Combining dentures and crown and bridgework

Question 1

How can milled crowns be utilised in dentures?

Answer 1

• Milled crowns are useful when there is a large restoration on a tooth that does not have longevity.
• Milled crown consists of buccal undercuts 0.25mm so cobalt chrome clasp can be utilised

Question 2

Give some advantages to milled crowns in denture work?

Answer 2

• Good longevity of tooth
• Can be made by lab to provide mesial or distal support via clasps
• Can give the 0.25mm buccal undercut so cobalt chrome clasp can be utilised
• Good rentention
• Porvide a lot of tooth borne support

Question 3

Give some disadvantages

Answer 3

• Require a lot of planning and need to plan denture design first!
• Require a lot of technical expertise
• Require both a crown bridge technician and a denture technician
• Require precision fit _ denture goes on immediately after crown fit to ensure it fits

Question 4

What are the most common prescision attachements?

Answer 4

• Studs
• Tubelocks

Question 5

Give some disadvanategs to precision attachments

Answer 5

• Oral hygiene can be difficult
• Technical difficulties
• Require two technician , crown bridge and denture
• Can be difficult to repair and replace if attachment hasn’t been properly recorded
• Precision fit - denture goes on immediately after to check it fits

Question 6

What type of teeth are precision attachments usually placed in?

Answer 6

• Usually placed in uppers canines
• Sometimes 5’s and rarely centrals
• Require root to be root treated

Question 7

If a survey line is unfavourable to denture design what can you do?

Answer 7

• Can modify to favourable denture design (undercut to allow clasp attachment)
• Can be done with composite or into a crown as well

Question 8

You fit a bounded saddle denture. This is perfectly fitted. There is a restoration on the abutment tooth that is being utilised with a clasp for the denture. What can you do?

Answer 8

• Temporise the tooth and then carve out material until the denture fits
• Use pattern resin (Duralay)
• Take impression of tooth without denture
• Place core material and prepare tooth for crown
• Take master impression of crown prep for new crown
• Using impression use pattern resin to make new temp crown as when it seats it takes fit of denture and temp filling
• Send off to lab impression, interocclusal record and opposing arch along with pattern resin cap
• Lab creates crown that should fit into mouth along with denture
• Try in denture immediately after cementing crown and check crown is fully seated

Question 9

Advantages and disadvantages of making a crown to existing denture when filling falls out abutment tooth

Answer 9

Advant
- Don’t need to make new denture
- Easier for metal crowns

Disad
- Technically complicated
- Harder for metal-ceramic and porcelain crowns
- Lots of visits for crown prep etc

Question 10

A pt has a single tooth saddle that keeps coming back to you for repairs as it keeps on snapping off. What is an option you can do instead of just putting the tooth back on?

Answer 10

• Instead of putting the tooth on the denture , place the tooth on an anterior bridge to avoid single teeth saddles
• Can also avoid dentures by using cantilever adhesive or fixed bridges, implants or acceptance of spaces

Question 11

Tooth wear rehabilitations are a common reason to combine crowns and dentures. What are some things you need to consider in these types of pts before you txt plan?

Answer 11

• Offten need to increase their OVD
• Usually have lack of denture wearing experience
• Need to use a transitional dentures prior to definitive txt
• Use a staged approach
• Pt may not want this then other than inform of risks to more tooth wear not a lot can be done

Question 12

This is a tooth wear pt. Describe what you see and what txt options can be provided.

Answer 12

• Moderate tooth wear , attrition and erosion noticeable by cupping defects in lower anterior and upper anterior
• Some missed teeth
• Overeruption of upper posteriors due to no lower posterior support
• Loss of OVD
• Loss of occluso-gingival height
• State of lower incisors poor
• Increase OVD slightly (3-4mm) using acrylic dentures to see if pt can tolerate wearing dentures by increasing lower denture height
• If pt tolerates and wears for few months - gives us more OVD
• Now can either XLA poor prognosis teeth and crown lower teeth with denture fit utilising any undercuts
• Upper teeth can be done via composite build up or crown and definitive denture