planning for crowns and bridges Flashcards
What is treatment planning?
Logical sequence of treatment designed to restore the patients dentition to good health with optimal function and appearance
What does treatment planning inform the patient about?
Current conditions
Extent of dental treatment proposed
Potential complications and implications of this
Time and cost
Level of home care
Level of maintenance/repairs/replacements
Should conform to pts needs not ‘ideal’ treatment plan
What is a crown?
Indirect extracoronal restoration that replaces missing tooth structure and restores form, function and if possible and appropriate aesthetics
What are indications for crowns?
Compromised structure
Trauma
TSL
Hypoplastic conditions
Atypical morphology
Alter/correct occlusion
Part of another restoration
Restore missing function
Appearance
What are contraindications for crowns?
If other more conservative options are viable
Poor and unstable oral hygiene
Compromised structure w v poor prognosis
Lack of retention/resistance form
Active and unstable perio disease
Endo disease (esp if untreated)
Active and unstable caries
How do you plan for crowns?
1. Comprehensive assessment
2. Critical thinking and decision making (risk-benefit)
3. Detailed planning and performing clinical and lab stages
How does the hx and clinical exam help plan for a crown?
Patient factors (general health, risk factors, maintenance ability)
Mouth condition (oral health, risk factors)
Tooth status (disease/structural/restorative status, strategic importance, occlusal considerations)
What patient factors contribute to crown planning?
Attitude and expectation
Need for multiple appts
Age (older often more brittle, younger large pulp chambers/degree of eruption/cooperation)
Social history- profession eg. Musicians
Habits eg. Pipe smoking
Cost
How does the mouth condition contribute to crown planning?
Oral hygiene (plaque, calculus, inflam)
Risk factors (sugar intake, dry mouth, TSL)
Status of other teeth (disease etc)
Presence/absence of other teeth
Soft tissue conditions (mucosal reactions to dental materials)
How does tooth status affect crown planning?
Strategic value
Position of tooth
Appearance
Disease status (endo/perio/caries/restorative)
Occlusal consideration
Structural status
What are the fundamental points of aesthetics?
1. Colour
2. Contour
3. Outline
4. Symmetry
5. Proportion
6. Soft tissue harmony
How is the endo status checked?
Vital, non vital or root canal treated
Sensibility testing
Preop PA
Assess size and depth of current restorations
15-20% become non vital after crown prep
If RCT required- do before placing crown
How is occlusion considered?
In contact?
Guidance?
Posterior support?
How are perio factors assessed?
Assess and diagnose status
Correct and control inflam defects
Assess soft tissue contours
Correct ortho and surgery if necessary
What perio factors may contribute?
Gingival cleft
High frenum insertion
Blunted papilla
Gingival asymmetry
Ridge defect
Gingival recession
How should you plan and execute a crown prep?
Conform or reorganise w regard to occlusion?
Crown lengthen?
Use a diagnostic wax up?
Provisional restorations?
Most appropriate material?
Timing of stages w lab and patient?
What is a conformative approach?
All unrestored tooth-tooth contacts remain the same before and after provision of crowns
No alteration in occlusal relationship in ICP
What is a reorganised approach?
All unrestored tooth-tooth contacts have changes after the provision of crown
Alteration of occlusal relationship by restoring RCP and creating new ICP
What is a bridge?
Tooth borne indirect fixed prosthesis used for the replacement of one or more missing teeth
Aka fixed partial denture, FPD
What are indications for bridges?
Replace missing teeth (due to caries, perio, trauma, hypodontia, tooth wear, cancer, iatrogenic)
What are different types of bridges?
Fixed-fixed
Fixed-movable
Full coverage, cantilevered
Resin bonded, cantilevered (gold standard but risk of debond and aesthetic issue)
Implant retained (also good but depends on cost and bone quality)
What are the options for partially dentate?
No treatment- compromised function and aesthetics, risk of tilting adjacent and over eruption of opposing
RPD- conservative and removable
Bridge- invasive and irreversible, loss of enamel, pulp damage but fixed and predictable
Should you use fixed-fixed or cantilever?
Depends on length of span
If one unit- cantilever
If more than one- fixed-fixed
Also depends on quality of supporting teeth
What are considerations for planning a bridge?
Length of span
Occlusion
Shape of ridge
Need for surgical ridge augmentation or other treatment