Intro to Fixed Partial Prostho

Prostho is the dental specialty pertaining to:

DTM of FCAH of patients

DTM

Diagnosis
Treatment
Maintenance

FCAH

Function
Comfort
Appearance
Health of Patient

Prosthodontics is associated with?

missing or deficient teeth and/or maxillofacial tissues using biocompatible substitutes

Branches of prosthodontics

Fixed
Removable
-partial
-complete
Maxillofacial

Maxillofacial prosthodontics

ex. Replace developmental defects(cleft lip &palate) or replace acquired defects(accidents that caused fracture of mandible)

Fixed Prosthodontics

partial denture that is luted or securely retained to natural teeth, tooth roots and/or dental implant abutments that furnish the primary support to the prosthesis

Fixed prostho is the restoration/ replacement of teeth using:

Artificial substitutes, attached to natural teeth, roots or implants, not readily removable

For successful treatmen

• Meticulous attention to every details
•Patient interview diagnosis and education
• Prevention of dental disease
• Periodontal therapy (if indicated)
• Occlusal consideration
• Appropriate treatment plan
• Operative skills and treatment
• Follow up care

Hard Tissue Variables

-condition of abutment
-remaining natural teeth

Soft-tissue variables

Condition of residual reach

Meticulous attention to every details

Includes hard and soft tissue variables

Patient interview diagnosis and education

Includes assessing past medical and dental history
*systemic disease can affect treatment

Prevention of dental disease

i.e. caries, periodontal disease

Which field of dentistry is the last treatment phase?

Prosthodontics

Indications of Fixed Prosthodontics

1. One/two adjacent teeth are missing in same arch/short span edentulous arches
2. Supporting tissues are healthy
3. Suitable abutment teeth present
4. Patient is in good health, wants to have prosthesis placed
5. Patients has skills & motivated to maintain good oral hygiene
6. Patient's preference

Contraindications of Fixed Prosthodontics

1. Necessary supportive tissues: missing/deceased
2. Suitable abutment teeth: not present
3. Patient not motivated to have prosthesis places
4. Patient has poor oral hygiene
5. Patient cant afford treatment

Types of Restorations

1. Extracoronal resto
2. Intracoronal resto
3. Radicular restoration

Extracoronal restoration

-covers all surfaces of tooth
-veneer to restore external portions of a prepared tooth

How does extracoronal resto obtain its retention and resistance to displacement?

from the fit of the restoration to the external walls of the restoration

intracoronal restoration

-only confined in coronal portion
Ex. Inlay, onlay

How does intracoronal restorations obtain their retention and resistance to displacement?

intimate fit of the restoration within the confines of the coronal portion of the tooth

Radicular restoration

-Consist of post/dowel +core
Ex. Post-retained crown

How does radicular resto obtains its retention and resistance ti displacement?

prepared root portion of an endodontically treated tooth

Extracoronal resto examples

Crown,
full veneer crown(cast metal),
metal ceramic crown,
partial veneer crown,
Three-quarter crown,
seven-eights crown,
one-half crown,
resin bonded restorations,
laminates and facial veneers

Crown

-cemented resto that covers/veneers outside surface of clinical crown

Crowns should reproduce the \___ and damaged of coronal portion of tooth while it functions

Morphology

Crown function

Protect remaining structures from further damage

Types of extracoronal crown

1. Full veneer crown
2. Partial veneer crown

Full veneer crown

cemented extracoronal restoration that covers or veneers the outer surface of the clinical crown

Full veneer crown primary function

protect the underlying tooth structure & restore the function, form and esthetics.

Partial veneer crown examples

• three quarter crowns
• reverse three-quarter crowns
• seven-eight crowns
• pin ledges
• inlay
• onlay

FULL VENEER CROWN (CAST METAL)

-covers all of the crown(full/complete veneer crown)

Full veneer crown(cast metal) can be fabricated with:

-entirely gold alloy
-some other untarnishable metal
-ceramic veneer fused to metal

Indications for full veneer crown(cast metal)

1. Teeth with extensive coronal destruction by caries/trauma
2. Chosen when maximum retention and resistance is needed
3. On endodontically treated teeth
4. Correction if occlusal plane

Contrandications for full veneer crown(cast metal)

1. Less than max retention & resistance is needed
2. Intact buccal/lingual wall
3. Enameloplasty
4. High esthetic needs(anterior teeth)

Advantages of full veneer crown(cast metal)

•Strong
•High retentive qualities
•Can be modify form and occlusion

Disadvantages of full veneer crown(cast metal)

-removes large amount of tooth structure
-display of metal

Metal ceramic crown is also called?

Porcelain Fused to Metal Crown (PFM)

Metal ceramic crown

complete coverage cast metal crown that is veneered with a fused porcelain to mimic the appearance of a natural tooth

Indications for Metal ceramic crown

-esthetics
-gingival involvement
-extensive tooth destruction by caries,trauma

Contraindication for Metal ceramic crown

• patients with active caries/untreated periodontal disease
• Large pulp chamber
• Intact buccal wall

enameloplasty

Tooth recontouring

Which patients have a larger pulp chamber, young or older patients?

Younger patiensts

Advantages of metal ceramic crown

1. superior esthetics
2. Excellent retentic qualities

Disadvantages of metal ceramic crown

•Removal of substantial tooth structure
•Fracture can occur
•Difficult to obtain accurate occlusion in glazed
porcelain
•expensive

Most frequent site of fracture in PFM?

Porcelain

Partial veneer crown

extracoronal metal restorations that covers only part of the clinical crown

Partial veneer crown indications

1. Clinical crown \= ave length/longer
2. Intact buccal/labial surface
3. Well supported by sound tooth structure

Contraindications for partial veneer crowm

1. Short teeth
2. High caries index
3. Extensive destruction
4. Endodontically treated teeth
5. Poor alignment
6. Bulbous teeth
7. Thin teeth

Why cant short teeth be treated with partial veneer crown?

Because of the vertical tooth structure

Why is endodonticallybtreated teeth a contraindication of partial veneer crown

Bcs non-vital teeth can be brittle, and PVC needs a sound tooth structure as support

Poor alignment, bulbous teeth, thin teeth are contraindication of partial veneer crown because?

These will leave unsupported enamel(manipis) which is more probe ti fracture

Partial veneer crown advantages

• Conservative of tooth structure
• Easy access to margins
• Less gingival involvement
• Verification of seating simple

Verification of Seating simple

Fit of criwn is easy to see

Full veneer crown disadvantages

• Less retentive than full crown
• Limited adjustment of path of withdrawal
• Not indicated on non vital teeth

Three-quarter crown

restore the occlusal surfaces and the three of the four axial surfaces but not including the facial surfaces

In three-quarter crown, which wall remains intact?

Buccal wall

Reverse three-quarter crown

Remaining intact wall: lingual wall

Seven-Eights (7/8) Crown

Extension of 3/4 crowns, includes major portion of facial surface

In 7/8 crowns, which wall remains intact?

Either mesial or distal half

One-half crown

restore the occlusal and mesial surfaces as well as portions of facial and lingual surfaces
-covers half the crown

One half crown is sometimes indicated as

retainer for FPD abutment

RESIN BONDED RESTORATIONS

-cast metal partial veneers, bonded to etched enamel

Most often use of resin bonded resto

Retainer for FPD

Laminates and facial veneer

-thin layer of dental porcelain or cast ceramic bonded to facial surface of tooth

When are laminates & facial veneer used?

in situations requiring an improved cosmetic appearance on the anterior tooth.

Intracoronal restorations examples

Inlay
Onlay
Fixed partial denture

Pinledge

Partial veneer retainer prep, incorporates pinholes on lingual surface of teeth to provide retention

How deep are the pin holes

2 mm

Inlay

*made outside the tooth -\> luted into tooth

Inlay is used as as single tooth resto for:

proximo-occlusal or gingival lesions with minimal to moderate extensions

Inlay is made from

Gold alloy or ceramic material

Inlays are similar to fillings, the work lies within \___ of the tooth

Cusps

Indications fror inlay

• Small carious lesion
• Adequate dentinal support
• Low caries rate
• Patient request for gold restorations

Contraindications for inlay

• high caries index
• Poor plaque control
• MODs
• Poor dentinal support require wide preparation

Onlay

restores one or more cusps and adjoining occlusal surfaces or the entire occlusal surface

How is onlay retained?

By mechanical or adhesive mean

Onlay is used for:

more extensively damaged posterior teeth needing wide mesio-occluso-distal restorations

Onlay indications

•Worn or carious teeth with intact buccal and lingual cusps
•MOD amalgam requiring replacements
•Low caries rate

Contraindications onlay

•High caries risk
• poor plaque control
•Short clinical crown/extruded tooth
•bruxism

Fixed partial denture is commonly called?

Bridge

Fixed partial denture

Prosthetic appliance permanently attached to remaining teeth which replaces one or more missing teeth

Parts of FPD

1. Retainer
2. Abutment
3. Pontic
4. Connector

Retainer is used for

-used for the stabilization or retention of a prosthesis
-Functional adaptation and protect the tooth against its fracture

Retainer is positioned at?

Margin, its lees susceptible to caries or recurrence of caries

Retainer

Metal coping, cemented
-Least destroys the cervical marginal ridge

Retainers need to be rigid, why?

To withstand the requisite load

Types of Retainers

*acc to materials used
• Full veneer crowns
• Partial veneer crowns
• Conservative retainers
• All metal retainers
• Metal ceramic retainers
• All ceramic retainers
• All acrylic retainers

Pontics

-artificial tooth on a fixed dental prosthesis

Pontics functions

replaces missing natural teeth,
Restores function,
Fills the space occupied by clinical crown

Requirements of pontics

Restore function
Provide esthetics and comfort
Be biologically acceptable
Permit effective oral hygiene
Preserve underlying residual mucosa

Materials used for pontics

Metals, resin, all-plastic

Abutment

tooth, a portion of a tooth, or that portion of a dental implant that serves to support and/or retain a prosthesis

Connector

-portion of FPD that untied retainer and pontic

Types of Connectors

Rigid connectors
Non-rigid connectors

non-rigid connector

• Tenon mortise connectors
• Loop connectors
• Split pontic connectors
• Cross pin and wing connectors

Tenon Mortise connectors(TMC)

Has male and female component/dovetail connectors

Male part of TMC

Tenon

Female part of TMC

Mortise