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BDS4 Restorative > Bridgework 1- Resin Bonded > Flashcards

Bridgework 1- Resin Bonded Flashcards

1
Q

What are the treatment options for missing teeth?

A

No treatment/Leave space

Replace tooth/teeth

Close space (Orthodontics)

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2
Q

What are the reasons for treating tooth loss?

A

To maintain:
Aesthetics

Function

Speech

Dental health- prevent tilting and over-eruption

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3
Q

What are the options when replacing teeth?

A

Denture- more missing teeth

Bridgework

Implants- false titanium roots, which are drilled into alveolar bone then restored with crown, bridge or denture

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4
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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5
Q

What is the main difference with a bridge and a partial denture?

A

An RPD replaces bone and soft tissue

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6
Q

What is an abutment?

A

A tooth which serves as an attachment for a bridge

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7
Q

What is a Pontic?

A

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

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8
Q

What is a retainer?

A

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

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9
Q

What is a connector?

A

Component which connects the pontic to the retainers/retainer

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10
Q

What is the span?

A

Edentulous space between natural teeth that is to be filled by a bridge or partial denture

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11
Q

What is the saddle?

A

Area of the edentulous ridge over which the pontic will lie

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12
Q

What is a 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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13
Q

What is a 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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14
Q

What are the types of bridgework?

A

Adhesive- most common
• Held on by wings on palatal surfaces

Conventional- held on by crowns

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15
Q

What are the general indications for bridgework?

A

To provide function and stability

Appearance

Speech

Psychological reasons- reluctance to wear dentures

Systemic disease e.g. in epileptics it prevents risk of inhaling denture

Co-operative patient

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16
Q

What are the local indications for bridgework?

A

Big teeth

Heavily restored teeth- don’t have to be as conservative

Favourable abutment angulations

Favourable occlusion

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17
Q

What are the general contra-indications for bridgework?

A

Uncooperative patient

Medical history contra-indications- allergy

Poor oral hygiene

High caries rate

Periodontal disease

Large pulps (conventional bridge)- more likely to expose pulp and lose vitality of tooth

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18
Q

What are the local contradictions for bridgework?

A

High possibility of further tooth loss within arch

Poor prognosis of abutment

Length of span too great- more than 1/2 teeth (causes flexing and failure)

Ridge form and tissue loss

Tilting and rotation of teeth

Overly restored

Poor periapical status

Poor periodontal status (bone loss)

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19
Q

What is a fixed-fixed bridge design?

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)

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20
Q

What is a cantilever bridge design?

A

This type of bridge has a retainer (or retainers) at one side of the pontic only
E.g. (Retainer)-(pontic)

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21
Q

What are the other names for Adhesive Bridgework

A

Resin Bonded/ Retained
Minimal preparation bridgework
Maryland bridge
Resin bonded fixed partial denture (RBFPD)

22
Q

What are the types of Adhesive cantilever bridges?

A

All ceramic

Traditional with metal wing (CoCr or nickel alloy)

23
Q

What are the advantages of Adhesive Bridges?

A

Minimal or no preparation

No anaesthetic needed

Less costly

Less surgery time

Can be used as a provisional restoration

If it fails - usually less destructive than alternatives

24
Q

When may it be useful to use an Adhesive bridge as a provisional?

A

Hypodontia patients- before they are old enough to receive implants

25
Q

What are the disadvantages of Adhesive Bridges?

A

Rigorous clinical technique- must be dry

Metal shine-through- due to poor design/ cementation or translucent incisal edge

Chipping pocelain

Can debond- high chance of recurrent debonding

Occlusal interferences- especially dynamic

No trial period possible

26
Q

Why are bridges often cemented high?

A

Daal Concept- occlusion reorganises naturally in 10-14 days

27
Q

What are the indications for adhesive bridges?

A

Young teeth- Less destructive

Good enamel quality

Large abutment tooth surface area- more space for bonding

Minimal occlusal load

Single tooth replacement

To simplify partial denture design

28
Q

What are the contraindications for Adhesive Bridges?

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?

29
Q

What should be checked before placing Adhesive bridge?

A

Habits- bruxism

Condition of abutments- caries/periodontal disease (radiographs)

Dynamic occlusal relationships- mount on semi-adjustable articulator with facebow

Soft tissue contour

Patient motivation- will they take care of prothesis

30
Q

What should be considered when checking occlusion before placing Adhesive Bridge?

A

Opposing dentition- contacts, over erupted teeth

Parafunction- look for attrition

Dynamic relationships- looking clinically AND at study models/wax-ups

31
Q

When are direct adhesive bridges used?

A

Emergency situations- trauma or loss of tooth

32
Q

What can be used as a Pontic in direct adhesive bridges?

A

Patients own tooth (ideal)

Acrylic ‘denture’ tooth

Polycarbonate crown

Cellulose matrix filled with composite

33
Q

What are the steps in using patient’s own tooth to produce a direct adhesive bridge?

A
  • Cut off root and remove pulpal tissue
  • Etch contact points of removed tooth and adjacent teeth
  • Cover pulp with composite
  • Join teeth together with composite interproximally
34
Q

What are the requirements for a successful indirect adhesive bridge?

A

Generous palatal/lingual coverage- greater surface area of enamel covered gives greater bond

Good quality enamel

Keep supra-gingival to allow cleaning- ideally 0.5mm

Care with coverage near incisal edge

35
Q

What adhesive bridge design is favoured in Anterior and Posterior Teeth?

A

Ant- cantilever

Post- fixed-fixed

36
Q

Why are fixed-fixed Adhesive bridges rarely used in anterior teeth?

A

If one wing debonds, resultant bacterial ingress can cause caries

Cantilevers are favoured as they are not affected by divergent guidance paths

37
Q

What should you do if Abutments have previously been restored?

A

Composite- consider replacement if restoration is old as bond will be better to new composite

Amalgam- replace

38
Q

What are the requirements of a preparation for an adhesive bridge?

A

180º ‘wrap-around’ preparation

Rest seats (posterior teeth)/ Cingulum rest (anterior teeth)- helps with relocating

Proximal grooves (vertical cuts)- aid mechanical retention

Supra-gingival chamfer finish line ~0.5mm

Ideally prep should remain in enamel

39
Q

What are the features of a minimal prep for an anterior cantilever adhesive bridge?

(May require no prep)

A

Occlusal contact reduction- if heavy contacts

Cingulum undercut removal only- simplifies POI

Chamfer margin (0.5mm supra-gingival, 0.5mm in width)

40
Q

What are the features for a heavier preparation for an anterior cantilever adhesive bridge?

A

0.5mm palatal reduction(NOTE – metal retainer wing should be 0.7mm thick)

Cingulum rest

+/- Proximal grooves

Chamfer margin (0.5mm supra-gingival)

41
Q

What are the features of a prep for a posterior adhesive bridge?

A

Occlusal rests- 2mm in depth

180º wrap-around with chamfer finish line (0.5mm supra-gingival)

+/- Proximal grooves

42
Q

Why is fixed-fixed preferred in posteriors?

A

Helps spread the occlusal load over two teeth (replacing a large tooth)

43
Q

What are the options for temporisation when placing indirect adhesive bridges?

A

RPD

Essix retainer

No temporary- if prep only into enamel

44
Q

If prep is into dentine, what can be used to prevent sensitivity/need for temporisation?

A

DBA

Duraphat

Desenitising toothpaste

45
Q

Why should bridge be placed as quickly as possible?

most labs take 2 weeks

A

As it minimises chance of over-eruption and tooth movement

46
Q

How should the fitting surface of the metal wing be prepared?

A

Sandblasting using aluminium oxide- provides micro-mechanical retention

47
Q

How can an adhesive bridge be tried-in before cementation?

A

Held with finger

Locating cleat- hook that goes over incisal edge to hold tooth in place temporarily

Small bit of composite can be used- but this will need to be cleaned via re-sandblasting, ultrasonic baths, ethanol

48
Q

What cement is used in Adhesive bridges?

A

Dual cure composite resin luting cement- PANAVIA 21

49
Q

Steps in fitting an Adhesive Bridge

A
  1. Prophylaxis
  2. Isolate with dental dam
  3. Etch tooth: 37% ortho-phosphoric acid (some preparations are 40%)

4.Wash & dry
5. Apply primer (A and B mixed together) for 30 seconds- Air dry for 2 seconds
6. No need to cure (unlike for direct composite restorations)
7. Fit retainer (coated with luting cement) to abutment tooth/teeth
8. Remove excess cement
9. Oxygen inhibitor (Oxyguard II) placed around cement margins for 3 minutes- wash off
10. Adjust any heavy occlusal contacts on pontics- be less concerned about wings

50
Q

What can be used to maintain cleanliness of Adhesive bridges?

A

ID brushes

Superfloss

51
Q

What is the survival rate of adhesive bridges?

A

5 year- 80.8%

10 year- 80.4%

Most failures occur in first 2 years

52
Q
A

BDS4 Restorative (12 decks)

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