Introduction To Bridgework Flashcards
What are the options for missing teeth
Do nothing, not all teeth need to be replaced
Removable prostheses: acrylic, cobalt chromium framework
Fixed prostheses: adhesive or conventional bridge
Dental implant
What to remember when replacing missing teeth
Very common conversation with patients
Be organized
Be structured when providing options
List options from simple to complex
This will also list the options in terms of costs
Explain the shortened dental arch concept
It is not necessary to replace all missing natural teeth, particularly posteriorly
SDA aims to provide 10 occluding pairs of teeth, generally towards the front of the mouth
Functionally orientated treatment planning
Low maintenance, well accepted, cost effective
Why replace missing teeth?
Restore function: chewing, eating, speech
Aesthetics
Patient preference: a feeling of completeness
Prevent tooth movement
Improve occlusal stability
Planning fixed prosthodontics- what to remember
Ensure that primary dental disease has been controlled
Management of caries
Management of periodontal disease
Good oral hygiene
Adhesive bridgework is utilised where abutment the are minimally / non restored
Conventional bridgework is utilised where abutment teeth are more heavily restored
Conventional bridgework
Fixed prosthodontic solution for missing teeth
Crowns are placed on abutment tooth / teeth to retain the bridge
As with provision of crowns: natural tooth tissue is sacrificed so technique is mostly used for heavily restored abtments
Assessing potential abutment teeth
Clinical assessment: restorability, caries, fractures, position in the arch
Radiographic assessment: PAP?, previous RCT, sufficient alveolar bone support
Teeth with posts in place are contraindicated as conventional bridge abutments
Occlusal assessment: static and dynamic occlusal assessment
An abutment is
a tooth to which a bridge is attached
A retainer is
a crown or other restoration that is cemented to the abutment
A pontic is
a replacement artificial tooth in a bridge
Each part of the bridge, ie abutment or pontic, is referred to as a
unit. For example, 2 abutments and 1 pontic = a 3-unit bridge
A span is
the space between natural teeth that is to be filled by the bridge
What is Ante’s law
The dimensions of the bridge are defined by Ante’s Law
“The root surface area of the abutment teeth has to equal or surpass that of the teeth being replaced with pontics”
Designing conventional bridges
Can be fixed-fixed design or cantilever
Cantilever designs now favoured: less destructive and more retrievable
Can be metal, metal ceramic or all ceramic
Designing fixed prosthodontics
Good quality study models
Interocclusal record
Mounted using facebow record as assessment of dynamic occlusion is very important
Clinical photographs
Contraindications for conventional bridges
Unrestorable teeth
Poor oral hygiene
High incidence of caries
Uncontrolled periodontal disease
Non-functional tooth
Very long spans
Cont… contraindications for conventional bridges
Very short clinical crown – inadequate retention
Patient’s age
< 16 years old
Elderly or infirm?
Patient cooperation
Presence of pulpal pathology
Preparation designs for conventional bridges
Exactly the same as crown preparations
Dependent on the materials selected
Preparation on the abutment teeth can be for all metallic, porcelain fused to metal or all ceramic crowns
Choice is often dependent on position in the mouth
Preparation designs for conventional bridges (PFM abutment)
Guidelines:
Labial Reduction - 1.5 mm
Palatal Reduction - 0.5 mm
Incisal Reduction - 2.0 mm
Shoulder preparation labially and chamfered palatal margins
What about impressions
High quality impressions are vital
Soft tissue management is key: retraction cord, silicone alternatives
Lower trays are suitable for all fixed prosthodontic impressions
Silicone impressions: dimensionally stable, accurate, reasonable working time
Impression stage
Watch video
Jaw registration
Silicone
Watch the video
Cementation
Watch the video
Adhesive resin cements
Watch the video
In conclusion- bridgework
Can be cemented or bonded
For bonding: read the instructions!
IPS E.max recommend: Ivoclar vivadent bonding system (etched in lab, monobond, variolink / multilink)
So overall prep including cementation is
Crown prep
Jaw registration (silicon)
Cementation
Adhesive resin cements
