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Restorative > Bridgework > Flashcards

Bridgework Flashcards

1
Q

General indications for bridgework

A

appearance
function
speech
stability
psychological

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2
Q

Local indications for bridgework

A

big teeth
heavily restored
favourable occlusion
favourable abutment angulation

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3
Q

general CONTRA-INDICATIONS for bridgework

A

non co-op pt
med hx
poor OH
high caries rate
Perio disease
Large pulp

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4
Q

local CONTRA-INDICATIONS for bridgework

A

poor abutment prognosis
long length of span
ridge form
tissue loss
further tooth loss in arch

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5
Q

local CONTRA-INDICATIONS for bridgework (2)

A

tilting/ rotation
PA status
Perio status
degree of restoration

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6
Q

abutment

A

tooth that serves as attachment for bridge

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7
Q

pontic

A

artificial tooth suspended from abutment

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8
Q

retainer

A

extra/intra coronal restoration that is connected to pontic that is cemented to abutment

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9
Q

connector

A

connects pontic to retainer

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10
Q

edentulous span

A

space b/w natural teeth to be filled by bridge

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11
Q

saddle

A

area of ridge where pontic will lie

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12
Q

pier

A

abutment that is between two pontics

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13
Q

bridge designs

A

fixed fixed
cantilever

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14
Q

RBB advantages

A

min/ no prep
no aesthetic needed
cheap
less time
provisional
less destructive if fails

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15
Q

RBB disadvantages

A

rigorous clinical technique
metal shine through
chipping porcelain
high chance to debond

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16
Q

RBB indications

A

young teeth
good enamel quality
large abutment S.Area
min occlusal load
single tooth replacement

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17
Q

RBB contraindications

A

poor enamel quality
long span
heavy occlusal load (bruxist)
poorly alligned tooth

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18
Q

Treatment planning

A

ask for habits (bruxism?)
I/O (perio, radiograph)
occlusal relationship
study models (diagnostic wax up)

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19
Q

occlusion criteria?

A

opposing contact point
over eruption of opposing?
bruxism?
diagnostic wax up/mounted study model

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20
Q

when to use direct RBB

A

useful for A&E situation
immediate XLA
tooth lost to trauma

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21
Q

Indirect RBB

A

no prep
min prep
heavy prep (undesirable)

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22
Q

Pontic type

A

pt own tooth
acrylic denture tooth
prolycarb crown
cellulose matirx w/ composite

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23
Q

RBB palatal/lingual coverage

A

greater coverage = greater bond
0.5mm supragingival
care w/ incisal edge (metal shine through)

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24
Q

anterior bridge

A

cantilever design
(divergent guidance paths)

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25
Q

posterior bridge

A

fixed-fixed design

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26
Q

existing restoration on abutment

A

need sound enamel
composite ok
replace amalgam (poor bond to cement)

27
Q

general preparation criteria

A

180* wrap around
rest seats (post)
cingulum rest (ant)
chamfer finish line 0.5mm

28
Q

anterior min preparation

A

cantilever
occlusal contact reduction
cingulum undercut removed
chamfer 0.5mm supra

29
Q

anterior heavy prep

A

0.5mm palatal reduction
cingulum rest
+/- proximal groove
chamfer 0.5mm supra

30
Q

posterior preparation

A

prefer fixed-fixed
180* wrap around
0.5mm chamfer supra
+/- proximal groove

31
Q

temporisation

A

prep into dentine? cover w/ DBA
remove before definitive

32
Q

retainer properties

A

0.7mm thick
co-cr/ ni-cr
sandblast fit surface w/ aluminium oxide (50microns)
micro-mechanical retention

33
Q

cementation

A

ethanol to degrease wing (reduces surface tension)
Panavia 21 EX

34
Q

Cementation steps

A

prohylaxis
dental dam isolation
etch 37% ortho-phosphoric acid
wash/dry
apply primer 30 secs
air dry 2 secs
no cure needed
fit retainer w/ cement
remove extra
Oxyguard II for 3 mins (wash off)

35
Q

Post cementation

A

check occlusion (make sure min force)
superfloss and Interdental post-op

36
Q

survival rate

A

5 year - 80.8%
10 year - 80.4%

37
Q

conventional bridge designs

A

fixed - fixed
fixed cantilever
fixed moveable
hybrid bridge
springe cantilever

38
Q

conventional fixed fixed advantages

A

robust design
max retention and strength
easy lab work
can use in long spans

39
Q

conventional fixed fixed disadvantages

A

difficult prep (parallel prep)
min taper (5-7*)
common path of insertion
risk of pulp damage

40
Q

conventional cantilever advantages

A

conservative design
easy lab work

41
Q

conventional cantilever disadvantages

A

short span only
rigid (avoid distortion)
mesial cantilever preferred

42
Q

fixed moveable bridge

A

rigid connector distal
moveable connecter mesially

43
Q

fixed moveable bridge advantages

A

no need for common insertion path
conservative of tissue
cemented in 2 parts
minor tooth movement

44
Q

fixed moveable bridge advantages

A

limited length of span
complicated lab work
difficulty in cleaning moveable joint

45
Q

spring cantilever advantages

A

spacing b/w upper incisors
adjacent tooth unrestored
post tooth suitable abutment (heavy restoration already)

46
Q

spring cantilever advantages

A

upper incisor replacement only
hard to clean under palatal connector
palatal mucosa irritation
hard to control movement of pontic due to springiness of arm and displaced palatal tissue

47
Q

abutment evaluation

A

able to withstand forces
supporting tissue free of inflammation (PA/ Perio pathology)
crown to root ratio 2:3 / 1:1

48
Q

Occlusal information to check?

A

Incisal class
Canine guided or group function
Over eruption of opposing tooth
Will bridge affect occlusion
Parafunction signs

49
Q

What to look out for in a possible abutment?

A

Root configuration
Angulation/ Rotation of root
Perio health
Surface area for bonding
Risk of pulpal damage

50
Q

Types of pontic designs

A

Wash through pontic
Dome pontic
Modified ridge lap
Total ridge lap pontic
Ovate pontic

51
Q

Considerations for pontic designs

A

Cleansibility
1. Smooth and highly polished surface
2. Smooth embrasure space

Appearance
1. As tooth like as possible anteriorly

Strength
1. Longer span greater thickness

52
Q

Wash through pontic

A

Makes no contact with soft tissue
Function> appearance
Lower molar area

53
Q

Dome shaped

A

Lower incisor/ premolar/ upper molar areas
Acceptable if occlusal 2/3 buccal surface visible

54
Q

Modified ridge lap

A

Buccal surface looks as much as tooth
Lingual surface cut away
Line contact with buccal of ridge
Food packing on lingual surface

55
Q

Ridge lap

A

Greatest contact with soft tissue
Less food packing
Good design can be cleaned
Care needed to prevent blanching of tissue

56
Q

Ovate pontic

A

Excellent aesthetics
More difficult to clean in perio/ caries/ inflammation
Cannot fully seat if poorly designed

57
Q

Materials for bridges

A

Metal (Gold, Ni-Cr, SS)
Metal ceramic
Ceramic (Zirconia, Lithium Disilicate)
Ceromeric ( BelleGlass, Vectris)

58
Q

LAVA 3M ESPE Bridge

A

3-4 unit (max span) milled zirconium oxide with feldspathic porcerlain
Good aesthetics
Similar reduction MCC
Withstand occlusal forces well

59
Q

Zirconia

A

Katana zirconia is ultra translucent multilayer (UTML)
Milled
With or without feldspathic porcelain` layer on top

60
Q

Implant retained bridges

A

For large spans
Either screw/ cement retained

61
Q

Preparation of Conventional Bridgework

A
  1. Mounted study models
  2. Consider diagnostic wax up and custom impression tray
  3. Ask lab for vacuum stent (for tooth prep and provisional)
  4. Select shade
  5. Pre-op putty
  6. Reduction
  7. Separation
  8. Aim for parallelism and confirm
  9. Construct provisional
  10. Impression and occlusal registration
  11. Demo cleaning with super-floss
  12. Write prescription for technician
62
Q

Parallelism

A

Increases retention
No undercuts
By direct vision
Use a straight right angle probe

63
Q

What definitive cementation to use?

A

All metal and metal ceramic:
Aquacem (GI Luting cement)
RelyX (RMGI Luting cement)

Adhesive resin:
Panavia 21 (anaerobic dual cure resin cement with 10-MDP)

All ceramic:
NEXUS kit (dual cure resin cement)

64
Q

Distal cantilevers

A

AVOID if possible
High occlusal forces on pontic will leverage abutment causing it to tilt
Consider from premolar abutment if opposed by a denture or unopposed.

Restorative (2 decks)

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