Pontics

Question 1

Although unpredictable, a greater amount of
alveolar ridge loss following extraction usually occurs
in the — dimension and affects the —
bone of the ridge.
In fact, –% of alveolar bone
dimension can be lost after tooth extraction, with
losses reported of up to —. Two-thirds of this loss
of bone volume can occur within the first —
months of tooth extraction.

Answer 1

horizontal
buccal

50
6–7 mm
three

Question 2

Loss of — ridge height can also occur and usually
takes place along the — aspect of the ridge to a
— degree than horizontal ridge loss. Corresponding
reductions in vertical ridge height ranging from — mm
have been noted. The combination of this resorptive
pattern results in a ridge that has moved in a
— direction and has atrophied vertically.

Answer 2

vertical
buccal
lesser

2–4
palatal/lingual

Question 3

Sockets that were preserved with bone
grafting and/or membrane on average lost —
mm less of ridge width, — mm less of ridge
height, and had —% more bone volume when
compared to sockets that were not
grafted. — sites lost more than
— sites, and most ridge resorption
occurred on the buccal aspect of the ridge.

Answer 3

2
1
20
Maxillary, mandibular

Question 4

The Edentulous Ridge – Classification of Deformities
Class I:
Class II:
Class III:
Normal:

Answer 4

F-L Width (32%)
O-G Height (3%)
F-L and OG Height (56%)
(8%)

Question 5

skipped
Pre-Treatment Assessment
Evaluate
(3)

Answer 5

Evaluate the dimensions of the
Edentulous space
Evalutate the positions of the abutment
teeth to assess the favorability for a bridge
Evaluate the possible occlusal outcomes

Question 6

Evaluate the dimensions of the
Edentulous space
Evalutate the positions of the abutment
teeth to assess the favorability for a bridge
Evaluate the possible occlusal outcomes
Is there a need to reposition the teeth
orthodontically prior to fixed work?

— up is key to answer these questions
before you begin treatment

Answer 6

Diagnostic Wax

Question 7

What Materials are used for Pontics?
(3)

Answer 7

Cast Metal
Metal-Ceramic
(Many configurations)
Zirconia or
All Ceramic

Question 8

When two materials are
used, the finish line for their
joining should not be on
the

Answer 8

edentulous ridge.

Question 9

What are the ideal characteristics we look for in a
pontic design?
(3)

Answer 9

Esthetic
Biologic
Mechanical

Question 10

Esthetic
(2)

Answer 10

-Appearance of replacement
-Replication of “emergence” from ridge

Question 11

Biologic
(4)

Answer 11

-Ability for the patient to clean well around
the bridge/pontic area
-Allows for healthy tissue
-Patient comfort of bridge
-Harmonious occlusion

Question 12

Mechanical
(1)

Answer 12

-Rigid framework to resist deformation or
fracture

Question 13

Esthetic Considerations
Ideally, a pontic should have the same — height as the original or
neighboring tooth.
When resorption of the bone has taken place, the pontic changes shape in order to
keep in contact with the —
Contour needs to be blended smoothly to avoid a ledge at the cervical.

Answer 13

inciso-gingival
ridge concavity

Question 14

Esthetic Considerations
Contour in — should approximate the length of the adjacent teeth
The facial surface is altered to curve gently from the

Answer 14

Apical ½

gingival-facial to the middle of the
facial surface

Question 15

Esthetic Considerations
Ideally, the pontic should adapt to the ridge well
When the pontic does not adapt well, (3) can
become troublesome

Answer 15

esthetics, speaking, and food impaction

Question 16

Biological Considerations
Pontic ridge contact should ideally be on — tissue. When on non-keratinized tissue,
(2) can occur.
Pontic contact with ridge should not inflict — on the tissue.
Contact with the — should be minimal. Pontic shape in contact with tissue should also be —

Answer 16

keratinized
ulceration and constant irritation
pressure
tissue, convex

Question 17

Delicate balance of light to slight tissue contact
-Contact too heavy?
-Contact too light?
Contact area should be small and shape of pontic convex

Answer 17

Tissue/bone resorption
Food impaction, esthetics compromised

Question 18

Biological Considerations
Convex shape of gingival aspect of pontic allows for

Answer 18

easier cleaning for patient
“Fullness” of pontic shape and proper gingival embrasures block out and keep food
and debris from being trapped under pontic.

Question 19

Biological Considerations
Oral Hygiene
(5)

Answer 19

Floss Threader
Super Floss
Proxabrush
Rubber Tip
Water Pik

Question 20

Physical Considerations – Strength
Pontic connectors need appropriate size to be strong
— Occlusal-Gingivally
— Facial-lingually

Answer 20

4mm
3-4mm

Question 21

Material Strength

Answer 21

Metal > Zirconia > Porcelain > Acrylic

Question 22

Pontic connectors should not impinge on –

Answer 22

embrasures

Question 23

Physical Considerations – Position
Pontics placed outside of the
inter-abutment axis creates

Answer 23

torque on the connectors and
abutments which can lead to
failure

Question 24

Recall that — is the biggest reason why we see mechanical failure in
bridgework. So replacing as ideal occlusion as possible extends the life of the
restoration.

Answer 24

occlusion

Question 25

Physical Considerations – Occlusion Occlusion development with a bridge should replace ideal occlusion

Answer 25

MI contacts, Working and Non-Working contacts in lateral excursions, Protrusive contacts, and canine guidance

Question 26

Ridge Lap -Also known as a --- pontic -Not used any longer -Forms a large --- contact area with ridge -Patient not able to --- -Creates

Answer 26

Saddle CONCAVE clean tissue inflammation leading to tissue ischemia and necrosis

Question 27

Hygenic Pontic -Also known as -- Pontic -No contact with -- -at least --- of space between the ridge and the pontic -Patient can easily clean without the pontic being a --- -Only for use in --- -Design and shape is --- in all directions.

Answer 27

Sanitary Ridge 2-3mm food trap non-esthetic areas CONVEX

Question 28

Pontic Design – Modified Hygenic Pontic -Perel Modification To increase --- of bridge in connectors with hygenic pontic --- is increased with less occlusal gingival height. So, lets beef up those connectors!

Answer 28

strength Deflection

Question 29

Conical Pontic -Passive contact with --- -Rounded and cleansable -Triangular embrasure space can -Best suited for --- -Also not best for --- areas.

Answer 29

ridge crest trap food thin mandibular ridges esthetic

Question 30

Modified Ridge Lap -Passive contact --- side of ridge crest -Can appear very --- --- tissue surface contact -Used frequently in the --- areas. -Shape can help keep --- much easier for patients

Answer 30

facial esthetic Convex esthetic food from trapping Cleansibility

Question 31

Pontic Design – Modfied Ridge Lap Pontic Convex in all directions except for

Answer 31

a small concavity on the lingual side of the facial-gingival aspect of the pontic

Question 32

Pontic Design – Modfied Ridge Lap Pontic Contact area is meant to be --- --- side needs to be smooth and highly polished Tissue contact ok but should not put --- on the tissue. Keep tissue contact on --- Tissue contact shape is ideally shaped like a ---

Answer 32

minimal Lingual pressure Keratinized tissue T

Question 33

Pontic Design – Ovate Pontic Blunt rounded Pontic shape that is set into a --- by well educated and motivated patients Highly ---

Answer 33

concavity in the tissue of the edentulous ridge Cleansable Esthetic

Question 34

Pontic Design – Ovate Pontic Generally requires planning (3)

Answer 34

-Pre-Prosthetic surgery via immediate provisionalization after extraction -Surgery/modification with provisional to develop tissue shape and contour -Ovate Pontics keep a slight pressure on the tissue to maintain the effect of emerging from the ridge

Question 35

--- requires lots of planning, possible surgery, and a patient willing to work to clean and maintain the area.

Answer 35

Ovate

Question 36

Modfied Ridge Lap then is the most common type of pontic because it is

Answer 36

esthetic but requires much less effort on the part of the doctor and patient.

Question 37

Connector design is important for the --- of the FPD.

Answer 37

strength

Question 38

Connector design is important for the strength of the FPD. Can be challenging to get appropriate --- with short or crowded dentition.

Answer 38

height and width

Question 39

Typical Connector dimensions: Height – Width – Gingival Embrasure form better to be Consideration needs to be made to design an appropriate cross-sectional area

Answer 39

3-4 mm 3-4 mm U shaped than V shaped

Question 40

Connectors are shaped to be concave in the

Answer 40

Buccal Lingual AND the Mesial Distal TOWARD the ridge.

Question 41

U shape from Occlusal to Gingival (2)

Answer 41

-U shape is stronger than a V shape. -U shape provides stronger fracture resistance.

Question 42

Remember... Minimum height is --- mm

Answer 42

3-4

Question 43

Remember... Minimum height is 3-4mm -if you increase the height, you increase the

Answer 43

strength -Height x2 = increased strength by a cube

Question 44

Connectors are designed large enough to prevent fracturing, but not to impinge on embrasure and physiological contouring Anterior connectors are placed more --- for esthetics Anterior connectors are longer --- for strength

Answer 44

lingually inciso-gingivally

Question 45

Anterior connectors considered ”--- Drop” shape

Answer 45

Tear

Question 46

Posterior Connectors --- height is more important than --- width for strength Posterior connector shape is considered “---” Getting appropriate 3-4mm height can be challenging in some posterior situations.

Answer 46

Occluso-Gingival, buccal-lingual heart shaped

Question 47

Connector size is at least --- and possibly needs to be larger

Answer 47

4mm

Question 48

U shaped connectors need a large radius at the

Answer 48

gingival embrasure

Question 49

Full strength Zirconia shows increased fracture resistance compared to all ceramic, but as of yet,

Answer 49

research shows the need for connectors in size similar to all ceramic

Question 49

Strength is a challenge thus far and there is an increased --- potential with all ceramic bridges

Answer 49

fracture

Question 49

-Metal frameworks are assembled in two ways: (2)

Answer 49

-Cast/milled as one piece -Two or more pieces are soldered together (metal only). **(Laser Welding in Titanium alloy situations can be used) **(CAD/CAM can be used to make a one piece bridge framework with ceramics/Zirconia)

Question 49

Strength is a challenge thus far and there is an increased --- potential with all ceramic bridges

Answer 49

fracture

Question 49

(2) are still the standard that others are measured against

Answer 49

PFM and Full Gold bridges

Question 49

Single Piece casting issues to watch for: -Distortion –

Answer 49

greater the length, the increased distortion

Question 49

Can be very challenging to verify the fit of all the retainers and therefore to over reduce the interior/intaglio of the framework to get it to seat fully Due to these problems, often longer span bridges are cast in

Answer 49

multiple pieces and soldered together. The idea is that two small pieces are easier to fit than one longer one.

Question 49

Also, if an FPD metal framework you are trying in does not fit due to distortion, you can

Answer 49

cut between a pontic and retainer, re-seat each smaller piece to verify each individual fit, and then capture the new seating with acrylic. This can be sent to the lab to solder the two pieces together.

Question 49

If your framework has distorted or you have two large pieces of framework to try in, how do you reconnect them? What is soldering and how is it done? Soldering – (3)

Answer 49

joining of metals by fusion of filler metal bonding to each of the parts being joined. -The bond is created by wetting the surface of parent metals with liquified solder -The metal framework does not melt during this

Question 50

Brazing –

Answer 50

A specific form of soldering when the filler material has a melting temperature above 450 degrees Celsius.

Question 51

skipped Dental Solder – What do we desire solder to do for us? (6)

Answer 51

-Resists tarnish and corrosion -The fusion temperature 100-150 degrees Fahrenheit below that of the substrate metal -Free flows when melted -Resists pitting -Is strong -Matches color of the two parts being joined.

Question 52

How do we classify Solder? And WHY? Solder is classified by Fineness -Fineness is the parts per thousand of gold in a solder -650 fine = Higher Fineness increases the Higher Fineness increases Higher Fineness results in

Answer 52

650 parts gold per thousand parts melting range resistance to tarnish or corrosion decreased hardness

Question 53

What factors affect the accuracy and prognosis of soldered connectors? (3)

Answer 53

1. Connector Space 2. Metal Surface Preparation 3. Indexing Technique for Investment

Question 54

Connector Space A proper space between the two metal surfaces allows the

Answer 54

solder to flow in- between

Question 55

A proper space allows for (2) of the solder

Answer 55

thermal expansion and shrinkage

Question 56

A proper space is small enough to minimize

Answer 56

distortion from the solder shrinkage as it cools

Question 57

A proper space is also large enough to allow for a

Answer 57

strong connector

Question 58

A proper space is

Answer 58

parallel and flat with a space for thickness the size of a business card (0.2mm)

Question 59

Metal Surface Preparation Metal Surface needs to be (2) Metal Surface needs to have a --- finish instead of highly polished.

Answer 59

clean and uncontaminated satin

Question 60

Indexing Technique for Investment 2 steps

Answer 60

1. Flow auto-polymerizing acrylic resin into space to hold two pieces together. Each side should be fully seated with margin integrity checked and verified. 2. Make an occlusal plaster index to send to the lab for soldering. Framework should be solidly planted in plaster index so that enough of the coronal portion is covered so framework can be held in place.

Question 61

Flux –

Answer 61

Enables solder to wet and spread over clean metal surfaces. Flux removes oxides, and prevents further oxide formation -contains Borate

Question 62

Anti-Flux –

Answer 62

Limits the spread of the solder. -Contains graphite or rouge

Question 63

Pre-Ceramic Veneer Soldering (5)

Answer 63

Uniting components of the same alloy BEFORE porcelain is fired. Uses high-fusing solder Melt solder with a torch Solder has lower melting temp than alloy, but higher melting temp than porcelain firing temperature Less Technique Sensitive

Question 64

Post-Ceramic Veneer Soldering (7)

Answer 64

Uniting components of the same alloy AFTER porcelain is fired Uses low-fusing solder Melt solder in oven Solder has lower melting temp than alloy and porcelain More Technique sensitive *Can compensate for slight discrepancies or distortions that occur AFTER the porcelain is fired. *Porcelain can crack in area of solder joint during solder process

Question 65

Open Contact with a All metal or PFM crown? Addition Soldering –

Answer 65

Adding material to contact area Smoothing and shaping contact area Voila! Contact! Can add contacts to Zirconia too but not to Lithium Disilicate