1. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Fixed Prosthodontics and Gingival Retraction Chapter 30

2. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Fixed Prosthodontics Specialty that deals with replacement of missing tooth structure in variety of ways Indirect restorations Cast restoration

3. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Purpose Restores masticatory function Improves aesthetics and often self-esteem Improves speech Promotes good oral hygiene Prevents further movement of teeth due to support of prostheses

4. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Advantages of a Fixed Prosthesis Aesthetic Secure in mouth Restores function for many years

5. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Role of the Dental Assistant Provide patient education Prepare treatment room Take pre-operative x-ray Make preliminary impressions and bite registration Select shade

6. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Role of the Dental Assistant Assist chairside Place and remove temporary crowns Remove cement Pour impressions Fabricate custom trays

7. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Patient Considerations Complete medical and dental history Examination of intra- and extraoral tissues Radiographs Impressions for study models –Diagnostic casts Intraoral photographs taken with intraoral camera Extraoral photographs

8. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Candidates for Fixed Prostheses Must have motivation to maintain prostheses Must have healthy, supportive tissues

9. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Case Presentation Provide treatment choices to patient Review costs and insurance coverage Discuss number of appointments required

10. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Fixed Prostheses Indirect restoration –Not placed immediately –Fabricated in dental laboratory –May be made using CAD/CAM

11. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Crowns Anatomically shaped and fitted to tooth Covers teeth with extensive decay or breakdown Placed when no longer enough tooth structure to retain filling

12. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Fixed Crowns Full-cast crown –Covers entire coronal surface of tooth Partial crown –Cast restoration that covers three or more surfaces of tooth –Facial surface left intact

13. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Porcelain Fused to Metal (PFM) Porcelain fused to metal crown Full porcelain crown © Cengage Learning 2013

14. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Three-Quarter Gold Crown © Cengage Learning 2013

15. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Inlays and Onlays: Cast Restorations Inlays –Restoration placed within tooth –Covers area between cusps in middle of tooth and proximal surfaces involved Onlays –Include cusp ridges of tooth

16. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Inlays and Onlays Gold onlay restoration on mandibular first molar Gold inlay restoration © Cengage Learning 2013

17. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Bridges Restoration that spans space of one or more missing teeth Requires coverage of one or more adjacent teeth

18. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Components of a Bridge Abutments –Teeth on either side of missing tooth that provide support to which fabricated tooth (pontic) can attach Pontic –Portion of bridge that replaces missing tooth

19. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Bridges and Abutments (A) Three unit bridge abutments, points, and retainers Missing tooth Tissue Abutments (prepared teeth) Fixed bridge Retainers Pontic Porcelain-fused-to-metal bridge (A) © Cengage Learning 2013

20. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Bridges and Abutments Maryland bridge (B) © Cengage Learning 2013

21. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Veneers Types: –Direct resin –Indirect resin –Porcelain Advantages: –Natural in appearance –Requires minimal tooth reduction

22. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Materials Used for Fixed Prosthetics Alginate impression material Bite registration materials Retraction cord Final impression material Temporary cement Bonding agent Permanent cement

23. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Materials Used for Fixed Prostheses Gold casting alloys –Gold used in crowns, inlays, and onlays is not pure gold Combination of metals known as alloy Platinum, palladium, tin, and iron

24. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Tooth-Colored Cast Restorations Porcelain –Used for inlays and bonded veneers –Porcelain fused to metal crowns and bridges –Porcelain crowns

25. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Tooth-Colored Cast Restorations Composite resin –Used for inlays, onlays, and veneers –Stronger than direct composite restorations –Bonded in place

26. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. CAD/CAM Restorative Systems Becoming more common Allows metal-free, tooth-colored restorations to be fabricated in one appointment Inlays, onlays, crowns, and veneers No unpleasant impressions No need for temporaries Less reduction of healthy tooth structure

27. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chairside Economical Restorations of Aesthetic Ceramics (CEREC) Switzerland (1980) Several factors to consider: –Time investment to train staff –Large financial investment –Computer familiarity

28. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Basic Steps of CEREC Restoration Patient seated and anesthetized Ceramic shade selected Ceramic tooth prepared Prep coated with reflective powder Camera prepared optical impression Restoration designed from CEREC data

29. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Basic Steps of CEREC Restoration Milling machine mills restoration Restoration tried in position and adjusted Restoration bonded in place Restoration polished

30. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Role of the Laboratory Technician Fabricates custom trays Pours impressions Articulates models (casts) Prepares wax patterns Invests and casts gold alloy restorations Prepares porcelain and PFM crowns Fabricates prosthesis according to dentist’s request

31. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Fabrication of the Prosthesis in the Dental Laboratory Pouring alginate impression of opposing arch in plaster Pouring final impression to make master mold and die Creating wax pattern on die Investing and preparing wax pattern for casting

32. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Fabrication of the Prosthesis in the Dental Laboratory Casting die once invested material and metal are heated Casting crown in gold alloy Painting porcelain on crown and curing Finishing and polishing

33. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Retention Techniques Core buildups –Provide retention for crown –Performed on vital teeth Retention pins –Used to enhance core buildup –Available in kits with various sizes and tools

34. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Retention Techniques Required when there has been extensive tooth loss due to the following: –Decay –Fractures –Broken tooth structure

35. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Pin Placement © Cengage Learning 2013

36. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Core Post Placement Core post in place in nonvital tooth Crown Core buildup Apical seal of root canal © Cengage Learning 2013

37. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Tooth with Core Post, Core Buildup, and Pins Core buildup Core post Crown Pins Natural tooth structure © Cengage Learning 2013

38. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Vital Tooth Pins inserted into enamel Buildup material then surrounds pins Examples of materials used: –Amalgam –Composite –Silver alloy/glass ionomer

39. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Nonvital Tooth Portion of gutta percha removed from coronal pulp region Post cemented into canal Core buildup material placed around post Buildup prepped for crown Master impressions taken

40. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Implant Retainer Prosthesis Can be placed after six months Attaches to post or screw May be crown or part of bridge

41. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Maintenance of Fixed Prosthodontics Part of patient’s daily routine Aids can be used to clean bridgework Should be removed routinely and thoroughly cleaned

42. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Crown Preparation Appointment Administer anesthetic Make preliminary impressions and bite registration Remove decay Using diamond bur, reduce tooth structure

43. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Crown Preparation Appointment Place retraction cord Take master impression Fabricate temporary crown Reschedule patient for delivery of crown

44. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Crown Preparation Tray © Cengage Learning 2013

45. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Shade Selection © Cengage Learning 2013

46. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Materials Used to Take the Bite Registration © Cengage Learning 2013

47. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Preparations Examples of cavity margin on preparation- chamfer, shoulder, and shoulder with beveled edge Pins placed in prepared tooth for support and retention

48. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Preparations Shoulder preparation Beveled shoulder preparation Chamfer preparation Preparation at gingiva margin Crown Prepared tooth © Cengage Learning 2013

49. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Gingival Retraction Techniques Placing retraction cord around prepared tooth © Cengage Learning 2013

50. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Master Impression Dental assistant receives syringe with light-bodied impression material and transfers tray with medium- to heavy- bodied impression material to dentist Final impression

51. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Master Impression © Cengage Learning 2013

52. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Try-in Appointment Remove temporary crown Remove excess cement Try-in crown Adjust contacts and occlusion, if needed Line inside of crown with cement Place crown on tooth and have patient close on bite stick Remove excess cement from margins

53. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Advanced Chairside Functions Gingival retraction –Ensures impression with clear margins –Retracts tissue horizontally to allow room for impression material –Displaces tissue vertically to completely expose margin

54. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Gingival Retraction Mechanical –Placed in sulcus of healthy gingiva –No drugs or chemicals used –Left in place for 10 to 15 minutes

55. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Gingival Retraction Retraction systems –Silicone placed to displace tissue –Prevents bleeding and creepage

56. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Gingival Retraction Chemical retraction –Use impregnated cord –Use topical solution –Know contraindications

57. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Gingival Retraction Surgical retraction –Dentist removes tissue with surgical knife –Electrosurgery unit may also be used