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BDS4 Restorative > Bridgework > Flashcards

Bridgework Flashcards

1
Q

Contra-indications for bridgework (local factors)

A
  • Poor prognosis abutment teeth
  • High possibility of further tooth loss within arch
  • Tilting and rotation of teeth
  • Degree of restoration (how much tooth is left after preparation)
  • Peri-apical status
  • Periodontal condition - bone loss
  • Length of span too great/ long
  • Ridge form and tissue loss - denture would be better in this area
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2
Q

Indications for bridgework - LOCAL

A
  • Big teeth- large SA
  • Heavily restored teeth - if you are going to crown teeth anyway – indication for conventional bridge.
  • Favourable abutment angulations
  • Favourable occlusion
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3
Q

Indications for bridgework - general

A
  • Co-operative patient
  • Restore funcitonal stability
  • Appearance
  • Systemic disease - epileptics - better to have retained restorative work in case of seizure.
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4
Q

Advantages of resin bonded bridge

A

Minimal or no preparation
No anaesthetic needed
Less costly
Less surgery time
Can be used as a provisional restoration
If fails - usually less destructive than alternatives

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5
Q

Disadvantages of resin bonded bridges

A

Rigorous clinical technique
Metal shine-through
Chipping porcelain
Can de-bond - then high chance of it debonding again
Occlusal interferences
No trial period possible

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6
Q

Indications for RBB

A

Young teeth - Less destructive
Good enamel quality
Large abutment tooth surface area
Minimal occlusal load
Good for single tooth replacement
Simplify partial denture design

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7
Q

Contraindications for RBB

A

Insufficient or poor quality enamel
Long spans- large edentulous areas
Excess soft or hard tissue loss
Heavy occlusal force e.g. Bruxist
Poorly aligned, tilted or spaced teeth

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8
Q

Conventional fixed-fixed bridge ADVANTAGES

A
  • Robust design
  • Max. retention an strength
  • Can splint abutment teeth together?
  • Can be used in longer spans
  • Lab construction straightforward
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9
Q

Conventional fixed-fixed bridge DISADVANTAGES

A
  • Preparation difficult (parallel tooth preparations needed)
  • Preparation must be minimally tapered
  • Common path of insertion for abutments
  • Removal of tooth tissue (danger to pulp)
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10
Q

Conventional cantilever bridge ADVANTAGES

A
  • Conservative design - compared to fixed-fixed conventional design
  • Lab construction straightforward
  • No need to ensure multiple tooth preparations are parallel
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11
Q

Conventional fixed-moveable bridge ADVANTAGES

A
  • Preparations don’t require a common path of insertion
  • Each prep designed to be retentive independent of others
  • More conservative of tooth tissue
  • Allows minor tooth movement
  • May be cemented in two parts
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12
Q

Conventional fixed-moveable bridge DISADVANTAGES

A
  • Length of span limited
  • Lab construction more complicated
  • Possible difficulty in cleaning beneath moveable joint
  • Can’t construct provisional bridge
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13
Q

Requirements for a good abutment tooth (long things)

A
  • good quality enamel
  • Must be able to withstand the forces previously directed to the missing tooth
  • Supporting tissues should be healthy and free of inflammation
  • Crown to root ratio- Optimum ratio 2:3. Minimum ratio 1:1.
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14
Q

What is the ridge surface like in a dome-shaped pontic and when would it be used?

A

Useful in lower incisor, premolar or upper molar areas.
Shaped like a dome and touched ridge surface.
Acceptable if occlusal 2/3 of buccal surface visible - poor aesthetics if gingival 1/3 of tooth visible.

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15
Q

What is the ridge surface like on a “wash-through” pontic?

A

Makes no contact with soft tissue - functional rather than for appearance.
Consider in lower molar areas.

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16
Q

What 3 things do you need to consider in pontic design?

A

Cleansability - should be smooth and highly polished. Should not harbour join of metal and porcelain

Appearance

Strength

17
Q

What is the function of a pontic?

A

Restore appearance of missing tooth
Stabilise occlusion
Improve masticatory function

18
Q

What to evaluate about potential abutments?

A
  • Root configuration
  • Angulation/ rotation of abutment
  • Periodontal health
  • SA for bonding and quality of enamel
  • Risk of pulpal damage
  • Quality of endo treatment if applicable
  • Remaining tooth structure present
19
Q

What is a problem with modified ridge lap pontic design?

A

Problem with food packing on lingual surface of ridge.

20
Q

What is the benefit of parallelism in fixed-fixed conventional bridge?

A

INCREASED RETENTION
Requires 2 or more teeth to be prepped in a manner to provide a common path of insertion

21
Q

What should be considered in conventional bridgework prep to add retention in short clinical crowns?

A

Consider adding slots or grooves.

22
Q

What cement should be used for metal conventional and metal ceramic bridgework definitive?

A

GI luting cement - aquacem
RMGI luting cement - relyX

23
Q

What cement should be used for adhesive/ resin bonded/ RRB and all ceramic bridgework definitive?

A

Dual-cure resin cement e.g. Nexus 3

24
Q

Why are distal cantilevers less preferable than mesial cantilevers?

A

When teeth occlude, they are more likely to contact teeth DISTALLY first.
If pontic is more distal, more likely to contact this first - you would get see-saw effect - bridge is more likely to lift up and fail.

25
Q

What are the details/ stages of bridge design?

A
  • Select abutment teeth
  • Select retainer
  • Select pontic and connector
  • Plan the occlusion
  • Prescribe material
26
Q

What bridge design is generally better in the anterior region?

A

Cantilever

27
Q

Why are cantilever designs more successful than fixed-fixed in the anterior region?

A

There are divergent guidance paths, so the longitudinal axis of each tooth is different, so the occlusal forces are directed down each of the teeth a different way.
More suitable for cantilever

28
Q

What is the thickness of a metal retainer wing?

A

0.7mm

29
Q

What is the material of metal retainer wings in bridges?

A

CoCr
OR
Nickel-chromium alloy

30
Q

How are metal wings treated in bridges prior to cementation in the mouth and what does this do?

A

Sandblasted in the lab - increases micro-mechanical retention

31
Q

What is the problems with occlusal clearance in anterior RRB?

A

For patients with a complete tooth-to-tooth overbite, placement of a resin retained bridge in the upper anterior
region will lead to premature occlusal contact of the lower
incisors with the wing retainer.

32
Q

What are the 5 different types of pontic design?

A

Wash-through
Dome (bullet-shaped)
Modified-ridge lap
Ridge lap (full saddle pontic)
Ovate pontic

33
Q

Where in the mouth are dome-shaped pontics best suited for?

A

Acceptable if occlusal 2/3 of buccal surface are visible - poor aesthetics is gingival 1/3 of tooth visible

Lower incisor
Premolar
Upper molar

34
Q

Describe modified-ridge lap pontic design.

A

Buccal surface looks as much like tooth as possible
Lingual surface cut away
Line contact with buccal of ridge

35
Q

Describe ridge lap/ saddle pontic design and what care needs to be taken with this type of pontic?

A

Greatest contact with the soft tissue
Less food packing than modified ridge lap

Take care not to displace soft tissue or cause tissue blanching

36
Q

What cement should be used for adhesive/ RBB? (all types)

A

Panavia 21 - Dual cure composite resin cement with 10-MDP.

37
Q

In what situation would you consider a distal cantilever?

A

May consider a distal cantilever from premolar abutment if unopposed or opposed by a denture

38
Q

Describe the steps of a direct resin-retained bridge?

A
  1. Extract tooth
    1. De-coronate extracted/ avulsed tooth
    2. Remove any pulpal tissue from the crown of the tooth using hand instruments - K files.
    3. Cover hole of pulp chamber with composite
    4. Etch the contacts points on the crown of the recently extracted tooth.
    5. Etch contact points of adjacent teeth of edentulous space
    6. Prime and bond on the surfaces that we have etched.
    7. Place the tooth back in situ.
      Put composite over contact points to join teeth together to make a temporary splint/ direct resin bonded bridge.
39
Q

How can you check if bridge has de-bonded?

A

Floss behind wing
Probe behind wing
Press on wing and see if any bubbles come out
Press on pontic and see if any movement of wings.#

BDS4 Restorative (3 decks)

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