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Revision Lec Fixed Pros Finals Flashcards

1
Q

What considerations should be made when deciding to replace missing teeth?

A

to replace or not to replace?
fixed or removable?
feasible + realistic or not?
financially possible or not?
patient or dentist led?
timeframe reasonable or not?
predictable or not?

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2
Q

What are the effects of tooth loss? (3) (FAB)

A

Functional issues
- Discomfort
- Reduced chewing ability/ speech impairment

Aesthetics
- including pt perception + self-image

Biological
- Drifting of teeth + over-eruption
- TMD
- BL
- Occlusal stability

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3
Q

What questions should you ask yourself (practitioner) + pt to gain more information about missing teeth?

A

how did they lose the tooth?

when did they loose the tooth?

is it affecting function?

is there food trapping?

is it affecting aesthetics? (especially, if wide buccal corridor or high smile line)

clinically - is there an opposing tooth? is there space? has occlusion been affected? is the opposing tooth drifted/over-erupted? - this will interfere w/ ICP/RCP to create occlusal interference)

Key 🔑 point to consider:
If over-eruption is going to happen it’ll happen in the first few years
after this less likely to happen unless changes in the occlusion
therefore, maybe do NOT need to replace this tooth?

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4
Q

What percentage of unopposed posterior teeth over-erupt?

A

83%

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5
Q

What are the 8 steps of pt assessment?

A

Initial consultation
Pt complain
Pt DH
Restorative status
Pt’s expectations
Pt’s compliance
OHI
MH

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6
Q

What are the tx options for replacing missing teeth?

A
  1. No tx
  2. Implants
  3. Bridges
  4. RBB
  5. Conventional
  6. RPD
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7
Q

List tx planning considerations when replacing missing teeth?

A

Benefits

**Risks **

**Cost **

Longevity, which depends on:
- materials used
- type of restorative procedure
- pt parameters
- operator variables
- local factors (i.e. occlusion)

Maintenance

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8
Q

What are some of the concerns when replacing missing teeth? (7)

A

Prolonged tx (for pt + operator)

Tx stress + discomfort

Subsequent problems w/ abutment teeth

Maintenance + replacement of defective prostheses

Risk of litigation from failed tx + dissatisfied pts

Iatrogenic tissue damage + resulting problems

Complex + costly dental tx required

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9
Q

In what cases would you consider NOT replacing teeth?

A

Long standing missing tooth/teeth

Pt not interested

Operator led

Would compromise remaining dentition

Pt medically compromised

Function is not undermined

Aesthetics not compromised

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10
Q

What is the shortened dental arch concept?

A

Min no of teeth = 20

Studies show oral function = adequate where at least 4 occluding premolar units were left (preferably in symmetrical position + pt’s age to be considered)

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11
Q

What the 3 different methods of placing implants?

A
  • immediate implant placement
  • early implant placement (4-8w, of ST healing, 12-16w after partial bone healing)
  • late implant placement (>6m later, after complete bone healing)
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12
Q

What are the indications of Removable Partial Dentures?

A
  1. Aesthetic concerns
  2. Extensive tooth loss or LONG-SPAN edent. areas
  3. Distal extension cases
  4. Periodontal considerations
  5. Economic factors
  6. Temporary or transitional solution; after XLA or young pt
  7. Pt specific factors: RPDs are indicated for pts who are physically or emotionally vulnerable, have dexterity issues, or OH concerns
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13
Q

What factors should you consider when selecting abutment teeth for RPDs?

A
  • strategic teeth
  • restorative status
  • favourable characteristics
  • need for preparation (rest seats/ guide planes/ create undercuts)
  • need for extra coronal restorations (milled ledges etc)
  • aesthetics
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14
Q

What are disadvantages of RPDs?

A

Many RPDs not worn:
- mandibular posterior free-end saddle appliances + those that do not improve the appearance of pts

The fit, retention, support + stability of acrylic resin RPDs = often unsatisfactory

OH- increased plaque retention, high caries risk + compromised periodontal status is assoc. w/ abutment teeth

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15
Q

Clinical scenarios RPDs

Lower denture: two canines, grade 1 mobility + BL.

Do we XLA the teeth or keep when planning the partial?

A

keep and do partial
plan for failure of the canines
but for now will increase retention + stability and allow pt’s muscles to get used to it

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16
Q

What is the definition of a RBB?

A

A fixed dental prosthesis that is luted to tooth structures, primarily enamel, which has been etched to provide mechanical retention for the resin cement

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17
Q

What are the 3 design types of an RBB?

A
  • Cantilever
  • Fixed-fixed
  • Hybrid (where one of the retainers = conventional)
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18
Q

What should the wing thickness for an RBB be?

A

metal= 0.7mm
zirconia= 0.7mm
emax= 0.7mm

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19
Q

State indications, +ves and -ves for use of sanitary/hygienic pontic design?

A

ind= posterior mandible, non aesthetic zone, impaired OH
+= good access for OH
-= poor aesthetics, contraindicated if minimal vertical dimension

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20
Q

State indications, +ves and -ves for use of saddle-ridge lap pontic design?

A

Not recommended due to poor OH
(only +ve = good aesthetics)

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21
Q

State indications, +ves and -ves for use of modified ridge lap as pontic design?

A

ind= high aesthetic requirements (anterior), premolar + some maxillary molars

+= good aesthetics, most OH friendly
-= small gap lingually/palatally, therefore discuss w/ pt so they can get used to it

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22
Q

State indications, +ves and -ves for use of conical pontic design?

A

ind= molars
+ = good access for OH
- = poor aesthetics

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23
Q

State indications, +ves and -ves for use of ovate pontic design?

A

ind= used most for immediate RBB, maxillary incisors, canines + premolar

+= superior aesthetics thus good for high smile line, decent OHI

  • = requires surgical preparation
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24
Q

What is the primary cause of RBB failing?

A

Debonding due to differential forces!

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25
What are the advantages of an RBB? (8)
Minimal removal of tooth structure Minimal potential for pulp trauma LA not routinely needed Can be kept entirely supragingival Provisional resto not needed Reduced chair time Reduced cost Rebond if possible
26
What are the disadvantages of an RBB?
Reduced restoration longevity Enamel modifications are required Space correction= difficult Tx of diastema is demanding; a cantilever option Good alignment of abutment teeth = needed Aesthetics is compromised on posterior teeth
27
What are the indications of an RBB?
Replacement of missing anterior tooth/teeth especially in children + adolescents Replacement of single posterior teeth Sound teeth or those w minimal restorations Significant CLINICAL CROWN LENGTH Periodontal splinting + post-orthodontic fixation Excellent moisture control
28
What surface is best to bond an RBB to?
Best bonding is to enamel Then composite Then amalgam or dentine (replace amalgam w composite for better bonding, replace old composites too for better bonding)
29
What are the contraindications for RBB placement?
Parafunctional Long edentulous span (posterior) Restored or damaged abutments Comprised enamel Aesthetics concern (significant pontic width discrepancy) Deep vertical overlap Nickel allergy; all-ceramic is an alternative
30
What factors should you consider when selecting abutment teeth for RBBs? (9)
Sensibility test Crown height Restorative status Periodontal status Mobility Periapical status Position/tilting Shape Occlusion
31
What 3 Fixed Bridge designs are there?
Fixed-fixed Fixed-movable Cantilever + spring cantilever
32
What the advantages of Fixed Bridges?
The lifespan = 15-20yrs For fixed-fixed design - stresses are distributed evenly between the abutments Provides a predictable + aesthetic result
33
What are the indications of Fixed-Fixed bridges?
The anterior region of the mouth Long posterior spans over two units When periodontal splinting is required
34
What are the disadvantages of fixed bridges?
Destructive of tooth structure RCT once a bridge is cemented is likely you need a remake because access preparation weakens the underlying dentine or core Failure can lead to complete fracture of the abutment (can lead to XLA) --> An RBB can be cleaned off + rebounded in position w minimal inconvenience to pt
35
Design considerations for distributing forces evenly in fixed-fixed bridges?
= important to **share the load equally** between abutments (rather than stress-broken design where load is transferred through the fixed retainer) The **HEIGHT, WIDTH + THICKNESS** of the **connector** should be maximised to provide rigidity to the framework - this reduces stress placed on the luting cement.
36
What factors should you consider when selecting an abutment for fixed-fixed bridges? part 1
teeth are structurally sound, w satisfactory appearance + crown forms the teeth are in good alignment + position (not needing orthodontic therapy or complex designs) previous restorations + endodontic tx are satisfactory **abutment tooth roots + supporting alveolar bone are functionally adequate** the alveolar bone of the edentulous ridge between, or distal to, the abutment teeth is adequate in quantity + quality the ST of the edent. ridge is satisfactory in quantity + quality
37
What factors should you consider when selecting an abutment for fixed-fixed bridges? part 2
Presence of RCT Periodontal Support Axial inclination Restorative Status Aesthetic Considerations Pulpal Status Distribution in the arch Neighbouring edentulous spaces
38
Questions to ask when doing a tooth assessment for restorability?
**Is it restorable?** (can't complete an RCT and then deem tooth unrestorable) If successful RCT, how confident are you in ensuring the **longevity of extra coronal restoration**? **Biological width (of edent space + abutment teeth)**
39
If caries approaching the root, what can you do to increase restorability of the tooth? i.e. restoring subgingival caries
**deep margin elevation** (DME) **crown lengthening** **ortho extrusion** (DME= better for composite, hard to achieve a seal w indirect resto. For indirect restos, DME mostly used to take a good impression)
40
You have prepared a tooth for a crown but not yet **cemented** it, **pt is symptomatic** - what should you do?
= **SENSIBILITY TESTING** (ideally should be recorded over multiple appointments, before LA) - if symptoms of reversible pulpitis you need to wait? 🏻 don't proceed to the final crown 👉🏻 ask lab to construct a lab provisional + cement it w/ permanent cement until symptoms resolved 👉🏻 if symptoms arise between impression + fit of permanent crown, then consider cementing w/ temporary cement, until symptoms (if not then remove crown w/ crown remover + RCT)
41
Key points about a cantilever bridge?
= should be used to replace SINGLE TOOTH (as they place a large load on the abutment + connector) - most commonly used in the anterior region to replace MAXILLARY LATERAL INCISOR using the CANINE as the abutment success = dependant on the abutment being the same size or larger than the pontic + arrangement of the occlusion to avoid heavy load on the pontic. (same as RBB- pontic light ICP contacts w/ no contact in lateral + protrusive excursions) a posterior cantilever bridge where occlusal loads = high is where double abutments indicated. Used when upper first premolar to be replaced w/ a conventional cantilever bridge - the 2nd premolar + 1st molar as recommended as the abutment
42
What are PROS of a cantilever conventional fixed bridge? (i.e. cantilever crown)
less invasive aesthetic (used for anterior teeth, esp. if all ceramic) less costly good longevity (59% survive after 15yrs)
43
What are CONS of a cantilever conventional fixed bridge? (i.e. cantilever crown)
Case selection Invasive Higher chance of debonding than fixed fixed (esp. if distal cantilever)
44
When is a Fixed- Movable Bridge used?
= most ideal for replacement of 1 or 2 teeth in the posterior region of the mouth. Mainly used for TILTED teeth - design according to the long axis of each tooth, this can help avoid overprepping 1 of the tilted teeth (don't need 1 common path of insertion)
45
What is the design of a Fixed-Movable Bridge?
The design utilises 'stress-breaking' effect, reducing the demands on the minor retainer + allowing the abutments to retain a degree of independent axial mobility. The minor retainer may be partial coverage, which preserves tooth structure + the design is useful where tilted abutment teeth present. ## Footnote A fixed-movable bridge is a dental bridge design where one of the abutments (the teeth that support the bridge) has a movable connection, allowing for some flexibility between the abutments. This design can be beneficial in certain situations, such as when the abutments are not perfectly parallel or when there's a need to distribute forces differentl
46
What is a Hybrid Bridge?
a combination of a conventional retainer on 1 abutment + resin-bonded wing on the other. +ve = preserves tooth tissue by using the appropriate retainer for each abutment -ve= problems arise w/ attempting to use different cement types simultaneously at cementation. Little long-term data about survival.
47
What are the prep dimensions for a full metal crown? (posterior)
1.5mm functional cusp reduction 1mm non-functional cusp reduction 0.5mm chamfer 0.5mm axial reduction 1.5mm bevel
48
What are the prep dimensions for an all ceramic crown? (anterior)
1-1.2mm labial reduction with 2-3 different planes 1-1.2mm palatal reduction 1.5-2mm incisal edge reduction 1mm shoulder margin all around
49
Shape of RBB pontic, crown etc is dictated by what? (7)
Occlusion Guidance Lip line/ smile line Existing teeth Old photos Photos of teeth of others (i.e. aspirational/examples) Operator preferences (square, rectangular, oval, pointed oval, triangular, + round)
50
Which type of conventional bridge has a superior 5yr survival rate PFM or ceramic bridges?
= PFM ! (94.4%) ceramic (85-90%) (other facts: secondary caries higher in abutment teeth of zirconia bridges cx to PFM bridges)
51
What the 6 different types of luting cements?
1. Zinc phosphate (if dentine is exposed, ZP= acidic, can cause sensitivity, if tooth=vital, try avoid this cement) 2. Zinc polycarboxylate 3. GIC 4. RMGIC (expands when setting, which can cause cracks in the zirconia upon setting) 5. Reinforced ZOE 6. Resin Cement
52
What luting cement should be used for each type of indirect restoration?
53
What are the setting mechanisms of luting cements + when to use each? (3)
light cure self cure dual cure (crowns= self cure + dual cure inlays + veneers= if thick then self or dual cure if thickness of ceramic >7mm then self + dual if <7mm can also used light cure )
54
What is the classification for All-Ceramic Systems?
55
What type of material is Lithium Dislocate + state key facts?
Li2Si2O5 = GLASS CERAMIC aka E.MAX Flexure strength= 360-400Mpa Made by 2 techniques: CAD/CAM Heat-pressed (wax up technique)
56
What are the 4 benefits of heat-pressed E.MAX vs CAD/CAM E.MAX?
1. Superior flexural strength= >400Mpa 2. Cleaner + more precise margin integrity + less chipping 3. Less wear on the opposing teeth due to the smoothness of restorative surface 4. Higher level of detail if possible when waxing for pressing (CAD/CAM used more despite this, due to ease)
57
What are the indications for Lithium-Disillicate Glass-Ceramic?
- thin veneers (0.3mm) - Occlusal veneers - Inlays, onlays, partial crowns - Minimally invasive crowns (>1mm) - 3 unit drives (up to 2nd premolar as the terminal abutment) - implant sub-structures
58
Key facts about Zirconia?
twice as strong + tough as alumina-based ceramic (due to metastable tetragonal phase, monoclinic phase + volume expansion) Flexural strength = 900-1100Mpa
59
Indications for use of Zirconia as indirect restoration?
Anterior + posterior crowns Anterior + posterior bridges RBB Implant abutments Endodontic posts Veneers, inlays, onlays?
60
Key facts about Monolithic zirconia restorations (new type of all-ceramic) ?
New Zirconia material that has been achieved by microstructural modifications, that have led to: increased translucency (better optics) but slightly decreased strength (one blob of zirconia rather than layers) can be used in tooth wear cases, as it causes less wear of enamel of the opposing tooth cx to ceramics
61
Ideal conditions for resin bonding cementation to the abutment?
To the abutment: RBB cementation required **UNCONTAMINATED, ETCHED + PRIMED ENAMEL or DENTINE SURFACE** **Rubber dam** during cementation reduces risk of restoration debonding If restored: enamel> composite>GIC> Amalgam=Dentine
62
What are the benefits of etching the inner surface of Lithium Disilicate RBBs w. hydrofluoric acid prior to cementation?
- creates retentive etch pattern - increases the SA for bonding - increases surface energy + wettability - dissolves selectively the glassy matrix (etch time = 20seconds conc= 4.9%)
63
What are the benefits of using ultrasonic cleaning before cementation of RBB?
To remove: residual acid + dissolved debris from the inner surface remineralised salts (white residue)
64
What are the benefits of silanizing the etched surface i.e bond before cementation of RBB?
= coupling agent w/ two arms CHEMICAL BONDING by bi-functional coupling agent (silane) Increase wettability
65
What bonding protocol is used for Zirconia RBBS (oxide ceramics)?
APC system A= air-particle abrasion (10mm distance, 75-90 degree angle for 5-10s) P= Zirconia Primer (uses phosphate monomers) C= adhesive composite resin (dual or self cure cements e.g. Panavia, Rely X)
66
Can we skip primer for RBB bonding?
Yes, sometimes in the resin cement itself
67
When using DUAL CURE resin cement, what 3 ways can you used to remove the XS?
- micro brush - partial light cure 1-3 secs + clean - using 12 blade
67
Why do we use oxy-guard the end of RBB cementation?
to avoid development of an OXYGEN-INHIBITED LAYER at the margins (oxygen inhibition or glycerin, should be applied prior to final polymerisation)
68
How do you check occlusion post cementation of RBB?
- in ICP and all excursive movements use 8-20 um thick articulating paper: - articulating foils - shim stock - mylar film
69
Restoring endodontically tx'd teeth: Need to careful when restoring when endodontically treated teeth, what assessments should you do?
- endodontic evaluation - periodontal evaluation - prosthetic considerations - aesthetic evaluation - strategic evaluation
70
What is the polishing protocol for RBBs, post checking occlusion?
- if adjusting occlusion you want to use something that is not TOO rough, because rough burrs remove the glaze + increase surface roughness which causes: at the cervical border= plaque accumulation, discolouring, caries the wear of opposing tooth reduces strength (thus use prisma finishing system if really needed, otherwise if not changes made don't need to polish)
71
What does an endodontic evaluation entail of?
Good apical seal No TTP No TTPal No exudate No fistula No active inflammation
72
What does a periodontal evaluation entail of?
Gingival condition (unstable disease, amount of bone loss) Violation of supracrestal tissue attachment; biological width Crown- to-root ratio Furcation defects Mobility (grade, progressive mobility occlusal trauma) Root morphology (grooves, concavities, root proximity)
73
What does a prosthetic evaluation entail of?
1. Extent of coronal destruction 2. Ferrule effect (an adequate circumferential supra marginal collar of dentine to retain an extra-coronal restoration) (studies show minimum 2mm)
74
State the name of a restorability index you can use to aid clinical decision making?
75
What are other factors to evaluate when assessing tooth restorability?
1. Tooth type (anterior or premolar or molar) 2. Position in arch 3. Occlusal + prosthetic forces applied to tooth (parafunctional loads can be 6 times the normal chewing force) 4. Gender + age 5. OH 6. Saliva flow 7. Material of the antagonist occlusal surfaced 8. Aesthetics
76
Anterior teeth cuspal coverage options and considerations? (pt.1)
77
Posterior teeth cuspal coverage options and considerations? (pt.2)
77
Anterior teeth cuspal coverage options and considerations? (pt.2)
78
What are the 3 crown options?
1. Gold 2. PFM (most commonly placed full coverage restoration in the posterior dentition; also used as bridge abutments)
79
What is an endocrown?
80
Steps for removing a crown?
take putty incase get consent - warn of failure immediate RBB + essex retaininer when planning for failure in anterior region discuss cost w pt - might use it might not rubber dam before removing diamond burr for cutting = for ceramic tungsten carbide for cutting metal flat plastic to lever off crown ultrasonic to remove excess

Fixed Pros Revision Lec BDS5 Bissu (1 decks)

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