FIXED PARTIAL DENTURE

TYPES OF SIMPLE FIXED BRIDGE

Rigidly Fixed Bridge

Semi-Fixed Bridge

Cantilever Bridge

Permits no individual or independent movements of its parts and is also known as STATIONARY FIXED BRIDGE

Rigidly Fixed Bridge

one which allows some individual or separate movements of some of its parts.

Semi-Fixed Bridge

Semi-fixed bridge is also known as

Limited stationary

Broken stress bridge

On a semi-fixed bridge what segment do you cement first?

MESIAL segment, followed by the DISTAL segment.

type of simple fixed bridge which has one or more abutments at one end of the bridge while the other end is unsupported

Cantilever Bridge

A combination FPD which employs two or more of the

simple type in one restoration.

Compound Fixed Bridge

SUBCLASSIFICATION ACCORDING TO LOCATION

Anterior or Labial Bridge

Posterior or Buccal Bridge

Combination Antero-Posterior Bridge or Labio-Buccal Bridge

COMPONENTS OF FIXED BRIDGE

Abutment

Retainer

Pontic

Connector

It is the selected remaining tooth or teeth where a crown or a bridge is attached

Abutment

It is the artificial crown or crowns used to attach the bridge to the abutment tooth/teeth.

Retainer

Part of the FPD that is cemented / in contact with the abutment.

Retainer

Artificial crown used to restore the missing tooth or teeth in the arch.

Pontic

Materials for Pontic

All porcelain

Porcelain fused to metal

Plastic attached to metal

All plastic

Serves to connect retainer on one side to the other retainer on the other side of the bridge as well as unites all the other parts of the bridge

Connector

FACTORS THAT INFLUENCES THE COMPONENTS SELECTION ON ABUTMENT

● With ____ ____

● With normal amount of ___________ attachment

● Capable of _________ additional forces to which it will

be subjected as part of the FPD

● Its preparation must be such that its retentive power

shall be _______ to resist the displacing forces to which

it will be exposed.

Vital pulp

Periodontal

Supporting

Sufficient

FACTORS THAT INFLUENCES THE COMPONENTS SELECTION ON RETAINER

● Must be so designed that it has ______ ______

● Margins prevent irritation of the soft tissues and _______ of caries

● Must be _______

● Does not ________

● Does not ______

● It is ______

Sufficient strength

Recurrence

Self-cleansing

Corrode or Tarnish

Discolor

Aesthetic

FACTORS THAT INFLUENCES THE COMPONENTS SELECTION ON PONTICS

● restore the _____ of the tooth it replaces

● meet the demands of _____ and _____

● be ______ ______ to the tissues

● ensure its ______

● prevent tissue ______ of underlying residual ridge

mucosa

Function
Esthetics and Comfort

Biologically Acceptable

Sanitation

Tissue inflammation

FACTORS THAT INFLUENCES THE COMPONENTS SELECTION ON CONNECTOR

● connector should be approximately ___ in size

● connector should always pass through what would be

normal ______ ___of teeth being replaced

● allows for creation of normal _____and

_______ ____

● Incisal/occlusal surface of connector should never have

_____ edge, which presents cleavage point to porcelain

● Connector should be contoured ________ to allow

for equal porcelain coverage on adjoining teeth

2mm

Contact area

Embrasures and Interdental spaces

Sharp

Interproximally

Important for connector. Should be sufficient so you can

allow contour and equal porcelain coverage.

Proximal clearance

Where do we usually put the connector?

Contact point/area

ANTERIOR AND POSTERIOR PONTIC DESIGN

Characteristics:

- All surfaces should be _____, smooth and properly finished

- The_______ ___ must be in functional harmony with the occlusion of all the teeth

- The overall length of the _____ surface should be equal

to that of the adjacent abutments/pontic.

- The ____ contour should be in harmony with adjacent

teeth or pontics

Convex

Occlusal table

Buccal

Lingual

FACTORS INFLUENCING FIXED BRIDGE DESIGN(19)

1. Crown Length

2. Crown Form

3. Degree of Mutilation

4. Root Length and Form

5. Crown-root ratio

6. Ante’s Law

7. Periodontal Health

8. Miller Mobility Value

9. Span length

10. Axial Alignment

11. Arch Form

12. Occlusion

13. Pulpal health’

14. Alveolar Ridge form

15. Age of patient

16. Phonetics

17. Long-term abutment prognosis

18. Esthetics

19. Psychological factors

CROWN LENGTH

teeth must have adequate _____-______

crown length to achieve sufficient retention

Occluso-cervical

CROWN FORM

- some teeth have tapered crown form which

interferes with _____

- incisors possessing a ____ ____ highly

translucent incisal edges

Paralellism

Very thin

DEGREE OF MUTILATION

- ___,____, and _______ of carious lesions or

restorations affect whether full or partial

coverage retainers are indicated

- _____ or _____ teeth not restorable and

should be thereby altering design and

creating the need for a prosthesis

size, number and location

Fractured or carious

ROOT LENGTH AND FORM

- roots with _____ _____ and ______ _____ are better able to resist additional

occlusal forces than are smooth-sided conical roots

- ______ ____ generally provide greater stability than single-rooted teeth

- _____ ____ has better retention than short root

Parallel sides and Developmental depression

Multirooted teeth

Longer root

CROWN-ROOT RATIO

- ____ ratio has been generally acceptable

whereas ___ ratio is considered minimal and

requires consideration of other factors

2:3(acceptable)

1:1(minimal)

ANTE’S LAW

- periodontal ligament area/pericemental area

of the abutment teeth should be _____ or _____ than the periodontal ligament

area/pericemental area of the missing

tooth/teeth

Equal or greater

PERIODONTAL HEALTH

- Absence of any form of periodontal disease

such as bone resorption and gingival recession

Bone resorption and gingival recession

MOBILITY: MILLER MOBILITY VALUE

- 1° mobility – ______

- 2° mobility – ___ ______ provided that you

must know the factor that cause the mobility

(px age, presence of calcular deposit) and

consider the # of tooth being replaced

- 3° mobility – _____________ /for extraction

1° Normal

2° Still acceptable

3° Can not be used as an abutment

SPAN LENGTH

- ______between abutments affects the

feasibility of placing fixed prosthesis

- ideal for 1-2 missing tooth

- loss of _________ requires careful

evaluation of other factors (_______,________,_______)

Distance

3 adjacent teeth

Crown-root ratio, Root length and form, Periodontal health, Mobility

If you cannot satisfy the ante’s law, you can use a?

Secondary Abutment

AXIAL ALIGNMENT

- crowns of proposed abutments must be __ ______. Minor alterations in axial alignment

(tipped/rotated) often necessitate the use of full coverage crowns to achieve retention or

_______ _________

Well aligned

Acceptable aesthetics

Arch form or curvature has its effect on stresses to the abutment

teeth. Usually applicable on the ___ ____. This arch curvature

especially if the fabricated pontic lies on the ________ ___,

it will create a ____ acting upon on the abutment.

Four Incisors

Interabutment axis

Lever

What are you going to do when there is Torquing force Rotational stress on the abutment teeth due to arch curvature?

- You will design it to have counterbalancing by using a

________ ______.

- This lever will produce ____ or ______ _____ on

the abutment (creating stress)

Secondary Abutment

Torquing or rotational forces

OCCLUSION

- Occlusal forces brought to bear on a prostheses are related to the ff:

a. degree of muscular activity

b. patients habit

c. # of tooth being replaced

d. leverage on the bridge

e. adequacy of bone support

PULPAL HEALTH

- abutment/s should not be sensitive to

_______ or _________

- abutments with poor pulpal health should

undergo _____ ____ prior to tooth preparation

Percussion or vitality testing

Endodontic treatment

ALVEOLAR RIDGE FORM

- not indicated for FPD if there is considerable

_____ ____

Bone Loss

AGE OF PATIENT

- not indicated in ____ patients as well as

_____ when teeth are not fully erupted

or with l___ ___

Older

Adolescents

Large Pulps

PHONETICS

- patients prefer FPD for ____ _____

(provides sufficient resistance to the flow of air

to allow normal speech sounds to be

produced) rather than _____

Good phonation

RPD

LONG-TERM ABUTMENT PROGNOSIS

- Take note of the ___ _____

- If there is a question on the ability of the remaining supporting structure to accept

additional occlusal forces, ___ is indicated.

- A tooth with sufficient loss of periodontal support and questionable prognosis may be

best treated with an ___ rather than an ___

Oral Hygiene

RPD

RPD rather than an FPD

ESTHETICS

- Prefer FPD because it resembles _____ but RPD may be indicated when the use of a pontic produces large and unsightly ______ ______ in a fixed prostheses.

Natural Tooth

Proximal Embrasures

PSYCHOLOGICAL FACTORS

- To most patients an FPD feels ___ ______than an RPD and more quickly becomes an

accepted part of the ___ _____

- Px feels ____ ______ and looks good wearing FPD than RPD

More normal

Oral Environment

More confident

An artificial tooth on a fixed dental prosthesis that

replaces a missing natural tooth, restores its function,

and usually fills the space previously occupied by the

clinical crown.

Pontics

According to Tylman, pontic is the suspended member

of a fixed partial denture. It _______ the lost natural

tooth, ______ _______, ,and ______ the _____ of the

missing tooth.

Replaces

Restores Function

Occupies the Space

IDEAL REQUIREMENTS OF PONTICS(10)

Smooth surfaced and convex in all directions

● Easily cleansable

● Pinpoint pressure free contact on the ridge

● No irritation to the gingival tissues

● Facilitate plaque control

● Emergence profile

● Strength and longevity

● Be esthetic

● Restore function

● No abutment overloading

● Color stable

Cases with newly extracted, you will

place ______ ___ so the healing process of gingiva

will be accordance with ______ _____of adjacent

tooth

Remporary RPD

Gingival margin

FUNCTIONS OF PONTICS

● Mastication

● Speech

● Esthetics

DESIGN CONSIDERATION

ANTERIOR TEETH

- All surfaces should be ____, ____and properly ____.

- Contact with the ___ ____ of the ridge should be minimal (pin point) and pressure free (___________).

- A _____________ is provided for a natural look. If a pinpoint contact is given for a case with ridge resorption, unaesthetic black spaces may become visible.

- ____ _____ should be in harmony with that of the adjacent teeth. (di dapat nakausli)

Convex, smooth, and properly finished

Labial slope

(Modified ridge lap design)

Larger contact with the ridge

Lingual Contour

DESIGN CONSIDERATION

POSTERIOR TEETH

- All surfaces should be convex, smooth and properly

finished.

- Contact with the _____ ____ of the ridge should be minimal (pinpoint) and pressure free (modified ridge lap design- discussed later).

- The ______ ______should be in harmony with the occlusion of all the other teeth.

- The _____________________ should correspond to that of the adjacent teeth.

- The ________ ______ of the buccal surface should be equal

to that of the adjacent abutments or pontics.

Buccal slope

Occlusal table

Buccal and lingual shunting mechanism

Overall length

Should be followed to make your patient comfortable,

easily clean and functional harmony with natural

teeth.

Buccal and lingual shunting mechanism

CLASSIFICATION DEPENDING ON MUCOSAL CONTACT

1. Conical

2. Ridge lap or saddle

3. Modified ridge lap

4. Ovate

CONIICAL shapes

egg-shaped, bullet-shaped, or heart-shaped

CONICAL should be made as _____ as possible, with only one

point of _______ at the center of the _______ ____

Convex

with only one contact at the center of the residual ridge

- Easy for the patient to keep clean.

- Recommended where esthetics is not of primary

concern ( posterior mandibular teeth)

- NOT suitable for broad residual ridges

CONICAL

has a concave fitting surface that overlaps the residual

ridge buccolingually

RIDGE LAP OR SADDLE

- Has a concave fitting surface that overlaps the residual

ridge buccolingually

RIDGE LAP OR SADDLE

- should be avoided because the concave gingival surface

of the pontic is not accessible to cleaning with dental floss

RIDGE LAP OR SADDLE

MODIFIED RIDGE LAP

- combines the best features of the _______ and ______ pontic designs

Hygienic and saddle pontic designs

- should be as convex as possible from mesial to distal

aspects

MODIFIED RIDGE LAP

MODIFIED RIDGE LAP tissue contact should resemble a _______

Letter T

the most common pontic form used in areas of the

mouth that are visible during function

Modified Ridge lap

most esthetically appealing pontic design. Literally

emerging from the gingiva.

Ovate

- convex tissue surface resides in a soft tissue depression or hollow in the residual ridge

Ovate

- used in cases where the residual ridge is defective or incompletely healed

Ovate

CLASSIFICATION DEPENDING ON NO MUCOSAL CONTACT

1. Sanitary or Hygienic

2. Modified Sanitary

- These pontics have zero tissue contact.

- easy to maintain, but highly unaesthetic

SANITARY OR HYGIENIC

Indicated only on posterior area because of its unaesthetic

appearance

SANITARY OR HYGIENIC

Modified Sanitary Pontic is also called

Perel pontic or Arc-fixed partial denture

MODIFIED SANITARY PONTIC

- gingival surface of the pontic is concave ________ and convex buccolingually

- Has no tissue contact due to __________ design.

Mesiodistally

Hyperparaboloid

Sanitary/ Hygienic Recommended location

Posterior Mandible

Sanitary/ Hygienic Advantages

Good access for oral hygiene

Disadvantages

Poor esthetics

Saddle-ridge-lap recommended location

Not recommended

Saddle-ridge-lap Advantages

Esthetic

Saddle-ridge-lap Disadvantages

Not amenable on oral hygiene

Conical recommended location

Molars without esthetic requirements

Conical Advantages

Good access for oral hygiene

Conical Disadvantages

Poor esthetics

Modified ridge-lap recommended locations

High esthetic requirements (anteriors, premolars, some maxillary molars)

Modified ridge-lap Advantages

Good esthetics

Modified ridge-lap Disadvantages

Moderately easy to clean

Ovate Recommended locations

Maxillary incisors cuspids and premolars

Ovate Advantages

Superior esthetics, Negligible food entrapment, Ease of cleaning

Ovate Disadvantages

Requires surgical preparation

CLASSIFICATION OF PONTIC BASED ON MATERIALS USED

1. Metal

2. Metal and Porcelain

3. Metal and Resin

METAL CERAMIC PONTICS

● Uniform veneer of porcelain- _-_mm

● Metal surface – _____ and _______

● _____ angles

● Occlusal centric contacts –

● ___ mm away from junction

1-2mm

Smooth and free of pits

Round

1.5

AVAILABLE PONTIC SYSTEM

Metal ceramic, All metal, Fibre reinforced all resin, Facings

Metal ceramic Advantages

Esthetics

Biocompatible

Metal ceramic Disadvantages

Difficult if abutment is not metal ceramic

Metal ceramic Indications

Most situations

Metal ceramic Contraindications

Long span with high stress

All Metal Advantages

Strength

Straight forward procedure

All Metal Disadvantages

Non-esthetic