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restorative > bridgework > Flashcards

bridgework Flashcards

1
Q

tx options for missing tooth/teeth

A

no tx - leave space
replace
close space - ortho

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2
Q

reasons for txing

A

aesthetics
fct
speech
maintenance of dental health

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3
Q

replacement options

A

denture
bridgework
implants

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4
Q

definition

A

a prosthesis which replaces a missing tooth/teeth and is attached to one or more natural teeth/implants
- fixed partial denture
- compared with a RPD which replaces ST and bone
adhesive or conventional

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5
Q

general indications

A 
fct and stability
appearance
speech
psychological reasons
systemic disease e.g. epileptics
 - small RPD aspiration risk
co-operative pt
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6
Q

local indications

A 
big teeth
heavily restored teeth
 - conventional destructive
favourable abutment angulations
favourable occlusions
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7
Q

general contraindications

A 
uncooperative pt
MH contraindications
poor OH
high caries rate
PDD
large pulps (conventional)
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8
Q

local contraindications

A

high possibility of further tooth loss within arch - look long term - dentures/implants
poor abutment prognosis
length of span too great
ridge form and tissue loss
- if teeth been missing for long time unlikely to get good aesthetics - bridges don’t replace ST, dentures better
tilting and rotation
degree of restoration (how much tooth is left after prep)
PA status
PD status (bone loss)

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9
Q

abutment

A

a tooth which serves as an attachment for a bridge

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10
Q

pontic

A

artificial tooth which is suspended from the abutments

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11
Q

retainers

A

the EC or IC Rxs that are connected to the pontic and cemented to the prepared abutment tooth

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12
Q

connectors

A

component which connects the pontic to the retainer(s)

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13
Q

edentulous span

A

space between natural teeth that is to be filled with bridge/RPD

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14
Q

saddle

A

area of the edentulous ridge over which the pontic will lie

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15
Q

pier

A

abutment tooth which stands between and is supporting 2 pontics, each pontic being attached to a further abutment (rare)

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16
Q

unit

A

retainer/pontic

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17
Q

tooth preparations

A 
conventional - not as common anymore
 - retainer(s) = crown
    - F-F, F-C, F-M
RR/adhesive
 - retainer(s) = metal (NiCr or CoCr) - minimal/no prep
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18
Q

bridge designs

A 
fixed fixed
 - conventional or adhesive/RR
cantilever
 - conventional or adhesive/RR
fixed-moveable
hybrid
spring cantilever
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19
Q

fixed fixed bridge

A

retainer at each end, pontic in middle, joined by rigid connectors

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20
Q

advantages of fixed fixed bridges

A 
robust
max retention and strength
abutments splinted together
 - perio mobile cases
can use in longer spans
lab construction straightforward
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21
Q

disadvantages of fixed fixed bridges

A

prep difficult (parallel)
prep must be minimally tapered
common PofI for abutments
removal of tooth tissue (pulp)

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22
Q

cantilever bridge

A

support for pontic at one end only
may be connected to one or more retainers
no retainer at other end of pontic

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23
Q

advantages of cantilever bridges

A

conservative vs FF - only one tooth
lab construction straightforward
no need to ensure multiple tooth preps are parallel

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24
Q

disadvantages of cantilever bridges

A

short span only (not as robust)
rigid to avoid distortion (fracture risk?)
mesial cantilever preferred
- abutment distal to pontic

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25
Q

fixed moveable bridge

A

has a rigid connector usually at distal end of pontic and a moveable connector mesially
- allows some vertical movement at the mesial abutment
potential solution when abutments aren’t parallel
bridge in 2 parts
- slot and dovetail
- slot in (this bit flexes a little)
- have 2 PofIs

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26
Q

advantages of fixed moveable bridge

A 
preps don't require a common PofI
each prep designed to be retentive independent of others
more conservative of tooth
allows minor tooth movement
may be cemented in 2 parts
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27
Q

disadvantages of fixed moveable bridge

A

length of span limited
lab construction complicated
possible difficulty cleaning beneath moveable joint-plaque trap
can’t construct provisional

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28
Q

hybrid

A

1 retainer = conventional prep

other retainer = min prep

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29
Q

spring cantilever

A

one pontic attached to the end of a metal arm that runs across the palate to a rigid connector on the palatal side of a retainer
v rare

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30
Q

advantages of a spring cantilever

A

useful if spacing between upper incisors
where adjacent teeth are unrestored
where a posterior tooth would provide a suitable abutment i.e. already has crown/large direct Rx

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31
Q

disadvantages of a spring cantilever

A

can only use to replace U incisors
difficult to clean beneath palatal connector
may irritate palatal mucosa
- candida infections
difficult to control movement of pontic, due to springiness of metal arm and displacement of palatal STs - v flexible

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32
Q

abutment evaluation

A

must be able to withstand forces prev directed to missing tooth/teeth (remaining tooth structure)
tissues healthy and free of inflammation i.e. PA and PDD
crown to root ratio
- length of tooth coronal to alv crest compared to length of root embedded in bone
- optimum 2:3, min 1:1
get radiographs

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33
Q

as a rule of thumb how long do bridges last if well maintained and looked after?

A

around 10 years

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34
Q

why do you need to have a plan for retrievability/back up plan?

A

will fail at some point

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35
Q

how should you examine the occlusion?

A

IO

study casts - Facebow mounted on semi-adjustable articulator

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36
Q

what should you examine in regards to occlusion?

A

canine guidance/group fct - dynamic occ relationships
opposing tooth over-erupted?
will bridge interfere with current occlusion?
signs of parafct present?
- wear facets, attrition etc

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37
Q

designing and planning thoughts

A

min or conventional prep?
material? - metal stronger, ceramic aesthetic
abutment evaluation
cleansability - will fail if OH not easily performed, manual dexterity
appearance/aesthetics - confirm pts expectations are achievable

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38
Q

evaluating potential abutments

A

root configuration
angulation/rotation of abutment
PD health
surface area for bonding and quality of E
risk of pulpal damage
quality of endo - re-RCT?
remaining tooth structure present? - at least 2-3mm height
core - remove and rebuild? - but if need post and core risk of root fracture

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39
Q

details of bridge design

A

select abutments
- judge longevity of adjacent teeth

select retainer

  • no/min/regular prep? RBBs
  • complete crown? conventional

select pontic and connector

plan occlusion
- avoid having contact on just pontic. Need contact on just retainer or on pontic and retainer

prescribe material

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40
Q

pontic fct

A

restore appearance of missing tooth
stabilise occlusion
- prevent tilting and overeruption
improve masticatory function

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41
Q

3 considerations for pontic design

A

cleansability
appearance
strength

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42
Q

considerations for pontic design - cleansability

A

smooth, with highly polished or glazed surface
surface shouldn’t harbour join of metal and porcelain (if metal ceramic design used)
embrasure space smooth and cleansable

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43
Q

considerations for pontic design - appearance

A

anteriorly - tooth like as possible

posteriorly - may compromise

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44
Q

considerations for pontic design - strength

A

longer span = greater thickness required to withstand occlusal forces (because flex increases fracture risk)

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45
Q

surfaces of pontic

A

occlusal
approximal
buccal and lingual
ridge

46
Q

surfaces of pontic - occlusal

A

resemble surface of tooth it replaces
narrower nearer cervical area to enable cleaning
should have sufficient occlusal contact
- esp if replacing for masticatory fct

47
Q

surfaces of pontic - approximal

A

connector: strength
embrasure: space (floss)

48
Q

wash through/hygienic/sanitary

A

makes no contact with ST - not supported by ridge
fct (increase occ area) rather than for appearance
consider in lower molar area
v cleansable - brush/saliva
slightly more prone to fracture due to flex - gold good material

49
Q

dome/bullet/torpedo

A

just touches ridge
useful in lower incisor, premolar or upper molar areas
acceptable if occlusal 2/3 of buccal surface visible
poor aesthetics if gingival 1/3 of tooth visible
quite cleansable in lower 1/3

50
Q

modified ridge lap

A

most commonly used
buccal surface looks as much like tooth as possible
lingual surface cut away (cleansable)
line contact with buccal of ridge
problems with food packing on lingual surface of ridge

51
Q

total ridge lap/saddle

A

good aesthetics
greatest contact with ST
if designed carefully can be cleansed
less food packing than modified ridge lap - but if there is food packing, really hard to get out
careful not to displace ST or cause blanching of tissue

52
Q

ovate

A

presses on ridge lap/saddle (2-3mm)
can be used to “mould and shape” gingivae
difficult to clean - increase risk of inflammation on saddle
often used with long term implant aim - emergence profile
may be a little uncomfortable - warn pt

53
Q

materials that can be used

A

all metal
metal ceramic
all ceramic
ceromeric

54
Q

materials that can be used - all metal

A

gold best - lower posteriors

Ni/Co Cr?

55
Q

what are the majority of bridges made in at present?

A

metal ceramic

56
Q

materials that can be used - all ceramic

A

Zi e.g. Lava and Procera

lithium disilicate e.g. Emax

57
Q

materials that can be used - ceromeric

A

not as common now
combination of composite and porcelain material
BelleGlass, Vectris, TargisVectris

58
Q

lava 3M espe

A

3-4 unit fixed bridge (max span) milled zirconium oxide frame with feldspathic porcelain overlying
withstand occ forces
good aesthetics
similar reduction to MCC

59
Q

Zi

A

preps on casts scanned
katana Zi - multilayered Zi, ultra translucent multilayer Zi
milled
+/- feldspathic (layer) porcelain on top

60
Q

implant retained bridges

A

large span bridges (implants can be abutments)

61
Q

screw-retained implant bridges

A

ideal

more retrievable and easy to dismantle

62
Q

cement-retained implant bridges

A

if cant get them in perfect SL access

much harder to dismantle

63
Q

which bridge requires parallelism?

A

F-F conventional
requires 2 or more teeth to be prepared to provide a common PofI
no undercuts but to give retentive preps

64
Q

paralleling by eye

A

direct vision, one eye closed
large mouth mirror posteriorly (hold at same angle)
use straight (right angle) probe like a lab surveyor but in the mouth

65
Q

EO survey for paralleling

A

quick imp
pour model
use a lab surveyor, useful in long span multiple unit bridges

66
Q

before starting preparation for conventional bridgework, what steps should be taken?

A

mounted study models
consider diagnostic wax up and custom imp tray
request lab to construct vacuum formed stent
- allows checking of reduction during tooth prep
- allows construction of provisional bridge (Protemp)
shade
lab made stent or make pre-op putty impression for provisional bridge

67
Q

prep conventional bridgework

A

occlusal or incisal reduction
separation of teeth
aim for parallelism of tapered surface of each prep
confirm parallelism
consider retentive features if short clinical crown height or over tapered - slots/grooves - rare as adhesives good

construct provisional bridge before imp - as then means you can get them back for imp if you run out of time

make imp and occlusal reg

temporarily cement provisional bridge

demonstrate cleaning with superfloss

write/draw prescription for technician

68
Q

definitive cementation - conventional metal and metal ceramic (fitting surface metal)

A

AquaCem (GIC) - avoid biting for 24hrs on it

RelyXLuting (RMGIC)

69
Q

definitive cementation - adhesive bridge

A

Panavia21
anaerobic dual cure resin cement with 10-MDP
- good bond between tooth and metal

70
Q

definitive cementation - all ceramic

A 
NEXUS kit (dual cure resin cement)
can't shine a light cure reliably
71
Q

distal cantilevers - why are they avoided?

A

tend to chew posteriorly, contact on pontic first
concern that occlusal forces on pontic will produce leverage forces on abutment causing tilting
mesial relieves the pontic (contact on retainer first)

72
Q

when might a distal cantilever be indicated?

A

e.g. in 4-4s to give a SDA

from premolar abutment if unopposed or opposed by a denture

73
Q

5 and 10 year longevity rates of RBBs

A

80.8%
80.4%
if it is going to fail it tends to fail in first 2yrs

74
Q

longevity of F-F MC

A

90%

75
Q

longevity of F-F C

A

88%

76
Q

success of implant root

A

97%

77
Q

longevity of implant retained bridge

A
  1. 2%

86. 7%

78
Q

longevity of conventional cantilever

A
  1. 4%

80. 3%

79
Q

removing adhesive bridgework

A

SafeRelax

Anthrogyr

80
Q

adhesive cantilever materials

A

all ceramic - more recent, not much evidence yet

ceramic with metal (NiCr/CoCr) wing - traditional

81
Q

advantages of adhesive bridgework

A

min/no prep
no anaesthetic needed
less £
less surgery time
can be used as provisional e.g. long-term aim of implant (children)
if fails usually less destructive than alternatives

82
Q

disadvantages of adhesive bridgework

A

rigorous clinical technique
metal shine through esp incisal edge
can debond (v little mechanical retention, relying on chemical)
- high chance of debonding again
- quality of E decreases
occlusal interferences - high failure in bruxists
no trial period possible

83
Q

indications for adhesive bridgework

A 
young teeth (less destructive)
good E quality
large abutment tooth surface area
minimal occlusal load (anterior teeth)
single tooth replacement
simplify RPD design
84
Q

contraindications for adhesive bridgework

A 
insufficient or poor quality E e.g. amelogenesis imperfecta
long spans
 - more pontics = more occlusal load
excess hard or soft tissue loss
 - loss of ID papillae - black triangles
heavy occlusal force e.g. bruxism
 - can do but need to give splint to protect bridge
poorly aligned, tilted or spaced teeth
contact sports?
85
Q

assessing the occlusion

A 
consider opposing dentition
 - contact points
 - over-eruption of opposing teeth/tilting
is there a parafct habit? - wear facets, linea alba
look at dynamic occlusal relationships
 - clinically
 - mounted study models with facebow
 - consider diagnostic wax ups
86
Q

types of adhesive bridge

A

direct

indirect

87
Q

direct adhesive bridges

A

rare
v useful in emergency situation
immediate extraction or traumatically lost

88
Q

construction of a direct adhesive bridge

A

pontic manufacture - ideally use pts own tooth
alternatives - acrylic ‘denture’ tooth, polycarbonate crown, cellulose matrix filled with composite
extract, drill root, remove pulp, cover orifice with composite, etch and bond IP areas

89
Q

levels of prep for an indirect adhesive bridge

A

no
min
heavier

90
Q

why is it ideal to bond to enamel?

A

dentine doesn’t bond as well to resin cement

91
Q

requirements for indirect adhesive bridge

A

need generous palatal/lingual coverage
- greater SE of E covered - greater bond
keep supra gingival - ideal 0.5mm
care with coverage near incisal edge - enamel translucent
ideally prep should remain in enamel 0.5mm

92
Q

providing bridge after extraction

A

don’t provide until 3m maxilla and 6m mandible after ext to allow healing
- related to blood supply - U cancellous bone vs L cortical bone

93
Q

what type of adhesive bridge is usually used anteriorly?

A

cantilever

94
Q

what type of adhesive bridge is usually used posteriorly?

A

F-F

increased occlusal load

95
Q

divergent guidance paths

A

why cantilevers are more successful anteriorly?

  • want only single direction of occlusal force
  • otherwise get shear forces - one side may debond
96
Q

restorations in abutment teeth for adhesive bridgework

A

ideally need sound E
composite ok
- consider replacement prior to prep (esp if old)
amalgam
- compromised bond to chemically cured composite cement
- consider replacement (w composite)

97
Q

anterior adhesive bridge - min prep

A

occlusal contact reduction
cingulum undercut removal only
chamfer margin 0.5mm supragingival

98
Q

anterior adhesive bridge - heavier prep

A

0.5mm palatal reduction - retainer wing should be 0.7mm thick - get occ adjustment in 2 weeks
cingulum rest (mechanical retention)
+/- proximal grooves
chamfer margin 0.5mm supragingival

99
Q

posterior adhesive bridgework prep options

A

no prep

prep

100
Q

posterior adhesive bridgework prep

A

occlusal rests (mechanical retention)
180 degree wrap around with chamfer finish 0.5mm supra gingival
+/- proximal grooves
can be cantilever or FF

101
Q

what is modern adhesive bridgework made from?

A

NiCr alloy

102
Q

sandblasting surface of adhesive bridgework

A

micro mechanical retention - from wing not tooth (cement flows into the dents)
aluminium oxide - 50 microns

103
Q

temporisation for adhesive bridgework

A

consider RPD
if prep remains in E - do you need temp?
if prep into D and tooth becomes sensitive cover with a layer of DBA
fit bridge as quickly as possible
- minimise over-eruption and tooth movement

104
Q

what do you use to cement adhesive bridgework?

A

panavia 21 ex

105
Q

what does Panavia 21 ex contain to allow tooth tissue to stick to metal better?

A

10 MDP

106
Q

adhesive bridgework - tx of retainer

A

try in - fit and aesthetics
chair side micro etching with 50 micron Al2O3 particles - sandblast (should already have been done by technician)
clean retainer
- US bath if required
- ethanol to ‘degrease’ if required (reduce surface tension)
apply chemical/dual cure composite luting cement just prior to placement of Rx after tooth tx

107
Q

adhesive bridgework - tx of tooth

A 
prophylaxis
isolate with dental dam
etch (37% orthophosphoric acid)
wash and dry
primer 30s (don't cure)
air dry 2s
108
Q

cementing the adhesive bridgework

A

fit adhesive bridge retainer (coated with luting cement) to abutment
remove excess cement
- can light cure after this to speed setting
oxygen inhibitor (oxyguard 2) placed around cement margins for 3mins, then wash off
2mins of finger pressure - hold while setting to ensure correct position

109
Q

locating clique e.g. duralay

A

hooks over incisal edge to ensure cement bridge in correct location
can twist/drill off post-cementation

110
Q

post-cementation of adhesive bridgework

A

check occlusion
- confirm pontic doesn’t have excessive occlusal forces applied
demonstrate to pt how to clean around and underneath bridge with superfloss

restorative (12 decks)

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