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BDS4 Restorative > Bridgework > Flashcards

Bridgework Flashcards

1
Q

What are our txt options for a missing tooth?

A
  • No txt
  • Orthodontic
  • Replace missing tooth
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2
Q

What are some reasons for replacing a missing tooth?

A
  • Aesthetics
  • Function
  • Speech
  • Maintenance of dental health (i.e. other tooth)
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3
Q

What are some options to replace missing teeth?

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

Why might a denture be preferred to a bridge?

A
  • When soft tissue needs to replaced or not much bone is there
  • Denture can replace these whereas bridge not as much
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6
Q

What are some indications for bridgework?

A
  • Function and stability
  • Appearance
  • Speech
  • Psychological (may not cope with removable prosthesis
  • Systemic disease e.g. epileptics
  • Co-operative pt
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7
Q

What are some local indications for bridgework?

A
  • Big teeth
  • Heavily retsored teeth
  • Favourable abutment angulations
  • Favourable occlusion (not too heavy contact as will come out)
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8
Q

What are some contra-indications for bridework?

A
  • Uncooperative pt
  • Medical history contra-indications (allergy to metal being used)
  • Poor oral hygiene
  • High caries rate
  • Large pulps (young pts likely to become non vital )
  • High possibility of further tooth loss within arch
  • Prognosis of abutment poor
  • Length of span too great (long bridges flex more when pt bites down)
  • Ridge form and tissue loss
  • Tilting and rotation of teeth
  • Degree of restoration (how much tooth is left after prep)
  • Periapical status
  • Active periodontal disease (bone loss - can’t receive additional occlusal force)
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9
Q

What is the definition of abutment?

A
  • A tooth which serves as an attachment for a bridge
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10
Q

What is the definition of a Pontic?

A
  • The artificial tooth which is suspended from the abutment teeth/tooth
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11
Q

What is the definition of Retainers?

A
  • The extracoronal or intracoronal restorations that are connected to the pontic and cemented to the prepared abutment teeth
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12
Q

What is the definition of connectors?

A
  • Componet whihc connects the pontic to the retainers/retainer
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13
Q

What is the definition of edentulous span?

A
  • Space between natural teeth that is to be filled by a bridge or partial denture
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14
Q

What is the definition of saddle?

A
  • Area of edentulous ridge over which the pontic will lie
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15
Q

What is the definition of 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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16
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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17
Q

What is a foxed-fixed bridge?

A
  • Type of bridge which has a retainer at each end with a pontic in the middle joined by rigid connectors
  • e.g. retainer - pontic - retainer
  • Can be Conventional or Adheshive/resin retained
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18
Q

What is a Cantilever bridge?

A
  • Type of bridge which has a retainer (or retainers) at one side of the pontic only
  • E.g. retainer - pontic
  • Can be conventional or adhesive/resin retained
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19
Q

What are Resin Bonded Bridgework (RBB) also known as?

A
  • Resin retained bridges
  • Adhesive bridgework
  • Minimal preparation bridgework
  • Maryland bridge
  • Resin bonded fixed partial denture
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20
Q

What are the two examples of Adhesive cantilever bridges?

A
  • All ceramic adhesive bridge
  • Traditional adhesive bridge with metal (CoCr) wing
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21
Q

What are some advantages of resin bonded bridges?

A
  • Minimal or no prep needed
  • No anaesthetic needed
  • Less costly
  • Less surgery time
  • Can be used as a provisional restoration (useful if pt child has hypodontia and are wanting a implant later on in life)
  • When it fails usually less destructive than alternatives
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22
Q

What re some disadvantages of resin bonded bridges?

A
  • Rigorous clinical technique (extensive moisture control needed)
  • Metal shine through occurs (less aesthetic)
  • Porcelain can chip from pontic
  • Can de bond (high chance of it debonding again if just re bonded back on)
  • May have occlusal interferences (more common with dynamic interference)
  • No trial period possible
23
Q

What are some indications of resin bonded bridges?

A
  • Young teeth (less destructive)
  • Good enamel quality
  • Large abutment tooth surface area
  • Minimal occlusal load
  • Good for single tooth replacement
  • Used to simplify partial denture deisgn
24
Q

What some contra-indications of resin bonded 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 ?
25
Q

Advantages to Direct resin bonded bridgework?

A
  • Very useful in emergency situation
  • If tooth needs to be extracted immediately
  • If tooth has been lost traumatically
26
Q

Advantages to Indirect resin bonded bridgework?

A
  • No prep needed or minimal needed
27
Q

What is a Direct resin bonded bride?

A
  • Ideally use pt own tooth as a pontic
  • Or can use Acrylic ‘denture’ tooth / Polycarbonate crown / Cellulose matrix filled with composite
  • Temp fix, better than pt having a hole / gap in between teeth
28
Q

What is an indirect resin bonded bridge?

A
  • Bridge with metal work on palatal, lingual coverage with 0.5mm supra-gingival left over
  • A greater surface of enamel covered therefore a greater bond
29
Q

What design of bride would you choose for Anteriors and Posteriors?

A

Anteriors - Generally cantilver design
Posteriors - Generally fixed-fixed

30
Q

Why do cantilever bridges generally work better for anterior teeth?

A
  • Divergent guidance path
31
Q

What can you do if there is existing restorations in abutment teeth?

A
  • Ideally need sound enamel
  • Composite restoration can be removed and replaced prior to prep so it has a better bond to the bridge
  • Amalgam has a compromised bond to chemically cured composite on the bridge, therefore consider replacing with comp
32
Q

What is the preparation technique for RBB if any is needed at all?

A
  • 180degree warp around prep
  • Rest seats in posterior (2mm) and cingulum rests in anterior teeth for mechanical retention
  • Can use proximal grooves if desired
  • Supra-gingival chamfer line approx 0.5mm (more easily cleansable for pt)
  • Remain in enamel as better bond than dentine
33
Q

What is the minimal prep if it is needed for cantilever design for anterior?

A
  • Occlusal contact reduction
  • Cingulum undercut removal only
  • Chamfer margin 0.5mm supra-gingivally
34
Q

What is the Heavier preparation for cantilever design if it is needed for anterior ?

A
  • 0.5mm palatal reduction (metal retainer wing should be 0.7mm thick)
  • Cingulum rest cut it
  • Proximial grooves
  • 0.5mm chamfer margin supra-gingival
35
Q

What should the fit surface of the metal retainer been done before you fit?

A
  • CoCr or Ni-Cr alloy should have been sandblasted by lab
  • Increases micro-mechanical retention
  • Use Aluminium oxide about 50 microns thick to sandblast
  • Improve bond between retoration and tooth
36
Q

What is the process for cementing the bridge?

A
  • Prophylaxis
  • Isolate with dental dam
  • Etch tooth 37% ortho-phosporic acid
  • Wash and dry
  • Apply primer for 30 sec
  • Air dry 2 sec and don’t cure
  • Fit retainer coated with luting cement (PANAVIA2 IEX) to abutment tooth/teeth
  • Remove Xs cement
  • Oxygen inhibitor (oxyguard II) placed around cement margins for 3 mins and wash off
37
Q

What is the 5 year and 10 year survival of RRB?

A

5 - 80.8%
10 - 80.4%

38
Q

What does conventional in bridge design mean?

A
  • Retainer (s) = crown
39
Q

What are some conventional fixed-fixed bridge advantages?

A
  • Robust design
  • Maximum retention and strength
  • Abutment teeth splinted together (good for perio cases with mobile teeth)
  • Can be used in longer spans
  • Lab construction is straightforward
40
Q

What are some conventional fixed-fixed bridge disadvantages?

A
  • Preparation difficult (parallel tooth preps needed)
  • Prep must be minimally tapered
  • Common path of insertion for abutments which can create issues when abutment teeth are not parallel
  • Removal of tooth tissue so danger to pulp
41
Q

What is a cantilever bridge?

A
  • Type of bridge provides support for the pontic at one end only
  • Can use conventiona/crown retainer OR adhesive/resin retained with metal wing
  • Pontic may be connected to one or more retainers
42
Q

What are some conventional cantilever bridge advantages?

A
  • Conservative design compared to fixed-fixed conventional design
  • Lab construction straightforward
  • No need to ensure multiple tooth prep are parallel
43
Q

What are some conventional cantilever disadvantages?

A
  • Short span only
  • Rigid to avoid distortion
  • Mesial cantilever is preferred but not always possible
44
Q

What is a potential solution to the common path of insertion issue in fixed-fixed moveable bridge?

A
  • Reatiners with separate paths of insertion
  • Bridge is united by a moveable connector
45
Q

What is a fixed-moveable bridge ?

A
  • Type of bridge has a rigid connector usually at distal end of pontic and moveable connector mesially
  • Allows for some vertical movement at the mesial abutment tooth
46
Q

What are some conventional fixed-moveable bridge advantages?

A
  • Preps don’t require common path of insertion
  • Each preps designed to be retentive independent of others
  • More conservative of tooth tissue
  • May be cemented in two parts
47
Q

What are the conventional fixed-moveable bridge disadvantages?

A
  • Length of span limited
  • Lab construction more complicated
  • Possible difficulty in cleaning beneath moveable joint
  • Can’t construct provsiional bridge
48
Q

What is Hybrid bridge?

A
  • One retainer = conventional prep
  • Other retainer with minimal prep (adhesive/resin retained/ resin bonded)
49
Q

What is a spring cantilever bridge?

A
  • One pontic attached to end of metal arm that runs across the palate to a rigid connector on palatal side retainer
50
Q

What are some conventional spring cantilever bridge advantages?

A
  • useful if spacing present between upper incisors
  • Where adjacent teeth are unrestored
  • Where a posterior tooth would provide a suitable abutment (i.e.e already has a crown/large direct restoration)
51
Q

What are some conventional spring cantilever bridge disadvantages?

A
  • Can only be used to replace upper incisor teeth
  • Difficlut to clean beaneth palatal connector
  • May irritate palatal mucosa
  • Difficult to control movement of pontic, due to springiness of metal arm and displacement of palatal soft tissues
52
Q

What are the important criteria for an abutment evaluation?

A
  • Must be able to withstand forces previously directed to missing teeth
  • Supporting tissue healthy and free of inflammation i.e. PA 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 , min ratio 1:1
53
Q
A

BDS4 Restorative (1 decks)

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