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BDS4 Exam Perp > Bridgework > Flashcards

Bridgework Flashcards

1
Q

What are the 3 broad treatment options for a missing tooth?

A
  • no treatment
  • Replace tooth
  • Close space (orthodontics)
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2
Q

4 reasons for treating tooth loss

A
  • Aesthetics
  • Function
  • Speech
  • Maintain dental health
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3
Q

3 ways to replace teeth?

A
  • Denture
  • Bridgework
  • Implants
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4
Q

What is a bridge?

A

A prosthesis which replaces missing tooth or teeth that is attached to one or more natural teeth (or implants)

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5
Q

What are the 2 types of bridgework?

A
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6
Q

What are 6 general indications for bridgework?

A
  • Function and stability
  • Appearance
  • Speech
  • Psychological reasons
  • Systemic disease
  • Co-operative patient
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7
Q

What systemic disease might be an indication for replacing missing teeth by a bridge?

A
  • Epilepsy
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8
Q

What are 4 local indications for bridgework?

A
  • Big teeth
  • heavily restored teeth
  • Favourable abutment angulations
  • Favourable occlusion
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9
Q

What are 7 general contraindications for bridgework?

A
  • uncooperative patient
  • Medical history contrainfdications
  • Poor oral hygiene
  • High caries rate
  • Periodontal disease
  • Large pulps for conventional bridge
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10
Q

What are 8 local contraindications for bridgework?

A
  • High possibility of tooth loss within arch
  • Poor prognosis of abutment teeth
  • Long spans
  • Ridge form and tissue loss
  • Tilting and rotation of teeth
  • Degree of restoration
  • PA status
  • Periodontal status (bone loss)
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11
Q

What is an abutment?

A

tooth serves as an attachment for a bridge

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12
Q

What is a pontic?

A

Artificial tooth which is suspended from the abutment/s

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13
Q

What is a retainer?

A

The extracoronal or intracoronal restorations that is connected to the Pontic and cemented to the prepared abutement tooth

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14
Q

What is connectors in bridgework?

A

Component that connect the pontic to the retainer

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15
Q

What is the edentulous span?

A
  • Space between natural teeth to be replaced
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16
Q

What is a saddle?

A

Area of edentulous ridge where the pontic will sit

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17
Q

What is pier?

A

An abutement tooth which is supporting two pontics

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18
Q

What is Unit?

A

Either a pontic or a retainer

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19
Q

What are the two types of bridge designs?

A
  • Fixed-Fixed : R-P-R
  • Cantilever : R-P
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20
Q

What two materials can retainers be in adhesive bridges?

A
  • Ceramic
  • Metal : CoCr, NiCR
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21
Q

What are 6 advantages of adhesive cantilever bridges?

A
  • Minimal or no preparation
  • No LA
  • better cost
  • less surgery time
  • Can be used as provisional restoration
  • Less destructive if it fails
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22
Q

What are 6 disadvantages of Cantilever adhesive bridges?

A
  • Advanced clinical technique
  • Metal can shine through
  • Chipping of porcelain
  • Can debond
  • Occlusal interference
  • No trial period possible
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23
Q

What are 6 indications of adhesive cantilever?

A
  • young teeth
  • good enamel quality
  • large surface area of abutment tooth
  • minimal occlusal load
  • single tooth replacement
  • simplify partial denture design
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24
Q

What are 6 contraindications for adhesive cantilever bridge?

A
  • Poor quality of enamel
  • long spans
  • Contact sports
  • bruxism
  • Soft or hard tissue loss
  • tilted or spaced teeth
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25
Q

What part of the history is important when making an adhesive cantilever bridge?

A

Parafunctional habits : bruxism

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26
Q

What part of the denal history is important when assessing a patient suitability for adhesive cantilever bridge work other than parafunctional habits:?

A

Oral hygiene

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27
Q

What Special investigations would you carry out when making an adhesive cantilever bridge?

A
  • Mounted study casts
  • Radiographs ( Pa, OPT?)
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28
Q

3 indications of direct resin bonded bridge?

A
  • very useful in emergency situations
  • if tooth needs to be extracted immediately
  • traumatic tooth loss
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29
Q

Patient comes to you as emergency , his tooth was fractured at the cervical margin, and you decide to make a direct adhesive cantilever bridge to replace the space, what will you use as a pontic?

A

Patient own tooth

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30
Q

Patient comes to you as emergency , his tooth was fractured at the cervical margin, and you decide to make a direct adhesive cantilever bridge to replace the space, How will you do that with the patient own tooth?

A
  • Acid etch patient tooth and abutement teeth at the contact points
  • Use composite to support the tooth between the two abutments
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31
Q

What other alternatives other than the patient tooth as a pontic for direct bridgework?

A
  • Acrylic denture tooth
  • Polycarbonate crown
  • Cellulose matrix filled with composite
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32
Q

How much space do you need supragingivally on an abutment tooth for an indirect resin bonded bridge?

A

0.5mm

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33
Q

What factors of an abutement tooth indicates better bond in indirect resin bonded bridge?

A
  • Large lingual/palatal surface area of enamel on abutement
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34
Q

Why should you avoid coverage of indirect RRB near incisal edges?

A
  • Because enamel is translucent in that area and metal can shine through
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35
Q

What bridge design is ideal for anteriors?

A
  • Cantilever
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36
Q

What bridge design is ideal for posterior teeth?

A

fixed-fixed

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37
Q

Why cantilevers are more successful anteriorly?

A

Due to divergent guidance paths of anterior teeth , making a fixed fixed design more likely to debond

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38
Q

Why should amalgam be replaced on an abutment tooth when placing an RBB bridge ?

A

Poor bond to chemically cured composite cement

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39
Q

4 characteristics of preparing abutment tooth for RRB if required?

A
  • 180 wrap around preparations
  • Rests ( seats for posterior , cingulum anteriors(
  • 0.5mm chamfer finish supra gingivally
  • Preparation should remain in enamel
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40
Q

What are 3 steps in minimally preparing an anterior abutment for RRB?

A
  • Occlusal contact reduction
  • Cingulum undercut removal
  • 0.5mm supra-gingival chamfer margin
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41
Q

What are 3 steps for a heavy RRB preparation in an anterior abutement tooth?

A
  • 0.5 mm palatal/ lingual reduction
  • Cingulum rest
  • 0.5mm supragingival chamfer margin
  • can add proximal grooves
42
Q

What is the minimum thickness of the metal in RRB?

A

0.7mm

43
Q

How to prepare a posterior tooth for bridgework?

A
  • 180 wrap around
  • Occlusal rests
  • 0.5 supragingival chamfer finish
  • can add proximal groove
44
Q

How to manage a tooth if the preparation goes into dentine?

A
  • cover with DBA if tooth becomes sensitive
45
Q

2 reasons why you should fit the bridge as quickly as possible?

A
  • minimise overeruption
  • minimise tooth movement
46
Q

What can you use for temporising a bridge?

A

Consider RPD

47
Q

How can you increase the bond of an RRB retainer ?

A

Sandblast with aluminum oxide (50 microns)

48
Q

What type of bond is created with a sandblasted RRB retainer?

A

Micro-mechanical bond

49
Q

How would you clean the retainer after trying it in if it has been contaminated with unset composite?

A
  • Ultrasonic bath
  • Ethanol to degrease
50
Q

What is the function of degreasing the tooth by ethanol if contaminated?

A

Reduce surface tension

51
Q

What cement would you use to cement a resin bonded bridge?

A
  • Chemically or dual cure composite luting cement
52
Q

What would you place around cement margins when cementing a bridge?

A

Oxyguard II gel for 3 minutes

53
Q

What is oxyguard gel?

A

Oxygen inhibitor

54
Q

What should you check after cementing a bridge?

A
  • Check occlusion - ensure no high occlusal load on pontic
  • Demonstrate how to clean around and underneath bridge
55
Q

What would you advice the patient to use for cleaning around and underneath the bridge (2)?

A
  • Superfloss
  • Interdental brushes
56
Q

What are the survival rate of RRB in 5 and 10 years?

A

5 - 80.8%
10 - 80.4%

57
Q

Give 5 examples of bridge designs with conventional component?

A
  • Fixed-Fixed
  • Fixed-cantilever
  • Hybrid bridge
  • Fixed-moveable
  • Spring cantilever
58
Q

What are 5 advantages of conventional fixed-fixed bridges?

A
  • Robust design
  • Maximum retention and strength
  • Abutement teeth splinted together - good in mobile teeth
  • Can be used for longer spans
  • Easy lab construction
59
Q

4 disadvantages of conventional fixed-fixed bridges?

A
  • difficult preparation ( parallel tooth prep)
  • Preparation must be minimally tapered
  • Removal tooth tissue (pulp damage?)
  • Common path of insertion needed for abutements
60
Q

What are 3 advantages of conventional cantilever bridge?

A
  • Conservative
  • Easy laboratory construction
  • No need for parallel tooth preparations
61
Q

What are 3 disadvantages of conventional cantilever

A
  • Used for short span only
  • Rigid (to avoid distortion)
  • Mesial cantilever is preferred
62
Q

What bridge design may be an alternative for conventional fixed-fixed design when parallel tooth preparation is not possible due to different path of insertion of one abutement ?

A
  • Fixed-moveable bridge
  • Have a dovetail on bridge and slot on abutment
63
Q

Describe a fixed moveable bridge?

A

rigid connector on the distal of pontic and a moveable connector at the mesial to allow some vertical movement on the mesial end

64
Q

What are 5 advantages of fixed moveable bridges?

A
  • Preparations do not require common path of insertion
  • Each preparation is retentive independently
  • More conservative to tooth tissue
  • Allow minor tooth movement
  • Can be cemented in two parts
65
Q

What are 4 disadvantages of fixed moveable bridge?

A
  • Limited length of span
  • Complicated laboratory construction
  • Difficulty cleaning beneath moveable joint
  • No provisional bridge
66
Q

What is a hybrid bridge?

A

A bridge with one conventional retainer and other minimal preparation retainer (adhesive)

67
Q

What is a spring cantilever bridge?

A

One pontic that is attached to a metal arm that runs across the palate to a rigid connector on the palatal side of the retainer

68
Q

What are 3 advantages of a spring cantilever bridge?

A
  • Replace space between upper incisors
  • where adjacent teeth not restored
  • where a posterior would be a suitable abutement (have a crown or a large direct restoration)
69
Q

What are 4 disadvantages of a 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
  • Difficulty to control movement of pontic (due to springiness of metal arm and displacement of palatal mucosa)
70
Q

What are 3 ideal properties of an abutement tooth in conventional bridgework?

A
  • Must withstand forces previously directed to the missing teeth
  • Healthy supporting tissue and free of inflammation
  • 2:3 crown to root ratio , minimum 1:1 crown to root ratio
71
Q

What type of study casts would you take for a bridge?

A

Face-bow mounted study casts on a semi-adjustable articulator

72
Q

5 things to note about the patient occlusion when designing a bridge?

A
  • Incisal classification
  • Guidance (canine or group function)
  • Opposing tooth (if overerupted)
  • Occlusal interference of bridge
  • Signs of parafunctional habits (wear, attrition)
73
Q

What 3 functions of the pontic in bridges?

A
  • Restore appearance of missing tooth
  • Stabilise the occlusion
  • Improve masticatory function
74
Q

What 3 things to consider when choosing a pontic design?

A
  • Cleansability
  • Appearance
  • Strength
75
Q

3 ways to achieve cleansability in the pontic design?

A
  • Always smooth with glazed surface
  • Surface should not harbour join of procelain and metal at occlusal contacts
  • Embrasure space should be smooth and cleansable
76
Q

What affects the decision of thickness of pontic design?

A

The length of the span , as the longer the thicker

77
Q

Which surface of the pontic should be the narrowest? and why?

A

Occlusal surface to enable cleaning

78
Q

What is on the approximal surface of the pontic?

A
  • Connector - strength
  • Embrasure - space
79
Q

What are 5 types of pontic designs?

A
  • Wash-through
  • Dome pontic
  • Modified ridge lap pontic
  • Ridge lap pontic
  • Ovate pontic
80
Q

What is wash-through pontic

A
  • Makes no contact with soft tissue
  • Good function and easy to clean
  • Consider in lower molar area due to its poor aesthetics
81
Q

What is Dome-shaped pontic?

A
  • Bullet shaped
  • lower incisors, premolar or upper molar area
  • Acceptable if 2/3 of buccal surface is visible
82
Q

What is modified ridge lap pontic?

A
  • Buccal surface looks as much like as tooth as possible
  • Lingual surface is cut away
  • Line contact with buccal of ridge
83
Q

What problems may be encountered with modified ridge lap ?

A
  • food packing in lingual surface of ridge
84
Q

What are 2 advantages of modified ridge lap design?

A
  • Good aesthetic on buccal aspect
  • Good cleans-ability of the lingual side
85
Q

What a ridge lap / saddle pontic?

A
  • Greatest contact with soft tissue
  • Can be cleaned if designed carefully
86
Q

Disadvantages of ridge lap pontic?

A
  • Need optimum oral hygiene
  • May cause blanching of soft tissue
87
Q

What are the advantages of ridge lap pontic?

A
  • Good aesthetics
  • Less food packing than modified ridge lap
88
Q

What materials are used in bridgework? (4)

A
  • All metal - Gold, NiCr, CoCr, SS
  • Metal ceramic
  • All ceramic - zirconia , lithium disilicate
  • Ceromeric - porcelain + composite
89
Q

Where to use metal and why?

A

Lower posterior area especially gold
* Can withstand occlusal forces
* No high aesthetic demand

90
Q

What material are majority of bridges made of?

A
  • Metal ceramic
    Metal for strength and ceramic for aesthetics
91
Q

2 methods of implant retained bridges?

A
  • Screw retained
  • Cement retained
92
Q

What would you request from the lab to construct during preparation? and why?

A
  • vacuum formed stent
  • allow checking reduction during preparation
  • allow construction of provisional bridge
93
Q

Ways to achieve parallelism during preparation of bridgework?

A
  • By direct vision - one eye closed ,mouth mirror, using a probe like a surveyor
  • By surveyed cast extra-orally
94
Q

How to increase retention in preparing for bridgework?

A
  • Slots
  • Grooves
95
Q

What would you use to cement all metal conventional bridge?

A

GI or RMGI luting cement

96
Q

What would you use for a metal ceramic bridge cementation?

A

GI or RMGI luting cement

97
Q

What cement would you use to cement RRB?

A

Anaerobic duel cure resin cement with 10-MDP

98
Q

What cement would you use to cement all ceramic cement?

A

Duel cure resin cement

99
Q

Why should you avoid distal cantilever designs?

A

because occlusal forces on Pontic will produce leverage forces on abutment tooth causing it to tilt

100
Q

When might you consider distal cantilever?

A
  • In shortened dental arch situation
  • From premolar if unopposed or opposed by a denture
101
Q
A

BDS4 Exam Perp (72 decks)

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