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BDS4 Operative Dentistry > Bridgework 1 > Flashcards

Bridgework 1 Flashcards

1
Q

Reasons for treating tooth loss

A

aesthetics
function
speech
maintenance of dental health

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2
Q

tooth replacement options

A

denture
bridgework
implants

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3
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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4
Q

2 main types of bridgework

A

Adhesive - held on with wings
Conventional - held on with crowns

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5
Q

most common type of bridgework

A

adhesive

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6
Q

indicaitons for bridgework (general)

A

function and stability
appearance
speech
psychological reasons
systemic disease e.g epileptics
OH co-operative patient

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7
Q

indications for bridgework (local)

A

big teeth
heavily restored (if conventional)
favourable abutment angulations
favourable occlusion (no too heavy contacts or fractures)

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8
Q

contraindications for bridgework (general)

A

uncooperative patient
medical history contra-indications
poor oh
high caries rate
periodontal disease
large pulps (conventional bridge - nb young pts as likely to cause non-vitality)

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9
Q

contraindicaitons for bridgework (local)

A
  • high possibliity 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
  • periapical status (active endo/perio disease)
  • periodontal status (active or advanced)
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10
Q

Define abutment

A

a tooth which serves as an attachement for a bridge

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11
Q

define pontic

A

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

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12
Q

define retainers

A

the extracoronal or intracoronal restorations that are connected to the pontic and cemented to the prepared abutment teeth e.g. like metal wing (adhesive) or crown (conventional)

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13
Q

define connectors

A

component which connects the pontic to the retainers/retainer

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14
Q

define edentulous span

A

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

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15
Q

define saddle

A

area of edentulous ridge over which the pontic will lie

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16
Q

define pier

A

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

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17
Q

define 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

describe a fixed-fixed bridge

A

a retainer at each end with a pontic in the middle joined by rigid connectors (can be adhesive or conventional)

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19
Q

describe a cantilever bridge

A

a retainer (or retainers) at one side of the pontic only (can be adhesive or conventional)

20
Q

Other names for resin retained bridgework

A
  • adhesive bridgework
  • minimal preparation bridgework
  • maryland bridge
  • resin bonded fixed partial denture
21
Q

what are adhesive cantilever bridges made from

A
  • all ceramic
  • CoCr wing
22
Q

advantages of RBBs

A
  • minimal preparation (just an impression)
  • no anaesthetic required
  • less costly (porcelain + metal)
  • less surgery time
  • can be used as a provisional restoration e.g. hypodontia until old enough for implants
  • if fails, usually less destructive than alternatives
23
Q

disadvantages of RBBs

A
  • rigourous clinical technique
  • metal shine through
  • chipping porcelain
  • can debond
  • occlusal interferences (less of a problem in static - dall concept)
  • no trial period possible
24
Q

indications for RBBs

A
  • young teeth
  • good enamel quality
  • large abutment tooth surface area
  • minimal occlusal load
  • good for single tooth replacement
  • simplify partial denture design
25
Q

contraindications for rbbs

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
  • contact sports (make sure mouth guards)
26
Q

How would you treatment plan for rbbs

A
  • history - establish habits e.g bruxism
  • clinical exam - dynamic occlusal relationships, perio, radiological
  • study models - mounted on semi-adjustable articulator with facebow registration, consider diagnostic wax-ups
27
Q

how do you decide if bridgework is appropriate

A
  • other options?
  • make sure they know what a bridge is
  • look at abutment teeth, occlusion, aesthetics including soft tissue contour
  • can patient maintain complex work? OHI
28
Q

why should you look at occlusion for bridgework

A
  • consider opposing dentition - contact points, over-eruption of opposing teeth
  • is there a parafunctional habit?
  • dynamic occlusion - clinically, mounted study models, diagnositc wax ups
29
Q

When would you use direct vs indirect RBB

A

Direct

  • emergency situation
  • if tooth needs extracted immediately
  • if tooth lost traumatically

Indirect

  • no preparation
  • minimal prep
  • heavy prep (undesirable e.g. dentine not as good a bond as enamel)
  • get impressions, lab makes, second appt to put in
30
Q

Describe options for pontic manufacture

A
  • patients own tooth
  • acrylic denture tooth
  • polycarbonate crown
  • cellulose matrix filled with composite
31
Q

Example case of root fracture 11

A
  • remove tooth
  • cut off root and remove pulpal tissue
  • etch contact points and composite over pulp chamber
  • etch and bond
  • composite to splint (buys time for long term solution)
32
Q

what is needed for indirect RBB palatal/lingual coverage

A
  • generous palatal/lingual coverage
  • good quality enamel
  • keep supra-gingival (0.5mm)
  • care with coverage near incisal edge
33
Q

what type of bridge work on anteriors

A

generally cantilever design

34
Q

what type of bridge work on posteriors

A

generally fixed-fixed design

35
Q

Why are cantilevers more successful anteriorally

A

Divergent guidance paths

  • occlusal forces are directed in different ways, means when fixed-fixed there are 2 occlusal forces in 2 directions, more likely to come off
36
Q

For RBBs what should we do about existing restorations in abutment teeth

A
  • ideally sound enamel but not always possible
  • composite
    • ok
    • however, consider replacing as better bond with newer composite/ roughen alternatively
  • amalgam
    • consider replacing as compromised bond to chemically cured composite cement
37
Q

What prep might be required for RBBs

A
  • 180 wrap around preparation
  • rests
    • rest seats on posteriors
    • cingulum rests on anteriors
  • +/- proximal grooves
  • supra-gingival chamfer finish line
  • ideally should remain in enamel
38
Q

What prep might be required for anterior preparation

A
  • cantilever design
  • no preparation
  • minimal prep
    • occlusal contact reduction
    • cingulum undercut removal only
    • chamfer margin
  • heavy prep
    • 0.5mm palatal reduction (nb metal retainer wing should be 0.7mm thick)
    • cingulum rest
    • +/- proximal grooves
    • chamfer margin (0.5mm supra-gingival)
39
Q

what prep might be needed for posteiror teeth for rbbs

A
  • no prep
  • prep
    • occlusal rests
    • 180 wrap around (supra-gingival 0.5mm)
    • +/- proximal grooves
  • Fixed-fixed more likely as want to spread load down >1 abutment tooth on posterior but cantilever possible too
40
Q

Temporisation of RBB

A
  • consider RPD
  • if prep remains in enamel- probably no need for temporary restoration
  • prep into dentine + sensitivity = cover with layer of DBA
  • fit bridge as quickly as possible (minimise over-eruption and tooth movement)
41
Q

Describe the fit surface of retainer

A
  • CoCr or NiCr alloy typically
  • Sandblasted surface by lab
    • micro-mechanical retention
    • aluminium oxide-50microns
42
Q

Describe how to cement an RBB

A

Treatment of Retainer

  • try-in
  • chairside micro-etching with 50 micron aluminium oxide particles (if not done by lab)
  • clean retainer (ultrasonic bath if required, ethanol to ‘degreace’ if required)
  • apply chemically (or dual cure) cure composite luting cement just prior to placement of restoration after tooth treatment

Treatment of tooth

  • prophylaxis
  • isolate with dental dam
  • etch tooth
  • wash and dry
  • apply primer (A+B mixed) for 30 seconds
  • air dry
  • no need to cure (unlike for direct composite restorations)

Fit retainer

remove excess cement

oxygen inhibitor (oxyguard II) placed around cement margins for 3 minutes then wash off

43
Q

what do we (GDH) use to cement RBBs

A

PANAVIA 21EX

44
Q

What do you need to do post-cementation of RBB

A
  • check occlusion
    • no excessive occlusal forces on pontic
  • demonstrate to patient how to clean around and underneath the bridge
    • superfloss
    • interdental brushes
45
Q

Longevity of RBBs?

A

5 and 10 year survival rates about 80%

i.e. if they do fail its most likely to be in the first couple of years and if they make 5 years they will likely make 10 years

46
Q

nb not finished

A
47
Q
A

BDS4 Operative Dentistry (3 decks)

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