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Bridges (fixed partial dentures) Flashcards

1
Q

5 parts of planning for missing teeth (5)

A 
Need a predictable and durable solution
Consider the need for transitional restorations
Build-in contingency planning
High pt expectations
Realistic tx plan
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2
Q

Restorative options for replacing missing teeth (3)

A 
RPD
-tooth supported partial denture
-removed and replaced by pt
Bridges
-conventional bridge
-permanently retained by other teeth
-cannot be removed by denture
Implants
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3
Q

Describe removable partial dentures (4)

A

Replace whole dento-alveolar complex
Non destructive
Fully reversive
Effective permanent or transitional option

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4
Q

Describe implants (3)

A

Replace teeth
Can replace bone/ soft tissue with grafts
Surgical option with higher morbidity

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5
Q

Success rate for implants (1)

A

predictable >90%

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6
Q

What do bridges replace? (1)

A

Teeth only

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7
Q

Prognosis of bridges (2)

A

Destructive

Unpredictable long-term prognosis

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8
Q

Design of choice for bridges (1)

A

Single-unit adhesive cantilevered

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9
Q

Clinical examination for replacing missing teeth (7)

A 
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
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10
Q

Radiographic examination for replacing missing teeth (+ study models + vitality tests) (6)

A 
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
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11
Q

Using panoramic radiograph vs intra-oral periapical to examine missing teeth (5)

A 
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
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12
Q

Aspects of design criteria (10)

A
  1. Periodontal support
    - abutment teeth need to have adequate bony support
    - perio condition must be stable
  2. Occlusal loading
    - magnitude and direction of forces
    - peeling effect if abutment is put under tensile load
  3. Conservation of tooth tissue
    - adhesive bridges important for this. Minimal or no reduction
  4. Cleansability
    - ensure we can use Tepes/ superfloss
  5. Appearance
    - esp. in anterior region. Greying of teeth with metal adhesive section
  6. Rigidity (of retainer/ connector)
    - reduce flexion
  7. Quality of abutments
    - endo, heavily restored not good choices
  8. Number of abutments
  9. Choice of adhesive lute
    - can’t use luting cement for adhesive bridges
  10. Contingency planning
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13
Q

Retention of bridges is achieved by (4)

A

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

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14
Q

Use of fixed-fixed abutments (1)

A

The bridge spans from one abutment to another with the pontic in between
Abutment-pontic-abutment

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15
Q

Use of cantilevered abutments (1)

A

The bridge is retained by one abutment only

Abutment-pontic

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16
Q

Periodontal support (3)

A

Perio disease history not so important
Current and future periodontal health are critical
Maintenance of periodontal health

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17
Q

Types of occlusal loading (6)

A 
Functional
Para-functional loads
Lateral excursive movements
-canine guidance
-group function
-interferences
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18
Q

Metals used for bridges (3)

A 
All cast metal
-base metal or (better) 60% gold
All ceramic
-zirconia, lithium disilicate
Metal-ceramic
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19
Q

Choice of abutments depends on (4)

A

Tooth position
Crown shape
Restorative status
Endodontic status

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20
Q

Poor abutment teeth (3)

A

Maxillary lateral incisors
Tilted incisor teeth (unfavourable pulp chamber morphology)
Root-filled teeth

21
Q

What is the bridge design of choice and why? (6)

A

Single tooth, fixed-cantilevered
-e.g. upper lateral cantilevered off a canine
More retentive than fixed-fixed counterparts
Pontic allowed to move with abutment
Reduced shear forces on pontic
Debond leads to cleansable surfaces
Risk of caries eliminated

22
Q

Describe best case for adhesive bridges (3)

A

Single tooth replacement
Fixed to only one carefully selected abutment
Cantilevered

23
Q

Framework design for adhesive bridges (6)

A 
Retainer thickness and configuration
Bonding area: maximise
Wrap-around
Occlusal extension of metalwork (e.g. on premolars)
Connector design
Length of span
24
Q

Retainer thickness and configuration (2)

A

Retainers for molars 0.8mm thick
Greater if retainer not joined over occlusal surface
-thickness provides rigidity

25
Bonding area (2)
Maximum enamel bonding Extension of metal work as far occlusogingivally and circumferentially around tooth as is possible -downside is metal shine through
26
Wrap-around maximum (1)
180 degrees | -mesial and distal groove
27
Occlusal / palatal extension of metalwork (3)
1. Full palatal coverage with no tooth prep (maximise SA/ minimise prep) 2. Reduced palatal coverage with tooth prep (finish 1-3mm short of incisal edge) Posterior occlusal coverage to -resist displacement apically or laterally -increase rigidity of framework -greater surface area for bonding
28
Connector design (4)
Significant width and height required Need to resist bending of alloy Must avoid putting adhesive lute under tensile loading Height of connector at least 50% height of pontic
29
Length of span (2)
Ideally one tooth replacement Longer spans not contra-indicated but tooth prep and framework design should be planned to reduce potential debonding stresses on retainer
30
Tooth prep features (5)
``` Axial tooth prep Grooves Occlusal rest seats Intracoronal prep Cantilevered resin bonded bridges ```
31
Axial tooth prep (3)
Increases area for bonding Increases resistance and retention form Minimal reduction with chamfer finish
32
Grooves (4)
Provide > resistance form to lateral displacement May help > retention form > structural rigidity of metal framework after cementation Use of 2 grooves (1mm deep) per abutment significantly > resistance to debonding forces for both anterior and posterior bridges
33
Occlusal rest seats (3)
Allow transmission of occlusal forces along long axis of tooth Provide resistance form Possibly limit shear forces to cement lute
34
Intracoronal prep (3)
Joining of mesial and distal rest seats of retainer over occlusal surface to form occlusal bar to improve rigidity of retainer Enhances retainer's resistance to deformation Improves resistance form and increase SA for bonding
35
What cements to use (4)
Always use an adhesive lute Self-cure composite lute (e.g. RelyX Unicem) -non adhesive -REQUIRES: in combination with bonding system -requires etched metal substrate Anaerobic adhesive lutes - Panavia -opaque -specific adhesion to metal retainers 4-Meta adhesive lutes (methacylate based e.g. Calebra?) -specific bonding to metal and ceramic retainers
36
Types of alloys for adhesive bridges (3)
``` Nickel chromium (cheap! so very common) -can be electrolytically etched -very rigid -work very well with composite luting systems Gold alloys -cannot be etched -not as rigid as Ni/Cr -need sandblasting -need specific adhesive systems Ceramics (e.g. Zirconia, lithium disilicate) -experimental -more aesthetic ```
37
Survival of metal vs non-metal framework - 5-year (2)
Metal framework 88% | Non-metal framework 84%
38
Choice of abutments for adhesive bridges (4)
Tooth position Crown shape Restorative status Endodontic status
39
Quality of adhesive bridge abutments depends on (5)
``` Endodontic status and prognosis -elective endo not unheard of Restorative status -if heavily restored, maybe conventional bridge better Quality of bonding substrate Anatomical shape Retention/ resistance form ```
40
Poor abutment teeth for adhesive bridges (3)
Maxillary lateral incisors Tilted incisor teeth Root-filled teeth (not never, but best avoid - dry, brittle, prone to fracture)
41
Resin bonded bridges 5 year survival (1)
88% | Pjetersson et al SR 2008
42
Reasons for failure of resin bonded bridges (3)
``` Debonding -failure of bond -lack of rigidity leading to a "peel effect" Caries under retainer Aesthetic failure -show through of retainer ```
43
What are double abutments for adhesive bridges? (2)
2 adjacent teeth as abutments - NOT required
44
What are fixed-fixed adhesive bridges? (3)
Adhesive retainers with intermediate pontics Generally not recommended Only exception is the mandibular incisors, where the 'peel-dislodgement' effect is less Minimal palatal and proximal preparation of two abutment teeth
45
What's better, cantilevered RBB or fixed-fixed RBB (2)
Cantilevered siginificantly better success | Reason - debond of fixed-fixed
46
Why do fixed-fixed adhesive bridges fail? (4)
Significant stresses applied to retainers of fixed-fixed resin-bonded bridges because of differential tooth movements between abutments during functional and parafunctional tooth contacts These forces tend to push one of the abutments away from the pontic Tensile stress of the cement Debonding of an abutment and caries under the retainer
47
Which patients are most suitable for adhesive bridges? (1)
Fairly intact dental arches: only 1 or 2 missing teeth, don't want to resort to an RPD Case selection v important
48
Adhesive bridges synonyms (4)
Resin-bonded bridges Bonded bridges Maryland bridges Rochette bridges
49
Fixed partial denture =
Conventional bridge work

ACS for FINALS (11 decks)

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