Planning for Crowns and Bridges Flashcards
Identify crowns and bridges as treatment options Indications/contraindications
A plan should be
Should inform patient about
Discussed in detail
Current conditions
Extent of tx
Time and cost
Level of home care
Level of maintenance/repairs and replacements
Possible alterations before irreversible changes are made
Identifying patient needs
Correct existing disease Prevent future disease - INDICATIONS Restoration of function Improve appearance Treatment plan should conform to the patient's needs not to plan
Crown
Indirect extracoronal restoration which replaces missing tooth structure and restores anatomy
Indications for crown placement
Broken down Trauma Tooth wear Anatomical defect Hypoplastic conditions and atypical shape Alter and correct occlusion Part of another restoration e.g on abutment teeth for bridges and RPDs
Restore missing fx
Appearance
Contraindications for crown placement
Other more conservative options available
Poor OH —> high risk of recurrent caries
Very broken down tooth with caries extending subgingivally - difficult to create good margins
Perio conditions - lack of bone support
Crown planning
History and examination
Critical thinking and decision making
Detailed planning of crowns and clinical and lab stages
History and examination
Patient factors - expectations, compliance, age
Mouth condition
Tooth and teeth in question
Effect of age on crown prep planning
Younger patients have larger pulps - higher risk of pulp necrosis - degree of eruption or cooperation of teeth
Older patients have more brittle teeth
Patient factors
Attitude and expectation - limitations understood
Cooperation of patient important
Age no upper or lower limit
Females generally more concerned about appearance
Social history
Habits e.g smoking
Cost - budget
Mouth condition
Oral hygiene
Status of other teeth
Soft tissue conditions such as mucosal reactions to dental materials
Individual tooth factors
Value of tooth Position Appearance Pulp status - vital or necrotic? Periodontium - healthy gingivae Occlusion - is it functional Root length - bone support
Aesthetics - 6 points
Colour Contour - bulbosity Outline - shape Symmetry - compare R to L Proportion - height:width of central incisors, width all the way (golden ratio) - define ideal aesthetics Soft tissue harmony - gum levels
Pulp status
Check vitality before crown prep - easier to do RCT pre-crown
15-20% of vital teeth die post crown prep
Take pre-op rad for bone levels and periapical status
Assess size and depth of current restorations
Occlusion
Anterior teeth determine the movement of the posterior teeth
Failure to conform to, or create correct anterior guidance will upset posterior occlusion
Understanding and planning the occlusion is essential for success
Periodontal factors
Correct and control inflammatory defects
Assess soft tissue contours
Correct if necessary
- Orthodontic correction
- Surgical correction
Periodontal factors - issues which could arise
Gingival cleft - perioplastics High frenum insertion Blunted papilla - can be corrected with fillers Gingival asymmetry Gingival recession - graft
Critical questions
Is tooth worth being kept?
Would another option be more suitable?
Is remaining tooth sufficient for a crown preparation
Will direct restoration be needed first?
Is pre-crown tx needed
Detailed planning?
Confirmative vs re-organisation Crown lengthening? Diagnostic wax-up can help visualise result prior to tooth prep Provisional restorations Determination of best material
Type of crown
Full coverage
Partial 3/4
Post-core crown
Type of crown material
Gold/metal Metal ceramic or porcelain fused to metal PFM Dentine Bonded Crown High strength core all ceramic crown Composite crown
Bridge
Tooth borne indirect fixed prosthesis used for replacement of one or more missing teeth
Indications for bridge
Missing
Caries, perio disease, trauma, hypodontia, toothwear, oral cancer
iatrogenic
Types of bridge
Fixed - fixed on both sides
Fixed moveable
Cantilever
Resin-bonded - pontic with a small wing glued to adjacent tooth
becomes cantilever
becomes fixed fixed resin bonded bridge if two wings present
Implant retained
Possible treatment option for partially edentulous patients
No prosthetic treatment
- compromising fx and aesthetics
- over eruption of opposing teeth
- risk of drifting
RPD
- conservative and removable
- periodontal management becomes more difficult - PRF
Conventional tooth supported FPD
- Place crown with replacement prosthetic tooth
- predictable
- invasive, irreversible
- risk of pulp damage
- enamel loss
Resin-bonded bridge
- fixed option
- risk of debond and some aesthetic issues
- 5-10 years lifetime
- risk of metal shadow
Implant-supported FPD
- expensive
- dependent on bone levels
