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BDS4 restorative > intro to bridgework > Flashcards

intro to bridgework Flashcards

1
Q

what are bridges for

A
  • missing tooth or teeth
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2
Q

what are the reasons to treat missing teeth

A
  • aesthetics
  • function
  • speech
  • maintenance of dental health
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3
Q

how does treating missing teeth help function

A
  • help eat and speak
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4
Q

how does treating missing teeth help speech

A
  • tongue is involved in contacting teeth to make sounds
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5
Q

how doe treating missing teeth help maintain dental health

A
  • if there is a space teeth can tilt or over erupt and can then expose root surface which is more susceptible to root caries and sensitivity
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6
Q

what are the tooth replacement options

A
  • denture
  • bridge
  • implants
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7
Q

what is a bridge

A
  • a prosthesis that replaces a missing tooth or teeth and is attached to one or more natural teeth
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8
Q

what is another term used for a bridge

A
  • fixed partial denture
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9
Q

why can dentures be better than bridges

A
  • they are better at replacing false gingiva to replicate lost soft tissue
  • can still add a little on bridges but dentures better
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10
Q

what are the 2 main types of bridges

A
  • adhesive which is most common

- conventional

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11
Q

what is an adhesive bridge

A
  • held onto abutments by little metal wings on the palatal surface
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12
Q

what is a conventional bridge

A
  • held on by crowns on the abutment teeth
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13
Q

what are the general indications for a bridge

A
  • function and stability
  • appearance
  • speech
  • psychological reasons
  • systemic disease such as epilepsy
  • co-operative patient
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14
Q

what are the psychological reasons for bridges

A
  • some patients struggle with the idea of taking their teeth in and out and would rather something fitted
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15
Q

why are bridges good for epilepsy

A
  • could inhale a denture during an epileptic fit but bridges are fitted
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16
Q

what are the local indications for a bridge

A
  • big teeth
  • heavily restored teeth
  • good abutment angulations
  • good occlusion
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17
Q

why are heavily restored teeth a good indication for a conventional bridge

A
  • because they have already been restored so are already compromised
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18
Q

what are the general contraindications for a bridge

A
  • uncooperative patient
  • medical history - allergy to materials
  • poor OH
  • high caries/perio
  • large pulps in young patients
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19
Q

why are large pulps a contraindication for bridGES

A

because tooth could go non-vital if start trimming it down and get close to pulp

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20
Q

what are the local contraindications for bridges

A
  • high chance of further tooth loss
  • prognosis of abutment poor
  • length of span too big
  • ridge form/tissue loss
  • tilting rotation of teeth
  • degree of restoration
  • good periapical status is required
  • perio needs to be stable
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21
Q

why are big spans a contraindication

A
  • will flex more as patient bites down and it will fail
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22
Q

what does abutment mean

A
  • tooth that serves as an attachment for a bridge
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23
Q

what is a pontic

A
  • artificial tooth suspended form abutment
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24
Q

what is a retainer

A
  • extracoronal pr intracoronal restorations connected to pontic and cemented to prepared abutment teeth
  • metal wing or crown
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25
Q

what is a connector

A
  • connects pontic to retainer
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26
Q

what is the edentulous span

A
  • space from missing teeth
27
Q

what is the saddle

A
  • space where the pontic sits
28
Q

what is a pier

A
  • abutment tooth that stands between and is supporting 2 pontics, each with another abutment on the other side
29
Q

what is a unit

A
  • either a retainer or pontic

- i.e. - bridge with 2 retainer and 1 pontic = 3 unit bridge

30
Q

what is a fixed-fixed bridge

A
  • retainer at each end and a pontic in the middle

- can be adhesive or conventional

31
Q

what is a cantilever bridge

A
  • retainer only on one side of the pontic

- can be adhesive or cantilever

32
Q

what are other names for an adhesive bridge

A
  • resin bonded
  • resin retained
  • minimal prep
  • maryland
  • resin bonded fixed partial denture
33
Q

what material is most commonly used for metal wings

A
  • CoCr

- some evidence showing ceramic is good but not much yet

34
Q

what are the advantages of adhesive bridges

A
  • minimal or no prep
  • no anaesthetic
  • less costly, less surgery time
  • used as a provisional - if getting implants
  • less destructive than alternatives
35
Q

what are the disadvantages of adhesive bridges

A
  • good clinical technique needed = needs to be bone dry
  • metal shine through tooth if overextended incisally
  • chipping porcelain
  • can debunk
  • occlusal interference
  • no trial period possible
36
Q

why should you check dynamic occlusion as well as static

A
  • to make sure when teeth are moving that the bridge is not going to be broken off
37
Q

what are the indications for adhesive bridge

A
  • young teeth as less destructive on them
  • good enamel quality
  • large abutment surface area
  • minimal occlusal load
  • good for single tooth replacement
  • can simplify PD design
38
Q

what are the contraindications for adhesive bridge

A
  • insufficient/poor enamel
  • long spans not possible
  • excess soft/hard tissue lost
  • heavy occlusal force as more chance to fail
  • poorly aligned, tilted or spaced teeth
  • contact sports = need to make sure wear a mouthguard
39
Q

what important to establish in history

A
  • any parafunctional habits
40
Q

what is a direct resin bonded bridge

A
  • good in emergency situation, done at chariside
  • use pt’s own tooth that has fallen out, or can use acrylic denture tooth, or polycarbonate crown or cellulose matrix filled with composite
  • cut root off crown and remove pulp and seal over pulp
  • use composite to hold the tooth onto the two abutments teeth
  • doesn’t look great but works as a temporary
41
Q

what is an indirect resin bonded bridge

A
  • made in the lab
  • take impressions and send to lab to make
  • need big palatal/lingual coverage
  • can have no prep/minimal prep/heavy prep
42
Q

how far supragingivally should bridge be kept

A
  • ideally 0.5mm
43
Q

what adhesive bridges are generally used anteriorly

A
  • cantilever
44
Q

what adhesive bridges are generally used posteriorly

A
  • fixed-fixed
45
Q

why use cantilever anteriorly

A
  • because of divergent guidance paths
  • the occlusal forces are directed down each tooth in a different way which means when the bridge is used it will move in different directions and break
46
Q

if there is previous restorations in abutment teeth what do you do with them

A
  • composite is ok to stay, but could roughen it with a slow speed for better retention, or could replace
  • if amalgam want to take out and replace
47
Q

what prep needs done for adhesive bridges

A
  • 180 degree wrap around
  • need rest seats occlusally for post, and on cingulum for anteriors
  • can do proximal grooves but not needed
  • chamfer line 0.5mm from gingival margin
  • prep should stay in enamel
48
Q

what is the anterior minimal prep

A
  • occlusal contact reduction
  • cingulum undercut removal
  • chamfer
49
Q

what is the anterior heavy prep

A
  • 0.5mm palatal reduction
  • cingulum rest
  • +/- proximal grooves
  • chamfer
50
Q

why will the bite feel high to the patient

A
  • because reduction is only 05.mm but wing is 0.7mm so there is a 0.2mm discrepancy
  • take 10-12 days to get used to
51
Q

what is the posterior prep

A
  • occlusal rests
  • 180 degree chamfer wrap-around
  • +/- proximal grooves
52
Q

how can missing tooth space be temporised while waiting for bridge

A
  • RPD
  • Essex retainer with missing tooth filled in
  • if prep only in enamel don’t really need temporary
  • if into dentine ca cover with DBA and give sensitive toothpaste
53
Q

how is the retention of the metal retainer improved

A
  • sandblasted
54
Q

what is sandblastign

A
  • micro mechanical retention
  • creates small indentations on the fitting surface where the cement will then ‘lock’ in
  • use aluminium oxide 50 microns
  • done in the lab
55
Q

what cement is often used to cement in

A
  • Panavia

- dual curing cement

56
Q

how is retainer treated before fitting

A
  • try in for fit and aesthetics
  • chair side micro-etching if not been done in lab
  • clean retainer = ultrasonic bath, ethanol to degrease
  • apple cement just prior to placement
57
Q

what can you ask lab to provide to make trying in fit of bridge easier

A
  • ask for them to place locating cleats on the incised surface that you can hold to try in
  • these then break off
58
Q

how are the teeth treated before fitting

A
  • isolate with dam
  • etch = 37% orthophosphoric acid
  • wash and dry
  • apply primer (A and B mixed) for 30 seconds then air dry for 2 seconds = don’t need to cure this primer
59
Q

after fitting bridge what is placed around cement margins

A
  • O2 inhibitor (Oxyguard II) is placed around cement margins for 3 minutes then washed off
60
Q

what do you need to do after cementation

A
  • check occlusion = make sure pontic doesn’t have excessive occlusal contact
  • demonstrate how to clean around and underneath the bridge
61
Q

what is the survival rate of adhesive bridges after 5 years

A
  • 80%
62
Q

what is the survival rate of adhesive bridges after 10 years

A
  • 80%
63
Q

if adhesive bridges are going to fail when is it most likely

A
  • first 2 years

BDS4 restorative (4 decks)

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