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Definition.

The prosthesis which is cemented to the abutment


and cannot be removed by the patient.
History taking:
Collecting the informations
which are important in
treatment planning and
diagnosis of the disease.
Chief complaint usually falls into one of the following four
categories:

a. Comfort( pain, sensitivity, swelling).

b. Function(difficulty in mastication or speech)

c. Social(bad taste or odor)

d. Appearance( fractured or unattractive teeth or restorations,


discoloration)
 It consists of clinical use of sight, touch, and hearing
to detect conditions outside the normal range.

 It is critical to record what is actual observed rather


than to make diagnostic comments about the
condition.

 For example, ”swelling” “redness” and “bleeding on


probing of gingival tissue” should be recorded
rather than “gingival inflammation”(which implies
a diagnosis).
 General Examination.

 Extra Oral Examination.

a. TMJ

b. Muscles of mastication

c. Lips
 Intraoral Examination:

a. Periodontal information
1. Gingiva.

2. Periodontium.

3. Occlusal examination
Radiographic
examination.
(X-ray)
Approach should be
logical and systematic.
 After completion of history and examination a
differential diagnosis is made.

 A definitive diagnosis can usually be developed after


such supporting evidence has been assembled.
Prognosis is an
estimation of the
likely course of a
disease.
 General Factors which affect the prognosis:

a. Overall caries rate.

b. Diabetes

c. Bite force of the patient.

d. others.
 Local factors which affect prognosis:

a. Vertical overlap of the anterior teeth.

b. Impaction adjacent to molar that will be crowned


may pose a serious threat in a younger individual in
whom additional growth can be anticipated but it may
be of lesser concern in an older individual.
c. Individual tooth mobility.

d. Root angulation.

e. Root morphology.

f. Crown-root ratio.

g. Others
 Material used

 Model making

 Articulation ( non-adjustable, semi-adjustable)


 IDENTIFICATION OF THE PATIENT’S NEEDS.

 Successful treatment planning is based on proper


identification of the patient’s needs

 “Ideal” treatment against the


patient's needs is usually a
failure.
 Correction of Existing Disease.

 Prevention of Future Disease.

 Restoration of function.

 Improvement of Appearance.
 Allexisting restorative
materials and techniques have
limitations and cannot exactly
match the properties of a
natural tooth structure.
 Whenever possible, FPDs should be design as simple
as possible with a single well anchored retainer fixed
rigidly at each end of the pontic.

 Teeth in which pulpal health is doubtful should be


endodontic ally treated before the initiation fixed
prosthodontics.
 Unrestored abutments: An unrestored caries free
tooth is an ideal abutment.

 Mesially Tilted Second Molar:

 Overloading of the abutment teeth should be


avoided.
 The occlusal forces should be directed along the long
axis of the tooth.

 Root surface area.

 Ante’s law: Root surface area of the


abutments supported by bone should be
equal or more than the root surface area of
the teeth which are being replaced.
 Nayman and Ericsson, however cast
doubt on the validity of Ante’s law by
demonstrating that teeth with
considerably reduced bone support can
be successfully used as fixed partial
denture abutments.
 ORAL SURGERY

 PERIODONTICS

 ENDODONTICS

 ORTHODONTICS

 FIXED PROSTHODONTICS

 REMOVABLE PROSTHODOTICS
 A foundation restoration, or ,
core, is used to build a damaged
tooth to ideal anatomic form
before it is prepared for a
crown.
Materials used:

1. Dental Amalgam.

2. Glass Ionomer.

3. Composite Resin.

4. Pin-retained cast metal core.


 1. BIOLOGICAL CONSIDERATIONS. Affect the
 health of the oral tissues.

 2. MECANICAL CONSIDERATIONS. Affect the


integrity and durability of the restoration.

 3. ESTHETIC CONSIDERATION. Affect the


appearance of the patient.
 PREVENTION OF DAMAGE DURING TOOTH PREPARATION:

 1. Adjacent teeth.

 2. Soft tissues.

 3. Pulp
 CAUSES OF INJURIES:

 1. Temperature.

 2. Chemical Action.

 3. Bacterial Action.
Conservation of Tooth Structure.
Considerations Affecting Future Dental Health.

 1. Axial reduction.

 2. Margin Placement.

 3. Margin adaptation.
 4. Margin Geometry.

 5. Occlusal Consideration.

 6. Preventing Tooth Fracture.


 Retention Form.

The quality of a preparation that prevents the


restoration from becoming dislodged by such forces
parallel to the path of withdrawal is known as
retention.
 Factors Affecting retention Form.

 1. Magnitude of dislodging forces.


 2. Geometry of the tooth preparation.
 3. Roughness of the fitting surface of the restoration.
 4. Material being cemented.
 5. Film thickness of the luting agent.
 Resistance Form.
The quality of preparation that prevents the
restoration from becoming dislodged by such forces as
horizontal or oblique which is applied during
mastication and par functional activities.
 Factors affecting resistance form.

 1.Magnitude and direction of the dislodging forces.

 2. Geometry of the tooth preparation.

 3. Physical properties of the luting agent.


 Factors affecting esthetic considerations.

 1. Metal- Ceramic Restoration.


 2. Facial Tooth Reduction.
 3. Incisal Reduction.
 4. Proximal Reduction.
 5. Labial Margin Placement.
 Quality is never an accident; it is
always the result of high
intention, sincere effort, intelligent
direction and skillful execution; it
represents the wise choice of
many alternatives.
 - William Foster
 CROWNS:

 Extracoronal Restoration.

 It protects the underlying tooth structure.

 It restore the function.

 Restore aesthetics.
 Clinical Crown: It is intraoral visible tooth
structure.
 Anatomical Crown: The area of tooth covered by
enamel.
 Artificial Crown.
 a. Full veneer crown.(FVC)
 b. Partial veneer crown(PVC)
 RETAINERS:
Part of FPD which is used as a support and
cemented to the natural tooth or implant.

ABUTMENT: may be tooth, root or implant.


 PONTIC:
 The artificial tooth that replaces a missing tooth in
FPD.

 CONNECTORS:
 It is the connection that exists between the retainer
and pontic.
 AVAILIBILTY

 ACCESSIBILITY.

 AFFORDIBILITY
 SHORT SPAN EDENTULOUS AREA.

 PROPER SUPPORT.

 PATIENT’S PREFERANCE.

 PATIENTS WHICH CANNOT MAINTAIN RPDs.


 LARGE AMOUNT OF BONE LOSS.

 VERY YOUNG PATIENTS.

 PERIODONTALLY COMPROMISED TEETH.

 LONG SPAN EDENTULOUS AREAS.


 UNCOPERATIVE PATIENTS.

 MEDICALLY COMPROMISED PATIENTS.

 VERY OLD PATIENTS.

 Distal extension denture bases as in class I, II.


 Three major classes.

 Each class is divided into three divisions.

 Each division is further divided into four


subdivisions.
CLASS:

It identify the location of the edentulous space.

CLASS I:

Posterior edentulous space(Molar or premolar)


 CLASS II:

 Anterior edentulous spaces( Incisors or Canines are


missing)

 CLASS III:

 Antero-posterior edentulous spaces.


 DIVISION:
 A division gives information about the abutment
teeth.

 DIVISION I:
 Cantilever FPDs. Abutment on one side.
 DIVISION II:
 Conventional FPDs, abutments on both sides of the
edentulous area.

 DIVISION III:
 Pier Abutments. A single tooth is surrounded by an
edentulous space on either side.
Sub-division:
 A sub-division denotes the status of the tooth that is
to be used as an abutment.

Sub-division I:

 Ideal abutments. Healthy teeth which provide good


support.
Sub-division II:

 Tilted Abutment.(Either the design of the prosthesis


is to be modified or the tilt should be corrected).

Sub-division III:
 Periodontally weak abutment.
Sub-division IV:

 Extensively damaged abutment.

Sub-division V:

 Implant abutment.
 DEPENDING ON THE TYPE OF CONNECTOR:

 Fixed fixed partial denture.

 Fixed movable partial denture.

 Removable fixed partial denture.


 DEPENDING ON MATERIAL USED.

 All metal

 Metal ceramic

 All ceramic

 All acrylic.
 LENGTH OF SPAN:

 Short span bridges.

 Long span bridges.


 DURATION OF USE.

 Permanent fixed PDs

 Interim bridges.
 TYPES OF ABUTMENTS:

 Normal/ Ideal abutment.


 Cantilever abutment.
 Pier abutment.
 Mesially tilted.
 Endodontically treated abutment.
 Implant abutment.
 Retainer is a crown or any part of FPD that is
cemented to the abutment.

 1. Major retainers( FVC,PVC.) which covers the


whole occlusal surface of the abutment.

 2. Minor retainers. It a small extension that is


cemented on to the tooth.
 BASED ON TOOTH COVERAGE:

 Full veneer retainers.

 Partial veneer retainers.

 Conservative retainers. ( Minimal preparation)


 BASED ON THE MATERIAL BEING USED.

 All metal

 Metal ceramic

 All ceramic

 All acrylic.
 It is an artificial tooth in a fixed partial denture that
replaces a missing tooth, restores its functions and
usually fills the space.
 1. It should restore the functions of a tooth it replaces.

 2. It should provide good aesthetics.

 3. It should be comfortable to the patient.

 4. It should be biocompatible.

 5. It should be easy to clean.

 6. It should preserve the underlying mucosa and bone.


 FACTORS AFFECTING THE DESIGN OF A
PONTIC.

 1.Space available for the placement of pontic.

 2. The contour of the residual alveolar ridge.

 3. The amount of occlusal load that anticipated for


that patient.
 Siebert’s Classification of Ridge defects.

 CLASS I defects: Normal faciolingual width with


normal height.

 CLASS II defects: Loss of ridge height with


normal width.

 CLASS II defects: Loss in both dimensions.


 A. Based on Mucosal contact.

 B. Type of material used.

 C. Method of fabrication.
 TISSUE SURFACE IN CONTACT.
 1.RIDGE LAP/Saddle
 2. MODIFIED RIDGE LAP
 3. OVATE
 4. CONICAL
TISSUE SURFACE NOT IN CONTACT.
1. SANITARY/Hygienic
2. MODIFIED SANITARY.
 SADLE OR RIDGE LAP:
 Concave fitting surface
 Overlap the residual ridge buccolingually.

 SHOULD BE AVOIDED
 Concave surface of the pontic is inaccessible.
 Cause tissue inflammation.
 MODIFIED RIDGELAP PONTIC:

 Combines best features of the Hygienic and Saddle


pontic designs.

 Combining esthetics and easy cleaning.


 CONICAL PONTIC:
 Also called Egg-shaped, Bullet-shaped, or Heart-
shaped.
 It only touches the residual ridge at one point.
 Easy to clean.
 Recommended in posterior teeth where esthetics is a
less concern.
 OVATE PONTIC:
 Esthetically superior.
 Its convex tissue surface reside in the soft tissue
depression.
 Socket preservation techniques are necessary for
successful results.
 Ridge contact:
 The contact between the underlying tissues and pontic
should be pressure free.
 Oral Hygiene Consideration:
 Pontic Material:
 It should provide good aesthetics.
 It should be biocompatible.
 It should withstand occlusal forces.
 Sanitary or Hygienic Pontic.
 Tissue surface remains clear of the residual ridge.
 Easy plaque control.
 Only in posterior teeth.
 Metal-ceramic Pontics
 All metal pontic
 All ceramic pontic
 Resin pontic
 Custom-made pontics.

 Prefabricated pontics
 Theportion of the Fixed Partial
Dentures that unites the retainer(s)
and pontic(s).
 Rigid connectors

 Non-rigid connectors.
 Used to unite the retainers with pontics in Fixed-
fixed partial dentures.

 These connectors are used when the load is


transferred directly from the pontics to the
abutments.
 Cast rigid connectors(conventional bridges)

 Soldered rigid connectors.


 Used in situation where single path of insertion
cannot be achieved due non parallel abutments.

 These types of connectors allow limited movement


between the retainer and pontics.
 Tenon Mortise connectors(TMC) /Dovetail
connectors.

 Mortise(female) prepared within the connectors of


the retainers.

 Tenon(male) attached to the pontic.


 Used to maintained an existing diastema.

 The connector consists of a loop on the


lingual/palatal surface.
 Definition:
 It is the static relationship of the opposing teeth.

 Centric occlusion:
 Occlusion of the opposing teeth when the mandible
is in centric relation.
 This may or may not coincide with maximum
intercuspation.
 Maximum intercuspation:

 The complete intrcuspation of the opposing teeth


independent of the condyle position.

 Eccentric occlusion:
 Ideal requirements of the impression material used
in fixed partial dentures.
 Dimensional stability and accuracy
 Elasticity after cure.
 Flow.
 Wettability.
 Compatibility.
 Elastomeric impression material.

 Two stage technique

 Primary impression in putty.

 Secondary impression in wash.


 Treatment planning.

 Case selection

 Case design

 Ante’s Law
 Preparation

 Selection of Impression material

 Impression technique

 Recording the fine details


 Pouring the cast

 Shade selection

 Corresponding with the laboratory.

 Demands and specific details.


 Proper Wax up.

 Investment

 Casting
 Recovery and finishing.
 Porcelain work
 Firing
 Shade and glaze
 Intraoral adjustment

 Cementation

 Follow up and maintenance.


 Tips & Warnings

 After mixing, turn the rubber mixing bowl upside


down. If the dental stone mixture does not drip to
the ground, then you have the appropriate
consistency. If the dental stone mixture drips to the
ground, there is too much water in the mixture and
more dental stone will need to be added.
 Air bubbles will distort the accuracy of the dental
stones.

Avoid over-vibrating the dental stone mixture.

Over-vibrating will create unnecessary air bubbles.


 During the setting time period, the stone undergoes
an exothermic reaction, releasing heat.

 Do not separate the model from the impression until


the model feels cold.

Leave the dental stone model undisturbed for 45 to


60 minutes until the material completely sets
 After setting remove the cast carefully.

 Check the prepared surface for bubbles and


deficiencies.

 Outline the prepared margins.


Apply hardener on the prepared surfaces.( Dural)

 Wax up with blue/pink wax


Definition:
Its a channel through which molten alloy can reach
the mold in an invested ring after the wax has been
eliminated. Role of a Sprue: Create a channel to allow
the molten wax to escape from the mold. Enable the
molten alloy to flow into the mold which was
previously occupied by the wax pattern
 FUNCTIONS OF SPRUE
 1 . Forms a mount for the wax pattern .
 2 . Creates a channel for elimination of wax .
 3 .Forms a channel for entry of molten metal
 4 . Provides a reservoir of molten metal to
compensate for the alloy shrinkage
 SELECTION OF SPRUE
1 . DIAMETER :
It should be approximately the same size of the
thickest portion of the wax pattern .
Too small sprue diameter suck back, results
porosity.
2 . SPRUE FORMER ATTACHMENT :
Sprue should be attached to the thickest portion of
the wax pattern .
It should be Flared for high density alloys &
Restricted for low density alloys
 3 . SPRUE FORMER POSITION
Based on the
1 .Individual judgment .
2 .Shape & form of the wax pattern .
Patterns may be sprued directly or indirectly ..
Indirect method is commonly used
Reservoir prevents localized shrinkage porosity .
Reservoir And Its Location
 Armamentarium :
 1. Sprue .
 2 . Sticky wax .
 3 . Rubber crucible former .
 4 . Casting ring .
 5 . Pattern cleaner .
 6 . Scalpel blade & Forceps .
 7 . Bunsen burner
 TYPES OF SPRUES
I . - Wax .
 II . Solid Plastic .
 III. Hollow Metal.
 WETTABILITY
To minimize the irregularities on the investment &
the casting a wetting agent(SURFACTANT) can be
used .

FUNCTIONS OF A SURFACTANT.
1 . Reduce contact angle between liquid & wax
surface .
2 .Remove any oily film left on wax pattern
 PREREQUISITES
 Wax pattern should be evaluated for smoothness ,
finish & contour .
 Pattern is inspected under magnification & residual
flash is removed
 CRUCIBLE FORMER

 It serves as a base for the casting ring during


investing .Usually convex in shape.
May be metal , plastic or rubber .
Shape depends on casting machine used .
Modern machines use tall crucible to enable the
pattern to be positioned near the end of the casting
machine .
 CASTING RING LINERS
Most common way to provide investment expansion
is by using a liner in the casting ring .Traditionally
asbestose was used .
Non asbestose ring liner used are :
1) Aluminosilicate ceramic liner .
2) Cellulose paper liner
 Purpose of Casting Ring Liner
Ringer liner is he most commonly used technique to
provide investment expansion. To ensure uniform
expansion , liner is cut to fit the inside diameter of
the casting ring with no overlap. Thickness of the
liner should not be less than approximately 1mm.
Place the liner somewhat short of the ends of the
ring, 3mm, tends to produce a more uniform
expansion, therefore less chance for distortion of the
wax pattern & mold
 CASTING CRUCIBLES
Four types are available ;
1) Clay .
2) Carbon .
3) Quartz .
4) Zirconia –Alumina
 Remove the whole wax pattern along with the
sprues very carefully.
 Attach the wax pattern and sprues on the crucible
former in such a way that the whole complex should
be accommodated in the casting ring.

 Put the insulating sheet within the casting ring so


that heat loss is prevented during shifting of the ring
from the furnace to the casting machine.
After putting the casting ring over the wax pattern,
the margins of the ring are properly sealed with
modeling wax so that investment plaster should not
come out of the ring.

A SURFACTANT solution is applied to prevent


bubble formation during pouring.

The ring is then poured with investment plaster.


 During the pouring vibrator is being used.

 Leave the plaster to cool at room temperature for


about 45minutes to 1hour.

 Put the casting ring in the oven for about 1hour and
30minutes and raise the temperature up to 1100
degrees cent.
 Melt the alloy in casting machine.

 Take out the RED HOT ring from the oven and put
it in the Casting machine.

 Now the red hot ring is transferred from the oven to


the casting machine.
 Centrifuge it in the casting machine.

 Now the casting is completed.

 Cool it down at room temperature.

 Recover the framework from the investment plaster.


 Cut all the sprues.

 Remove the plaster.

 Blast the framework in the blasting machine.

 Finish the metal with burs.


 Do the final blasting on all the surfaces except the
inner surfaces of the retainers/crowns.

 A thin layer of thin mix porcelain is applied with


brush on all surfaces which will be covered with
porcelain.

 This is called wash core.


 After application of the wash core firing is done
according to the specific programme.

 The temperature of the wash core is raised up to 950


degrees instead of 930 degrees which is meant for
porcelain body.

 After firing the wash core in furnace the bridge is


cool down.
 Then opaque layer is applied and the bridge is fired
in furnace again.

 The bridge is cool down at room temperature.

 Apply the body, cervical and incisal shades and put


it in furnace for another required programme and
raise the temperature up to 930 degrees.
 Cool down the bridge and finish the surfaces with
burs, discs, wheels.
 After finishing , apply the glaze powder and put it in
furnace .

 Preheat for three minutes, then increase the


temperature up to 930 degrees in five minutes and
hold at 930 degrees for 1 minute.
 Ifminor changes in shade are
required, it can be done at this
stage.
Purpose of Prosthodontics
Restore masticatory function
Improve appearance
Improve speech
Promote good oral hygiene
Stabilize arch and occlusion

140
Copyright © 2006 Thomson Delmar Learning. ALL RIGHTS RESERVED.
Lack of supporting alveolar bone

Presence of periodontal disease

Excessive mobility of abutment teeth

Lack of patient interest in oral hygiene

Patient cannot afford treatment


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Delmar Learning. ALL RIGHTS
141 RESERVED.
Porcelain Full-cast
crown Partial
veneers
crown
Direct
resin Fixed Inlays
veneers prostheses

Indirect Onlays
resin
Bridges
veneers
Copyright © 2006 Thomson
Delmar Learning. ALL RIGHTS
142 RESERVED.
Gold
alloy
Porcelain
fused to metal

Porcelain
Composite
resin
143
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Retention of Restorations

• Core buildup
– Recreation of lost tooth structure
• Retention pins
– Screwed into dentin
– Hold core filling material
• Post and core
– After root canal therapy
– Strengthens tooth
Copyright © 2006 Thomson Delmar Learning. ALL RIGHTS RESERVED. 144
The Dental Laboratory

• Dental lab technician


– Fabricates restoration
– Makes die from impression
– Creates wax pattern on die
– Invests wax and casts invested material into
metal
– Prepares metal for porcelain layers
– Finishes and polishes final restoration

Copyright © 2006 Thomson Delmar Learning. ALL RIGHTS RESERVED. 145


Selecting a Tooth Shade

• Before preparation
• Moisten shade guide
• Match to natural teeth
under natural light
• Record in patient’s
chart
• Record on lab
prescription

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Tissue Retraction

• Placed in gingival
sulcus
• Mechanical and
chemical retraction
• Prevents bleeding
• Ensures
impression of
gingival margin
Copyright © 2006 Thomson Delmar Learning. ALL RIGHTS RESERVED. 147
Provisional Restorations

Temporary coverage to protect tooth


between appointments
Esthetics and patient comfort

Stabilize contacts and occlusion

Protect gingiva and interproximal areas

Fit gingival margin snugly


Copyright © 2006 Thomson Delmar Learning. ALL RIGHTS RESERVED. 148
The Laboratory Prescription

Patient’s Tooth
name shade

Description Dentist’s
of prosthesis information

Materials Date
for prosthesis requested
Copyright © 2006 Thomson Delmar Learning. ALL RIGHTS RESERVED. 149
Crown Cementation

• Check fit
– Margin
– Contacts
– Occlusion
• Adjust if necessary
• Permanent cement

Copyright © 2006 Thomson Delmar Learning. ALL RIGHTS RESERVED. 150


Fixed Prostheses Maintenance

• Crowns Toothbrush
• Bridges
Antimicrobial Threading
• Dental
rinses systems
implants
Plaque
removal
Water Dental
irrigators floss
Interproximal
bushes
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