planning for crowns and bridges

Question 1

What is treatment planning?

Answer 1

Logical sequence of treatment designed to restore the patients dentition to good health with optimal function and appearance

Question 2

What does treatment planning inform the patient about?

Answer 2

Current conditions
Extent of dental treatment proposed
Potential complications and implications of this
Time and cost
Level of home care
Level of maintenance/repairs/replacements

Should conform to pts needs not ‘ideal’ treatment plan

Question 3

What is a crown?

Answer 3

Indirect extracoronal restoration that replaces missing tooth structure and restores form, function and if possible and appropriate aesthetics

Question 4

What are indications for crowns?

Answer 4

Compromised structure
Trauma
TSL
Hypoplastic conditions
Atypical morphology
Alter/correct occlusion
Part of another restoration
Restore missing function
Appearance

Question 5

What are contraindications for crowns?

Answer 5

If other more conservative options are viable
Poor and unstable oral hygiene
Compromised structure w v poor prognosis
Lack of retention/resistance form
Active and unstable perio disease
Endo disease (esp if untreated)
Active and unstable caries

Question 6

How do you plan for crowns?

Answer 6

1. Comprehensive assessment
2. Critical thinking and decision making (risk-benefit)
3. Detailed planning and performing clinical and lab stages

Question 7

How does the hx and clinical exam help plan for a crown?

Answer 7

Patient factors (general health, risk factors, maintenance ability)

Mouth condition (oral health, risk factors)

Tooth status (disease/structural/restorative status, strategic importance, occlusal considerations)

Question 8

What patient factors contribute to crown planning?

Answer 8

Attitude and expectation
Need for multiple appts
Age (older often more brittle, younger large pulp chambers/degree of eruption/cooperation)
Social history- profession eg. Musicians
Habits eg. Pipe smoking
Cost

Question 9

How does the mouth condition contribute to crown planning?

Answer 9

Oral hygiene (plaque, calculus, inflam)
Risk factors (sugar intake, dry mouth, TSL)
Status of other teeth (disease etc)
Presence/absence of other teeth
Soft tissue conditions (mucosal reactions to dental materials)

Question 10

How does tooth status affect crown planning?

Answer 10

Strategic value
Position of tooth
Appearance
Disease status (endo/perio/caries/restorative)
Occlusal consideration
Structural status

Question 11

What are the fundamental points of aesthetics?

Answer 11

1. Colour
2. Contour
3. Outline
4. Symmetry
5. Proportion
6. Soft tissue harmony

Question 12

How is the endo status checked?

Answer 12

Vital, non vital or root canal treated

Sensibility testing
Preop PA
Assess size and depth of current restorations
15-20% become non vital after crown prep
If RCT required- do before placing crown

Question 13

How is occlusion considered?

Answer 13

In contact?
Guidance?
Posterior support?

Question 14

How are perio factors assessed?

Answer 14

Assess and diagnose status
Correct and control inflam defects
Assess soft tissue contours
Correct ortho and surgery if necessary

Question 15

What perio factors may contribute?

Answer 15

Gingival cleft
High frenum insertion
Blunted papilla
Gingival asymmetry
Ridge defect
Gingival recession

Question 16

How should you plan and execute a crown prep?

Answer 16

Conform or reorganise w regard to occlusion?
Crown lengthen?
Use a diagnostic wax up?
Provisional restorations?
Most appropriate material?
Timing of stages w lab and patient?

Question 17

What is a conformative approach?

Answer 17

All unrestored tooth-tooth contacts remain the same before and after provision of crowns
No alteration in occlusal relationship in ICP

Question 18

What is a reorganised approach?

Answer 18

All unrestored tooth-tooth contacts have changes after the provision of crown
Alteration of occlusal relationship by restoring RCP and creating new ICP

Question 19

What is a bridge?

Answer 19

Tooth borne indirect fixed prosthesis used for the replacement of one or more missing teeth
Aka fixed partial denture, FPD

Question 20

What are indications for bridges?

Answer 20

Replace missing teeth (due to caries, perio, trauma, hypodontia, tooth wear, cancer, iatrogenic)

Question 21

What are different types of bridges?

Answer 21

Fixed-fixed
Fixed-movable
Full coverage, cantilevered
Resin bonded, cantilevered (gold standard but risk of debond and aesthetic issue)
Implant retained (also good but depends on cost and bone quality)

Question 22

What are the options for partially dentate?

Answer 22

No treatment- compromised function and aesthetics, risk of tilting adjacent and over eruption of opposing

RPD- conservative and removable

Bridge- invasive and irreversible, loss of enamel, pulp damage but fixed and predictable

Question 23

Should you use fixed-fixed or cantilever?

Answer 23

Depends on length of span
If one unit- cantilever
If more than one- fixed-fixed
Also depends on quality of supporting teeth

Question 24

What are considerations for planning a bridge?

Answer 24

Length of span
Occlusion
Shape of ridge
Need for surgical ridge augmentation or other treatment