PROSTHODONTICSPROSTHODONTICS

definitiondefinitionProsthodontics is the dental specialty pertaining to the diagnosis,

treatment planning, rehabilitation and maintenance of theoral function, comfort, appearance and health of patients with clinical

conditions associated with missing or deficient teeth and/ormaxillofacial tissues using biocompatible substitutes

BRANCHES

FIXED REMOVABLE MAXILLOFACIAL

: Fixed : Movable : Removable COMPLETE PARTIAL

: Extracoronal.

: Intracoronal

JINISHNATH

(Final Year ,Part I )

INTRODUCTION TO FIXED PARTIAL DENTURE

FIXED PARTIAL DENTURE

Definition

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

FIXED PROSTHODONTICS.

Fixed prosthodontics pertains to the restoration or replacement of teeth with artificial substitutes that are attached to natural teeth, roots or implants and that are not readily removable.

FOR SUCESSFUL TREATMENTMeticulous attention to every detailspatient interview diagnosis and

educationprevention of dental diseaseperiodont. Therapy (if indicated) occl. ConsiderationAppropriate treatment planoperative skills and treatmentfollow up care

Usually belongs following categories following categories

• comfort• social• function• appearance

Personal detailsMedical historyMedical condition affecting treatment method, treatment plan and systemic condition

Dental history

• Periodontal history

• Restorative history

• Endodontic history

• Surgical history

• Tmj dysfunction history

Examination•General examination

•Extra oral examination

•Tmj

•Muscles

•Lips

Intraoral examination

Periodontal

Occusal

Radiographic examination

INDICATIONS OF FIXED PROSTHESIS.

One or two adjacent teeth are missing in the same arch or short span edentulous arches.

The supportive tissues are healthy. Suitable abutment teeth are present. The patient is in good health and wants to have

the prosthesis placed. The patient has the skills and motivation to

maintain good oral hygiene. Patient’s preference

One or two adjacent teeth are missing in the same arch or short span edentulous arches.

The supportive tissues are healthy. Suitable abutment teeth are present. The patient is in good health and wants to have

the prosthesis placed. The patient has the skills and motivation to

maintain good oral hygiene. Patient’s preference

Contraindications for a Fixed Prosthesis

o Necessary supportive tissues are diseased or missing.

o Suitable abutment teeth are not present. o The patient is in poor health. o The patient is not motivated to have the

prosthesis placed. o The patient has poor oral hygiene habits. o The patient cannot afford the treatment.

Common Terms CROWN

Laminate Veneers/Facial Veneers

INLAY

ONLAY

ABUTMENT

PONTIC

CONNECTORS

RETAINER

1) Full veneer crown.

2) Partial veneer crown.

:-three quarter crowns

:-reverse three-quarter crowns

:-seven-eight crowns

:-pinledges

:-inlay

:-onlay

CROWCROWNN It is a cemented extracoronal restoration that covers

or veneers the outer surface of the clinical crown.Primary function is to protect the underlying tooth

structure & restore the function, form and esthetics.

TYPES

Full Veneer Crown (cast metal)

If it covers all of the crown, the restoration is a full or complete veneer crown

It may be fabricated entirely of a gold alloy or some other untarnishable metal, a ceramic veneer fused to metal.

INDICATIONS

• Teeth that have extensive coronal destructions by caries or trauma

•Restoration of choice whenever maximum retention is needed

•Indicated on endodontically treated teeth

•Correction of occlusal plane

CONTRAINDICATIONS

•If less than maximum retention and resistance is needed

•Wherever intact buccal or lingual wall exists

•Enameloplasty

•For high esthetic needed exists like anterior teeth

Advantages•Strong

•High retentive qualities

•Can be modify form and occlusion

•Easy to obtain adequate resistance form

Disadvantages

•Removal of large amount of tooth structure

•Display of metal

METAL CERAMIC CROWNS

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

Indications

•Esthetics•Gingival involvement•If porcelian jacket crowns is contraindicated

Contraindications

•Large pulp chamber•Intact buccal wall

Advantages

•Superior esthetics•Retentive qualities are excellent

Disadvantages

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

Partial Veneer CrownAn extracoronal metal restorations that covers only part of the clinical crown is considered to be a partial veneer crown

Partial Veneer CrownMOD Gold Onlay

Indications

•Clinical crown of average length or longer•Intact buccal/labial surface•Well supported by sound tooth structure

Contraindications

•Short teeth•High caries index•Extensive destruction•Not used in endodontically treated teeth•Poor alignment•Bulbous teeth•Thin teeth

Disadvantages

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

Advantages

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

Three-quarter crowns

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

Pinledge

Indications

•High esthetic requirement•Undamaged anterior teeth•When proximal grooves are impossible to prepare•To alter lingual contour of maxillary anterior teeth

A partial veneer retainer preparation incorporatingpins holes to provide retention

Contraindications

•Large pulp•Non vital teeth•Thin teeth• carious involvement

Advantages

•Minimal tooth reduction•Minimal marginal length•Minimal gingival involvement•Adequate retention•Excellent esthetics

Disadvantages

•Less retentive•Techanically demanding

INLAY

A fixed intracoronal restoration; a dentalrestoration made outside of a tooth to correspond to the form of

the prepared cavity, which is then luted into the tooth

Inlay may be used as a single tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions.

They may be made up of gold alloy or ceramic material.

Inlays are similar to fillings but the entire work lies within the cusps on the chewing surface of the tooth.

Indications

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

Contraindications

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

ONLAYA restoration that restores one or more cusps and

adjoining occlusal surfaces or the entire occlusal surface and is retainedby mechanical or adhesive mean

It is used for restoring more extensively damaged posterior teeth needing wide mesio-occluso-distal restorations.

Indications

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

Contraindications

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

Laminate Veneers/Facial Veneers

It consists of a thin layer of dental porcelain or cast ceramic that is bonded to the facial surfaces of the tooth with an appropriate resin

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

PARTS OF FIXED PARTIAL DENTURE

RETAINER

ABUTMENT

PONTIC

CONNECTOR

RETAINER

Any type of device used for the stabilizationor retention of a prosthesis

Positioned at margin - less susceptible to caries or recurrence of caries

Rigidity – withstand the requisite load

Functional adaptation and protect the tooth against its fracture

Least destroys the cervical marginal ridge

Types of retainer

• Full veneer crowns• Partial veneer crowns• Conservative retainers• All metal retainers• Metal ceramic retainers• All ceramic retainers• All acrylic retainers

PonticsAn artificial tooth on a fixed dental prosthesis that

replaces a missing natural tooth, restores its function, and usuallyfills the space previously occupied by the clinical crown

Pontics

Requirements of pontics

-restore function -provide esthetics and comfort -be biologically acceptable -permit effective oral hygeine -preserve underlying residual mucosa

Material used

•Metal-ceramic pontics•Resin veneered•All metal•Facings

ABUTMENT

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

ConnectorsFixed dental prosthodontics, the portion of a fixed dental prosthesis that unites the retainer(s) and pontics

Types- -Rigid connectors -Non rigid connectors -tenon mortise connectors -loop connectors -split pontic connectors -cross pin and wing connectors

Nonrigid connectors

Loop connectors

Loop connectors are used for when existing diastema is to be maintained in the planned fixed prosthesis

T he connector consists of a loop on the lingual aspect of the prosthesis that connects adjacent retainers and /or pontics

FUNCTIONS OF FIXED PARTIAL DENTURE

Provide proper occlusal function.

Maintain arch integrity/tooth position.

Maintain occlusal relationships.

Protect and preserve the remaining structures.

REFERENCE Fundamentals of Fixed Prosthodontics Third edition. Herbert.T.Shillingburg.

Theory and practice of Fixed Prosthodontics. Tylman’s

Contemporary Fixed Prosthodontics.stephen F Rosenstiel

Have a nice dayHave a nice day

Keep smiling…………………

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