Bridgework

Question 1

Alternatives to bridges

Answer 1

No Tx
Implants
Close space with ortho
RPD

Question 2

Why should we replace teeth

Answer 2

Aesthetics
Function: mastication/speech
Maintaining dental health of other teeth i.e. tilting of adjacent teeth/overeruption of opposing teeth

Question 3

What is a bridge

Answer 3

Prosthesis which replaces a missing tooth/teeth and is attached to 1 or more natural teeth/implants

Question 4

Types of bridge designs

Answer 4

Adhesive:
cantilever
fixed-fixed
Conventional:
cantilever
fixed-fixed
fixed-movable
hybrid
spring cantilever

Question 5

What is an adhesive bridge

Answer 5

Where the pontic is held by wing retainer(s) on abutment teeth
1 wing=cantilever
2 wing=fixed-fixed

Question 6

What is a conventional bridge

Answer 6

Where the pontic is held by crown retainer(s) on abutment teeth
1=cantilever
2=fixed-fixed

Question 7

General pt indications for using bridge

Answer 7

aesthetics
function: mastication, speech, stability
psychological reasons
systemic diseases e.g. epileptics
cooperative pt

Question 8

Local indications for bridgework

Answer 8

big teeth
heavily restored teeth
favourable abutment angulations/occlusion

Question 9

general pt contraindications for bridgework

Answer 9

uncooperative pt
MH-allergies
Poor OH/caries/periodontal disease
large pulp

Question 10

Local contraindication for bridgework

Answer 10

high chance of further tooth loss
poor prognosis of abutment
length of space too great
ridge form and tissue loss
tilting/rotation of teeth
degree of restoration
PA/PD status

Question 11

Why are fixed-fixed used mostly posterior?

Answer 11

Maxillary anterior teeth have divergent guidance path
Different longitudinal axis
Occlusal forces directed down teeth in different ways
Don’t want to cement these teeth together as can cause jutting of bridge=fail+debond

Question 12

Advantages of adhesive bridges

Answer 12

Minimal/no tooth prep
No LA
Cheaper
Less surgery time
Can be used as provisionals
Less destructive if fails

Question 13

Disadvantages of adhesive bridges

Answer 13

Rigorous clinical technique
Metal shine through
Chipping porcelain
Can debond
Occlusal interference
No trial period possible

Question 14

Indications of adhesive bridges

Answer 14

Younger teeth
Good enamel quality
Large abutment tooth surface area
Minimal occlusal load
Good for single tooth replacement
Simplify RPD design

Question 15

Contraindications of adhesive bridges

Answer 15

Poor enamel quality
Long spans
Excess soft/hard tissue loss
Heavy occlusal force
Partially aligned/tilted/spaced teeth
Contact sports

Question 16

Types of adhesive bridges

Answer 16

Direct: useful for emergency- after extraction/trauma

Indirect: no prep/minimal prep/heavy prep

Question 17

Construction of direct adhesive bridge after trauma

Answer 17

Use pt’s own tooth as pontic
If tooth lost used acrylic denture tooth, polycarbonate crown, cellulose matrix filled with composite

Question 18

Requirements for indirect adhesive bridge

Answer 18

Need large palatal/lingual coverage to increase surface area
Need good enough enamel quality
Keep supragingival (ideal 0.5mm)

Question 19

How to bond adhesive bridge to tooth with existing restoration

Answer 19

Comp: comp bonds to comp- if old, replace to increase chances of success- roughen older comp with ssh

Amalgam: remove and replace with conp

Question 20

What do we use to temporise adhesive bridges with between appts?

Answer 20

RPD
No need if prep remains in enamel
If prep in dentine and tooth sensitive- duraphat or DBA

Question 21

How to improve bond between bridge components and tooth

Answer 21

Fitting surface of tooth is sandblasted(with aluminium oxide of 50 microns thick)

Question 22

Pt OHI for bridge

Answer 22

Superfloss to clean beneath pontic
Tepe brushes

Question 23

Material used to cement adhesive bridges

Answer 23

Panavia 21- anaerobic dual cured resin cement with 10- MDP- helps adhere to metal work