Fixed Partial Denture (Bridge) Lecture Notes PDF

2 Fixed Partial Denture (Bridge) By Dr. Faisal Alhuwaizi  What We will study this year What We will study this Lecture Lec.1 Prosthodontics - Terminology. Lec.2 Fixed Partial Denture (Bridge) - Purposes (Benefits) Of Fixed Bridges....

2 Fixed Partial Denture (Bridge) By Dr. Faisal Alhuwaizi  What We will study this year What We will study this Lecture Lec.1 Prosthodontics - Terminology. Lec.2 Fixed Partial Denture (Bridge) - Purposes (Benefits) Of Fixed Bridges. Lec.3 Evaluation of Abutment - Indications (General & Local). Lec.4 Biomechanical Consideration - Contraindications (General & Local). Lec.5 Bridge Retainers - Advantages & Disadvantages of Bridges. Lec.6 Pontic - Comparison & Advantages of Fixed Bridge Over RPDs. Lec.7 Fluid Control & Soft Tissue Management. - Classification of Dental Bridges. Lec.8 Impression Materials - a) Depending upon the tooth reduction. (5) Lec.9 Interocclusal Record (Bite Registration) - b) Depending upon the connectors. (5) Lec.10 Shade Selection P.1 Lec.10 Provisional (Temporary) Restorations P.2 Lec.11 Try in and Cementation Lec.12 Adhesive Bridge Lec.13 Failure In Crown & Bridge Prosthodontics Lec.14 Dental Ceramic 01 Terminology 1) Bridge: A prosthetic appliance that is definitively attached to remaining teeth and replaces a missing tooth or teeth. 2) Retention: Prevents removal of the restoration along the path of insertion or vertical direction of the preparation. 3) Support: The ability of the abutment teeth to bear the occlusal load on the restoration. 4) Resistance: The stability of a restoration and resists dislodgement along an axis other than the path of placement. 02  Purposes (Benefits) Of Fixed Bridges 1) Correcting abnormal oral conditions. 2) Restoring mastication to full functional efficiency. 3) Maintaining the health of the remaining dentition & prevent further injury. 4) Restoring appearance & aesthetic. Indications Contraindication A) General (Psychological, Systemic, A) General (Uncooperative patient, Orthodontic consideration, Speech, Social problem, Occupation, Poor oral Periodontal reasons). hygiene, Age). B) Local B) Local 03 Purposes (Benefits) Of Fixed Bridges Indications A General 1) Psychological: FPDs are more rapidly tolerated by patients than RPDs. 2) Systemic: as in epileptic patients (attack of unconsciousness), the FPDs have adequate strength & retention, while in RPD, there is a potential for fracture or inhalation. 3) Orthodontic consideration: FPDs are indicated for stabilizing the orthodontic results (e.g., FPD is used to replace missing lateral incisors after diastema between two centrals has been closed). 4) Speech: RPDs are bulky, which causes difficulty in speech. In contrast, in FPD, the size of pontics is similar to the missed teeth which rarely cause difficulty in speech. ‫اذا ﺟﺎن ﻋﺪﻧﺔ ﻛﺮاودﻧﻚ واﻟﻠﺘﺮﻳﻞ ﻣﻔﻘﻮد ﻓـ ﺣﻨﺴﻮي اورﺛﻮ‬ bridge ‫وﻧﻌﻮض اﻟﻠﺘﺮﻳﻞ ﺑـ‬ 04 Indications A General 5) Periodontal reasons: FPDs can stabilize teeth with minor mobility using a fixed splint (bridge), to prevent further movement that leads to drifting or over extrusion with more loss of bony support, additionally, to ensure that the mastication forces are eventually distributed over several teeth rather than overloading on a tissue that is seriously weakened by the disease. lower incisors teeth ‫ﻧﺴﺘﺨﺪﻣﺔ اﻛﺜﺮ ﺷﻲ ﺑﻠـ‬ 05 Indications A Local 1) The bridges are indicated wherever properly distributed healthy teeth serve as abutments. ▪ Vital tooth or endodontically treated with no radiographic evidence of pathology. ▪ Adequate crown/root ratio. ▪ Good periodontal condition. FPD→periodontium ▪ Root configuration & angulations. RPD→muco_ periostium 2) Tooth suitable as abutment which requires cast restoration (the same tooth lies adjacent to edentulous space & is ideal as an abutment). 3) Unfavourable angulations of teeth for removable prostheses (badly tilted teeth). 4) It is advisable to restore edentulous space with fixed rather than RPD because the force of occlusion is transmitted to the periodontium, then to the alveolar bone (natural) In contrast, in the RPD the occlusal force is transmitted to muco- periostium, and then the underlying bone (which is not designed this function). 06 Contraindications A General 1) Uncooperative patient: difficult to achieve satisfactory results. 2) Social problem: FPDs are more expensive than RPDs. Usually, the patient must be given what he wants, which makes him sometimes unsatisfied with the results. 3) Occupation: boxers, hockey players, and pipe smokers are not advisable for FPDs (fracture of teeth or restorations). 4) Poor oral hygiene: A bad attitude toward dentistry limits the decision to make FPDs unless the patients are positively motivated before treatment. 5) Age: FPDs are preferred to be done after the age of 18 years. especially in the posterior region due to the large pulp size or teeth are not fully erupted. They are not indicated for elderly patients when there is a lack of resilience of the periodontal membrane or teeth attrition which increases the size of occluding surfaces. 07 Contraindications A Local 1) Absence of distal abutment. 2) A considerable bone loss in the visible area of the mouth. 3) Long span. 4) Abutment-related factors (tooth not suitable as abutment: length, shape, caries, and periodontal support). 08  Fixed Partial Denture (Bridge) Advantages of The Bridges Disadvantage of The Bridges They improve appearance, function, They may induce tooth & pulp & speech. damage They maintain the occlusal stability. Potential secondary caries. Provide periodontal splinting. Periodontal problem. Restore occlusal vertical dimension. The high cost. 09  Comparison & Advantages of Fixed Bridge Over RPDs 1 More stable & comfortable because it covers less tissue surface (there is no acrylic base, flanges, or clasps). 2 More aesthetics. 3 More stable occlusion with even distribution of the occlusal forces. 4 Provide a splinting action, while the RPDs push the teeth and cause mobility. 5 Easier cleaning using toothbrushes and dental floss (when there is a point contact between the pontic & the underlying tissue), in contrast, the RPD must be removed to be cleaned. 6 Do not irritate tissues or apply pressure on them. 7 Psychological patients can easily tolerate FPD rather than removable ones. 10 Comparison & Advantages of Fixed Bridge Over RPDs 8 The FPDs are preferred for handicapped, epileptic patients, and patients with Parkinson’s disease due to the possibility of fracture or inhalation of the RPD. 9 No speech difficulty in FPDs. 10 Badly tilted abutment teeth may interfere with the construction of PD (due to the presence of an undercut that leads to food stagnation). A telescopic bridge with metal coping, or fixed-movable bridge, or a proximal half-crown can be used. 11 Anatomical limitations of RPDs such an abnormally large tongue, muscular disorder, mandibular tori (torus), and palatal surface tissue. 11  Classification of Dental Bridges (Types of Bridge) A Depending on the materials used D Depending upon the tooth reduction ▪ Cast metal FPDs. ▪ All-ceramic FPDs. ▪ Conventional ▪ Metal-ceramic FPDs. ▪ Resin-veneered FPDs. ▪ Minimally-prepared bridges ▪ Hybrid bridges ▪ Implant-Supported FPDs B Depending upon location ▪ Removable bridges ▪ Anterior FPDs E Depending upon the connectors ▪ posterior FPDs ▪ Fixed-fixed bridge ▪ Fixed-mobile design C Depending on number of teeth ▪ Simple cantilever ▪ Two units FPDs ▪ Spring cantilever ▪ Three units FPDs. ▪ Combination designs (Complex or compound bridge) 12 D Depending upon the tooth reduction 1. Conventional (Conventional preparation) bridges Where a substantial tooth reduction is necessary for the abutment teeth. 2. Minimally-prepared bridges (Adhesive, acid-etched, resin-bonded bridge): These bridges are luted to the unprepared or minimally prepared surfaces of the abutments with resin adhesives. 3. Hybrid bridges A combination of conventional & minimally prepared teeth. The figure shows a Fixed-movable with a minimal- retainer carrying the movable connectors. 4. Implant-Supported FPDs Bridges that are supported by implant fixers, usually are not attached to the adjoining natural teeth, which are either can be removed by the dentist only or can be removed by the patient for cleaning or any other reasons. 13 D Depending upon the tooth reduction 5. Removable bridges Bridges that are supported by teeth which differ from the RPDs. They can either be removed by the dentist only or can be removed by the patient for cleaning or any other reason. They are designed to overcome problems associated with long-span FPD, such as Andrew’s bridge system which is indicated for edentulous ridges with severe vertical defect. The prosthesis consists of a fixed & a removable component. 14 E Depending upon the connectors (Basic bridge designs) 1. Fixed-fixed bridge ▪ Preferred for long-span bridges. ▪ Have a rigid connector at both ends of the pontic. ▪ Maximum retention & strength. ▪ All retainers are major and require extensive tooth reduction. ▪ Unconservative, more destruction of the tooth structure & trauma to the pulp. ▪ Must have only one path of insertion (the preparations of both abutments need to be parallel). ▪ The entire occlusal surfaces of both abutments must be covered with retainers otherwise the occlusal forces will be directed on the unprepared area which depress the tooth downward & break the connectors. 15 E Depending upon the connectors (Basic bridge designs) 1. Fixed-fixed bridge ▪ All retainers must have approximately the same amount of retention reducing the risk of dislodgement when the force is applied on weak retainers. ▪ Abutment teeth are splinted together (adequate in case of mobile teeth). ▪ Cemented as one piece. 16 E Depending upon the connectors (Basic bridge designs) 2. Fixed- mobile design ▪ Have rigid connector (major) at the distal end of pontic & mobile (minor) connector mesially. ▪ More conservative to tooth structure than fixed-fixed design, because minor retainers need less tooth reduction. ▪ It allows minor tooth movement (lateral & vertical). ▪ Limited to one missing tooth (limited length of span). ▪ Parts of the bridge can be cemented separately. ▪ Lab. construction is complex & difficult. ▪ Preparation of abutment does not need to be parallel. ▪ It is indicated to be used in divergent abutment teeth (unparallel), whenever a pier abutment is present (complex bridge), and for aesthetic consideration (class III inlay on distal of canine). 17 E Depending upon the connectors (Basic bridge designs) 3. Simple cantilever ▪ The support for the pontic at one end only. ▪ Pontic may attach to one or two retainers. ▪ Abutment tooth is either mesial or distal to the span. ▪ It is the most conservative design. ▪ Limited cases, as in lateral incisor replacement using the canine as abutment when the occlusion is favorable. ▪ The design can be used to replace the upper or lower first premolar & second molar. 18 E Depending upon the connectors (Basic bridge designs) 4. Spring cantilever ▪ The pontic attaches to a long metal arm (flexible bar) runs into the palate & terminates with the rigid connector on the palatal side of a single retainer on upper 4 or pair 4 & 5. ▪ Tooth retained and tissue borne. ▪ Forces are absorbed by the springing of the arm and by displacement of the soft tissue of the palate. ▪ The abutments are usually posterior teeth (tooth need restoration is better to be used). ▪ Contraindicated in V-shape palate & the lower arch. ▪ It is indicated only for replacing missing upper incisors when the adjacent teeth are sound, midline diastema, spacing of anterior teeth, or posterior teeth need a crown. ▪ Not advised for the lower arch due to the instability of the sub- mucosal tissue, and a potential for plaque & calculus deposition. 19 E Depending upon the connectors (Basic bridge designs) 5. Combination designs (Complex or compound bridge) It is a combination of two or more conventional designs incorporated in the general design of the bridge, such as: ▪ Fixed-fixed with simple cantilever. ▪ Fixed-fixed with fixed-mobile. Benefits ▪ Simplify the construction of the prosthesis. ▪ Unfavourable angulation of abutments. ▪ Simplify the preparation and conserve tooth tissues. ▪ Easily repaired after fracture. ▪ Precision retainers permit the separation of two or more components. 20