Fixed Prosthodontics Lecture 5

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Questions and Answers

What is the primary advantage of casting over soldering in fixed prosthodontics?

It requires less technical expertise

It allows for more uniform and controllable connections (correct)

It is a more cost-effective method

It produces stronger bridges

What is the purpose of soldering in fixed prosthodontics?

To section a single unit pattern

To connect multiple units together (correct)

To create a single unit pattern

To fabricate pontics and retainers separately

What is a characteristic of soldered connectors in fixed prosthodontics?

They are less strong than cast connections

They are more prone to galvanic corrosion

They are more uniform, flat, and parallel (correct)

They are more difficult to control

How are pontics and retainers fabricated in a fixed fixed bridge?

As a single unit pattern with a connection Signup and view all the answers

What is the term for a fixed bridge that is also removable?

Fixed removable bridge Signup and view all the answers

How many types of fixed bridges are listed in the lecture?

12 Signup and view all the answers

Why are electrosurgical procedures avoided in patients with pacemaker?

To prevent electrical interference Signup and view all the answers

What is a consideration for patients with uncontrolled diabetes mellitus?

Increased risk of periodontal disease Signup and view all the answers

Why is it important to note medications a patient is currently taking?

To identify potential anticoagulant use Signup and view all the answers

What is a potential consequence of xerostomia on dental restorations?

Increased risk of caries Signup and view all the answers

What is the primary purpose of obtaining a dental history?

To identify previous dental treatment Signup and view all the answers

What is the purpose of clinical examination in dental evaluation?

To detect conditions outside the normal range Signup and view all the answers

What is assessed during the general appearance evaluation of a patient?

Skin color and vital signs Signup and view all the answers

What is a potential consequence of not considering a patient's medical history in treatment planning?

Increased risk of complications Signup and view all the answers

During the extraoral examination, which of the following muscles are palpated?

Masseter, temporalis, medial pterygoid, and lateral pterygoid Signup and view all the answers

What is the maximum jaw opening indicative of jaw restriction?

Less than 40mm Signup and view all the answers

During the Temporo-mandibular joint (TMJ) examination, what is palpated?

Just anterior to the auricular tragus Signup and view all the answers

What is measured during the Temporo-mandibular joint (TMJ) examination?

Maximum lateral movement and jaw opening Signup and view all the answers

Why is pulpal health measured before restorative treatment?

To assess the vitality of the tooth Signup and view all the answers

What is the purpose of the intraoral examination?

To assess the patient's oral hygiene Signup and view all the answers

What is recorded during the intraoral examination?

The presence or absence of inflammation, and the location and depth of pockets Signup and view all the answers

What is palpated during the extraoral examination?

The masseter, temporalis, medial pterygoid, lateral pterygoid, trapezius, and sternocleido mastoid muscles Signup and view all the answers

What is the primary purpose of recording the chief complaint in a patient's own words?

To analyze the patient's primary reason for seeking treatment Signup and view all the answers

What type of information should be included in a patient's medical history?

All necessary information concerning the reasons for seeking treatment along with personal details and past medical and dental experiences Signup and view all the answers

What is the significance of determining the prognosis of a patient?

To offer a favorable treatment outcome Signup and view all the answers

What is the purpose of a screening questionnaire in history taking?

To assist in gathering necessary information concerning the reasons for seeking treatment Signup and view all the answers

What is the benefit of including a patient's personal details in their history?

It provides a better understanding of the patient's reasons for seeking treatment Signup and view all the answers

What is a characteristic of patients with cardiovascular conditions?

They may need prophylactic medications before and/or during treatment Signup and view all the answers

What is the primary purpose of a treatment plan?

To offer a favorable treatment outcome based on a careful evaluation of all available information Signup and view all the answers

What is the significance of a realistic treatment plan?

It ensures a favorable treatment outcome Signup and view all the answers

What is the primary focus when recording tooth mobility?

Relationship with occlusal prematurities Signup and view all the answers

What should be examined carefully in a radiograph?

Caries and presence of P.A lesions Signup and view all the answers

What is NOT a part of the supplement information provided by radiographic examination?

Crown-root ratio Signup and view all the answers

What is the purpose of evaluating the bone before implant placement?

To evaluate the bone quality for implant placement Signup and view all the answers

What is the primary purpose of vitality testing?

To assess pulpal health Signup and view all the answers

How is a diagnosis of non-vitality confirmed?

By preparing a test cavity before the administration of local anesthetic Signup and view all the answers

What is the primary goal of patient history taking in prosthodontics?

To assess the patient's overall health and identify any potential risks Signup and view all the answers

What is the significance of evaluating the crown-root ratio in radiographic evaluation?

It helps in assessing the prognosis of the tooth Signup and view all the answers

What is the primary purpose of diagnostic casts?

To allow an unobstructed view of the edentulous space Signup and view all the answers

Which of the following is a benefit of including diagnostic photography in treatment planning?

It helps the patient to co-diagnose and understand their needs better Signup and view all the answers

What is the goal of an ideal treatment plan?

To address all patient concerns and active problems with the minimum necessary intervention Signup and view all the answers

What is the first step in the mouth preparation sequence?

Relief of symptoms Signup and view all the answers

What is the purpose of evaluating the path of insertion in diagnostic casts?

To determine the need for any modification Signup and view all the answers

What can be evaluated using diagnostic casts?

The shape and length of the abutment teeth, span length and curvature of the ridge, and more Signup and view all the answers

What is the primary goal of mouth preparation?

To relieve symptoms and remove etiological factors Signup and view all the answers

What is the benefit of using diagnostic casts to evaluate occlusion?

It helps to evaluate the interocclusal space necessary to re-establish a proper occlusal plane Signup and view all the answers

What is the primary advantage of a pontic with mucosal contact?

The emergence profile of a pontic simulates the adjacent natural tooth Signup and view all the answers

What is a characteristic of a pontic without mucosal contact (hygienic pontic)?

Good access for oral hygiene Signup and view all the answers

What is an indication for a pontic without mucosal contact (hygienic pontic)?

Knife-edged posterior ridges Signup and view all the answers

What is a characteristic of a complete metal crown?

More expensive than minimal-preparation retainers Signup and view all the answers

What is an advantage of minimal-preparation retainers?

Are less expensive than all ceramic crowns Signup and view all the answers

What is a characteristic of all ceramic crowns?

More expensive than metal-ceramic crowns Signup and view all the answers

What is a consideration when choosing between creating space by reducing the opposing teeth, moving the abutment teeth orthodontically, and a combination of these approaches?

Space available for a minimal-preparation retainer Signup and view all the answers

What is the primary advantage of partial veneer crowns?

Less expensive than complete metal crowns Signup and view all the answers

What is the classification of a fixed partial denture that extends both anteriorly and posteriorly?

Combination Signup and view all the answers

What type of abutment is used in a cantilever design?

Cantilever Signup and view all the answers

What type of connector allows for some vertical movement?

Fixed-movable Signup and view all the answers

What is the term for a crown that is made of metal with a ceramic layer on top?

Metal ceramic Signup and view all the answers

What type of restoration is fabricated using only ceramics with no metal component?

All ceramic Signup and view all the answers

What type of prosthesis is developed by Dr. James Andrews?

Andrews Bridge Signup and view all the answers

What is the purpose of the retainer in a fixed dental prosthesis?

To unite the abutment(s) to the remainder of the restoration Signup and view all the answers

What is the main difference between a posterior and an anterior fixed partial denture?

Location of the edentulous space Signup and view all the answers

What is the primary advantage of using a cantilever design?

None of the above Signup and view all the answers

What type of crowns cover all the five surfaces of the abutment?

Full veneer crown Signup and view all the answers

What is the main consideration when using a spring cantilever design?

Stability of the abutment Signup and view all the answers

What type of retainers are indicated for extensively damaged teeth?

Major retainers Signup and view all the answers

What is the main difference between metal with ceramic facing and metal with resin facings?

The type of facing material used Signup and view all the answers

What type of restorations are used as provisional restorations?

All acrylic, composite and fibre-reinforced composite Signup and view all the answers

What is the purpose of the connector in a fixed dental prosthesis?

To unite the retainer(s) and pontic(s) Signup and view all the answers

What type of retainers are used for minimal preparation bridges?

Minor retainers Signup and view all the answers

What is a characteristic of a full veneer crown?

It involves all of the surfaces of the clinical crown Signup and view all the answers

What is the primary purpose of a laminate veneer?

To restore the appearance of discolored teeth Signup and view all the answers

What is the difference between a retainer and an abutment?

An abutment is a tooth to which a bridge is attached, while a retainer is a crown or restoration Signup and view all the answers

What is a post crown?

A crown that replaces the natural crown entirely Signup and view all the answers

What is the term for a natural tooth that stands between and supports two pontics?

Pier Signup and view all the answers

What is the purpose of a connector in a bridge?

All of the above Signup and view all the answers

What is the term for a fixed bridge that consists of two retainers and one pontic?

Three-unit bridge Signup and view all the answers

What type of retainer is always present at one end of the pontic in fixed-movable bridges?

Major retainer Signup and view all the answers

Which of the following is a consideration when selecting a retainer for a pontic?

Alignment of abutment teeth and retention Signup and view all the answers

When abutment teeth are not parallel to each other, what is the solution to achieve a single path of insertion?

Employ a minimal preparation bridge Signup and view all the answers

What is a characteristic of partial veneer crowns?

They are more conservative than full crowns Signup and view all the answers

Why is a complete crown retainer chosen in some cases?

Because of the presence of caries or large restorations Signup and view all the answers

What is the least conservative type of dental crown?

All ceramic crown Signup and view all the answers

Why is it important to conserve the buccal/facial surface of the tooth?

To conserve tooth tissue Signup and view all the answers

What should be considered when deciding between a partial crown and a complete crown retainer?

The condition of the abutment teeth Signup and view all the answers

Study Notes

Types of Fixed Bridges

There are 12 types of fixed bridges: Fixed Fixed Bridge, Fixed Movable Bridges, Cantilever Fixed Bridges, Spring Cantilever Fixed Bridges, Fixed Removable Bridges, Modified Fixed Removable Bridges, All Metal Fixed Bridges, Metal-ceramic Fixed Bridges, All Ceramic Fixed Bridges, All Acrylic Fixed Bridges, Fiber-reinforced Composite Resin Bridges, and Resin-bonded Fixed Bridges

Fabrication of Fixed Bridges

The pontics and retainers are fabricated as a single unit pattern
Multiunit wax patterns are cast separately and approximated against each other and soldered together using a different soldering alloy
Alternatively, a single unit wax pattern is cast, sectioned using a saw, and then soldered

Soldering in Fixed Bridge Fabrication

Used to join multiple units together
Preferred because it avoids galvanic corrosion
Soldered connectors are uniform, flat, and parallel due to the controllable flow of the solder alloy

Electrosurgical Procedures and Medical Conditions

Electrosurgical procedures are avoided in patients with pacemakers.
Adrenaline may be avoided in local anesthetic and during retraction procedures in patients with hypertension.
Uncontrolled diabetes mellitus can lead to periodontal breakdown and affect prognosis.
Xerostomia (dry mouth) can lead to caries affecting restoration margins.
Patients with certain medical conditions, such as pacemakers, may need to discontinue medications before surgical procedures.

Dental History

Obtaining a dental history provides information about previously rendered dental treatment.
It highlights genetic predisposition to periodontal disease, malocclusion, and facial deformities.
It also reveals cause for tooth loss, complications following dental procedures, and patient attitude towards oral hygiene measures.

Clinical Examination

Clinical examination involves the clinician's use of sight, touch, and hearing to detect conditions outside the normal range.
General appearance includes gait, weight, skin color, and vital signs (respiration, pulse, temperature, and blood pressure).
Fixed Prosthodontics involves diagnosis and treatment planning.

Diagnosis and Treatment Planning

Diagnosis is the determination of the nature of the disease process.
A good diagnostic work-up includes seven elements: chief complaint, vitality testing, history, extra-oral examination, intra-oral examination, diagnostic casts, and radiographic evaluation.

Chief Complaint

The chief complaint should be recorded in the patient's own words.
It should analyze the patient's primary reason for seeking treatment and reveal problems and conditions of which the patient is often unaware.
Complaints usually belong to one of the following categories: comfort, function, social, or appearance.

History

A patient's history should include necessary information concerning the reasons for seeking treatment, as well as personal details and past medical and dental experiences.
A screening questionnaire is useful for history taking.
Medical history should include any medication the patient is taking and all relevant medical conditions.

Extra-Oral Examination

Facial asymmetry, cervical lymph nodes, TMJ, and muscles of mastication are assessed.

Diagnostic Aids

Radiographs, vitality tests, diagnostic casts, and periodontal probes are used as diagnostic aids.

Intra-Oral Examination

The patient's general oral hygiene is observed, and the presence or absence of inflammation, gingival architecture, and stippling are noted.
Pockets and tooth mobility are recorded with special attention to any relationship with occlusal prematurities and potential abutment teeth.

Radiographic Evaluation

Radiographs are examined for caries, P.A lesions, previous endodontic treatment, alveolar bone level, crown-root ratio, root configuration, and direction of root.
The presence of retained root in edentulous areas is recorded.

Vitality Testing

Pulpal health must be assessed, usually by measuring the response to percussion, thermal, and electrical stimulation.

Diagnostic Casts

Diagnostic casts are mounted on a semi-adjustable articulator to assess the edentulous space, abutment teeth, and path of insertion.
They are used for diagnostic wax-up, constructing special trays, and provisional restorations.

Ideal Treatment Plan

An ideal treatment plan achieves the best possible long-term outcomes for the patient while addressing all patient concerns and active problems with the minimum necessary intervention.

Occlusion

In some cases, the abutment teeth are sound, but there is insufficient space for a minimal-preparation retainer, so the choice is between creating space by reducing the opposing teeth, moving the abutment teeth orthodontically, or a combination of these approaches.

Cost

Partial crowns and complete metal crowns may be less expensive than metal-ceramic crowns.
Minimal-preparation retainers are the least expensive.
All-ceramic crowns are the most expensive.

Pontics

A pontic is an artificial tooth that replaces a missing natural tooth, restoring its function and usually filling the space previously occupied by the clinical crown.
Ideal requirements of a pontic:
- Restore function of the replaced tooth.
- Provide aesthetics and comfort.
- Be biologically acceptable.
- Permit effective oral hygiene.
- Preserve the underlying residual ridge and mucosa.
- Have adequate strength to withstand occlusal forces.
Classification of pontics based on the amount of contact with the underlying mucosa:
- With mucosal contact:
  - Advantage: Aesthetically superior.
  - Disadvantages: Difficulty in cleaning, potential tissue inflammation.
- Without mucosal contact (hygienic pontic):
  - Advantage: Good access for oral hygiene.
  - Disadvantage: Poor aesthetics.

Crowns

A crown is a fixed extra-coronal restoration that restores missing tooth structure by surrounding most or all of the remaining structure with material.
Types of crowns:
- Full veneer crown: Involves all surfaces of the clinical crown.
- Partial veneer crown: Covers some of the tooth crown and leaves the other intact (e.g., 3/4 crown, 7/8 crown, pin ledge, etc.).
- Laminate veneers: A conservative method of restoring the appearance of discolored, pitted, or fractured anterior teeth, consisting of bonding thin ceramic laminates onto the labial surfaces of affected teeth.
- Complete replacement (Post crown): Replaces the natural crown entirely, retaining itself by means of a dowel (post) extended inside the root canal space of the tooth.

Abutment and Retainer

An abutment is a tooth to which a bridge (or partial denture) is attached.
A retainer is a crown or other restoration that is cemented to the abutment.
The terms 'retainer' and 'abutment' should not be confused or used interchangeably.

Bridge Components

A span is the space between natural teeth that is to be filled by the bridge.
A unit, when applied to bridgework, means either a retainer or a pontic.
A connector (or joint) connects a pontic to a retainer, or two retainers to each other.
Connectors may be fixed or allow some movement between the components that they join.

Retainer Selection

Criteria for selecting a particular retainer include:
- Alignment of abutment teeth and retention.
- Appearance.
- Condition of abutment teeth.
- Conservation of tooth tissue.
- Occlusion.
- Cost.

Classification of Fixed Partial Dentures

According to the location of the edentulous space:
- Posterior: Fixed partial denture confined to the posterior region.
- Anterior: Fixed partial denture confined to the anterior region.
- Combination: Fixed partial denture extending both anteriorly and posteriorly.
According to the location of the abutment:
- Conventional: Abutment is located adjacent to the edentulous space and pontic is supported on both sides.
- Cantilever: Abutment is located adjacent to the edentulous space but pontic is supported on one side only.
- Spring cantilever: Abutment is not located adjacent to the edentulous space and pontic receives support from one side only.

Types of Connectors

Fixed-fixed: Connectors on both sides of the pontic are rigid with no scope for any movement.
Fixed-movable: One of the connectors of the FPD assembly is non-rigid and is made of a precision or semiprecision attachment which allows some vertical movement.
Fixed-removable: This prosthesis was developed by Dr. James Andrews and is called 'Andrews Bridge'.

Materials Used

All metal: Used only to replace posterior teeth, not aesthetic.
Metal ceramic: Also termed as 'porcelain fused to metal' (PFM) crowns/retainers.

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Description

Learn about the different types of fixed bridges in dentistry, including fixed fixed bridges, cantilever fixed bridges, and more. This lecture covers the basics of fixed prosthodontics.