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BDS4 Restorative > Bridgework > Flashcards

Bridgework Flashcards

1
Q

what do you do with a missing tooth/teeth?

A
  1. No treatment/Leave space
  2. Replace tooth/teeth
  3. Close space (Orthodontics)
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2
Q

what are reasons for treating tooth loss?

A
  • aesthetics
  • function
  • speech
  • maintenance of dental health
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3
Q

what are tooth replacement options?

A
  • denture
  • bridgework
  • implants
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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 difference between a fixed partial denture and bridge?

A

a fixed partial denture replaces soft tissue and bone

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6
Q

what are some indications for bridgework?

A

GENERAL
- Function and stability
- Appearance
- Speech
- Psychological reasons
- Systemic disease e.g. epileptics
- Co-operative patient

LOCAL
- big teeth
- heavily restored teeth
- favourable abutment angulation
- favourable occlusion

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7
Q

what are contra-indicaations for bridgework?

A

GENERAL
- Uncooperative patient
- Medical history contra-indications
- Poor oral hygiene
- High caries rate
- Periodontal disease
- Large pulps (conventional bridge)

LOCAL
- High possibility 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 (how much of tooth is left after preparation)
- Periapical status
- Periodontal status (bone loss)

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8
Q

what is an abutment?

A

A tooth which serves as an attachment for a bridge

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9
Q

what is a pontic?

A

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

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10
Q

what is retainers?

A

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

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11
Q

what are the connectors?

A

Component which connects the pontic to the retainers/retainer

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12
Q

what is edentulous span?

A

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

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13
Q

what is saddle?

A

Area of the edentulous ridge over which the pontic will lie

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14
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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15
Q

what is a unit? and for example what would a bridge with 2 retainers and one pontic be?

A

Either a retainer or a pontic

  • e.g. A bridge with two retainers and one pontic = 3 unit bridge
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16
Q

what are types of bridge designs?

A

conventional (means commonly used)
- fixed-fixed
- cantilever

fixed moveable bridge

hybrid bridge

spring cantilever bridge

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17
Q

what is a fixed-fixed bridge?

A

This type of bridge has a retainer at each end with a pontic in the middle joined by rigid connectors.

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18
Q

what can a fixed-fixed be?

A
  • Adhesive/resin retained
  • Conventional
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19
Q

what is a cantilever bridge?

A

This type of bridge has a retainer (or retainers) at one side of the pontic only

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20
Q

what cana cantilever bridge be?

A
  • Adhesive/resin retained
  • Conventional
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21
Q

what are advantages of resin bonded bridgework?

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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22
Q

what are disadvantages of resin bonded bridgework?

A
  • Rigorous clinical technique
  • Metal shine-through
  • Chipping pocelain
  • Can debond (High chance of it debonding again)
  • Occlusal interferences
  • No trial period possible
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23
Q

what are indications for resin bonded bridgework?

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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24
Q

what are contraindications for for resin bonded bridgework?

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?
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25
Q

when planning treatment what must you establish during history taking?

A

habits e.g bruxism

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26
Q

during a clinical exam for resin bonded bridge what do you exam?

A
  • dynamic occlusal relationships
  • periodontal
  • radiological
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27
Q

what must you do with study models for resin bonded bridgework and what may you consider

A
  • mounted on semi-adjustable articulator with facebow registration
  • may consider diagnostic wax-ups
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28
Q

what must you consider when making a decision on treatment?

A
  • Is bridgework appropriate? (Other options?)
  • Take care if patient is insistent on bridgework
  • Look at: (Abutment teeth, Occlusion, Aesthetics (including soft tissue contour))
  • Can patient maintain this complex work? (Poor OH?)
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29
Q

what is important to check for with a resin bonded bridge in terms of occlusion?

A

Consider opposing dentition
- e.g. Contact points
- Over-eruption of opposing teeth

Is there a parafunctional habit?
- Bruxism (clenching and/or grinding teeth)

Look at dynamic occlusal relationships
- Clinically
- Mounted study models
- Consider diagnostic wax-ups

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30
Q

when to use a direct resin bonded bridge?

A
  • Very useful in emergency situation
  • If tooth needs to be extracted immediately
  • If tooth has been lost traumatically
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31
Q

what do you ideally use when manufacturing a pontic?

A

the patient’s own tooth

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32
Q

what are alternatives to using patient’s own toot when manufacturing a pontic?

A
  • Acrylic ‘denture’ tooth
  • Polycarbonate crown
  • Cellulose matrix filled with composite
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33
Q

for an indirect resin bonded bridge what do you need in terms of palatal/lingual coverage?

A
  • Need generous palatal/lingual coverage
  • Need good quality enamel
  • Keep supra-gingival (Ideal 0.5mm )
  • Care with coverage near incisal edge
    (Enamel translucent (Grey shine through))
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34
Q

why do you need general palatal/llingual coverage?

A

Greater surface area of enamel covered leads to Greater bond

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35
Q

when would you do cantilever or fixed-fixed?

A

anterior - generally cantilever
posterior - generally fixed-fixed

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36
Q

what are considerations in regards to existing restorations in abutment teeth?

A
  • firstly need sound enamel

composite - ok but might need to consider replacing prior to prep

amalgam - compromised bond to chemically cured composite cement so consider replacing

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37
Q

if preparation is required what kind of prep do you do?

A
  • 180 degrees wrap around preparation

rests
-anterior- cingulum rests
- posterior - rest seats

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38
Q

what is supra gignival chamfer finish line for bridge?

A

0.5mm

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39
Q

what are types of preparation for bridges?

A

no prep
minimal prep
heavier prep

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40
Q

how do you do a minimal prep anterior preparation?

A
  • Occlusal contact reduction,
  • Cingulum undercut removal only
  • Chamfer margin (0.5mm supra-gingival)
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41
Q

how do you do a heavier preparation anterior prep?

A

0.5mm palatal reduction(NOTE – metal retainer wing should be 0.7mm thick)
Cingulum rest
+/- Proximal grooves
Chamfer margin (0.5mm supra-gingival)

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42
Q

how do you do posterior preparation?

A
  • Occlusal rests
  • 180º wrap-around with chamfer finish line (0.5mm supra-gingival)
  • +/- Proximal grooves
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43
Q

if prep is into dentine and tooth becomes sensitive in the temporary time what do you do?

A

Cover with layer of dentine bonding agent

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44
Q

why must you fit bridge as quickly as possible?

A

Minimise over-eruption and tooth movement

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45
Q

what is fit surace of retainer?

A

Cobalt chrome or nickel-chromium alloy (typically)

Sandblasted surface
- Micro-mechanical retention
- Aluminium Oxide - 50 microns

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46
Q

what is treatment of retainer?

A

try in
- fit and aesthetics

chairside micro-etching with 50 micron aluminium oxide particles (sandblast)
- should have been done by technician

clean retainer
- ultrasonic bath if required
- use ethanol to ‘degrasse’ if required (reduced surface tension)

apply chemically (or dual cure) cure composite luting cement just prior to placement of restoration after tooth treatment

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47
Q

how would you go about the treatment on the tooth prior to placing retainer?

A
  • Prophylaxis
  • Isolate with dental dam
  • Etch tooth: 37% ortho-phosphoric acid (some preparations are 40%)
  • Wash & dry
  • Apply primer (A and B mixed together) for 30 seconds
  • Air dry for 2 seconds
  • No need to cure (unlike for direct composite restorations)
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48
Q

after treatment of tooth what do you do?

A

Fit retainer (coated with luting cement) to abutment tooth/teeth

Remove excess cement

Oxygen inhibitor (Oxyguard II) placed around cement margins for 3 minutes
- Wash off

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49
Q

what do you do post-cementation?

A

check occlusion
- confirm pontic does not have excessive occlusal forces applied

demonstrate to patient how to clean around and underneath the bridge
- superfloss
- interdental brushes

50
Q

what is longevity for bridges?

A

5 years - 80.8 percent
10 years - 80.4 percent

51
Q

what are advantages of a conventional fixed-fixed bridge?

A
  • Robust design
  • Maximum retention and strength
  • Abutment teeth splinted together ? (Perio cases with mobile teeth)
  • Can be used in longer spans
  • Laboratory construction straightforward
52
Q

what are disadvantages of a conventional fixed-fixed bridge?

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)
53
Q

how many retainers can a cantilever bridge have?

A
  • could have one or more as long as only on one end
54
Q

what are advantages of a cantilever bridge?

A

Conservative design
- Compared to fixed-fixed conventional design

Laboratory construction straightforward

No need to ensure multiple tooth preparations are parallel

55
Q

what are disadvantages of a conventional cantilever bridge?

A
  • Short span only
  • Rigid to avoid distortion
  • Mesial cantilever preferred
56
Q

what is a solution to fixed-fixed designs when abutment teeth are not parallel?

A

fixed moveable bridge
- retainers with separate paths of insertion the bridge is united by a moveable connector

57
Q

what is a fixed-moveble bridge?

A

This type of bridge has a rigid connector usually at the distal end of the pontic and a moveable connector mesially
- Allows some vertical movement at the mesial abutment tooth

58
Q

what are advantages of conventional fixed-moveable bridge?

A
  • Preparations don’t require a common path of insertion
  • Each preparation designed to be retentive independent of others
  • More conservative of tooth tissue
  • Allows minor tooth movement
  • May be cemented in two parts
59
Q

what are disadvantages of conventional fixed-moveable?

A
  • Length of span limited
  • Laboratory construction more complicated
  • Possible difficulty in cleaning beneath moveable joint
  • Can’t construct provisional bridge
60
Q

what is a hybrid bridge?

A

one retainer is conventional preparation the other retainer is minimal preparation (adhesive/ resin retained/ resin bonded)

61
Q

what is spring cantilever bridge?

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

62
Q

what are advantages of conventional spring cantilever bridge?

A
  • Useful if spacing present between upper incisors
  • Where adjacent teeth are unrestored
  • Where a posterior tooth would provide a suitable abutment (i.e. already has a crown/large direct restoration)
63
Q

what are disadvantages of conventional spring cantilever bridge?

A
  • Can only be used to replace upper incisor teeth
  • Difficult to clean beneath palatal connector
  • May irritate the palatal mucosa
  • Difficult to control movement of pontic, due to springiness of metal arm and displacement of palatal soft tissues
64
Q

how do you evaluate abutment?

A

Must be able to withstand the forces previously directed to the missing teeth

Supporting tissues should be healthy and free of inflammation
- i.e. periapical disease and periodontal disease

Crown to root ratio
- length of tooth coronal to alveolar crest compared to length of root embedded in bone. Optimum ratio 2:3. (Minimum ratio 1:1)

65
Q

Bridgework 3

what must be thought of when designing and planning bridges?

A

Minimal preparation or conventional preparation?
- i.e. Conservation of tooth tissue

Material?

Abutment evaluation?

Cleansability
- Bridges will fail if OH isn’t easily performed

Appearance/Aesthetics
- Confirm that the patient’s expectations are achievable

66
Q

how to evaluate potential abutments?

A
  • Root configuration
  • Angulation/rotation of abutment
  • Periodontal health
  • Surface area for bonding & quality of enamel
  • Risk of pulpal damage
  • Quality of endodontics:
    Re-root canal treatment?
  • Remaining tooth structure present?
  • Core (Remove and rebuild?)
67
Q

what is the function of the pontic?

A
  • Restore appearance of missing tooth
  • Stabilise the occlusion
  • Improve masticatory function
68
Q

what are considerations for pontic design?

A

Cleansability
- Should always be smooth, with highly polished or glazed surface
- Surface should not harbour join of metal and porcelain (if metal-ceramic design used)
- Embrasure space smooth and cleansable

Appearance
- Anteriorly - as ‘tooth like’ as possible
- Posteriorly - may compromise

Strength
- Longer the span - Greater the thickness required to withstand occlusal forces

69
Q

what are surfaces of pontic?

A

Occlusal surface
- Resemble surface of tooth it replaces
- Narrower if possible to enable cleaning
- Should have sufficient occlusal contact

Approximal surface
- Connector: strength
- Embrasure: space

Buccal & lingual surface

Ridge surface

70
Q

what are types of pontic designs?

A
  • wash through
  • dome shaped
  • modified ridge lap
  • ridge lap pontic (full saddle pontic)
71
Q

what are types of materials for conventional bridges?

A
  • All metal
    Gold
    Nickel/Cobalt chromium?
    Stainless steal
  • Metal ceramic
  • All ceramic
    Zirconia
    E.g. LAVA and Procera®
    Lithium disilicate
    E.g. - E.max
  • Ceromeric
    BelleGlass™
    Vectris®
    Targis® Vectris®
72
Q

when would you especially use gold material for conventional bridges?

A

lower posterior area

73
Q

what is most common material for conventional bridges?

A

metal ceramic

74
Q

what is properties of LAVA?

A
  • 3-4 unit fixed bridge (max span)
  • withstand occlusal forces
  • good aesthetics
  • similar reduction to MCC
75
Q

what are properties of zirconia?

A
  • preps on casts scanned (straumann)
  • milled
  • +/- feldspathic (layer) porcelain on top
76
Q

what are properties of implant retained bridges?

A
  • large span bridges
  • either screw retained or cement retained
77
Q

what should you consider before prep of conventional bridgework?

A

must have mounted study models

consider diagnostic wax-up and custom impression tray

78
Q

what must you request from lab for preparation of conventional bridgework?

A

to construct a vaccum-formed stent

79
Q

what does a vaccum formed stent allow during construction of bridge?

A
  • checking of reduction during tooth prep
  • construction of provisional bridge
80
Q

what must you aim for when doing a conventional bridgework prep?

A

parallelism of tapered surface of each prep

81
Q

what is parallelism of tapered surface of each prep?

A

it is doing same side of both abutments one after other instead of whole abutment then other abutment for example

82
Q

what is process of prep of conventional bridgework?

A
  • select shade
  • lab made stent or make pre-op putty impression for provisional bridge
  • occlusal or incisal reduction
  • seperation of teeth
  • paralelism of tapered surface of each prep
83
Q

when must you consider parallelism during prep?

A
  • for fixed-fixed conventional bridge
  • requires 2 or more teeth to be prepared in a manner to provide a common path of insertion - increased retention
  • no undercuts
84
Q

why is it important to provide a good common path of insertion?

A

to increase retention

85
Q

when must you consider retentive features during prep of conventional bridge work? and what kind of retentive features?

A

if short clinic crown height or overtapered
- slots
- grooves

86
Q

after parallelism what is next stage of prep?

A
  • Confirm parallelism
  • Consider retentive features if short clinical crown height or overtapered
  • Construct provisional bridge
  • Make impression and occlusal registration
  • Temporarily cement provisional bridge
  • Demonstrate cleaning with Superfloss™
  • Write/draw prescription for technician
87
Q

what do you use for definitive cementation for all metal conventional bridge work and metal ceramic bridgework?

A
  • aquacem (GI luting agent)
  • RelyX luting (RMGI luting agent)
88
Q

what do you use for a definitive cementation for an adhesive/resin bonded/resin retained bridgwork?

A
  • panavia 21 (anaerobic duel cure resin cement with 10-MDP)
89
Q

what do you use for a definitive cementation for an all ceramic bridge?

A

NEXUS (duel cure resin cement)

90
Q

when should you use distal cantilevers and why?

A

avoid if possible

concern that occlusal forces on pontic will produce leverage forces on abutment tooth causing it to tilt

91
Q

when may you consider a distal cantilever?

A
  • may consider distal cantilever from premolar abutment if unopposed or opposed by a denture
92
Q

what are all types of bridges?

A
  • resin bonded/resin retained/adhesive
  • conventional fixed-fixed
  • conventional cantilever
  • implant retained bridge
93
Q

what bridge has best and worst survival rate over 5 and 10 years?

A

best 5 years - implant retained bridge
worst 5 years - resin-bonded

best 10 years - conventional fixed - fixed (metal ceramic)
worst 10 years - conventional cantilever bridge

94
Q
A
95
Q
A
96
Q

what does direct bridgework mean?

A

done chairside

97
Q

what happens when it is an indirect bridgwork?

A

lab work is done

98
Q

what happens during a heavy prep?

A

usually cut into dentine and dentine doesn’t give a good bond as enamel

99
Q

when would you use alternatives for pontic during a direct?

A

when patient loses own tooth

100
Q

explain process of direct resin retained bridge?

A
  • cut root off crown
  • remove any pulpal tissue from crown and pulp chamber
  • etch contact points as well as composite over hole going into pulp chamber
  • etch on interproximal of adjacent teeth
  • prime and bond in areas were etched and place tooth back in and composite areas
  • not long term solution so plan a long term one
101
Q

why is fixed-fixed resin bonded ridge rare?

A

because complication is one of wings debonded which leads to small space which leads to bacteria gets in

102
Q

when would a fixed-fixed resin bonded bridge be used?

A
  • lower anteriors or post ortho
103
Q

why do you use cantilevers more anteriorly?

A

arch of dentition makes it so that occlusal forces on a fixed-fixed will lead to abutment pulling pontics in diff directions leading to debonding of 1 surface and then plaque gets trapped underneath a wing causing caries

104
Q

where is the 180 degrees wrap around prep used?

A

on palatal or lingual surface

105
Q

how deep are occlusal rests?

A

2mm

106
Q

why do you want a fixed-fixed on posterior teeth

A
  • more likely as you want to spread occlusal load over several teeth
107
Q

what do you do during a temporary restoration for prep if they are sensitive?

A

use sensitive toothpaste or prescribe duraphat

108
Q

what does sandblasted do?

A

creates small indentations on fitting surface

109
Q

what do you do during cementation?

A
  • etch abutment tooth
  • apply A and B primer that mixed together apply microbrush about 30 sec. 5 layers on abutment tooth. air thin for sec or 2. it is self curing
  • put resin cement on fitting surface
  • seat it home while starting to set and clean up excess
110
Q

when is there a higher risk of failure for bridges?

A
  • when abutment tooth is smaller than pontic
111
Q

what if there is high occlusal contacts on retaining wings?

A

going to get relative axial tooth movements without any issues of bridge coming off - not ideal situation

112
Q

not ideal but when would a fixed-fixed on upper anteriors with both canines as abutments work?

A
  • a class 2 occlusion or anterior open bite
  • because it wont have much occlusal contact
113
Q

what does overtaper result in?

A

reduced retention

114
Q

what is degree of taper for fixed-fixed?

A

5-7 degrees

115
Q

why is mesial cantilever preferred?

A
  • reason is when patients occlude they are more likely to bite onto posterior teeth before anterior ones
116
Q

what does a wash through pontic do?

A

give patient extra occlusal contact to bite on
more for a lower molar and is for function not appearance

117
Q

when is ovate pontic used?

A
  • for pts with good OH but want best aesthetic result.
  • pushes down onto gingiva and gives look of pontic piercing out of gum
118
Q

what is properties of zirconia and lithium disilicate?

A

ceramic is more likey to fracture than metal
- zirconia - stronger but poorer aesthetic
- lithium disilicate - weaker but better aesthetic

119
Q

what is cerometric and when is it used?

A
  • basically porcelain and composite
  • not really used anymore
120
Q

what would you put on prescription for conventional bridgework to the lab?

A
  • name abutment teeth
  • pontic you want
  • shape of pontic
  • materials want to use
    etc
121
Q

what is difference between adhesive and conventional by how they look?

A

adhesive has a metal wing because of minimal prep
conventional has another crown on top of abutments as it requires significant prep

BDS4 Restorative (7 decks)

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