Destructive
Unpredictable long-term prognosis
Design of choice for bridges (1)
Single-unit adhesive cantilevered
Clinical examination for replacing missing teeth (7)
Occlusal relationship - guidance? Inter-occlusal space Centre line Lip smile line Position of teeth present Shape and position of potential abutments Restorative and vitality status of teeth
Radiographic examination for replacing missing teeth (+ study models + vitality tests) (6)
Position of normal anatomical features Pathological conditions Periapical status of abutment teeth Alveolar support of abutment teeth Root remnants and foreign bodies Alveolar height and width
Using panoramic radiograph vs intra-oral periapical to examine missing teeth (5)
Panoramic radiograph -distortion in the horizontal plane -shadowing of incisor region Intra-oral periapical better -using paralleling technique -to check individual teeth -to assess alveolar bone width
Aspects of design criteria (10)
- Periodontal support
- abutment teeth need to have adequate bony support
- perio condition must be stable - Occlusal loading
- magnitude and direction of forces
- peeling effect if abutment is put under tensile load - Conservation of tooth tissue
- adhesive bridges important for this. Minimal or no reduction - Cleansability
- ensure we can use Tepes/ superfloss - Appearance
- esp. in anterior region. Greying of teeth with metal adhesive section - Rigidity (of retainer/ connector)
- reduce flexion - Quality of abutments
- endo, heavily restored not good choices - Number of abutments
- Choice of adhesive lute
- can’t use luting cement for adhesive bridges - Contingency planning
Retention of bridges is achieved by (4)
Full coverage retainers
-prep of abutment tooth is a FGC, PFM or all-ceramic
Adhesive retainers
-prep of abutment tooth is minimal and involves palatal and proximal surfaces only
Use of fixed-fixed abutments (1)
The bridge spans from one abutment to another with the pontic in between
Abutment-pontic-abutment
Use of cantilevered abutments (1)
The bridge is retained by one abutment only
Abutment-pontic
Periodontal support (3)
Perio disease history not so important
Current and future periodontal health are critical
Maintenance of periodontal health
Types of occlusal loading (6)
Functional Para-functional loads Lateral excursive movements -canine guidance -group function -interferences
Metals used for bridges (3)
All cast metal -base metal or (better) 60% gold All ceramic -zirconia, lithium disilicate Metal-ceramic
Choice of abutments depends on (4)
Tooth position
Crown shape
Restorative status
Endodontic status