Bridgework 3

Question 1

Options to replace a missing tooth

Answer 1

1. Leave space
2. Denture
3. Bridge
4. Implant

Question 2

Things to consider with holistic treatment planning

Answer 2

• look at the whole mouth
• not only a specific tooth
• plan for retrievability (always have a back-up plan)
• what will the dentition be like in 10 years

Question 3

What information do we need to gather

Answer 3

History
- CO
- MH, DH, SH

Clinical exam
- soft tissues
- periodontal
- caries risk assessment
- occlusion
- parafunction

Abutment evaluation
- remaining tooth structure
- radiographs

Occlusal information (v.important):
- intra-oral exam
- study casts (face bow mounted on semi-adjustable articular or)
- incisal classification
- canine guided or group function
- opposing tooth over-erupted?
- will bridge interfere with current occlusion?
- signs of parafunction present?

Question 4

What to consider when designing and planning bridges?

Answer 4

• minimal prep or conventional preparation? I.e. conservation of tooth tissue
• material?
• abutment evaluation?
• cleansability
• appearance/aesthetics

Question 5

What to consider when evaluating potential abutments

Answer 5

1. radiographs of any abutments
2. root configuration
   3.angulation/rotation of abutment
3. Periodontal health (can they withstand extra occlusal forces
4. Surface area for bonding and quality of enamel
5. risk of pulpal damage
6. quality of Endodontics
7. remaining tooth structure present
8. core - remove and rebuild?

Question 6

Options of bridge design

Answer 6

1. Resin- bonded/Resin-retained/Adhesive
   - cantilever
   - fixed-fixed
2. “Conventional”
   - cantilever
   - fixed-fixed
   - fixed-movable
3. Hybrid

Question 7

What are the details of bridge design

Answer 7

1. Select abutment teeth
   - judge longevity of adjacent teeth
2. Select retainer
   - no prep, minimal prep,regular prep
   - complete crown retainer?
3. Select Pontic and connector
   - sanitary/wash-through Pontic
   - dome/bullet/torpedo
   - modified ridge lap
   - total ridge lap
   - ovate Pontic
4. Plan the occlusion
5. Prescribe material

Question 8

What is the function of the pontic

Answer 8

1. Restore appearance of missing teeth
2. Stabilise the occlusion
3. Improve masticatory function
   Nb don’t need to always achieve all of these features

Question 9

What do you always need to consider for pontic design

Answer 9

1. Cleansability
   - always smooth, highly polished or glazed surface
   - surface should not harbour join of metal and porcelain (if metal-ceramic design used)
   - embrasure space smooth and clean sable
2. Appearance
   - anteriorly - as “tooth like” as possible
   - posteriorly - may compromise, function more important
3. Strength
   - longer the span, greater the thickness required to withstand occlusal forces

Question 10

Describe how the the surfaces of the pontic should be designed/finished

Answer 10

Occlusal surface
- resemble surface of tooth it replaces
- narrower if possible to enable cleaning
- should have sufficient occlusal contact
- forces driven longitudinally

Approximal surface
- Connector: strength (2x2mm at least)
- Embrasure: space (balance aesthetics and cleansability)

Buccal and lingual surface
- changes

Ridge surface
- fitting surface