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BDS4 CDS Operative > Bridgework 1 > Flashcards

Bridgework 1 Flashcards

1
Q

tx options for missing tooth/teeth

A
  1. no tx/leave spapce
  2. replace tooth/teeth
  3. close space (orthodontics)
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2
Q

reasons for treating tooth loss (4)

A
  • Aesthetics
  • Function
  • Speech
  • Maintenance of dental health
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3
Q

tooth replacement options

A
  • denture
  • bridgework
  • implants
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4
Q

define bridge

A

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

  • “Fixed partial denture” USA*
  • Compared with a removable partial denture which replaces soft tissue and bone (bridges do not replace soft tissue usually - limited)
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5
Q

2 types of bridgework

A

adhesive

  • most common, held by wings on palatal surface

‘conventional’

  • held by crowns
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6
Q

general indications for bridgework (6)

A
  • Function and stability
  • Appearance
  • Speech
  • Psychological reasons
  • Systemic disease e.g. epileptics
  • Co-operative patient – plaque control, no active disease, motivated
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7
Q

4 local indications for bridgework

A
  • Big teeth
  • Heavily restored teeth (for ‘conventional’ bridge)
  • Favourable abutment angulations
  • Favourable occlusion
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8
Q

6 general contraindications for bridgework

A
  • Uncooperative patient
  • Medical history contra-indications (e.g. allergies to metals)
  • Poor oral hygiene
  • High caries rate
  • Periodontal disease
  • Large pulps esp in primary teeth (conventional bridge
    • Turkey teeth
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9
Q

8 local contraindications for bridge work

A
  • High possibility of further tooth loss within arch
  • Prognosis of abutment poor
  • Length of span too great
  • Ridge form and tissue loss
    • Denture tend to be better
    • Gingival architecture concern with aesthetics not just tooth loss
  • Tilting and rotation of teeth
  • Degree of restoration (how much of tooth is left after preparation)
  • Periapical status
  • Periodontal status (bone loss) – active or advanced
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10
Q

abutment

A

a tooth which serves as an attachment for a bridge

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11
Q

pontic

A

the artificial tooth which is suspended from the abutement teeth/tooth

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12
Q

retainers

A

the extracoronal or intracoronal restorations that are connected to the pontic and cemented to teh prepared abutment teeth

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13
Q

connectors

A

component which connects the pontic to the retainer(s)

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14
Q

edentulous span

A

space between natural teeth that is to be filled by a bridge

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15
Q

saddle

A

area of the edentuolous ridge over which the pontic will lie

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16
Q

pier

A

an abutment tooth which stands between and is supporting two pontic - each pontic being attached to a further abutment tooth

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17
Q

unit

A

either a retainer or a pontic

e.g. a bridge with two retainers and one pontic = 3 unit bridge

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18
Q

2 types of bridge design

A

fixed-fixed

cantilever

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19
Q

fixed-fixed bridge

A

This type of bridge has a retainer at each end with a pontic in the middle joined by rigid connectors.

  • E.g. (Retainer)-(pontic)-(Retainer)

Can be:

  • Adhesive/resin retained
  • Conventional
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20
Q

cantilever

A

This type of bridge has a retainer (or retainers) at one side of the pontic only

  • E.g. (Retainer)-(pontic)

Can be:

  • Adhesive/resin retained
  • Conventional
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21
Q

resin bonded bridgework (RBB) a.k.a

A
  • Resin retained bridgework (RRB)
  • Adhesive bridgework
  • Minimal preparation bridgework
  • Maryland bridge
  • Resin bonded fixed partial denture (RBFPD)
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22
Q

2 options for adhesive cantilever bridges

A

all ceramic adhesive bridge

or

traditional adhesive bridge with metal (CoCr) wing

can be nickel chromium oness too

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23
Q

6 advantages of RBB

A
  • Minimal or no preparation
    • Occlusal contact can be high but tend to resolve in 10-14 days due to DAAL movements
  • No anaesthetic needed
  • Less costly
  • Less surgery time
  • Can be used as a provisional restoration
    • Hypodontia pt. – long term implant work, but wont want to provide till fully grown 18/19 girls and 20 boys
      • Easy and quick to provide in teens and then can give implants when fully grown or when fails and then re-discuss options
  • If fails - usually less destructive than alternatives
24
Q

6 disadv of RBB

A
  • Rigorous clinical technique
    • Need to be completely dry
  • Metal shine-through
    • See on 21 – poor cementation or design so metal seen at incisal edge
      • Be careful not to overextend retainer
  • Chipping pocelain
  • Can debond
    • High chance of it debonding again
      • First bond will be best bond
  • Occlusal interferences – less of issue, DAAL concept
  • No trial period possible
25
Q

6 indications for RBB

A
  • Young teeth
    • Less destructive
  • Good enamel quality
  • Large abutment tooth surface area (more bonding area)
  • Minimal occlusal load
  • Good for single tooth replacement
  • Simplify partial denture design
26
Q

6 contraindications for RBB

A
  • Insufficient or poor quality enamel
  • Long spans – break, # risk
  • Excess soft or hard tissue loss
  • Heavy occlusal force e.g. Bruxist
  • Poorly aligned, tilted or spaced teeth
  • Contact sports?
27
Q

tx planning for RBB bridges

A
  • History
    • Establish habits e.g. Bruxism
  • Examination
    • Clinical
      • Dynamic occlusal relationships
      • Periodontal
    • Radiological
      • Caries, periapical pathology check
      • Bone level
  • Study models
    • Mounted on semi-adjustable articulator with facebow registration
    • Consider diagnostic wax-ups
28
Q

decision making for RBB bridgework

A
  • Is bridgework appropriate?
    • Other options?
      • Consider what you want for final aesthetic outcome first and work how to get there
  • Take care if patient is insistent on bridgework
  • Look at:
    • Abutment teeth
    • Occlusion
    • Aesthetics (including soft tissue contour)
  • Can patient maintain this complex work?
    • Poor OH
29
Q

occlusion considerations for bridgework planning

A
  • Consider opposing dentition
    • e.g. Contact points
    • Over-eruption of opposing teeth
  • Is there a parafunctional habit?
    • Bruxism (clenching and/or grinding teeth)
  • Look at dynamic occlusal relationships
    • Clinically
    • Mounted study models
    • Consider diagnostic wax-ups
30
Q

direct resin bonded bridgework used when?

A
  • Very useful in emergency situation
    • If tooth needs to be extracted immediately
    • If tooth has been lost traumatically
31
Q

indirect resin bonded bridgework

can be (3)

A
  • No preparation
  • Minimal preparation
  • Heavy preparation (Undesirable)
    • Dentine bone is poor compared to enamel
32
Q

pontic manufacture for direct resin bonded bridgework

A
  • Pontic manufacture
    • Ideally use patient’s own tooth
    • Alternatives:
      • Acrylic ‘denture’ tooth
      • Polycarbonate crown
      • Cellulose matrix filled with composite

e.g. Root fracture tooth 11 – not restorable

33
Q

indirect resin bonded bridgework - palatal/lingual coverage (metal)

A
  • Need generous palatal/lingual coverage
    • Greater surface area of enamel covered à Greater bond
  • Need good quality enamel
  • Keep supra-gingival
    • Ideal 0.5mm
      • Allow pt OH clean around gingiva – prevent caries
  • Care with coverage near incisal edge
    • Enamel translucent
      • Grey shine through
34
Q

cantilever or fixed-fixed?

anterior

A

generally cantilever design

35
Q

cantilever or fixed-fixed?

posterior

A

generally fixed-fixed

36
Q

minimal or full prepartion first?

A

think long term

stick to simplest first before advancing to more destructive

37
Q

Divergent guide paths in anterior mean more likely to use

A

cantilever designs

longitudinally axis of each tooth different, so occlusal forces directed down slightly differently causing a fixed-fixed restoration to get jutted about and more likely to fall off

38
Q

can abutment teeth have exisitng restorations?

A

ideally need sound enamel

  • Composite
    • OK?
    • However consider composite replacement prior to preparation if old composite (better bond to new) or roughen with rose head bur
  • Amalgam
    • Compromised bond to chemically cured composite cement
    • Consider replacing
39
Q

preparation for RBB if needed

A
  • 180º ‘wrap-around’ preparation on palatal/lingual surface
  • Rests – can help locate it on position and mechanical retention
    • Rest seats (posterior teeth)
    • Cingulum rest (anterior teeth)
  • +/- Proximal grooves (mechanical retention – rare)
  • Supra-gingival chamfer finish line ~0.5mm
  • Ideally prep should remain in enamel
40
Q

anterior RBB preparation options

A
  • Cantilever design
    • No preparation
  • Minimal preparation
    • Occlusal contact reduction – on abutment tooth
    • Cingulum undercut removal only – path of insertion
    • Chamfer margin (0.5mm supra-gingival)
  • Heavier preparation
    • 0.5mm whole palatal surface reduction (NOTE – metal retainer wing should be 0.7mm thick), settle with time
    • Cingulum rest
    • +/- Proximal grooves
    • Chamfer margin (0.5mm supra-gingival)
41
Q

minimal prep for anterior cantilever

A
  • Occlusal contact reduction – on abutment tooth
  • Cingulum undercut removal only – path of insertion
  • Chamfer margin (0.5mm supra-gingival)
42
Q

heavier prep for anterior cantilever

A
  • 0.5mm whole palatal surface reduction (NOTE – metal retainer wing should be 0.7mm thick), settle with time
  • Cingulum rest
  • +/- Proximal grooves
  • Chamfer margin (0.5mm supra-gingival)
43
Q

posterior RBB preparation options

A
  • No preparation
  • Preparation:
    • Occlusal rests – 2mm deep
    • 180º wrap-around with chamfer finish line (0.5mm supra-gingival) on palatal/lingual surface
    • +/- Proximal grooves
    • Can be cantilever or fixed-fixed design
      • Increased occlusal force so tend to be better to spread the load over two abutment teeth to help inc longevity
44
Q

temporisation for RBB options

A

cosider RPD or essix retainer with missing tooth incorporated

if prep remains in enamel - is there any need for a temporary restoration?

  • May experience sensitivity – Duraphat toothpaste prescription

If prep into dentine and tooth becomes sensitive:

  • Cover with thin layer of dentine bonding agent

Fit bridge as quickly as possible

  • Minimise over-eruption and tooth movement (tilting into saddle space)
45
Q

RBB prep remains in enamel temporisation needed

A

not necessarily

if experience sensitivity - duraphat toothpaste prescription

46
Q

RBB extends into dentine temporisation needed

A

cover with thin layer of dentine bonding agent

47
Q

temporisation length for RBB

A

short

fit bridge as quickly as possible - minimise over-eruption and tooth movement (tilting into saddle space)

48
Q

fit surface of retainer

A
  • Cobalt chrome or nickel-chromium alloy (typically)
  • Sandblasted surface
    • Micro-mechanical retention
    • Aluminium Oxide - 50 microns
49
Q

cementation of RBB with

A

Panavia®21EX

a dual cured composite resin luting cement

50
Q

treatment of retainer for cementation of RBB

A

Try-in

  • Fit and aesthetics
  • By hand or can ask lab to make a locating cleat on it – hook on incisal edge of retainer tooth

Chairside micro-etching with 50 micron aluminium oxide particles (sandblast)

  • Should have already been done by technician (as per previous slide)

Clean retainer (if contaminated e.g. by unset composite resin used to try in bridge)

  • Ultrasonic bath if required
  • Use ethanol to ‘degrease’ if required
    • Reduces surface tension

Apply chemically (or dual cure) cure composite luting cement just prior to placement of restoration after tooth treatment

51
Q

treatment of tooth of RBB for cementation

A
  • Prophylaxis
  • Isolate with dental dam
  • Etch tooth: 37% ortho-phosphoric acid (some preparations are 40%)
  • Wash & dry
  • Apply primer (A and B mixed together) for 30 seconds, about 5 layers
  • Air dry for 2 seconds
  • No need to cure (unlike for direct composite restorations), self cures
52
Q

final stage of placement in cementation

A
  • Fit retainer (coated with luting cement) to abutment tooth/teeth
  • Remove excess cement
  • Oxygen inhibitor (Oxyguard II) placed around cement margins for 3 minutes
    • Wash off
53
Q

after cementation of RBB

A
  • Check occlusion
    • Confirm pontic does not have excessive occlusal forces applied, retaining wings less concern – will adjust with time and DAAL movements
  • Demonstrate to patient how to clean around and underneath the bridge
    • Superfloss
      • Thin and thick bits – feed the thin bit underneath the pontic and thread the thick bit through after whilst sweeping, show then pt demonstrate
    • Interdental brushes
54
Q

5 year survival of RBB

A

80.8%

most likely to fail within first 2 years

55
Q

10 year survival of RBB

A

80.4%

most likley to fail within first 2 years

BDS4 CDS Operative (11 decks)

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