Planning for Crowns and Bridges Flashcards
Define treatment planning
Logical sequence of treatment to restore the dentition to good health with optimal func and aesthetics
What to inform the pt of regarding their TP?
Current conditions Extent of dental tx proposed Time and cost Level of home care Level of maintenance/repairs/replacements Possible alterations Informed consent
What may the pt need regarding their tx?
Correct disease Prevent future disease Restore func Improve appearance Conform to pt needs
Define crown
Indirect extracoronal restoration which replaces missiImpng tooth structure and restores anatomy
Crown indications?
Badly broken down/previously heavily restored teeth Trauma Tooth wear Hypoplastic conditions and typical shape Alter and correct occlusion Part of another restoration Restore missing function Appearance
Crown contraindications?
More conservative restorative options viable
Poor OH
V broken down tooth with caries extending subginigvally
Periodontal condition - not enough bone support
How to plan for crowns?
History and examination
Critical thinking and decision making - what is the best for the pt
Detailed planning of the crown and performing clinical and lab stages
Features of pt history and examination for crowns?
Pt factors - compliance, expectations, age, understand limitations of procedure, complex procedure, social history, profession, habits, cost
Mouth condition - OH, status of other teeth, soft tissue conditions - mucosal reactions to dental materials
Tooth/teeth in question - value of tooth, position of tooth, appearance, pulp status, periodontium, occlusion, root length - bone support
What to consider with young pts?
Size of pulp
Degree of eruption of teeth
Cooperation of pt
Aesthetics in crowns?
Colour Contour Outline Symmetry Proportion Soft tissue harmony
Features of pulp status with crowns?
Check for vitality prior to crown prep (EPT, ethyl chloride)
15-20% of vital teeth will become non-vital following crown prep
Preop periapical radiograph
Assess size and depth of current restorations
Features of occlusion with crowns?
Anterior teeth determine movement of posterior teeth
Failure to conform to, or correct anterior guidance upsets posterior occlusion
Understand and plan the occlusion
Periodontal factors with crowns?
Correct and control inflam defects Assess soft tissue contours Correct if necessary: - Ortho - Surgical
Questions to ask before crowning?
Is it worth to be kept? Better extracted?
Suitable to be kept? Different restoration more suitable?
Remaining tooth sufficient for crown prep?
Will it need a restoration with a direct material first? - GIC, amalgam, composite
Pre-crown tx necessary - RCT?
Change occlusion?
Need for lengthening
Diagnostic waxup to help visualise result
Provisional restorations
Determination of best material?
Types of crowns?
Full coverage crown
Partial coverage crown: 3/4
Post core crown
Type of crown materials?
Gold or metal = good for posteriors as provides strength
Metal ceramic or porcelain fused to metal (PFM)
Dentine bonded crowns (ceramic)
High strength core all ceramic crown
Composite crown
Define bridge
Bridge = tooth borne indirect fixed prosthetics used for the replacement of one or more missing teeth
Indications for bridges?
Replacement of missing teeth and restoration of edentulous areas
Reasons for tooth loss?
Caries PD Trauma Hypodontia Toothwear Oral cancer Iatrogenic
Types of bridges?
Fixed-fixed = fixed both sides via abutments, pontic in middle
Fixed-moveable = in long stand bridges for flexibility
Cantilever = fixed from one end and free on the other
Resin bonded = pontic with wing
Implant retained = can be fixed fixed or cantilever
Steps for bridge planning?
History and examination
Critical thinking and decision making
Detailed planning of the bridge and performing clinical and lab stages
Is the pt suitable for a bridge?
What are the possible tx options for partially edentulous pts? Disadvantages?
No prosthetic tx: compromised func and aesthetics. Risk of tilting the adjacent teeth and over eruption of the opposing teeth
RPD: Conservative but removable option
Conventional tooth supported FPD: Invasive and irreversible approach, loss of enamel, pulp damage but fixed and predictable soln
Resin bonded bridge: Conservative fixed option but risk of debond and some aesthetic issues
Implant-supported FPD: Bone quantity and costs
Clinical examination of bridges requires what?
Assessment of abutment teeth:
- Perio assessment
- Periapical abscess
- Root configuration; teeth with conical roots more suitable for short-span bridge
Radiographic exam to evaluate above
Length of span: how many missing teeth, fixed bridge more suitable than cantilever? Implant supported bridge?
Occlusion - sufficient intra-occlusal space?
Shape of ridge: ridge defect?
Surgical ridge augmentation?
