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BDS4 Restorative > Bridgework 3 > Flashcards

Bridgework 3 Flashcards

1
Q

What are the treatment options to offer the patient as an alternative to bridges?

A

No restoration
Denture(s)
Implants(s)

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2
Q

What is involved in holistic treatment planning for Bridgework?

A

Look at the whole mouth

Not only at a specific tooth

Plan for retrievability (always have a back-up plan)- consider remaining options as deterioration occurs each time (replacement not like for like)

What will the dentition be like in 10-years- 90% success rate over this time

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3
Q

What are the occlusal considerations for bridgework

A

Incisal classification

Canine-guided or group function

Are opposing tooth over-erupted?

Will bridge interfere with current occlusion?

Signs of parafunction- wear facets, attrition

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4
Q

How can occlusal information be analysed?

A

Look intra-orally

Produce study models and mount using face bow

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5
Q

What are the considerations when planning and designing bridges?

A

Minimal preparation or conventional preparation- conservation of tooth tissue

Material- Ceramic, MC

Abutment evaluation

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

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

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6
Q

What is considered in an abutment evaluation?

A

Amount of tissue remaining (would crown lengthening be helpful?)

root configuration (larger and multirooted teeth are better)

Absence of pulpal/periodontal/periapical path.

Angulation/rotation

RCT quality evaluation- redo if required

Surface area for bonding and Enamel Quality

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7
Q

What developmental disorder can cause issues with bonding?

A

Amelogenesis imperfecta

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8
Q

What are the steps in bridgework design?

A

Select abutments- judge longevity of adjacent teeth

Select retainer- consider preparation

Select pontic and connector

Plan occlusion

Prescribe material

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9
Q

What are the types of pontic design?

A

Sanitary/Wash-through pontic

Dome/Bullet/Torpedo

Modified ridge lap

Total ridge lap

Ovate pontic

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10
Q

What is the function of a pontic?

A

Restore appearance of missing tooth

Stabilise the occlusion

Improve masticatory function

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11
Q

What are the considerations for pontic design?

A

Cleansability:
-> Should always be smooth, with highly polished or glazed surface (prevents plaque adherence)
-> Surface should not harbour join of metal and porcelain (if metal-ceramic design used)
-> Embrasure space smooth and cleansable (reduce if highly aesthetic case)

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

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

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12
Q

What are the surfaces of a Bridge?

A

Occlusal surface- Resemble surface of tooth it replaces, should have sufficient occlusal contact

Approximal surface- Connector: strength, Embrasure: space

Buccal & lingual surface

Ridge surface

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13
Q

What are the features/uses of Wash Through pontics?

A

Makes no contact with soft tissue

Functional rather than for appearance- gives another occlusal surface to bite on

Consider in lower molar area

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14
Q

What are the features/uses of dome pontics

A

Useful in lower incisor, premolar or upper molar areas

Acceptable if occlusal 2/3 of buccal surface visible (appears tooth like)- Poor aesthetics if gingival 1/3 of tooth visible (narrower)

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15
Q

What are the features and uses of Modified Ridge lap pontic?

A

Buccal surface looks as much like tooth as possible- good facial aesthetics

Lingual surface cut away- may allow better cleaning (or does it create food trap)

Line contacts with buccal of ridge

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16
Q

What are the features of Ridge Lap pontics (full saddle)?

A

Greatest contact with soft tissue

If designed carefully: can be cleansed

Less food packing than ridge-lap

Care taken not to displace soft tissue or cause blanching of tissue

17
Q

What are the features of Ovate Pontics?

A

Best aesthetics- tooth looks like it has erupted from gum

Requires meticulous OH

18
Q

How does an Ovate pontic work?

A

Presses down on gingivae and remoulds it to make it look natural
->Requires essix retainer with ovate tooth beforehand, composite can be added to this to control tissue remodelling

19
Q

What are the different materials that can be used to make bridges?

A

All metal- Gold , Nickel/Cobalt chromium, Stainless steel

Metal ceramic (most common)

All ceramic- Zirconia
E.g. LAVATM and Procera®
Lithium disilicate
E.g. - E.max

Ceromeric- BelleGlass™, Vectris® , Targis® Vectris®

20
Q

What are the advantages/disadvantages of Gold Bridges?

A

ADV- strong, malleable (good in posteriors)

DIS- expensive, not tooth coloured

21
Q

What are the advantage/disadvantages of all ceramic bridges

A

ADV:
Excellent aesthetic (lithium disilicate is best)
Modern materials rivalling metal in strength
Similar reduction as MCC (LAVA),

DIS:
Prone to fracture
Maximum span is 3-4,

22
Q

What are the forms of Zirconia that can be used in bridges?

A

Preparations on casts scanned
Straűmann© – 7 Series by Dental Wings
Nobel BioCare © – Series 5

KATANA© zirconia
Multi-layered (ML) zirconia
Ultra translucent multilayer (UTML) zirconia

Milled

+/- feldspathic (layer) porcelain on top (if area not involved in occlusion)

23
Q

What are ceromeric materials and their purpose?

A

Combination of composite (good at withstanding occlusal forces) and ceramic (aesthetic)

24
Q

What are the steps in conventional bridgework?

A
  1. Produce mounted study models
    Consider diagnostic wax-up and custom impression tray
  2. Request laboratory to construct vacuum-formed stent allows checking of reduction during tooth preparation, allows construction of provisional bridge
  3. Select shade
  4. Use Laboratory made stent or make pre-operative putty impression for provisional bridge
  5. Occlusal or incisal reduction
  6. Separation of teeth- Aim for parallelism of tapered surface of each preparation (confirm)
    -> Consider retentive features if short clinical crown height or overtapered- Slots, grooves
  7. Construct provisional bridge
  8. Make impression and occlusal registration
  9. Temporarily cement provisional bridge
  10. Demonstrate cleaning with Superfloss™
  11. Write/draw prescription for technician- abutments, pontic, shape of pontic, shade, material
25
Q

Example of how to achieve parallelism:

A

Preparation of fixed-fixed bridge for 13 12 11:
Prep mesial of 11, then mesial of 13
Prep distal of 11, then distal of 13
Prep labial (2-planes) of 11, then labial 13 …..etc

26
Q

When is parallelism required?

A

For Fixed-fixed conventional bridge (Single POI with no undercuts)

27
Q

What are the methods of achieving parallelism?

A

Paralleling by eye:
Direct vision, one-eye closed
Large mouth mirror (posteriorly)
Use of a straight (right angle) probe like a laboratory surveyor, but in the mouth

Extra-oral survey:
Quick impression, Pour a model, Use a laboratory surveyor (useful in long span multiple unit bridges)

28
Q

When is parallelism required?

A

For Fixed-fixed conventional bridge (Single POI with no undercuts)

29
Q

What is used for definite cementation of bridges (by material)?

A

All metal conventional bridgework/MCC- Aquacem (GI luting cement), RelyX™Luting (RMGI luting cement)

Adhesive/resin-bonded/resin-retained bridgework (all types)- Panavia 21 (anaerobic duel cure resin cement with 10-MDP)

All ceramic- NEXUS® kit (duel cure resin cement)

30
Q

Why are distal cantilevers avoided?

A

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

-> may consider if premolar region and opposed by denture

31
Q

What are the failure rates in different bridge types?

A

Resin-bonded/Resin retained/adhesive- 80.8% (5-years), 80.4% (10-years)

Conventional fixed-fixed(metal ceramic)- 93.8% (5-years), 89.2% (10-years)

Conventional fixed-fixed (ceramic)- 88.6% (5-years)

Conventional cantilever bridge- 91.4% (5-years), 80.3% (10-years)

Implant retained bridge- 95.2% (5-years), 86.7% (10-years)

BDS4 Restorative (12 decks)

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