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Introduction and orientation to Fixed Prosthodontics DR TAJAMMUL AHMED

1 Topics to be Covered COURSE TOPICS: No of Weeks Contact hours Introduction and orientation. 1 Alginate impression and diagnostic cast. 3. Treatment planning for the replacement of missing teeth. 4. Principles of tooth preparation 5. Retention and resistance and its theoretical and practical attainment 6. Metal ceramic crown preparation. 7. Introduction to ceramics and metal ceramic restoration

8. All ceramic crowns 1 Impressions 10. Fabrication of working cast and dies. 11. Waxing patterns 12. Fundamentals of occlusion and articulators. Wax-up procedure, cut back and framework design for metal ceramic restoration. Investing and casting.

Learning Objectives 1. To define FPD. 2. Enumeration of treatment options in FPD. 3. Enumeration of indications and contraindications of FPD. 4. Enumeration of types in FPD. 5. Enumeration of casting procedures in FPD.

Fixed Prosthodontics DEFINITION; Fixed prosthodontics is the specialized area of dentistry devoted to the replacement of missing teeth with cast prostheses that are permanently cemented in place.

Treatment Options Intracoronal Restorations Glass Ionomer Composite Resin Simple Amalgam Complex Amalgam Gold Foil Gold Inlay Ceramic Inlay

Treatment Options Extracoronal Restorations Ceramic Onlay Gold Onlay Partial Veneer Crowns (3/4, 7/8) Full Gold Crown Porcelain/Metal Crown (Porcelain Fused to Metal) All-Ceramic Crown Ceramic Veneer

Indications for Fixed Prosthodontics One or two adjacent teeth are missing in the same arch. The supportive tissues are healthy. Suitable abutment teeth are present. The patient is in good health and wants the prosthesis placed. The patient has the skills and motivation to maintain good oral hygiene. Fixed prosthodontics is also known as “crown and bridge.” Fixed prosthetics require good home care by the patient. The supportive tissues must be healthy, because they will be supporting the bridge. 9

Contraindications for Fixed Prosthodontics The supportive tissues are diseased or missing. Suitable abutment teeth are not present. The patient is in poor health. The patient is not motivated to have the prosthesis placed. The patient has poor oral hygiene habits. The patient cannot afford the treatment. Would a patient with severe periodontal disease be good candidates for fixed prostheses? Why or why not? If suitable abutment teeth are not present, what is another option for the patient? (Removable prosthesis or implants.) 10

Terminologies Inlay Covers a portion of the occlusal and proximal surface Onlay Covers proximal surfaces and most or all of the occlusal surface Porcelain veneers Thin shell-like covering placed to improve the appearance of anterior teeth. Full crown Completely covers the anatomic crown of an individual tooth Three-quarter crown Covers the anatomic crown of a tooth except for the facial portion Cast restorations are also known as indirect restorations. They are fabricated outside the patient’s mouth, in a dental laboratory. Where is the proximal surface? Why can’t veneers be placed on posterior teeth? 11

Inlay; Covers a portion of the occlusal and proximal surface An inlay involves the proximal surface and only a portion of the occlusal surface. 12

Onlay; Covers proximal surfaces and most or all of the occlusal surface An onlay involves the proximal surface and most or all of the occlusal surface. Cusp tips are involved. 13

Porcelain veneers Are thin shell-like covering placed to improve the appearance of anterior teeth. A B Veneers are placed to cover defects such as hypocalcification and intrinsic stains. What is an intrinsic stain? (A stain that comes from the inside.) An opaquer may be used to block out any underlying color or structural defects. The cement used for veneers may also be shaded to enhance the color match. What is the best lighting for shade selection? 14

Completely covers the anatomic crown of an individual tooth FULL CROWN; Completely covers the anatomic crown of an individual tooth Which anterior tooth might this be? (Canine.) The metal “ring” is healthier for the gum tissue because it is not as “bulky” as the porcelain fused to metal. gold crowns Porcelain fused to metal full crown 15

Types of Multiple Tooth Restorations Fixed bridge A prosthesis for missing teeth within the same arch Splint A prosthesis where multiple crowns are tied together for support without any pontics Resin-bonded bridge Also known as a Maryland bridge, with winglike extensions coming from the proximal sides Combination; Conventional and Maryland bridge A porcelain jacket crown is a very thin metal shell covered by layers of porcelain to resemble the shading and translucence of the enamel of a natural tooth. A fixed bridge contains a series of two or more units and is cemented permanently in place. Winglike extensions of the resin-bonded bridge are bonded onto the lingual surfaces of the teeth adjacent to the missing tooth. 16

Conventional four unit porcelain fused to metal bridge How many units are involved in this bridge? What are the components of the bridge? (Two pontics, two abutments.) Which teeth are being replaced? 17

Porcelain Fused To Metal Crown (PFM) Porcelain is baked to a thin cast metal coping

Porcelain Veneers & Fixed Partial Denture

Porcelain is baked over a cast metal framework Fixed Partial Denture Porcelain is baked over a cast metal framework

Fixed Partial Denture (Gold)

Resin bonded bridge/ Maryland bridge This is an example of a Maryland bridge. Wings are bonded onto the lingual surfaces of the adjacent teeth. Would a Maryland bridge be placed on the posterior teeth? Why or why not? 22

Fixed Partial Denture attached to implants

2. Temporization (Ready before impression) 3. Impression Casting procedure/Crown Fabrication 1. Tooth Preparation, 2. Temporization (Ready before impression) 3. Impression 4. Model (Cast) and Die Fabrication 5. Wax-Up (Exact shape & size of desired crown) 6. Investing and Casting 7. Crown Adjusting and Polishing 8. Clinical Try-In and Cementation

1. Tooth Preparations

2. Provisional Restoration (Custom Made Acrylic) Provisional restoration smoothed & polished.

Provisional Restorations (Relined Polycarbonate Crowns) Pre-formed polycarbonate crown selected & adjusted Polycarbonate crown relined with acrylic, adjusted, polished & cemented

3. Impressions Impression of whole arch using light & heavy body impression material capturing detail with no bubbles

4. Model Cast & Die Fabrication Full arch impression is used to fabricate full arch cast with removable dies

5.Wax Pattern Fabrication Fabricate a wax pattern exactly like the desired crown,

6. Invest & Cast Crown Pattern is burned out in oven & molten gold flowed into the void in the ring, creating the casting as shown above

7. Crown Adjusting and Polishing 8.Crown Cementation Crown tried in, adjusted & cemented

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