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BDS4 Restorative > Bridgework 1- Resin Bonded > Flashcards

Bridgework 1- Resin Bonded Flashcards

(52 cards)

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1
Q

What are the treatment options for missing teeth?

A

No treatment/Leave space

Replace tooth/teeth

Close space (Orthodontics)

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2
Q

What are the reasons for treating tooth loss?

A

To maintain:
Aesthetics

Function

Speech

Dental health- prevent tilting and over-eruption

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3
Q

What are the options when replacing teeth?

A

Denture- more missing teeth

Bridgework

Implants- false titanium roots, which are drilled into alveolar bone then restored with crown, bridge or denture

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4
Q

What is a bridge?

A

A prosthesis which replaces a missing tooth or teeth and is attached to one or more natural teeth (or implants)

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5
Q

What is the main difference with a bridge and a partial denture?

A

An RPD replaces bone and soft tissue

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6
Q

What is an abutment?

A

A tooth which serves as an attachment for a bridge

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7
Q

What is a Pontic?

A

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

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8
Q

What is a retainer?

A

The extracoronal or intracoronal restorations that are connected to the pontic and cemented to the prepared abutment teeth

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9
Q

What is a connector?

A

Component which connects the pontic to the retainers/retainer

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10
Q

What is the span?

A

Edentulous space between natural teeth that is to be filled by a bridge or partial denture

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11
Q

What is the saddle?

A

Area of the edentulous ridge over which the pontic will lie

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12
Q

What is a pier?

A

An abutment tooth which stands between and is supporting two pontics, each pontic being attached to a further abutment tooth

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13
Q

What is a unit?

A

Either a retainer or a pontic

e.g. A bridge with two retainers and one pontic = 3 unit bridge

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14
Q

What are the types of bridgework?

A

Adhesive- most common
• Held on by wings on palatal surfaces

Conventional- held on by crowns

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15
Q

What are the general indications for bridgework?

A

To provide function and stability

Appearance

Speech

Psychological reasons- reluctance to wear dentures

Systemic disease e.g. in epileptics it prevents risk of inhaling denture

Co-operative patient

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16
Q

What are the local indications for bridgework?

A

Big teeth

Heavily restored teeth- don’t have to be as conservative

Favourable abutment angulations

Favourable occlusion

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17
Q

What are the general contra-indications for bridgework?

A

Uncooperative patient

Medical history contra-indications- allergy

Poor oral hygiene

High caries rate

Periodontal disease

Large pulps (conventional bridge)- more likely to expose pulp and lose vitality of tooth

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18
Q

What are the local contradictions for bridgework?

A

High possibility of further tooth loss within arch

Poor prognosis of abutment

Length of span too great- more than 1/2 teeth (causes flexing and failure)

Ridge form and tissue loss

Tilting and rotation of teeth

Overly restored

Poor periapical status

Poor periodontal status (bone loss)

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19
Q

What is a fixed-fixed bridge design?

A

This type of bridge has a retainer at each end with a pontic in the middle joined by rigid connectors.
E.g. (Retainer)-(pontic)-(Retainer)

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20
Q

What is a cantilever bridge design?

A

This type of bridge has a retainer (or retainers) at one side of the pontic only
E.g. (Retainer)-(pontic)

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21
Q

What are the other names for Adhesive Bridgework

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A

Resin Bonded/ Retained
Minimal preparation bridgework
Maryland bridge
Resin bonded fixed partial denture (RBFPD)

22
Q

What are the types of Adhesive cantilever bridges?

Study These Flashcards
A

All ceramic

Traditional with metal wing (CoCr or nickel alloy)

23
Q

What are the advantages of Adhesive Bridges?

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A

Minimal or no preparation

No anaesthetic needed

Less costly

Less surgery time

Can be used as a provisional restoration

If it fails - usually less destructive than alternatives

24
Q

When may it be useful to use an Adhesive bridge as a provisional?

Study These Flashcards
A

Hypodontia patients- before they are old enough to receive implants

25
What are the disadvantages of Adhesive Bridges?
Rigorous clinical technique- must be dry Metal shine-through- due to poor design/ cementation or translucent incisal edge Chipping pocelain Can debond- high chance of recurrent debonding Occlusal interferences- especially dynamic No trial period possible
26
Why are bridges often cemented high?
Daal Concept- occlusion reorganises naturally in 10-14 days
27
What are the indications for adhesive bridges?
Young teeth- Less destructive Good enamel quality Large abutment tooth surface area- more space for bonding Minimal occlusal load Single tooth replacement To simplify partial denture design
28
What are the contraindications for Adhesive Bridges?
Insufficient or poor quality enamel Long spans Excess soft or hard tissue loss Heavy occlusal force e.g. Bruxist Poorly aligned, tilted or spaced teeth Contact sports?
29
What should be checked before placing Adhesive bridge?
Habits- bruxism Condition of abutments- caries/periodontal disease (radiographs) Dynamic occlusal relationships- mount on semi-adjustable articulator with facebow Soft tissue contour Patient motivation- will they take care of prothesis
30
What should be considered when checking occlusion before placing Adhesive Bridge?
Opposing dentition- contacts, over erupted teeth Parafunction- look for attrition Dynamic relationships- looking clinically AND at study models/wax-ups
31
When are direct adhesive bridges used?
Emergency situations- trauma or loss of tooth
32
What can be used as a Pontic in direct adhesive bridges?
Patients own tooth (ideal) Acrylic ‘denture’ tooth Polycarbonate crown Cellulose matrix filled with composite
33
What are the steps in using patient's own tooth to produce a direct adhesive bridge?
* Cut off root and remove pulpal tissue * Etch contact points of removed tooth and adjacent teeth * Cover pulp with composite * Join teeth together with composite interproximally
34
What are the requirements for a successful indirect adhesive bridge?
Generous palatal/lingual coverage- greater surface area of enamel covered gives greater bond Good quality enamel Keep supra-gingival to allow cleaning- ideally 0.5mm Care with coverage near incisal edge
35
What adhesive bridge design is favoured in Anterior and Posterior Teeth?
Ant- cantilever Post- fixed-fixed
36
Why are fixed-fixed Adhesive bridges rarely used in anterior teeth?
If one wing debonds, resultant bacterial ingress can cause caries Cantilevers are favoured as they are not affected by divergent guidance paths
37
What should you do if Abutments have previously been restored?
Composite- consider replacement if restoration is old as bond will be better to new composite Amalgam- replace
38
What are the requirements of a preparation for an adhesive bridge?
180º ‘wrap-around’ preparation Rest seats (posterior teeth)/ Cingulum rest (anterior teeth)- helps with relocating Proximal grooves (vertical cuts)- aid mechanical retention Supra-gingival chamfer finish line ~0.5mm Ideally prep should remain in enamel
39
What are the features of a minimal prep for an anterior cantilever adhesive bridge? (May require no prep)
Occlusal contact reduction- if heavy contacts Cingulum undercut removal only- simplifies POI Chamfer margin (0.5mm supra-gingival, 0.5mm in width)
40
What are the features for a heavier preparation for an anterior cantilever adhesive bridge?
0.5mm palatal reduction(NOTE – metal retainer wing should be 0.7mm thick) Cingulum rest +/- Proximal grooves Chamfer margin (0.5mm supra-gingival)
41
What are the features of a prep for a posterior adhesive bridge?
Occlusal rests- 2mm in depth 180º wrap-around with chamfer finish line (0.5mm supra-gingival) +/- Proximal grooves
42
Why is fixed-fixed preferred in posteriors?
Helps spread the occlusal load over two teeth (replacing a large tooth)
43
What are the options for temporisation when placing indirect adhesive bridges?
RPD Essix retainer No temporary- if prep only into enamel
44
If prep is into dentine, what can be used to prevent sensitivity/need for temporisation?
DBA Duraphat Desenitising toothpaste
45
Why should bridge be placed as quickly as possible? | most labs take 2 weeks
As it minimises chance of over-eruption and tooth movement
46
How should the fitting surface of the metal wing be prepared?
Sandblasting using aluminium oxide- provides micro-mechanical retention
47
How can an adhesive bridge be tried-in before cementation?
Held with finger Locating cleat- hook that goes over incisal edge to hold tooth in place temporarily Small bit of composite can be used- but this will need to be cleaned via re-sandblasting, ultrasonic baths, ethanol
48
What cement is used in Adhesive bridges?
Dual cure composite resin luting cement- PANAVIA 21
49
Steps in fitting an Adhesive Bridge
1. Prophylaxis 2. Isolate with dental dam 3. Etch tooth: 37% ortho-phosphoric acid (some preparations are 40%) 4.Wash & dry 5. Apply primer (A and B mixed together) for 30 seconds- Air dry for 2 seconds 6. No need to cure (unlike for direct composite restorations) 7. Fit retainer (coated with luting cement) to abutment tooth/teeth 8. Remove excess cement 9. Oxygen inhibitor (Oxyguard II) placed around cement margins for 3 minutes- wash off 10. Adjust any heavy occlusal contacts on pontics- be less concerned about wings
50
What can be used to maintain cleanliness of Adhesive bridges?
ID brushes Superfloss
51
What is the survival rate of adhesive bridges?
5 year- 80.8% 10 year- 80.4% Most failures occur in first 2 years
52

BDS4 Restorative (12 decks)

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