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Fixed 2 > Treatment Planning and Biomechanics of Fixed Partial Dentures > Flashcards

Treatment Planning and Biomechanics of Fixed Partial Dentures Flashcards

1
Q

What is a fixed partial denture (bridge)?

A

A dental prosthesis definitively attached to remaining teeth or to dental implants, which replaces one or more missing teeth.

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2
Q

What is an abutment?

A

Natural tooth or implant serving as attachment for Fixed Partial Denture

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3
Q

What is a retainer?

A

Extra-coronal restoration cemented to abutment

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4
Q

What is a pontic?

A

Artificial tooth suspended from abutments

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5
Q

What is a connector?

A

Rigid (or non-rigid) connecting pontic and retainers

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6
Q

What is an edentulous ridge?

A

The site of the alveolar bone and its covering soft tissues that remains after tooth loss.

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7
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11
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12
Q

What allows for a state of dynamic equalibrium?

A

Equal pressures keeping teeth in their locations

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13
Q

What would the consequences be for loss of #19?

A

-Improper occlusal pressures on #14 and #18
-Food trap #20 and #21 due to drifting
-Lack of inter-occlusal space in area #19
-Occlusal plane is now disrupted and out of harmony
-Excursive movement interferences and possible loss of full range of
movement.

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14
Q

What are the consequences of unrestored tooth loss?

A

Tooth Movement
-Over-eruption
-Tilting and drifting
-Disruption of occlusion (Pain, TMJ disfunction)

No tooth Movement
-for some reason, some teeth never move after loss of proximal or opposing contact

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15
Q

Occlusal interferences are produced when a FPD is made to the…

A

over-erupted dentition

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16
Q

How do you prevent interferences with making an FPD to the over-erupted dentition?

A

Opposing tooth being restored to a corrected occlusal plane
- Odontoplasty, restoration, crown, RCT, crown lengthening, intrusion, or even extraction

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17
Q

Partially Edentulous Patient Treatment Options…

A

-Removeable Partial denture
-Tooth supported Fixed Partial Denture (Conventional, Resin-Bonded, Cantilever)
-Implant supported Fixed Partial Denture
-Always the option to do nothing.

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18
Q

What are the indications for removeable partial denture?

A

-Long edentulous spans
-No distal abutment
-Multiple Edentulous spaces
-Abnormal abutments (Tipped, divergent, or few abutments)
-Periodontally weakened primary abutments (Bridge abutments compromised)
-Severe loss of tissue/bone in residual ridge

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19
Q

What information would you need to know to determine the prognosis of a fixed bridge for treatment planning?

A

X-rays
Perio charting
Decay prevention
Home care
Reason for previous tooth loss
Clencher/grinder?
Finances?
Condition of existing crowns

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20
Q

What are the indications for a fixed partial denture?

A

-To replace function of missing teeth
-To stabilize occlusion and keep teeth from drifting and extruding
-To create esthetics and phonetics
- Properly distributed abutments
- Abutment strength

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21
Q

What should you be aware of for properly distributed abutments for an FPD?

A
  • Abutment on both ends of the edentulous space
  • Span length falls within structural limits
  • Straight alignment of restoration (slight variations)
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22
Q

What should you be aware of for abutments strength for an FPD?

A
  • Abutments need to be restorable
  • Peridontally sound and stable
  • No questionable pathology (PARL, non-vital)
  • In Occlusal harmony
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23
Q

What are the contraindications for an FPD?

A
  • excessive loss of alveolar ridge
  • abutments not restorable
  • abutments are periodontally compromised
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24
Q

What should you be aware of for escessive loss of alveolar ridge for not doing an FPD?

A
  • Difficultly cleaning
  • Difficult to make esthetic
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25
Q

What should you be aware of for non restorable abutments for not doing an FPD?

A
  • Short clinical crown
  • Heavily restored already
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26
Q

What should you be aware of for abutments that are periodontally compromised for not doing an FPD?

A
  • Loss of bone
  • Crown to root ratio
  • Span between abutments too long
27
Q

What does an ideal Fixed Partial Denture look like?

A

-Periodontally sound abutments
-Tissue follows contour of pontic and connector
-Span is within structural parameters

28
Q

How do we evaluate Abutments?

A

-Clinical exam including hard and soft tissues, periodontal exam and occlusal evaluation.
-Radiographic exam: A Full Mouth Series is always recommended for a patient this complex!!
-Diagnostic casts (articulated on full- size articulator w/ facebow if needed)

29
Q

What are the criteria we use for Abutment evaluation?

A
  • Restorative assessment (coronal tooth structure, previous restorative treatment)
  • Endo assessment (pulp status, PARL, previous endo)
  • Periodontal assessment (crown/root ratio, root configurations)
  • Abutment Positional assessment (tilted tooth, inclined tooth, path of insertion)
  • Radiographic assessment (anomalies)
30
Q

Questions to ask yourself about the teeth being assessed as abutments:

A
  • Adequate retention and resistance form possible?
  • Is there adequate wall length?
  • Is the tooth restorable as is or is decay present?
  • If not, can restorability be gained with foundation or modification of preparation?
  • What is the apical extent of caries or restoration?
31
Q

What do you need to evaluate on the coronal tooth structure of an abutment?

A

Remove all caries, old restorations, then evaluate:
-Is there a Pulp exposure, symptomatic tooth, or Periapical pathology?
-Proximity of cavity depth to alveolar crest.
—Biologic width violation likely?
-Adequacy of retention/resistance form to support retainer crown.
—Do I have the necessary tooth structure?

32
Q

What do you do to an abutment with existing RCT?

A

Assess radiographically first. Is there a PARL present? Is the RCT adequate?

33
Q

When can you use an abutment with vital pulp?

A

Ideally tooth is asymptomatic with
sound tooth structure remaining

34
Q

When can you use an abutment with nonvital pulp?

A

RCT if sound tooth structure remaining with non-vital tooth.
–Post may be needed

35
Q

Periodontal health is a prerequisite for any fixed prosthodontic restorations. What do you need to make sure for abutments?

A

-Need a zone of attached tissue
- No mobility
-Patient home care adequate
–Crown to root ratio, root shape and configuration, periodontal ligament area all need to be assessed and evaluated

36
Q

What is the crown to root ratio?

A

The ratio of the portion of the tooth occlusal to the alveolar crest (crown) versus the portion of the tooth embedded in bone (root).

37
Q

What is the optimum crown/root ratio?

A

Optimum C:R is 2:3

38
Q

What is the minimum crown/root ratio?

A

Minimum C:R is 1:1 for fixed restorations

39
Q

The ______ root shape diminishes the actual area of support more than expected from the height of the bone

A

conical

40
Q

___________ bone loss dramatically reduces supported root surface area

A

Horizontal

41
Q

The __________________ (R) moves apically and the lever arm (L) increases, greatly magnifying the forces on the supporting structures.

A

center of rotation

42
Q

What are the exceptions for the crown/root ratio rules?

A

If opposing occlusal forces are diminished such as:
- Artificial teeth (Full denture, RPD)
- Periodontally compromised opposing teeth

43
Q

What are the best teeth for abutments (multi-rooted or single rooted)?

A

Multi-rooted teeth are better than single rooted teeth, conical teeth.

44
Q

What are the best teeth for abutments (widely separated roots or fused roots)?

A

Widely separated roots are better abutments than fused roots.

45
Q

What are the best teeth for abutments (long roots or short roots)?

A

Long roots are better abutments than short roots.

46
Q

What type of single rooted tooth is good for abutments?

A

Irregular configurations or curvatures are preferable compared to a perfect taper

47
Q

The tooth root should be boader FL or MD for an abutment?

A

FL

48
Q

What is ante’s law?

A

The root surface area (embedded in bone) of the abutment teeth should be equal or surpass that of the teeth being replaced with pontics.

49
Q

Is this ante’s law favorable or unfavorable?

A
50
Q

Is this ante’s law favorable or unfavorable?

A
51
Q

Is this ante’s law favorable or unfavorable?

A
52
Q

What is the principle for any FPD replacing more than 2 posterior teeth has guarded/poor prognosis?

A

Maxillary arch has longer crowns and less tooth inclinations and therefore can occasionally be acceptable

53
Q

What is ante’s law not as reliable?

A

“Occlusion is the key to success. Even the worst cases with doubtful
prognosis had good success rates when occlusion was right.”
-Failure in FPD’s are more due to biomechanical factors like caries, gingival inflammation, poor framework design, poor occlusion and material failure than due to overstressing of periodontal ligaments
-The suggested ratio cannot be made standard for all patients as individual variations in crown root ratio, root morphology and bone exist.
-Occlusal scheme which is the key factor has not been considered at all.

54
Q

Axial walls of abutment teeth must be aligned without ____________________ for a path of insertion of a bridge

A

undercuts or interferences

55
Q

Why is a tipped tooth difficult to prepare?

A

-often exposes mesial pulp horn
-unfavorable occlusal forces if tilt is too significant

56
Q

What can you evaluate using casts?

A

-Edentulous spaces and span length
-Curvature of the arch
-M-D drifting, rotations, F-L displacement of the abutments
-Inclination
-Occlusion and inter-occlusal space
-Path of Insertion

57
Q

When teeth are not perfectly aligned, a ________ can be used to identify the path of insertion and to help you create the appropriate planes in tooth preparation to create a path of insertion.

A

surveyor

58
Q

What do you need to look for on radiographs of abutment teeth?

A

-Caries – Where and how much
-RCT present? – is it healthy?
-Bone levels – C:R ratio, direction of roots, PDL widened, bone loss
-Maxillary sinus – Is there lack of bone support due to sinus pneumatization

59
Q

When can you do a resin-bonded fixed partial prosthesis?

A

-Conservative enamel only preparation
-Used for single missing tooth with slight to moderate tissue resorption in missing tooth area
-Only areas of light occlusal stresses and good alignment with neighboring teeth
-Not indicated for deep vertical overlaps (Deep bite)
-Excellent option in younger patients where age contraindicates implant or bridge
-Most often used to replace missing maxillary lateral incisors

60
Q

What is a cantilever fixed partial prosthesis?

A

A fixed partial denture that has an abutment(s) at one end with the pontic remaining unconnected on the other end.

61
Q

What are the indications for an implant supported FPD?

A

-Implant abutments must be soundly integrated
-Implant parallelism very important
-Availability of bone to support implant critical
-Patient must demonstrate adequate home care

62
Q

Why are implant supported FPDs controversial?

A

–Clear Choice and others fabricate full arch one piece fixed appliance.
–$25,ooo per arch
–Patient cannot remove
–Hygiene is a huge challenge here.
–Need to be replaced around every 10 years with current materials.

63
Q

What are the limitations of implant placement?

A
  • Amount of bone critical
  • Location of bone critical
  • Anatomy
    –Maxillary sinus
    –IAN
    –Anterior angulation of bone

Fixed 2 (3 decks)

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