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Bridgework Flashcards

(64 cards)

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1
Q

General indications for bridgework

A

appearance
function
speech
stability
psychological

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2
Q

Local indications for bridgework

A

big teeth
heavily restored
favourable occlusion
favourable abutment angulation

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3
Q

general CONTRA-INDICATIONS for bridgework

A

non co-op pt
med hx
poor OH
high caries rate
Perio disease
Large pulp

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4
Q

local CONTRA-INDICATIONS for bridgework

A

poor abutment prognosis
long length of span
ridge form
tissue loss
further tooth loss in arch

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5
Q

local CONTRA-INDICATIONS for bridgework (2)

A

tilting/ rotation
PA status
Perio status
degree of restoration

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6
Q

abutment

A

tooth that serves as attachment for bridge

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7
Q

pontic

A

artificial tooth suspended from abutment

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8
Q

retainer

A

extra/intra coronal restoration that is connected to pontic that is cemented to abutment

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9
Q

connector

A

connects pontic to retainer

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10
Q

edentulous span

A

space b/w natural teeth to be filled by bridge

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11
Q

saddle

A

area of ridge where pontic will lie

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12
Q

pier

A

abutment that is between two pontics

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13
Q

bridge designs

A

fixed fixed
cantilever

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14
Q

RBB advantages

A

min/ no prep
no aesthetic needed
cheap
less time
provisional
less destructive if fails

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15
Q

RBB disadvantages

A

rigorous clinical technique
metal shine through
chipping porcelain
high chance to debond

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16
Q

RBB indications

A

young teeth
good enamel quality
large abutment S.Area
min occlusal load
single tooth replacement

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17
Q

RBB contraindications

A

poor enamel quality
long span
heavy occlusal load (bruxist)
poorly alligned tooth

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18
Q

Treatment planning

A

ask for habits (bruxism?)
I/O (perio, radiograph)
occlusal relationship
study models (diagnostic wax up)

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19
Q

occlusion criteria?

A

opposing contact point
over eruption of opposing?
bruxism?
diagnostic wax up/mounted study model

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20
Q

when to use direct RBB

A

useful for A&E situation
immediate XLA
tooth lost to trauma

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21
Q

Indirect RBB

A

no prep
min prep
heavy prep (undesirable)

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22
Q

Pontic type

A

pt own tooth
acrylic denture tooth
prolycarb crown
cellulose matirx w/ composite

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23
Q

RBB palatal/lingual coverage

A

greater coverage = greater bond
0.5mm supragingival
care w/ incisal edge (metal shine through)

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24
Q

anterior bridge

A

cantilever design
(divergent guidance paths)

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25
posterior bridge
fixed-fixed design
26
existing restoration on abutment
need sound enamel composite ok replace amalgam (poor bond to cement)
27
general preparation criteria
180* wrap around rest seats (post) cingulum rest (ant) chamfer finish line 0.5mm
28
anterior min preparation
cantilever occlusal contact reduction cingulum undercut removed chamfer 0.5mm supra
29
anterior heavy prep
0.5mm palatal reduction cingulum rest +/- proximal groove chamfer 0.5mm supra
30
posterior preparation
prefer fixed-fixed 180* wrap around 0.5mm chamfer supra +/- proximal groove
31
temporisation
prep into dentine? cover w/ DBA remove before definitive
32
retainer properties
0.7mm thick co-cr/ ni-cr sandblast fit surface w/ aluminium oxide (50microns) micro-mechanical retention
33
cementation
ethanol to degrease wing (reduces surface tension) Panavia 21 EX
34
Cementation steps
prohylaxis dental dam isolation etch 37% ortho-phosphoric acid wash/dry apply primer 30 secs air dry 2 secs no cure needed fit retainer w/ cement remove extra Oxyguard II for 3 mins (wash off)
35
Post cementation
check occlusion (make sure min force) superfloss and Interdental post-op
36
survival rate
5 year - 80.8% 10 year - 80.4%
37
conventional bridge designs
fixed - fixed fixed cantilever fixed moveable hybrid bridge springe cantilever
38
conventional fixed fixed advantages
robust design max retention and strength easy lab work can use in long spans
39
conventional fixed fixed disadvantages
difficult prep (parallel prep) min taper (5-7*) common path of insertion risk of pulp damage
40
conventional cantilever advantages
conservative design easy lab work
41
conventional cantilever disadvantages
short span only rigid (avoid distortion) mesial cantilever preferred
42
fixed moveable bridge
rigid connector distal moveable connecter mesially
43
fixed moveable bridge advantages
no need for common insertion path conservative of tissue cemented in 2 parts minor tooth movement
44
fixed moveable bridge advantages
limited length of span complicated lab work difficulty in cleaning moveable joint
45
spring cantilever advantages
spacing b/w upper incisors adjacent tooth unrestored post tooth suitable abutment (heavy restoration already)
46
spring cantilever advantages
upper incisor replacement only hard to clean under palatal connector palatal mucosa irritation hard to control movement of pontic due to springiness of arm and displaced palatal tissue
47
abutment evaluation
able to withstand forces supporting tissue free of inflammation (PA/ Perio pathology) crown to root ratio 2:3 / 1:1
48
Occlusal information to check?
Incisal class Canine guided or group function Over eruption of opposing tooth Will bridge affect occlusion Parafunction signs
49
What to look out for in a possible abutment?
Root configuration Angulation/ Rotation of root Perio health Surface area for bonding Risk of pulpal damage
50
Types of pontic designs
Wash through pontic Dome pontic Modified ridge lap Total ridge lap pontic Ovate pontic
51
Considerations for pontic designs
Cleansibility 1. Smooth and highly polished surface 2. Smooth embrasure space Appearance 1. As tooth like as possible anteriorly Strength 1. Longer span greater thickness
52
Wash through pontic
Makes no contact with soft tissue Function> appearance Lower molar area
53
Dome shaped
Lower incisor/ premolar/ upper molar areas Acceptable if occlusal 2/3 buccal surface visible
54
Modified ridge lap
Buccal surface looks as much as tooth Lingual surface cut away Line contact with buccal of ridge Food packing on lingual surface
55
Ridge lap
Greatest contact with soft tissue Less food packing Good design can be cleaned Care needed to prevent blanching of tissue
56
Ovate pontic
Excellent aesthetics More difficult to clean in perio/ caries/ inflammation Cannot fully seat if poorly designed
57
Materials for bridges
Metal (Gold, Ni-Cr, SS) Metal ceramic Ceramic (Zirconia, Lithium Disilicate) Ceromeric ( BelleGlass, Vectris)
58
LAVA 3M ESPE Bridge
3-4 unit (max span) milled zirconium oxide with feldspathic porcerlain Good aesthetics Similar reduction MCC Withstand occlusal forces well
59
Zirconia
Katana zirconia is ultra translucent multilayer (UTML) Milled With or without feldspathic porcelain` layer on top
60
Implant retained bridges
For large spans Either screw/ cement retained
61
Preparation of Conventional Bridgework
1. Mounted study models 2. Consider diagnostic wax up and custom impression tray 3. Ask lab for vacuum stent (for tooth prep and provisional) 4. Select shade 5. Pre-op putty 6. Reduction 7. Separation 8. Aim for parallelism and confirm 9. Construct provisional 10. Impression and occlusal registration 11. Demo cleaning with super-floss 12. Write prescription for technician
62
Parallelism
Increases retention No undercuts By direct vision Use a straight right angle probe
63
What definitive cementation to use?
All metal and metal ceramic: Aquacem (GI Luting cement) RelyX (RMGI Luting cement) Adhesive resin: Panavia 21 (anaerobic dual cure resin cement with 10-MDP) All ceramic: NEXUS kit (dual cure resin cement)
64
Distal cantilevers
AVOID if possible High occlusal forces on pontic will leverage abutment causing it to tilt Consider from premolar abutment if opposed by a denture or unopposed.

Restorative (2 decks)

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