1 - Bridgework

Question 1

What are the treatment options for a space from tooth loss?

Answer 1

• no treatment
• replacement
• orthodontics

Question 2

What are the reasons for treating tooth loss?

Answer 2

• aesthetics
• function
• speech
• maintenance of dental health

Question 3

What are the options for replacing a tooth?

Answer 3

• denture
• bridge
• implants

Question 4

Define a bridge.

Answer 4

A prothesis that replaces missing tooth/teeth that is attached to one or more natural teeth/implants (abutments)

Question 5

What are the different types of bridge (by retention)?

Answer 5

• adhesive
• conventional

Question 6

What are the different types of bridge (by units)?

Answer 6

• fixed fixed
• cantilever

Question 7

What are general indications for bridgework?

Answer 7

• function and stability
• appearance
• speech
• psychological reasons
• systemic disease
• cooperative patient

Question 8

How does systemic disease impact the decision to use a bridge?

Answer 8

Some patients cannot tolerate removal prosthesis ie patients with epilepsy

Question 9

What are local indications for bridgework?

Answer 9

• big teeth
• heavily restored teeth (conventional)
• favourable abutment angulation
• favourable occlusion

Question 10

Describe favourable occlusion for bridgework.

Answer 10

No heavy contact

Question 11

What are general contraindications for bridgework?

Answer 11

• uncooperative patient
• medical history
• poor OH
• high caries rate
• periodontal disease
• large pulp (young teeth, conventional)

Question 12

What are local contraindications for bridgework?

Answer 12

• high possibility for tooth loss within same arch
• prognosis of abutment teeth poor
• span of bridge too great
• ridge form or soft tissue loss
• tilting/rotation of teeth
• degree of prep required
• periapical status
• periodontal status

Question 13

Define abutment.

Answer 13

A tooth that serves as an attachment for a bridge

Question 14

Define pontic.

Answer 14

The artificial tooth which is suspended from the abutment tooth/teeth

Question 15

Define retainers.

Answer 15

The extra- or intracoronal restorations that are connected to the pontic and cemented to the prepared abutment teeth (eg wing or crown)

Question 16

Define connectors.

Answer 16

Component that connects the pontic to the retainers

Question 17

Define edentulous span.

Answer 17

Space between natural span that is to be filled by bridge or partial denture

Question 18

Define saddle.

Answer 18

Area of edentulous ridge over which the pontic will lie

Question 19

Define pier.

Answer 19

Abutment tooth which stands between and support two pontics, each pontic being attached to a further abutment tooth

Question 20

Define unit.

Answer 20

Either a pontic or retainer

Question 21

Define a fixed fixed bridge.

Answer 21

Retainer at each of the bridge with a pontic suspended between, joined by rigid connectors

Question 22

Define a cantilever bridge.

Answer 22

Retainer at one side of the pontic

Question 23

What are the types of adhesive cantilever bridge?

Answer 23

• metal CoCr wing
• all ceramic

Question 24

What are the advantages of adhesive cantilever bridges?

Answer 24

• minimal to no prep
• no anaesthetic
• cheaper
• less chair time
• can be used as provisional
• minimal interference with occlusion

Question 25

What are the disadvantages of adhesive cantilever bridges?

Answer 25

• require excellent clinical technique
• metal shine through
• can chip
• can debond
• no trial possible

Question 26

What are the indications for adhesive cantilever bridges?

Answer 26

• young teeth
• good enamel
• large abutment area
• minimal occlusal load
• single tooth replacement
• can simplify RPD design

Question 27

What are the contraindications for adhesive cantilever bridges?

Answer 27

• poor enamel
• long spans
• excessive soft tissue loss
• heavy occlusal contacts
• poor alignment of teeth
• contact sports (?)

Question 28

What makes up the clinical examination for adhesive bridges?

Answer 28

• dynamic occlusal relationships
• periodontal health
• radiographs

Question 29

What can be used as a pontic?

Answer 29

• patients own tooth
• acrylic denture tooth
• polycarbonate crown
• cellulose matrix filled with composite

Question 30

What type of bridge is typically used in the anterior?

Answer 30

Cantilever

Question 31

What type of bridge is typically used in the posterior?

Answer 31

Fixed fixed

Question 32

What are cantilever bridges more successful in the anteriors?

Answer 32

There are divergent guidance paths in the anterior due to the long axises of the teeth being at different angles

Question 33

How do you prepare adhesive bridge abutments?

Answer 33

• if sound enamel, no prep required
• if composite restoration, roughened with slow sped
• if amalgam, replace with composite

Question 34

Describe the prep for an adhesive posterior bridge.

Answer 34

• 180 degree wrap around
• rest seats (posterior)
• supragingival chamfer finish 0.5mm
• remain in enamel

Question 35

Describe the retainer of a CoCr adhesive bridge.

Answer 35

Metal wing with sandblasted surface for micromechanical retention

Question 36

What cement is used for an adhesive bridge?

Answer 36

• dual cure
• Panavia 21EX

Question 37

Describe the steps of cementing an adhesive bridge.

Answer 37

• isolate tooth
• etch with phosphoric acid
• wash and dry
• apply primer (A and B mixed) for 30s
• air dry for 2s
• fit retainer coated in luting cement to abutment
• remove excess cement
• oxygen inhibitor placed around cement margins for 3mins

Question 38

What should be done after cementation?

Answer 38

• check occlusion
• demo how to clean bridge to patient

Question 39

What can be used to clean around a bridge?

Answer 39

• superfloss
• interdental brushes

Question 40

How does the occlusion adjust to an adhesive bridge?

Answer 40

Minimal interference with the occlusion self corrects within 10-14 days due to relative axial tooth movement