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Reference: Shi l l ingburg Funamentals of 

Fixed Prostho dont ics, thi rd edi t ion 

chapter on e  

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The scope of fixed prosthodontic

treatment can range from therestoration of a single tooth to therehabilitation of the entire occlusion

Introduction 

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I. Single teeth restorations

Extracoronal restorations.

Intracoronal restorations.

II. Missing teeth replacementFixed partial denture. (bridge)

Cemented Restorations 

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A crown is a cemented extracoronal restoration thatcovers, or veneers, the outer surface of the clinicalcrown.

• Reproduces the morphology and contours of thedamaged coronal portions of a tooth whileperforming its function.

• Protects the remaining tooth structure fromfurther damage.

Extracoronal Restorations 

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If it covers all of theclinical crown =>

full or complete veneercrown 

Classified according tomaterial into:

1- full metal

2- ceramo-metal3- all ceramic

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If only portions ofthe clinical crownare veneered =>

partial veneer crown

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➥ Facial veneer :it consists of a thin

layer of dental

porcelain or castceramic that isbonded to the facialsurface of the

tooth.

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• Intracoronal cast restorations are thosethat fit within the anatomic contours of

the clinical crown of a tooth. 

Intracoronal Restorations 

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➥ inlays : single-tooth restorations for proximo-occlusal or gingival lesions with minimal to

moderate extensions 

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 ➥ onlays:

inlays modified with anocclusal veneer used forrestoring more extensivelydamaged teeth, needingwide mesio-occluso-distal

restoration

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It’s a prostheticappliance,permanentlyattached toremaining teeth,

which replacesone or moremissing teeth.

abutment

retainer 

Abutment

preparation

connector pontic

Fixed partial denture

“bridge” 

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• A thorough diagnosis must be made of thepatient’s dental condition, considering both

hard and soft tissues.

This must be correlated with the individual’s

overall physical health and psychologicalneeds.

Diagnosis 

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Five elements to a good diagnostic workup inpreparation for fixed prosthodontic

treatment:

1.History art of

discussion

2.TMJ/occlusal evaluation art

3.Intraoral examination of exam.

4.Full mouth radiographs art of

5.Diagnostic cast analysis 

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1. History

A good history must be taken before the initiationof treatment

• Medical history

• Patient complaint

• Attitude about previous treatment

• Patient expectations

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Medical history:• A history of infection diseases: serum hepatitis or

acquired immunodeficiency syndrome

• Previous reaction to drugs, most commonly: localanaesthetics and antibiotics

• Reaction to a dental material: impressions materials andnickel containing alloys

• History of cardiovascular problems or uncontrolledhypertension

• History of previous bacterial endocarditis, prostheticheart valves (premedication)

• Patients with anticoagulant

• Epilepsy

• Diabetes and hypoglycemia 

• Xerostomia 

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2.TMJ/Occlusal evaluation 

* Prior to the start of fixedprosthodontic procedures, the patient’s

occlusion must be evaluated todetermine if it’s healthy enough to allowthe fabrication of such restorations

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 => if the occlusion is within normal limits,

➥➥all treatment should be designed tomaintain that occlusal relationship.

=> if the occlusion is dysfunctional,➥➥ improve occlusion prior to the placementof the restorations

or employ the restorations in thecorrection of the occlusal problem

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 * Patient suffering from occasions of head

, neck or shoulder pain=> determine the origin of such pain

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 Assessment of TMJ: • Healthy TMJ: free of clicking,crepitation, or limitation of movementon opening, closing or lateral movements

• Palpation of the joints

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• Palpation of muscles

Checking habits such asclinching the teeth andplaying with the bite =>fatigue and muscle spasm

Observation of thetenderness and physical

appearance withoverdeveloped musclesfrom hyperactivity

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 • Checking the opening “all the way” forany limitation or deviation

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• Evidence of pain or dysfunction in either the TMJ or the muscles associated with the head and neck 

region is an indication for further evaluation prior to starting any fixed  prosthodontic procedures 

Why??

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3.Intraoral examination

• Oral hygiene and periodontal health

• Evaluation of edentulous ridges

• Condition of abutment teeth• Condition of previous restorations andprosthesis

• Occlusion

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• General oral hygiene

• Presence or absence of inflammation

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• Presence or absence of pockets

• Attached gingiva

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• Presence and amount of tooth mobility

• Condition of edentulous ridges andabutment teeth

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• Presence and location of caries

• Condition of previous restorations andprostheses

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 • Evaluation of the

occlusion:

- large facets of wear

- deviation and amount ofslide between theretruded position and

the position of maximumintercuspation

- presence or absence ofsimultaneous contact onboth sides of the mouth

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• accurate reproductions ofthe maxillary andmandibular arches

• Diagnostic casts shouldbe:

- Accurate

- Free of bubbles ornodules

- Mounted on the

articulater

4.Diagnostic cast

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Mounted diagnostic casts

provide an unobstructed viewof:

• Edentulous spaces

• occlusogingival dimension• The curvature of the arch• Length and inclination of the

abutment teeth

• Mesio-distal drifting, rotationand facio-lingual displacementof prospective abutment

• occlusion

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 Diagnostic wax-up

the wax-up will help thedentist to:

- Anticipate treatmentoutcomes and explain itto the patient

- Plan and execute the

preparations- Make provisional, or

temporary restorations.

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5.Full mouth radiographs 

Radiographs➨

final aspect of the diagnosticprocedure

➥ informations to help correlate all the facts thathave been collected in listening, examining the

mouth and evaluating the diagnostic cast

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☞ signs of caries☞ presence of periapical

lesions ☞ existence and quality of

previous endodontictreatments☞ alveolar bone levels observed ☞ crown-root ratio of

abutment teeth calculated☞ length, configuration and

direction of the rootsexamined

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☞ widening of the periodontal

membrane,☞ evaluation of the thickness of

bone around the teeth

☞ presence of retained root tipsor other pathosis in theedentulous areas

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Protection against Infectious

diseases• Nature of dental procedures carries therisk of cross infection

• Every patient should be treated asbeing potentially infectious

• Cross infection control measures should

be applied in dental clinic as well as inthe dental laboratory

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Thank you,

Next lecture:Principles of tooth

preparationreference, Shillingburgchapter 9