Look at the whole mouth Not only at a specific tooth Plan for retrievability (always have a back-up plan) All restorations will eventually fail What will be options? Replace like for like? More destructive resort? What will the dentition be like in 10-years?

Bridgework 3 Flashcards by L T

alternatives to bridgework

no restoration

denture(s)

implant(s)

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holistic tx planning

Look at the whole mouth
Not only at a specific tooth
Plan for retrievability (always have a back-up plan)
- All restorations will eventually fail
- What will be options? Replace like for like? More destructive resort?
What will the dentition be like in 10-years?

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longevity of RBB

80% over 5-10years

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longevity of cantilever bridge

80% over 5-10years

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longevity of fixed-fixed over 5-10years

90%

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collect information when gathering pt history in regards to bridge planning

History
- Presenting complaint
- Medical and social history
- Past dental history
  - attendance, OH
Clinical examination (Extra- and intra-oral)
- Soft tissues
- Periodontal
- Caries risk assessment
- Occlusion
- Parafunction
Abutment evaluation
- Remaining tooth structure
- Special tests
  - Radiographs

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occlusal information for bridgework planning

Examine:
- Intra-orally
- Study casts
  - Facebow-mounted on semi-adjustable articulator
Incisal classification (ortho lectures)
Canine-guided or group function?
Opposing tooth over-erupted?
- Reducing interocclusal space
Will bridge interfere with current occlusion?
- Will it be changed when bridge placed?
Signs of parafunction present?
- Wear facets, attrition etc.
  - Bruxism – risk of destroying bridge when placed

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evaluation of potential abutments when designing and planning bridges (8)

Root configuration
- Big or multi rooted best
Angulation/rotation of abutment
Periodontal health
Surface area for bonding & quality of enamel
Risk of pulpal damage
Quality of endodontics:
Remaining tooth structure present?
Core
- Remove and rebuild?

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options for bridge design (3 main groups with subgroups)

Resin-bonded/Resin-retained/Adhesive
- Cantilever
- Fixed-fixed
“Conventional”
- Cantilever
- Fixed-fixed
- Fixed-moveable
Hybrid
Spring Cantilever Bridge

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Pontic design

Wash-through pontic
Dome/Bullet/Torpedo
Modified ridge lap
Total ridge lap
Ovate pontic

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3 functions of pontic

restore appearance of missing tooth
stabilise occlusion
improve masticatory function

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3 considerations for pontic design

cleansability

appearance

strength

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cleansability in pontic design

Should always be smooth, with highly polished or glazed surface
Surface should not harbour join of metal and porcelain (if metal-ceramic design used)
- Shearing off due to occlusal force
Embrasure space smooth and cleansable

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appaerance for pontic design

anteriorly - as ‘tooth like’ as possible

posteriorly - may compromise

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strength for pontic design

longer the span - greater the thickness required to withstand occlusal forces

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4 surfaces of pontic

Occlusal surface
- Resemble surface of tooth it replaces
- Narrower if possible to enable cleaning
- Should have sufficient occlusal contact so can function
  - Need driven down long axis of tooth
Approximal surface
- Connector: strength (roughly 2 by 2 mm for strength)
- Embrasure: space – floss/interdental, but want to try and reduce for aesthetic
Buccal & lingual surface
Ridge surface

wash through pontic design

no contact with soft tissue

fucntional rather than for appearance

consider in lower molar area

easy to clean

a.k. hygienic or sanitary

dome shaped pontic design

useful in lower incisor, premolar or upper molar areas

acceptable if occlusal 2/3 of buccal surface visible - poor aesthetics if gingival 1/3 of tooth visible

good for cleaning

a.k.a torpedo or bullet shaped

modified ridge lap pontic design

buccal surface looks as much like tooth as possible

lingual surface cut away

line contact with buccal of ridge

problems with food packing on lingual surface of ridge

ridge lap/saddle pontic design

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

ovate pontic design

good for OH good pt

and want optimal aesthetics

presses on gingivae, looks like natural tooth piercing out of ginivae

materials for conventional bridges

All metal
- Gold
- Nickel/Cobalt chromium?
- Stainless steal
Metal ceramic
All ceramic – more likely to #, but starting to rival MC
- Zirconia – very strong, but less aesthetic than lithium disilicate
  - E.g. LAVATM and Procera®
- Lithium disilicate
  - e.g. - E.max
Ceromeric (porcelain with composite), less used
- BelleGlass™
- Vectris®
- Targis® Vectris®

common place for all metal bridges

lower posterior area (gold)

metal ceramic bridges usually

make up the majority of bridges made in UK currently

Lava^TM3M ESPE bridges | Zirconia

* 3 – 4 unit fixed bridge (Maximum span) milled zirconium oxide frame with **feldspathic porcelain** overlying * Withstand occlusal forces * Good aesthetics * Similar reduction to MCC

zirconia bridge

* GDH&S Fixed Pros lab now producing more all ceramic restorations * 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

implant retained bridges for types

large span bridges screw-retained or cement retained

technique for conventional bridgework

* Mounted study models * Consider **diagnostic wax-up** and custom impression tray * Request laboratory to construct v**acuum-formed stent** * Allows checking of reduction during tooth preparation * Allows construction of provisional bridge * Select shade * Laboratory made stent or make pre-operative putty impression for provisional bridge * Occlusal or incisal reduction * Separation of teeth * Aim for parallelism of tapered surface of each preparation * Example: 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 * **Confirm parallelism** * Consider **retentive features** if short clinical crown height or overtapered * **Slots** * **Grooves** * Construct provisional bridge *(do first before definitive imp)* * Make impression and occlusal registration * Temporarily cement provisional bridge * Demonstrate cleaning with Superfloss™ * Write/draw prescription for technician – be specific * Type of bridge * Abutment teeth * Pontic teeth * Shape of pontic * Material to be used

parallelism

Consider for **fixed-fixed conventional bridge** * Common POI – increased retention * No undercuts **Paralleling by eye** * Direct vision, one-eye closed * Large mouth mirror (posteriorly) * Use of a **straight 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

definitive cementation for **all metal** conventional bridgework (2 options)

* **Aquacem** (GI luting cement) * **RelyX**™Luting (RMGI luting cement)

defintive cementation for **metal ceramic** bridgework (2 options)

* Aquacem (GI luting cement) * RelyX™Luting (RMGI luting cement)

defintive cementation for **adhesive**/resin-bonded/resin-retained bridgework

**Panavia** **21** (anaerobic dual cure resin cement with **10-MDP**) ## Footnote 10-MDP helps tooth stick to metal work

definitive cementation for **all ceramic** bridgework

**NEXUS**®/ **NX3** kit (dual cure resin cement)

distal cantilevers

Avoid if possible * Occlusal forces on pontic --> **leverage forces** on abutment tooth causing it to tilt May consider in **shortened dental arch**, pontic 5, abutment 4 (unopposed/ opposed by denture)

longevity