diastema closure

approaches for tx for this pt

• flipped

• conventional bridge

• bonded bridges

  • maryland, all-ceramic, fiber-reinforced composite

• implant

what is this

flipper

what is this

metal-ceramic adhesive bridge → maryland

what is the major problem w these restorations

debonding is a major cause of failure

major complications w maryland bridges

• one debonded wing

• improper preparation

• occlusal forces

what is the most severe complications and why

• one debonded wing

• improper preparation

• occlusal forces

one debonded wing: debonded tooth would suffer form dental caries as bacteria would be trapped under the ‘loose’ wing w the pt unable to clean the area

debonding can be caused by improper preparation, explain this

• improper tx of the metal by the lab tach

• poor preparation design or adhesion protocols employed by the dentist

unilateral debonding can occur from occlusal forces, explain this

even if there was strict attention to proper protocols by dentist and lab tech → in C-I → forces on canine would be more in a lateral direction

why cantilever over maryland bridge

• better aesthetics

• easy cleaning

• less biological damage

• reduced risk of an undetected debonded retainer w caries underneath

C

light cervical chamfer

S

light incisal finishing shoulder

B

small proximal box

P

small pinhole

minimum thickness for retainer wing of zirconia canti-lever bridge

.7 mm

the minimum zirconia ceramic dimensions of the proximal connect were mm horizontally x __ mm vertically

2;3

bond or lute zirconia

bond

first step to preping zirconia restoration

sandblast w aluminum oxide → even if lab did it weeks ago, want a fresh sandblasted surface

primer for zirconia needs to have what in it

MDP monomer

what did this study show

• all ceramic cantilever provide and excellent minimally invasive tx alternative to implants and conventional prosthetic methods when single missing anterior teeth need to be replaced

• all 6 failures were debonding due to trauma

if you wanted to do direct composite in this case, how would you approach

fiber-reinforced composite direct adhesive bridge

advantages of fiber-reinforced composite

• relatively good aesthetics

• better adhesions of the luting agent to the framework

• direct manufacturing possible → lower cost

• possible repair w addition of composite resin/fibers

disadvantages of fiber-reinforced composite

• unsure long-term prognosis

• wear of the composite resin material

• framework fracturing difficult to repair

• unstable aesthetics

• adequate thickness required → bulky

advantages of all-ceramic

• superb aesthetics

• biocompatible

• reduced plaque accumulation

disadvantages of all-ceramic

• high failure risk

• unsure long-term prognosis

• impossible to repair

• least minimally invasive

• adequate thickness required → bulky

• high lab cost

advantages of metal-ceramic

• long-term clinical data available

• most minimally invasive

• simple rebonding

• suits a cantilever design

• w more extensive prep the success becomes more predictable

disadvantages of metal-ceramic

• medium aesthetics

• metal unpopular

fiber-reinforced direct adhesive bridge can withstand ______ forces, so there is no need for a cantilever

bilateral forces

fiber-reinforced direct adhesive bridge can be placed as ____ on lower anteriors

non-prep

a ____ preparation is usually recommended when placing a fiber-reinforced direct adhesive bridge can

slot

2 layers of fiber can increase the comprehensive strength of the frame-work up to __ times

2

placement of the fiber is time-consuming and technique sensitive. the success of fiber placement depends on…

full integration and impregnation of fiber-resin

what ca fiber do to composite

• reduced polymerization shrinkage stress

• reduce total resin volume mass

• reinforce the composite

• provide increased fatigue resistance

• crack stopping mechanism

some examples of fiber-reinforced composite applications

• periodontal splinting

• adhesive bridge framework

• reinforced cracked teeth

• core buildup for endo-treated teeth

• trauma stabilization

• ortho retainers

• and more!

pontic type

sanitary/hygienic

advantage/disadvantage of sanitary pontic

• advantage: good access for oral hygiene

• disadvantage: poor esthetic

recommended location for sanitary

posterior mandible

pontic type

saddle-ridge lap

recommended locations for saddle-ridge lap

NOT recommended

advantage and disadvantage for saddle-ridge lap

• adv: esthetic

• disadv: nor amenable to oral hygiene

pontic type

conical

location recommended for conical

molars w/o esthetic requirement

advantage and disadvantage for conical

• adv: good access for oral hygiene

• disadv: poor esthetics

pontic type

modified ridge-lap

recommended location for modified ridge-lap

high esthetic requirement

advantage and disadvantage for modified ridge-lap

• adv: good esthetics

• disadv: moderately easy to clean

pontic type

ovate

recommended location for ovate

maxillary incisors, cuspids, and premolars

advantage and disadvantage for ovate

• adv: superior esthetics, negligible food entrapment, ease of cleaning

• disadv: requires surgical preparation