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Topic 2: Fixed Partial Denture [DCCPRO1C] [DCCPRO1C ] : CLINICAL CONFERENCE PROSTHODONTICS 1 SY 2024-...

Topic 2: Fixed Partial Denture [DCCPRO1C] [DCCPRO1C ] : CLINICAL CONFERENCE PROSTHODONTICS 1 SY 2024-2025 1ST SEMESTER [DR. NICK C. GUZMAN] 3. Plaque Control OUTLINE Use of cemented restoration I FIxed Partial Denture - Treatment Planning for Single ○ demands the institution and maintenance of Tooth Restoration a good plaque-control program to increase A. Factors the chances for success of the restoration. B. Intracoronal Restorations Crowns should be carefully weighed C. Extracoronal Restorations ○ Many teeth are seemingly prime candidates for cast metal or ceramic restorations, based TREATMENT PLANNING FOR SINGLE TOOTH solely on the amount of tooth destruction RESTORATION that has previously occurred. However, when Whether full crown or amalgam/composite is these teeth are evaluated from the standpoint done, the design and material selection of the of the oral environment, they may, in fact, be restoration is based on these factors: poor candidates for cemented restorations. ○ Destruction of tooth structure ○ If extensive plaque, decalcification, and ○ Esthetics caries are present in a mouth, the use of ○ Plaque control crowns of any kind should be carefully ○ Financial considerations weighed. ○ Retention Maintain adequate hygiene Brushing, flossing, and dietary regulation regimen 1. Destruction of Tooth Structure Pin retained amalgam or temp If the amount of destruction previously suffered ○ It may be desirable to use pin-retained by the tooth to be restored is such that the amalgam pro- visional restorations to save remaining tooth structure must gain strength and the teeth until the conditions responsible for protection from the restoration, cast metal or the tooth destruction can be controlled. ceramic is indicated over amalgam or composite Give the patient the time to learn resin. Reinforce the skills Evaluate the patient’s willingness and ability 2. Esthetics If measures are successful, restorations can be If the tooth to be restored with a cemented fabricated. restoration is in a highly visible area, or if the patient is highly discriminating, the esthetic effect SIDE NOTE: of the restoration must be considered. Your treatment option should always depend on your Sometimes a partial coverage restoration will patient's hygiene and cooperation. If the patient takes serve this function. Where full coverage is care of their restoration, the longer the restoration will required in such an area, the use of ceramic in stay some form is indicated. Metal-ceramic crowns can be used for single-unit anterior or posterior crowns, as well as for fixed 4. Financial Considerations partial denture retainers. Finances All-ceramic crowns are most commonly used on Government agency, a branch of the military, an incisors, although they can be used on posterior insurance company, and/or the patient. teeth when an adequate amount of tooth When a patient is to pay, give best advice and structure has been removed and the patient is allow the patient to make the choice. willing to accept the possibility of more frequent Dentist must walk a fine ethical line replacement. Be sensitive to the individual patient’s situation 5. Retention SIDE NOTE: Full veneer 1st Pm to 1st Pm - cornerstone of the teeth (for doc, ○ unquestionably the most retentive but usually its canine to canine) Single-tooth restoration vs FPD (Bridge) retainers. Short teeth and future RPD abutments TARRAYO, C. | DMD 1  TOPIC 2: FPD - TREATMENT PLANNING FOR SINGLE TOOTH PREPARATION SIDE NOTE: Porcelain fused to metal - less destructive Always aim for the best retention Plastic restoration Direct restoration The plastic restoration is inserted as a soft (ie, plastic) mass into the cavity preparation, where it will harden and be retained by mechanical undercuts or adhesion. INTRACORONAL RESTORATIONS SIDE NOTE: Plasticized - refers to the change in shape that occurs in certain materials, particularly composite resins, during the light-curing process.. Composite Restoration of a Chipped Central Incisor Inlay Small - medium lesions; stays within the crown Coverage: An inlay covers a cavity that is within the cusps (the raised points) of a tooth. Material: Typically made from gold, porcelain, or resin. Composite Restoration of a Carious Lateral Incisor Process: The inlay is custom-made in a dental laboratory and then cemented into the prepared tooth. Onlay Bigger lesions; one cusp or more Cemented Restorations Coverage: An onlay extends slightly beyond the cusps of a tooth, covering more of the tooth's surface. Material: Similar to inlays, they can be made from gold, porcelain, or resin. Process: Like inlays, onlays are custom-made and cemented into place. Overlay Covering the whole occlusal surface Coverage: An overlay covers a significant portion of the tooth's surface, including the cusps and often some of the tooth's biting surface. Material: Typically made from porcelain or metal. Process: Overlays are often used when a large portion of the tooth is missing or severely damaged. They are custom-made and cemented onto the tooth. SIDE NOTE: All ceramic crown - most destructive All metal crown- least destructive TARRAYO, C. | DMD 2  TOPIC 2: FPD - TREATMENT PLANNING FOR SINGLE TOOTH PREPARATION SIDE NOTE: COMPOSITE RESIN Wedge retention - is a technique used in dentistry to This material can be used for minor to provide temporary support and stability during dental moderate lesions in esthetically critical areas. procedures, particularly when preparing teeth for They are available in different shades to match restorations like fillings or crowns. natural teeth Onlay and Overlay - often used to prevent wedge Indirect inlays of composite resin can be used fractures by restoring damaged or weakened tooth for proximo-occlusal restorations on posterior structure to prevent slipping. teeth. GLASS IONOMER SIDE NOTE: Composite inlay - usually eliminates shrinkage It is useful for restoring Class V lesions caused by erosion or abrasion GI has found a niche in the restoration of root SIMPLE AMALGAM caries in geriatric and periodontal patients. A simple amalgam restoration placed in an MOD Can also be used for incipient lesions on the preparation on a molar proximal surfaces of posterior teeth by a tunnel Has been the standard one- to three-surface prep which leaves the marginal ridge intact. restoration for minor- to moderate-sized Rampant caries can be brought under control with lesions in esthetically noncritical areas. GI. The American Dental Association’s Statement on Used as liner for deep caries before composite Dental Amalgam states that amalgam is a restoration. valuable, viable, and safe choice for dental serve as an interim treatment restoration to assist patients. A European Commission’s Scientific in the control of rampant caries. This is further Committee also concluded that amalgams are enhanced by the release of fluoride by the effective and safe. material. They further state that there is no clinical justification for removing satisfactory amalgams except for allergic reactions. Nor is the mere presence of a defective margin alone enough to require replacement. They are best used where more than half of the coronal dentin is intact. SIDE NOTE: Rampant caries can be brought under control with glass ionomer. Class I Amalgam - usually last a lifetime Mercury content causes birth defect and etc COMPLEX AMALGAM SIDE NOTE: Amalgam augmented by pins or other auxiliary Usually used as a restorative material means of retention can be used to restore teeth Popular to use because of its ability to release with moderate to severe lesions in which less fluoride and remineralizes tooth. than half of the coronal dentin remains. TARRAYO, C. | DMD 3  TOPIC 2: FPD - TREATMENT PLANNING FOR SINGLE TOOTH PREPARATION Amalgam used in this manner can be employed SIDE NOTE: as a definitive restoration when a crown is Metal inlay - most popular material used for inlay contraindicated be- cause of limited finances or Gold - deflects microorganisms and causes dark poor oral hygiene. edges It can be used in the restoration of teeth with missing cusps or endodontically treated premolars and molars—teeth that ordinarily CERAMIC INLAY would be restored with mesio-occlusodistal Ceramic inlay restorations are used to restore teeth (MOD) onlays or other extracoronal restorations. with small- to moderate-sized lesions that In such situations, amalgam is used to replace or permit a narrow preparation isthmus in an area overlay the cusp to provide the pro- tection of of the mouth where the esthetic demand is high. occlusal coverage. Premolars should have one intact marginal ridge, Although amalgam produces good strength in but MOD ceramic inlays can be used in molars. the restored tooth,ideally a crown should be This type of restoration can also be etched to constructed over the pin-retained amalgam, enhance bonding, and there is some evidence that using it as a core, or foundation restoration. the structural integrity of the tooth cusps may be stabilized by bonding. The relatively large size of the cavity preparation required for this restoration precludes its use in the treatment of incipient lesions. METAL INLAY Teeth with low esthetic requirements and small- to moderate- sized lesions can be restored with metal inlay restorations. Although usually made of softer gold alloys, metal MESIO-OOCLUSODISTAL (MOD) ONLAY inlays also can be fabricated of etchable base This design can be used for restoring moderately metal alloys if a bonding effect is desired. large lesions on premolars and molars with The preparation isthmus should be narrow to intact facial and lingual surfaces. It will minimize stress in the surrounding tooth structure. accommodate a wide isthmus and up to one Premolars should have one intact marginal ridge to missing cusp on a molar. preserve structural integrity and minimize the If a cast metal resto- ration is needed on a possibility of coronal fracture. premolar with both marginal ridges compromised, The additional bulk of tooth structure found in a it should include occlusal coverage to protect the molar permits the use of this restoration type in an remaining tooth structure. MOD configuration. This restoration also can be considered an The indications for this type of restoration are much extracoronal restoration because of the occlusal the same as those for an amalgam because this coverage that overlays and protects the tooth restoration only replaces lost tooth structure and cusps. will not protect remaining tooth structure. Because The MOD onlay does not have the necessary of the amount of destruction of tooth structure resistance to be used as a fixed partial denture required by this restoration, it is not recom- retainer. Although ordinarily fabricated of a gold mended for incipient lesions. alloy, this restoration design has been used with cast glass and other types of ceramics. Ceramic MOD onlays should be used very cautiously. Without gener- ous occlusal thickness, these restorations are susceptible to fracture. TARRAYO, C. | DMD 4  TOPIC 2: FPD - TREATMENT PLANNING FOR SINGLE TOOTH PREPARATION ⅞ Crown A 7/8 crown is a type of dental restoration that covers the majority of a tooth, typically leaving only the mesiobuccal cusp (the most prominent cusp on the front side of the tooth) uncovered. This type of restoration is often used in molars, especially the first molars, where the mesiobuccal cusp is strong and intact. EXTRACORONAL RESTORATIONS If insufficient coronal tooth structure exists to retain the restoration within the crown of the FULL METAL CROWN / ALL-METAL CROWN tooth, an extracoronal res- toration, or crown, is Usually the least destructive needed. It may also be used where there are The all-metal conventional crown can be used to extensive areas of defective axial tooth structure restore teeth with multiple defective axial or if there is a need to modify contours to refine surfaces. occlusion or improve esthetics. It will provide the maximum retention possible in any given situation, but its use must be restricted PARTIAL COVERAGE CROWN / PARTIAL VENEER to situations where there are no esthetic CROWN expectations. This is a crown that leaves one or more axial This will usually limit it to second molars, some surfaces uncovered. Therefore, it can be used to mandibular first molars, and occasionally mandibular second premolars. Because less restore a tooth with one or more intact axial tooth structure must be removed for its surfaces with half or more of the coronal tooth preparation than for crowns with a ceramic structure remaining. component, and because its fabrication is the It will provide moderate retention and can be simplest of any crown, this restoration should used as a retainer for short-span fixed partial remain among those designs considered in dentures. If tooth destruction is not excessive, a planning single-tooth restorations on molars as well as posterior fixed partial dentures. partial coverage crown with a minimally extended preparation and carefully finished margins can satisfy moderate esthetic demands in the maxillary arch. 3/4 Crown Type of dental restoration that covers the back three-quarters of a tooth. It's often used when a significant portion of the tooth's crown (the METAL CERAMIC CROWN visible part above the gumline) is missing or A metal-ceramic crown also can be used to damaged. restore teeth with multiple defective axial surfaces. Coverage: Covers the back three-quarters of a It, too, is capable of providing maximum retention, tooth, leaving the front quarter intact. but it also will meet high esthetic requirements. It can be used as a fixed partial denture retainer where full coverage and a good cosmetic result must be combined. TARRAYO, C. | DMD 5  TOPIC 2: FPD - TREATMENT PLANNING FOR SINGLE TOOTH PREPARATION ALL CERAMIC CROWN Usually the most destructive When full coverage and maximum esthetics must be combined, an all-ceramic crown is the treatment of choice. All-ceramic crowns are not as resistant to fracture as metal-ceramic crowns, so their use must be restricted to situations likely to produce low to moderate stress. They are usually used for incisors, although cast glass ceramics are also employed in the restoration of posterior teeth. Preparations for this type of restoration on premolars and molars require the removal of large quantities of tooth structure. CERAMIC VENEER (LAMINATES) Usually done on anteriors; eg. for diastema closure Because all-ceramic and metal-ceramic crowns require the removal of such large quantities of tooth structure, there has been considerable interest in less destructive alternatives. The ceramic veneer has emerged as a means of producing an esthetic result on otherwise intact anterior teeth that are marred by severe staining or developmental defects restricted to the facial surface of the tooth. This restoration also can be used to restore moderate incisal chipping and small proximal lesions. The use of a veneer requires only minimal tooth preparation and therefore offers an alternative to crowns that is attractive to the patient and dentist alike. TARRAYO, C. | DMD 6