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Fixed Prostodontics 2 > Pontics > Flashcards

Pontics Flashcards

1
Q

Although unpredictable, a greater amount of
alveolar ridge loss following extraction usually occurs
in the — dimension and affects the —
bone of the ridge.
In fact, –% of alveolar bone
dimension can be lost after tooth extraction, with
losses reported of up to —. Two-thirds of this loss
of bone volume can occur within the first —
months of tooth extraction.

A

horizontal
buccal

50
6–7 mm
three

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2
Q

Loss of — ridge height can also occur and usually
takes place along the — aspect of the ridge to a
— degree than horizontal ridge loss. Corresponding
reductions in vertical ridge height ranging from — mm
have been noted. The combination of this resorptive
pattern results in a ridge that has moved in a
— direction and has atrophied vertically.

A

vertical
buccal
lesser

2–4
palatal/lingual

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3
Q

Sockets that were preserved with bone
grafting and/or membrane on average lost —
mm less of ridge width, — mm less of ridge
height, and had —% more bone volume when
compared to sockets that were not
grafted. — sites lost more than
— sites, and most ridge resorption
occurred on the buccal aspect of the ridge.

A

2
1
20
Maxillary, mandibular

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4
Q

The Edentulous Ridge – Classification of Deformities
Class I:
Class II:
Class III:
Normal:

A

F-L Width (32%)
O-G Height (3%)
F-L and OG Height (56%)
(8%)

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5
Q

skipped
Pre-Treatment Assessment
Evaluate
(3)

A

Evaluate the dimensions of the
Edentulous space
Evalutate the positions of the abutment
teeth to assess the favorability for a bridge
Evaluate the possible occlusal outcomes

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6
Q

Evaluate the dimensions of the
Edentulous space
Evalutate the positions of the abutment
teeth to assess the favorability for a bridge
Evaluate the possible occlusal outcomes
Is there a need to reposition the teeth
orthodontically prior to fixed work?

— up is key to answer these questions
before you begin treatment

A

Diagnostic Wax

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7
Q

What Materials are used for Pontics?
(3)

A

Cast Metal
Metal-Ceramic
(Many configurations)
Zirconia or
All Ceramic

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8
Q

When two materials are
used, the finish line for their
joining should not be on
the

A

edentulous ridge.

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9
Q

What are the ideal characteristics we look for in a
pontic design?
(3)

A

Esthetic
Biologic
Mechanical

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10
Q

Esthetic
(2)

A

-Appearance of replacement
-Replication of “emergence” from ridge

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11
Q

Biologic
(4)

A

-Ability for the patient to clean well around
the bridge/pontic area
-Allows for healthy tissue
-Patient comfort of bridge
-Harmonious occlusion

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12
Q

Mechanical
(1)

A

-Rigid framework to resist deformation or
fracture

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13
Q

Esthetic Considerations
Ideally, a pontic should have the same — height as the original or
neighboring tooth.
When resorption of the bone has taken place, the pontic changes shape in order to
keep in contact with the —
Contour needs to be blended smoothly to avoid a ledge at the cervical.

A

inciso-gingival
ridge concavity

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14
Q

Esthetic Considerations
Contour in — should approximate the length of the adjacent teeth
The facial surface is altered to curve gently from the

A

Apical ½

gingival-facial to the middle of the
facial surface

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15
Q

Esthetic Considerations
Ideally, the pontic should adapt to the ridge well
When the pontic does not adapt well, (3) can
become troublesome

A

esthetics, speaking, and food impaction

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16
Q

Biological Considerations
Pontic ridge contact should ideally be on — tissue. When on non-keratinized tissue,
(2) can occur.
Pontic contact with ridge should not inflict — on the tissue.
Contact with the — should be minimal. Pontic shape in contact with tissue should also be —

A

keratinized
ulceration and constant irritation
pressure
tissue, convex

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17
Q

Delicate balance of light to slight tissue contact
-Contact too heavy?
-Contact too light?
Contact area should be small and shape of pontic convex

A

Tissue/bone resorption
Food impaction, esthetics compromised

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18
Q

Biological Considerations
Convex shape of gingival aspect of pontic allows for

A

easier cleaning for patient
“Fullness” of pontic shape and proper gingival embrasures block out and keep food
and debris from being trapped under pontic.

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19
Q

Biological Considerations
Oral Hygiene
(5)

A

Floss Threader
Super Floss
Proxabrush
Rubber Tip
Water Pik

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20
Q

Physical Considerations – Strength
Pontic connectors need appropriate size to be strong
— Occlusal-Gingivally
— Facial-lingually

A

4mm
3-4mm

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21
Q

Material Strength

A

Metal > Zirconia > Porcelain > Acrylic

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22
Q

Pontic connectors should not impinge on –

A

embrasures

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23
Q

Physical Considerations – Position
Pontics placed outside of the
inter-abutment axis creates

A

torque on the connectors and
abutments which can lead to
failure

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24
Q

Recall that — is the biggest reason why we see mechanical failure in
bridgework. So replacing as ideal occlusion as possible extends the life of the
restoration.

A

occlusion

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25
Q

Physical Considerations – Occlusion
Occlusion development with a bridge should replace ideal occlusion

A

MI contacts, Working and Non-Working contacts in lateral excursions, Protrusive
contacts, and canine guidance

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26
Q

Ridge Lap
-Also known as a — pontic
-Not used any longer
-Forms a large — contact area with ridge
-Patient not able to —
-Creates

A

Saddle
CONCAVE
clean
tissue inflammation leading to tissue ischemia and necrosis

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27
Q

Hygenic Pontic
-Also known as – Pontic
-No contact with –
-at least — of space between the
ridge and the pontic
-Patient can easily clean without the
pontic being a —
-Only for use in —
-Design and shape is — in all
directions.

A

Sanitary
Ridge
2-3mm
food trap
non-esthetic areas
CONVEX

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28
Q

Pontic Design
– Modified Hygenic Pontic
-Perel Modification
To increase — of
bridge in connectors with
hygenic pontic

— is increased
with less occlusal gingival
height. So, lets beef up
those connectors!

A

strength
Deflection

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29
Q

Conical Pontic
-Passive contact with —
-Rounded and cleansable
-Triangular embrasure space can
-Best suited for —
-Also not best for — areas.

A

ridge crest
trap food
thin mandibular ridges
esthetic

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30
Q

Modified Ridge Lap
-Passive contact — side of ridge crest
-Can appear very —
— tissue surface contact
-Used frequently in the — areas.
-Shape can help keep
— much easier for patients

A

facial
esthetic
Convex
esthetic
food from trapping
Cleansibility

31
Q

Pontic Design – Modfied Ridge Lap Pontic
Convex in all directions except for

A

a small concavity on the lingual
side of the facial-gingival aspect
of the pontic

32
Q

Pontic Design – Modfied Ridge Lap Pontic
Contact area is meant to be —
— side needs to be smooth
and highly polished
Tissue contact ok but should not
put — on the tissue.
Keep tissue contact on —
Tissue contact shape is ideally
shaped like a —

A

minimal
Lingual
pressure
Keratinized tissue
T

33
Q

Pontic Design – Ovate Pontic
Blunt rounded Pontic shape that is set into a
— by well educated and motivated patients
Highly —

A

concavity in the tissue of the edentulous ridge
Cleansable
Esthetic

34
Q

Pontic Design – Ovate Pontic
Generally requires planning
(3)

A

-Pre-Prosthetic surgery via immediate
provisionalization after extraction
-Surgery/modification with provisional to
develop tissue shape and contour
-Ovate Pontics keep a slight pressure on the
tissue to maintain the effect of
emerging from the ridge

35
Q

— requires lots of planning, possible
surgery, and a patient willing to work to
clean and maintain the area.

A

Ovate

36
Q

Modfied Ridge Lap then is the most
common type of pontic because it is

A

esthetic but requires much less effort on
the part of the doctor and patient.

37
Q

Connector design is important for the — of the FPD.

A

strength

38
Q

Connector design is important for the strength of the FPD.
Can be challenging to get appropriate —
with short or crowded dentition.

A

height and width

39
Q

Typical Connector dimensions:
Height –
Width –
Gingival Embrasure form better to be
Consideration needs to be made to design an
appropriate cross-sectional area

A

3-4 mm
3-4 mm
U shaped than V shaped

40
Q

Connectors are shaped to be concave in the

A

Buccal Lingual AND the Mesial Distal
TOWARD the ridge.

41
Q

U shape from Occlusal to Gingival
(2)

A

-U shape is stronger than a V shape.
-U shape provides stronger fracture
resistance.

42
Q

Remember… Minimum height is — mm

A

3-4

43
Q

Remember… Minimum height is 3-4mm
-if you increase the height, you increase the

A

strength
-Height x2 = increased strength by a cube

44
Q

Connectors are designed large enough to
prevent fracturing, but not to impinge on
embrasure and physiological contouring
Anterior connectors are placed more —
for esthetics
Anterior connectors are longer —
for strength

A

lingually
inciso-gingivally

45
Q

Anterior connectors considered ”—
Drop” shape

A

Tear

46
Q

Posterior Connectors
— height is more important
than — width for strength
Posterior connector shape is considered “—”
Getting appropriate 3-4mm height can be
challenging in some posterior
situations.

A

Occluso-Gingival, buccal-lingual
heart shaped

47
Q

Connector size is at least — and possibly needs to
be larger

A

4mm

48
Q

U shaped connectors need a large radius at the

A

gingival embrasure

49
Q

Full strength Zirconia shows increased fracture
resistance compared to all ceramic, but as of yet,

A

research shows the need for connectors in size
similar to all ceramic

49
Q

Strength is a challenge thus far and there is an
increased — potential with all ceramic
bridges

A

fracture

49
Q

-Metal frameworks are assembled in two ways:
(2)

A

-Cast/milled as one piece
-Two or more pieces are soldered together (metal
only).

**(Laser Welding in Titanium alloy situations can be
used)
**(CAD/CAM can be used to make a one piece
bridge framework with ceramics/Zirconia)

49
Q

Strength is a challenge thus far and there is an
increased — potential with all ceramic
bridges

A

fracture

49
Q

(2) are still the standard that others
are measured against

A

PFM and Full Gold bridges

49
Q

Single Piece casting issues to watch for:
-Distortion –

A

greater the length, the increased distortion

49
Q

Can be very challenging to verify the fit of all the
retainers and therefore to over reduce the
interior/intaglio of the framework to get it to seat
fully

Due to these problems, often longer span bridges are cast in

A

multiple pieces and soldered together. The idea is that two small pieces are easier to fit than
one longer one.

49
Q

Also, if an FPD metal framework you are trying in does not fit due to distortion, you can

A

cut between a
pontic and retainer, re-seat each smaller piece to
verify each individual fit, and then capture the new
seating with acrylic. This can be sent to the lab to
solder the two pieces together.

49
Q

If your framework has distorted or you have two large
pieces of framework to try in, how do you reconnect
them? What is soldering and how is it done?
Soldering –
(3)

A

joining of metals by fusion of filler metal bonding
to each of the parts being joined.
-The bond is created by wetting the surface of parent
metals with liquified solder
-The metal framework does not melt during this

50
Q

Brazing –

A

A specific form of soldering when the filler
material has a melting temperature above 450
degrees Celsius.

51
Q

skipped
Dental Solder – What do we desire solder to do
for us?
(6)

A

-Resists tarnish and corrosion
-The fusion temperature 100-150 degrees Fahrenheit below
that of the substrate metal
-Free flows when melted
-Resists pitting
-Is strong
-Matches color of the two parts being joined.

52
Q

How do we classify Solder? And WHY?
Solder is classified by Fineness
-Fineness is the parts per thousand of gold in a
solder
-650 fine =
Higher Fineness increases the
Higher Fineness increases
Higher Fineness results in

A

650 parts gold per thousand parts
melting range
resistance to tarnish or corrosion
decreased hardness

53
Q

What factors affect the accuracy and
prognosis of soldered connectors?
(3)

A
  1. Connector Space
  2. Metal Surface Preparation
  3. Indexing Technique for Investment
54
Q

Connector Space
A proper space between the two metal
surfaces allows the

A

solder to flow in-
between

55
Q

A proper space allows for (2) of the solder

A

thermal expansion
and shrinkage

56
Q

A proper space is small enough to minimize

A

distortion from the solder shrinkage as it
cools

57
Q

A proper space is also large enough to allow
for a

A

strong connector

58
Q

A proper space is

A

parallel and flat with a space
for thickness the size of a business card
(0.2mm)

59
Q

Metal Surface Preparation
Metal Surface needs to be (2)
Metal Surface needs to have a — finish instead of
highly polished.

A

clean and uncontaminated
satin

60
Q

Indexing Technique for Investment
2 steps

A
  1. Flow auto-polymerizing acrylic resin into space to hold two pieces together.
    Each side should be fully seated with margin integrity checked and
    verified.
  2. Make an occlusal plaster index to send to the lab for soldering. Framework should be
    solidly planted in plaster index so that enough of the coronal portion is covered so
    framework can be held in place.
61
Q

Flux –

A

Enables solder to wet and spread over clean
metal surfaces. Flux removes oxides, and
prevents further oxide formation
-contains Borate

62
Q

Anti-Flux –

A

Limits the spread of the solder.
-Contains graphite or rouge

63
Q

Pre-Ceramic Veneer Soldering
(5)

A

Uniting components of the same alloy
BEFORE porcelain is fired.
Uses high-fusing solder
Melt solder with a torch
Solder has lower melting temp than alloy,
but higher melting temp than porcelain
firing temperature
Less Technique Sensitive

64
Q

Post-Ceramic Veneer Soldering
(7)

A

Uniting components of the same alloy AFTER
porcelain is fired
Uses low-fusing solder
Melt solder in oven
Solder has lower melting temp than alloy and
porcelain
More Technique sensitive
*Can compensate for slight discrepancies or
distortions that occur AFTER the porcelain is
fired.
*Porcelain can crack in area of solder joint
during solder process

65
Q

Open Contact with a All metal or PFM
crown?
Addition Soldering –

A

Adding material to contact area
Smoothing and shaping contact area
Voila! Contact!
Can add contacts to Zirconia too but not
to Lithium Disilicate

Fixed Prostodontics 2 (13 decks)

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