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BDS4 Restorative Dentistry > Bridgework 1 > Flashcards

Bridgework 1 Flashcards

1
Q

What are tx options for missing teeth? (5)

A

No tx - leave space as is

RPD/ Complete denture

Bridgework

Implants

Close space with ortho tx

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2
Q

When might opting for no tx when missing teeth be an option?

A

Posterior teeth

uncommon in anterior teeth as aesthetic zone

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3
Q

When are RPDs a less viable option for replacing missing teeth?

A

When only small number of missing teeth

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4
Q

How do we restore teeth after implant placement?

A

Crown
Bridge
Implant retained denture

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5
Q

Why do we tx tooth loss? (4)

A

Aesthetics
Function
Speech
Maintain dental health of other teeth

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6
Q

How can missing teeth affect other teeth?

A

If we have edentulous space, adjacent teeth can tilt or over erupt which can have long term effect on prognosis of tooth (root exposure, sensitivity, more caries prone

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7
Q

What is a bridge?

A

dental prosthesis that replaces missing tooth or teeth and is attached to one or more natural teeth or implants

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8
Q

What is different between a RPD and bridgework?

A

RPD replaces tsoft tissue and bone

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9
Q

What are the two categories of bridgework?

A

Adhesive (held on with wings to palatal surface of teeth)

Conventional - held on with crowns

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10
Q

What are some general indications of bridgework? (6)

A

Function and stability reasons (eating etc)

Appearance (aesthetics)

SPeech

Psychological reasons - some pts struggle with concept of removable prosthesis

Systemic disease - pts with epilepsy likely to inhale denture or break risk during fit

cooperative pt - pt withe excellent OH, complaint, no active disase, wanting to look after teeth

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11
Q

Why may bridgework be better with pt for epilepsy that RPD?

A

Risk of inhalation and RPD #during seizure

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12
Q

What are some local indications of bridgework? 4

A

Big teeth

Heavily restored teeth (if already compromised then good for conventional bridgework - not destroying lots of tooth tissue as already lost)

Favourable abutment angles

Favourable occlusion

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12
Q

What are some local indications of bridgework? 4

A

Big teeth

Heavily restored teeth (if already compromised then good for conventional bridgework - not destroying lots of tooth tissue as already lost)

Favourable abutment angles

Favourable occlusion - not heavy occlusal contacts as risks bridge fracture or loss of bridge

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13
Q

What are general contraindications for bridgework? (6)

A

large pulps - conventional bridge not good as crown prep reuquired to hold bridge on and pulp exposure likely

Poor OH

Unccoperatiev pt - poor OH, lack of interest in dental health, active disease

MH contraindications - allergy to metals

High caries rate

PD disease

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14
Q

What are some local contraidincations fo bridgework? (8)

A

High possibility of further tooth loss - if pt is likely to lose more teeth and have large edentulous area then consider denture

Poor prognosis of abutment teeth

large edentulous area (we want to replace as few teeth as possible)

Ridge form and tissue loss (if lots of bone and soft tissue loss denture better for replacing this as bridge only replaces tooth)

Titling and rotating of teeth

if large resto and no tooth left after prep

PA status - active endo or perio disease is NO

PD status - advanced bone loss, abutment teeth poorly supported by alveolar bone so not ideal for occlusal load

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15
Q

What is an abutment?

A

This is a tooth that is used as bridge attachment

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16
Q

What is a Pontic?

A

This is area/false tooth that replaces missing tooth and is attached to abutment tooth/teeth

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17
Q

What is a retainers?

A

These are extra coronal or intra coronal restorations that are connected to Pontic and cemented to prepared abutment teeth (can be metal wing in adhesive bridges or conventional crowns)

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18
Q

What is a connector?

A

This is a component that connect Pontic to retainer/retainers (Pontic = missing teeth that are replaced, retainer is the metal work palatally in adhesive or crowns in convention and is intra or extra coronal resto connected to Pontic and cemented to abutment teeth)

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19
Q

What is a saddle?

A

This is an ara of edentulous ridge over which the Pontic lies

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20
Q

What is a pier?

A

This is an abutment tooth which stands between and supports two poetics, each is attached to another abutment tooth

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21
Q

What is a 3 unit bridge?

A

This is when a bridge can have two retainers and one photic

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22
Q

What is a unit?

A

Can be a retainer or a Pontic

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23
Q

What is a fixed fixed bridge?

A

This is a bridge with a retainer at each end of the Pontic in the middle joined by RIGID connectors

RETAINER PONTIC RETAINER

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24
Q

What are the two types of fixed fixed bridges?

A

Adhesive/resin retained

conventional

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25
Q

What is a cantilever bridge?

A

Retainer PONTIC

Adhesive or conventional

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26
Q

What is resin bonded bridgework also known as?

A

Adhesive

resin retained bridgework

minimal prep bridgework

Maryland bridge

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27
Q

What is the Pontic and retainer most commonly made out of in adhesive bridges?

A

Porcelain - pontic

Cocr - retainer

or all ceramic

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28
Q

What are 6 advantages of adhesive bridgework?

A

Minimal tooth prep required/ or none

No LA needed

Less costly

Less surgery time

Good for provisional restorations in hypodontia cases

If failure –> less restrictive due to minimal prep so pt not much worse off

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29
Q

What are some disadvantages of adhesive bridgework?

A

Difficult clinical technique - resin retained os moisture control very important as held in by composite cement or wont last long

Metal can shine through - if poorly designed or cemented poorly and if pt has translucent incisal edges

porcelain chipping off Pontic

can debond (we can recumbent but first bond is best bond so will become weaker and higher debond chance)

occlusal interference - high bridges over time can reorganise occlusion via Dahl concept

no trial period possible - we can’t check occlusal and excersive movemebts

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30
Q

Why may adhesive bridgework have metal sheen through?

A

Transparent incisal edges

poor design

poor cememtnation

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31
Q

What ice most common disadvantage of adhesive bridgework?

A

Porcelin chipping from Pontic

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32
Q

What is the issue with porcelain bridgework debonding?

A

First bond strongest

second bond has less strength so higher chance of debunking

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33
Q

What is the only thing we can guarantee pts with restorative work?

A

It will fail eventually

34
Q

What are indications of adhesive bonded bridges?

A

Young teeth (less destruction as no minimal prep req)

Large abutment tooth surface with large bonding area which increases retention

single tooth replacement

minimal occlusal load

remove need for partial denture

35
Q

Why are adhesive bonded bridges good for young teeth?

A

They are minimally destructive as little to no prep is reqiuires

36
Q

Why do we want large abutment teeth for adhesive bridges?

A

Larger surface area to bond to so increased retention

37
Q

What are contraindications to adhesive bridges?

A

Lack of enamel

Insufficent quality of enamel

Excessive soft or hard tissue loss

Parafunctional habits such as bruxism leading to high occlusal force which will lead to fracture or debone of bridgework

Pt plays contact sports such as rugby, boxing that has high risk of facial trauma inc debunking of bridge

38
Q

How do we tx plan for bridges?

A

History - SH important, stresses, habits, bruxist

Examination - check occlusal relationships (dynamic and static), PD status, radiological status - caries, PA pathology, bone levels

must assess abutment teeth

39
Q

In potential bridgework cases what do we create?

A

Study casts (take imps of pt and send to lab and then mount on semi-adjustable articulator with face bow registration (esp I canines)

we then can consider wax up to show pt final aesthetic result and allows us to look at occlusal relationship - if any heavy contacts

40
Q

When we do a bridge what do we look at?

A

Abutment teeth

Occlusion

Aesthetics - soft tissue contour

pts OH

41
Q

Why do we consider occlusion in bridgework cases?

A

We want to look at:

OPPOSING DENTITION (contact points)
if theres any over euption of opposing teeth

any parafucntional habits - bruxism (lines alba, attrition, scalloped tongue)

Dyanamic occlusal relationships - clinically and on study casts

42
Q

What is a direct resin bonded bridge?

A

This is a type of bridge that is useful in EMERGENCY SITUATIONS - if pt comes in with trauma and tooth has been avulsed leaving edentulous space then we can use pts tooth to create a temporary direct bridge for aesthetic reasons until perm bridge is fabricated

43
Q

What can we use for direct bridge if pt doesn’t have their tooth?

A

Acrylic denture tooth from lab

prefabricated polycarbonate crown

cellulose matrix filled with composite

44
Q

What are the problems with direct bridges?

A

Poor aesthetics

Short lasting - fail at quick rate

45
Q

What are advantages of direct bridges?

A

gives pt immediate sort term solution and buys them time while we plan for implant/bridge/denture

46
Q

How would we construct direct bridge following traumatic avulsion of 11

A

Cut the root of 11
Drill out any pulpal tissue
Etch contact points of 11
PLace composite over hole at crown going into pulp chamber
place etch on adjacent teeth followed by bond
place tooth in situate, with composite to splint teeth together creating direct resin bonded bridge

47
Q

What is an indirect bridge?

A

This is where prosthesis is made in the lab (pt attends, tooth prep if req –> lab constructs prostheses –> pt returns for cementing)

48
Q

Why do we not like heavy prep in adhesive bonded bridges?

A

Dentine has poor bond that enamel so we dont want any prep or minimal prep if req

49
Q

How much coverage do we need for adhesive bridges?

A

LArge SA as possible of palatal/lingual covering as more enamel we cover then greater the bond

50
Q

What is the issue with fixed-fixed adhesive bonded bridges?

A

One wing can debone whilst other is still in position resulting in pt not noticing but bacteria can then ingress under debunked wing resulting in caries in abutment tooth

51
Q

What quality of enamel do we need for adhesive bonded bridges?

A

Good quality - as we are bonding directly to enamel and rely on this for adhesion of bridge

52
Q

Why do we need to be careful with incisal edge coverage in adhesive bonded bridges?

A

incisal edges can be transulcent resulting in metal shine through

53
Q

What type of bridge we normally use for anterior teeth?

A

Adhesive cantilever bridgework

54
Q

What are divergent guidance pathways?

A

This describes how in the maxilla the longitudinal axis of teeth are all different as we go through the arch resulting in occlusal forces being directed down the teeth in different ways

CANINE AND CENTRALS FORCE IS DIRECTED IN DIFF WAYS

55
Q

What bridgework do we usually use on posterior teeth?

A

Adhesive bonded fixed fixed design - metal wings designed differently so more obvious when they have debunked

56
Q

Why do we need sound enamel for adhesive bridgework?

A

As we bond to enamel

57
Q

Can we do adhesive bridgework on a. tooth restored with composite?

A

Yes as composite bonds to composite - but consider replacing composite before bridge if old

58
Q

How can we modify the composite restoration for adhesive bridgework placement?

A

Can use rose head bur to roughen up the composite so resin cement sticks better

59
Q

Can we do adhesive bridgework to tooth with AM filling?

A

No - poor bond of Am to composite - consider replacement if this is tx option

60
Q

How is minimal bridgework prep done fo adhesive bonded bridges?

A

180 degree wrap around on PALATAL OR LINGUAL SURFACE with supra gingival chamfer finish line 0.5mm above gingival margin

We can also prep rests (cingulum on anterior, east east on posterior teeth) which gives us mechanical retention and helps to locate retainer when we come to cement it)

can add in proximal grooves to aid mechanical retention

61
Q

What can we do to aid retention of adhesive bonded bridges?

A

We can get mechanical retention via:

  • rest seat preps (cingulum anterior, rest seats posterior)
  • proximal grooves
62
Q

What is the finish line for adhesive bonded bridges?

A

0.5mm chamfer line supra gingivally

63
Q

How would we do adhesive bonded bridgework prep on an anterior tooth with a heavy occlusal contact on abutment tooth that requires minimal prep?

A

Occlusal contact reduction - due to heavy contact on abutment teeth

remove cingulum undercut s

0.5mm chamfer margin palatally/lingually spragingivally

64
Q

How would we do adhesive bonded bridgework prep on an anterior tooth with a heavy occlusal contact on abutment tooth that requires heavier prep?

A

Occlusal contact reduction if heavy occlusal contact on abutment tooth

0.5mm palatal reduction (metal retainer is 0.7mm thick) - 0.2mm may feel high but will settle

cingulum rests

proximal groovers

chamfer margin 0.5mm supra gingival palatally

65
Q

What adhesive bridgework design do we use:

anteriorly?
posteriorly?

A

Anterior = cantilever

posterior = fixed fixed

66
Q

Why do we use fixed fixed adhesive bridgework on posterior teeth?

A

Replacing larger tooth so we dont want abutment tooth carrying large occlusal load down single abutment tooth - we want to spread this land over larger surface area of 2 abutment teeth

67
Q

What is the ideal prep for posterior fixed fixed adhesive bridgework?

A

Ideally none but we normally do some to prepare rest seats which are 2mm deep

68
Q

How do we carry out prep of posterior adhesive fixed fixed bridge?

A

Occlusal rest east - 2mm deep

180 degree finish line palatally or lingua with 0.5mm supraginvgal chamfer

proximal grooves can be put in middle aspect but this is far

69
Q

What can be used whilst pt is waiting for definite e resin bonded bridge?

A

Essix retainer with missing tooth incorporated

70
Q

If prep is in enamell only do we need demo bridge?

A

No - as only in enamel but if pt has sensitivity then can suggest sensitive toothpaste, duraphat or DBA (thin layer)

71
Q

If we do tooth pre into dentine what can we do for the patient?

A

Apply dentine bonding agent layer

72
Q

What can happen if there is delay between bridge prep and bridge fit?

A

If longer than 2 weeks teeth may begin tilting and over erupting which isn’t ideal

73
Q

What does the lab do to the retainer of the bridge?

A

The lab will sandblast metal work as this creates small indentation on fitting surface of which resin can flow into and set and lock to give micro mechanical retention

74
Q

In bridgework what is used to help inc bond?

A

Aluminium oxide

75
Q

What do we cement bridgework with?

A

Panavia 21 EX

76
Q

Can we try in bridge work?

A

Yes we can hold bridge work in with finger or ask lab to make locating hook on retainer which goes over incisal edge and goes over retainer tooth (abutment) and holds in place temporarily so pt can see aesthetics and we can check occlusion

if we dont have the locating hooks then we can place composite on fitting surface of retainer and it will hold enough to check aesthetics and occlusion

77
Q

What if bridgework retainer doesn’t have locating hook?

A

We can use composite on retainer and the will hold enough to try in and check aesthetics and occlusion but will have to clean up composite - UNSET COMPOSITE

78
Q

If we try in bridgework retainer what must we do?

A

Clean retainer beofore final cement - can use US bath or ethanol to degrease

79
Q

What do we apply to adhesive bridgework before placement?

A

Chemically cured composite luting cement

80
Q

How do we prep tooth for bridge placeent

A

isolation with dam

etch

Applying A+B primer with micro brush for 3 seconds - 5 lauyers on abutment tooth and air dry for 2 seconds

NO NEED TO CRE

Fit retainerr coated with luting cement to abutment tooth

remove excess cement

place oxygen inhibitor around cement margins for 3 mins then wash off

81
Q

Do we use bond for adhesive bridge cases?

A

NO after etch we apply

A+B primer 1 layer = air dry 2 seconds 5 times then apply cement coated bridge

82
Q

What dow e do after cementation of bridgework?

A

check occlusion - both static and dynamic -

demonstarte cleaning of bridge with superfood (thin bit fed under Pontic and pull up until thick bit underneath then see under

83
Q

What are survival rates of resin bonded bridges?

A

80% 5 and 10 year survive;

BDS4 Restorative Dentistry (10 decks)

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