78786739 Fixed Partial Denture 1

7/26/2019 78786739 Fixed Partial Denture 1

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INTRODUCTION, TERMINOLOGY,INTRODUCTION, TERMINOLOGY,

CLASSIFICATION,CLASSIFICATION,

INDICATIONS& CONTRAINDICATIONSINDICATIONS& CONTRAINDICATIONS

ADVANTAGES& DISADVANTAGESADVANTAGES& DISADVANTAGES

Seminar by H.SUNILSURESHSeminar by H.SUNILSURESH

FIXED ARTIALFIXED ARTIALDENTUREDENTURE


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DEFINITION:DEFINITION:

Fixed partial denture is a partial dentureFixed partial denture is a partial denturethat is luted or otherwise securelythat is luted or otherwise securelyretained to natural teeth, tooth roots andretained to natural teeth, tooth roots andor dental implant abutments that furnishor dental implant abutments that furnishthe primary support for the prosthesesthe primary support for the prostheses


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CLASSIFICATION OFCLASSIFICATION OF

F!F!


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Conventional and minimal-Conventional and minimal-preparation bridges

preparation bridges""

Con#entional brid$es in#ol#eCon#entional brid$es in#ol#e

remo#in$ tooth tissue, or a pre#iousremo#in$ tooth tissue, or a pre#iousrestoration, and replacin$ it with arestoration, and replacin$ it with aretainer% This may be destructi#e ofretainer% This may be destructi#e of

tooth tissue and will certainly be timetooth tissue and will certainly be timeconsumin$ and expensi#e%consumin$ and expensi#e%


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&inimal' preparation brid$e in#ol#es&inimal' preparation brid$e in#ol#esattachin$ pontics #ia a metal plate toattachin$ pontics #ia a metal plate to

the unprepared (or minimally prepared)the unprepared (or minimally prepared)

lin$ual surfaces of ad*acent teeth%lin$ual surfaces of ad*acent teeth%

Attachment is made by a compositeAttachment is made by a composite

resin material, ob#iously these brid$esresin material, ob#iously these brid$es

can be used only when the abutmentcan be used only when the abutment

teeth ha#e su+cient intact enamel%teeth ha#e su+cient intact enamel%


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Classication of Fixed partial dentureClassication of Fixed partial denture

is basically based on theis basically based on the

-% !esi$n of the brid$es, the-% !esi$n of the brid$es, the

di.erence bein$ the type of supportdi.erence bein$ the type of supportpro#ided at each ends of the pontic%pro#ided at each ends of the pontic%

/% Types of materials used for brid$es%/% Types of materials used for brid$es%


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DESIGNS:DESIGNS:There are four basic desi$ns ofThere are four basic desi$ns ofbrid$e, the di.erence bein$ the typebrid$e, the di.erence bein$ the typeof support pro#ided at each end ofof support pro#ided at each end of

the pontic, namely"the pontic, namely"-% FI01!'FI01! 23I!41-% FI01!'FI01! 23I!41

/%FI01!' &O5A2L1 23I!41/%FI01!' &O5A2L1 23I!41

6%CANTIL1513 23I!416%CANTIL1513 23I!417%S3IN4 CANTIL1513 23I!417%S3IN4 CANTIL1513 23I!41


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The four basic desi$ns are the sameThe four basic desi$ns are the samewhether the brid$e is a con#entionalwhether the brid$e is a con#entional

or minimal' preparation type% It isor minimal' preparation type% It ispossible to combine / or more of thepossible to combine / or more of thefour basic desi$ns and to combinefour basic desi$ns and to combinecon#entional and minimal'preparationcon#entional and minimal'preparation

retainers in the same brid$e%retainers in the same brid$e%

Of the four desi$ns, the rst 6 desi$nsOf the four desi$ns, the rst 6 desi$ns

may be either con#entional ormay be either con#entional orminimal'preparation types% It isminimal'preparation types% It isunusual to ha#e a minimal'preparationunusual to ha#e a minimal'preparationtype in sprin$ cantile#er brid$e%type in sprin$ cantile#er brid$e%


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FOUR !ASIC DESIGNSFOUR !ASIC DESIGNS".". FIXED#FIXED !RIDGEFIXED#FIXED !RIDGE""

A Fixed'Fixed brid$e has a ri$id connectorA Fixed'Fixed brid$e has a ri$id connectorat both ends of the pontic%at both ends of the pontic%

The abutment teeth are therefore ri$idlyThe abutment teeth are therefore ri$idly

splinted to$ether, and for a con#entionalsplinted to$ether, and for a con#entionalbrid$e, must be prepared parallel to eachbrid$e, must be prepared parallel to eachother so that the brid$e, which is aother so that the brid$e, which is aminimum of 6 units, can be cemented inminimum of 6 units, can be cemented inone piece%one piece%


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The retainers should ha#eThe retainers should ha#eapproximately the same retention asapproximately the same retention as

each other to reduce the ris8 that forceseach other to reduce the ris8 that forcesapplied to the brid$e will dislod$e oneapplied to the brid$e will dislod$e oneretainer from its abutment, lea#in$ theretainer from its abutment, lea#in$ thebrid$e suspended from the otherbrid$e suspended from the other

abutment%abutment%

To minimi9e this ris8, it is also importantTo minimi9e this ris8, it is also important

for the entire occludin$ surfaces of allfor the entire occludin$ surfaces of allthe abutment teeth for a con#entionalthe abutment teeth for a con#entionalbrid$e to be co#ered by the retainers%brid$e to be co#ered by the retainers%


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The opposin$ teeth cannot then contactThe opposin$ teeth cannot then contactthe surface of an abutment tooth,the surface of an abutment tooth,depress it in its soc8et and brea8 thedepress it in its soc8et and brea8 thecement lute%cement lute%

If this should happen, the retainer will notIf this should happen, the retainer will notappear loose since it will be held in placeappear loose since it will be held in placeby the rest of the brid$e% :owe#er, oralby the rest of the brid$e% :owe#er, oral

;uids will enter the space between the;uids will enter the space between theretainer and the abutment preparation,retainer and the abutment preparation,and caries will rapidly de#elop%and caries will rapidly de#elop%


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This rule does not apply to minimal


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/%/% FI01!' &O5A2L1 23I!41"FI01!' &O5A2L1 23I!41"

A Fixed' mo#able brid$e has a ri$idA Fixed' mo#able brid$e has a ri$idconnector, usually at the distal end of theconnector, usually at the distal end of thepontic, and a mo#able connector thatpontic, and a mo#able connector that

allows some #ertical mo#ement of theallows some #ertical mo#ement of themesial abutment tooth%mesial abutment tooth%

The mo#able connector should resist bothThe mo#able connector should resist bothseparation of the pontic from the retainerseparation of the pontic from the retainerand lateral mo#ement of the pontic%and lateral mo#ement of the pontic%


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Occasionally the xed and mo#ableOccasionally the xed and mo#able

connectors are re#ersed, but this hasconnectors are re#ersed, but this has

number of disad#anta$es%number of disad#anta$es%

The retainer with the mo#able connectorThe retainer with the mo#able connector

(the minor retainer) is smaller and less(the minor retainer) is smaller and less#isible and so is better in the more#isible and so is better in the more

anterior abutment tooth% osterior teethanterior abutment tooth% osterior teeth

commonly tilt mesially, and this tends tocommonly tilt mesially, and this tends to

unseat distal mo#able connectors, but isunseat distal mo#able connectors, but is

resisted by mesial ones%resisted by mesial ones%


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The mo#able connector can be separatedThe mo#able connector can be separated

before the brid$e is cemented, and so thebefore the brid$e is cemented, and so the

two parts of the brid$e can be cementedtwo parts of the brid$e can be cemented

separately%separately%

The abutment teeth do not therefore ha#eThe abutment teeth do not therefore ha#eto be prepared parallel to each other andto be prepared parallel to each other and

the retention for the minor retainer does notthe retention for the minor retainer does not

need to be as extensi#e as for the ma*orneed to be as extensi#e as for the ma*orretainer% Neither does it need full occlusalretainer% Neither does it need full occlusal

protection%protection%


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Occlusal forces applied to the toothOcclusal forces applied to the toothsurface not co#ered by the retainer willsurface not co#ered by the retainer will

depress the tooth in its soc8et, anddepress the tooth in its soc8et, andthere will be mo#ement at the mo#ablethere will be mo#ement at the mo#able*oint rather than rupturin$ of the*oint rather than rupturin$ of thecement lute%cement lute%

A xed' mo#able minimal' preparationA xed' mo#able minimal' preparationbrid$e cannot ha#e the mo#able *ointbrid$e cannot ha#e the mo#able *ointwithin the contour of the ori$inalwithin the contour of the ori$inalabutment tooth unless this is preparedabutment tooth unless this is prepared

su+ciently for the mo#able connector,su+ciently for the mo#able connector,or there is su+cient occlusal clearance,or there is su+cient occlusal clearance,which is sometimes the case followin$which is sometimes the case followin$tiltin$ of the minor abutment tooth%tiltin$ of the minor abutment tooth%


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The xed' mo#able desi$n forThe xed' mo#able desi$n for

minimal' preparation brid$es hasminimal' preparation brid$es hasbecome popular in recent times, andbecome popular in recent times, and

early results su$$est that it is moreearly results su$$est that it is more

successful than xed'xed%successful than xed'xed%

This is because it can accommodateThis is because it can accommodate

indi#idual mo#ement of theindi#idual mo#ement of theabutment teeth and the ris8 ofabutment teeth and the ris8 of

debondin$ is therefore reduced%debondin$ is therefore reduced%


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6%6% CANTIL1513 23I!41"CANTIL1513 23I!41"

A cantile#er brid$e pro#ides support forA cantile#er brid$e pro#ides support forthe pontic at one end only% The ponticthe pontic at one end only% The ponticmay be attached to a sin$le retainer or tomay be attached to a sin$le retainer or totwo or more retainers splinted to$ether,two or more retainers splinted to$ether,but has no connection at the other end ofbut has no connection at the other end ofthe pontic%the pontic%

The abutment tooth or teeth for aThe abutment tooth or teeth for acantile#er brid$e may be either mesial orcantile#er brid$e may be either mesial ordistal to the span, but for small brid$esdistal to the span, but for small brid$esthey are usually distal%they are usually distal%


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$.$.S3IN4 CANTIL1513 23I!41"S3IN4 CANTIL1513 23I!41"

Sprin$ cantile#er brid$es are restrictedSprin$ cantile#er brid$es are restricted

to the replacement of upper incisorto the replacement of upper incisorteeth% Only one pontic can be supportedteeth% Only one pontic can be supported

by a sprin$ cantile#er brid$e%by a sprin$ cantile#er brid$e%

This is attached to the end of a lon$This is attached to the end of a lon$

metal arm runnin$ hi$h into the palatemetal arm runnin$ hi$h into the palate

and then sweepin$ down to a ri$idand then sweepin$ down to a ri$id

connector on the palatal side of a sin$leconnector on the palatal side of a sin$le

retainer or a pair of splinted retainers%retainer or a pair of splinted retainers%


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The arm is made lon$ and fairly thinThe arm is made lon$ and fairly thinso that it is sprin$y, but not so thinso that it is sprin$y, but not so thin

that it will deform permanently withthat it will deform permanently withnormal occlusal forces%normal occlusal forces% Forces applied to the pontic areForces applied to the pontic are

absorbed by the sprin$iness of theabsorbed by the sprin$iness of thearm and by displacement of the softarm and by displacement of the softtissues of the palate so thattissues of the palate so thatexcessi#e le#era$e forces do notexcessi#e le#era$e forces do not

disturb the abutment teeth%disturb the abutment teeth%The abutments are usually the twoThe abutments are usually the two

premolar teeth splinted to$ether, or apremolar teeth splinted to$ether, or asin$le premolar or molar tooth%sin$le premolar or molar tooth%


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Sprin$ cantile#er brid$es are seldomSprin$ cantile#er brid$es are seldom

made these days and ha#e beenmade these days and ha#e been

replaced either by minimal'preparationreplaced either by minimal'preparationbrid$es or by sin$le'tooth implants%brid$es or by sin$le'tooth implants%

The two commonest reasons forThe two commonest reasons forma8in$ sprin$ cantile#er brid$es usedma8in$ sprin$ cantile#er brid$es used

to be to preser#e intact anterior teethto be to preser#e intact anterior teeth

when posterior teeth needed crownin$when posterior teeth needed crownin$

in any case and also to preser#ein any case and also to preser#e

diastemas between the anterior teeth%diastemas between the anterior teeth%


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The four basic desi$ns can be combined inThe four basic desi$ns can be combined ina #ariety of ways in particular the xed'a #ariety of ways in particular the xed'xed and cantile#er desi$ns are oftenxed and cantile#er desi$ns are often

combined% In lar$er brid$es additionalcombined% In lar$er brid$es additionalcantile#er pontics may be suspended fromcantile#er pontics may be suspended fromthe end of a lar$e xed'xed section%the end of a lar$e xed'xed section%Similarly, it is possible to combine xed'Similarly, it is possible to combine xed'

xed and xed'mo#able desi$ns%xed and xed'mo#able desi$ns% It is possible to combine a brid$e with aIt is possible to combine a brid$e with a

remo#able buccal ;an$e that replaces lostremo#able buccal ;an$e that replaces lostal#eolar tissue%al#eolar tissue%

Combination !esi$ns"Combination !esi$ns"


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:ybrid desi$n:ybrid desi$nThis term refers to a brid$e with aThis term refers to a brid$e with a

combination of con#entional and minimal'combination of con#entional and minimal'preparation retainers%preparation retainers%

There are three di.erent hybrid desi$ns"There are three di.erent hybrid desi$ns" Fixed'xed with one con#entional and oneFixed'xed with one con#entional and one

minimal'preparation retainer%minimal'preparation retainer%

Fixed'mo#able with a minimal'preparationFixed'mo#able with a minimal'preparationretainer carryin$ the mo#able connector%retainer carryin$ the mo#able connector% Fixed'mo#able with the con#entionalFixed'mo#able with the con#entional

retainer carryin$ the mo#able connector%retainer carryin$ the mo#able connector%


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The rst desi$n should not be used and theThe rst desi$n should not be used and thesecond only rarely% In either case, if the minimalsecond only rarely% In either case, if the minimalpreparation retainer becomes debonded then itpreparation retainer becomes debonded then it

will not be possible to re'cement it withoutwill not be possible to re'cement it withoutremo#in$ the con#entional retainer, which mayremo#in$ the con#entional retainer, which maywell in#ol#e destroyin$ the brid$e%well in#ol#e destroyin$ the brid$e%

The third desi$n is acceptable and may well beThe third desi$n is acceptable and may well bethe one of choice $i#en circumstances in whichthe one of choice $i#en circumstances in whichone of the abutment teeth (usually the mesialone of the abutment teeth (usually the mesialone) already has a restoration that could beone) already has a restoration that could bereplaced by means of an inlay or otherreplaced by means of an inlay or othercon#entional retainer and the other abutmentcon#entional retainer and the other abutment

tooth is unrestored or the restoration does nottooth is unrestored or the restoration does notin#ol#e the surfaces to be co#ered by a minimal'in#ol#e the surfaces to be co#ered by a minimal'preparation retainer% These circumstances occurpreparation retainer% These circumstances occursurprisin$ly often, and so this desi$n of brid$e issurprisin$ly often, and so this desi$n of brid$e is

increasin$ly bein$ used%increasin$ly bein$ used%


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5ariations"5ariations"

3emo#able brid$es3emo#able brid$es All the desi$ns described so far areAll the desi$ns described so far are

permanently cemented in the patient=spermanently cemented in the patient=s

mouth% >ith lar$e brid$es there aremouth% >ith lar$e brid$es there are

disad#anta$es in permanent cementationdisad#anta$es in permanent cementationin that the maintenance and furtherin that the maintenance and further

endoclontic or periodontal treatment ofendoclontic or periodontal treatment of

abutment teeth is di+cult, and if somethin$abutment teeth is di+cult, and if somethin$

$oes wron$ with one part of the brid$e or$oes wron$ with one part of the brid$e or

with one of the abutment teeth, usually thewith one of the abutment teeth, usually the

whole brid$e has to be sacriced%whole brid$e has to be sacriced%


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For this reason, lar$er brid$es, includin$For this reason, lar$er brid$es, includin$

full arch brid$es, are sometimes made sofull arch brid$es, are sometimes made so

that they can be remo#ed by the patient%that they can be remo#ed by the patient%The ad#anta$e of this is that cleanin$The ad#anta$e of this is that cleanin$

around the abutment teeth and under thearound the abutment teeth and under the

pontics is much easier% The brid$e has topontics is much easier% The brid$e has to

withstand handlin$ by the patient, and sowithstand handlin$ by the patient, and so

it is usually made with acrylic facin$s% Theit is usually made with acrylic facin$s% The

acrylic facin$s are less liable to chip if theacrylic facin$s are less liable to chip if the

brid$e is dropped% They can also bebrid$e is dropped% They can also bereplaced without the ris8 of distortin$ thereplaced without the ris8 of distortin$ the

framewor8 as would be the case withframewor8 as would be the case with

porcelain%porcelain%


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!a%e On Ma'eria(%!a%e On Ma'eria(%


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&etal only&etal only

&any posterior brid$es, both con#entional&any posterior brid$es, both con#entionaland minimal'preparation can be madeand minimal'preparation can be madeentirely of cast metal, whether they areentirely of cast metal, whether they arexed'xed, xed'mo#able or cantile#er%xed'xed, xed'mo#able or cantile#er%

If the retainers or pontics do not showIf the retainers or pontics do not showwhen the patient smiles and spea8s thenwhen the patient smiles and spea8s thenan all'metal brid$e is the best choice withan all'metal brid$e is the best choice withcon#entional brid$es ' the materialcon#entional brid$es ' the material

necessitates the least destruction of toothnecessitates the least destruction of toothtissue and dependin$ on the choice oftissue and dependin$ on the choice ofmetal, may be the least costly% &ar$ins aremetal, may be the least costly% &ar$ins arealso easier to adapt to the preparations%also easier to adapt to the preparations%


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&etal'ceramic&etal'ceramic

>hen the stren$th of metal is re?uired>hen the stren$th of metal is re?uired

to$ether with a tooth'coloured retainerto$ether with a tooth'coloured retainer

or pontic, metal'ceramic is the bestor pontic, metal'ceramic is the bestmaterial%material%

A ran$e of composite crown and brid$eA ran$e of composite crown and brid$efacin$ materials is also a#ailable%facin$ materials is also a#ailable%


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Ceramic onlyCeramic only

The all'ceramic brid$e is limited by itsThe all'ceramic brid$e is limited by itsrelati#ely poor stren$th to two'unit cantile#errelati#ely poor stren$th to two'unit cantile#erbrid$es or three'unit xed'xed brid$es% All'brid$es or three'unit xed'xed brid$es% All'

porcelain brid$es made from con#entionalporcelain brid$es made from con#entionalfeldspathic porcelain can ha#e a #eryfeldspathic porcelain can ha#e a #erysatisfactory appearance% >ith impro#ements,satisfactory appearance% >ith impro#ements,All'ceramic materials ha#e produced a newAll'ceramic materials ha#e produced a new

$eneration of all'ceramic brid$es%$eneration of all'ceramic brid$es%

All'ceramic brid$es, if properly desi$ned andAll'ceramic brid$es, if properly desi$ned andconstructed, ha#e su+cient stren$th toconstructed, ha#e su+cient stren$th tosur#i#e normal functional forces%sur#i#e normal functional forces%


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Combinations of materialsCombinations of materials

&any combinations are possible, but&any combinations are possible, butthree deser#e special mention% The rstthree deser#e special mention% The rst

two are common%two are common% A metal'ceramic retainer and pontic withA metal'ceramic retainer and pontic with

a mo#able connector to a $old inlay ora mo#able connector to a $old inlay orother minor retainer%other minor retainer%

An all'metal retainer (a full or partialAn all'metal retainer (a full or partialcrown) towards the posterior end of thecrown) towards the posterior end of thebrid$e with anterior metal'ceramic units%brid$e with anterior metal'ceramic units%


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A framewor8 of standard castin$ alloyA framewor8 of standard castin$ alloyand separately constructed porcelainand separately constructed porcelain

crowns cemented to them@ this type ofcrowns cemented to them@ this type of

construction is now uncommon, butconstruction is now uncommon, butthey are still seen in a number ofthey are still seen in a number of

patients and need to be maintained,patients and need to be maintained,

sometimes by the replacement ofsometimes by the replacement offractured crownsfractured crowns

&INI&AL 31A3ATION&INI&AL 31A3ATION


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&INI&AL 31A3ATION&INI&AL 31A3ATION

23I!41S23I!41S !I31CT!I31CT IN!I31CTIN!I31CT

-%-% &acro &echanical 3etention&acro &echanical 3etention-%-% e%$% 3ochettee%$% 3ochette

/%/% &edium &echanical 3etention&edium &echanical 3etention

-%-% e%$% 5ir$inia Salt &esh Crystal 2onde%$% 5ir$inia Salt &esh Crystal 2ond

6%6% &icro &echanical 3etention&icro &echanical 3etention-%-% e%$% &arylande%$% &aryland

7%7% Chemically Adhesi#eChemically Adhesi#e

-%-% e%$% ana#ia 'exe%$% ana#ia 'ex


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!irect brid$es!irect brid$es !irect brid$es may be made usin$ the!irect brid$es may be made usin$ the

crown of the patient=s own tooth% This cancrown of the patient=s own tooth% This canoften be done as a simple and rapid way ofoften be done as a simple and rapid way ofreplacin$ a tooth lost throu$h in*ury (whichreplacin$ a tooth lost throu$h in*ury (whichcannot re reimplanted) or which has to becannot re reimplanted) or which has to beextracted ur$ently%extracted ur$ently%

Sometimes metal mesh or wire is added toSometimes metal mesh or wire is added tothe lin$ual surface to increase stren$th,the lin$ual surface to increase stren$th,

but this is not always necessary% If thebut this is not always necessary% If thenatural crown of the tooth is not a#ailablenatural crown of the tooth is not a#ailableor is not suitable, an acrylic denture toothor is not suitable, an acrylic denture toothcan be used in the same waycan be used in the same way


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&acro'mechanically retenti#e&acro'mechanically retenti#e

brid$esbrid$es

&acro'mechanically retenti#e brid$es&acro'mechanically retenti#e brid$es

(3ochette) ha#e lar$e undercut(3ochette) ha#e lar$e undercut

perforations throu$h the cast'metalperforations throu$h the cast'metalplate, throu$h which the compositeplate, throu$h which the composite

;ows% These holes are cut in the wax;ows% These holes are cut in the wax

or acrylic pattern with a bur and areor acrylic pattern with a bur and arethen countersun8%then countersun8%


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& di h i l t ti& di h i l t ti


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&edium'mechanical retenti#e&edium'mechanical retenti#e

systemssystems

In#ol#e retenti#e features cast as part of the metalIn#ol#e retenti#e features cast as part of the metalframewor8% They all add si$nicantly to theframewor8% They all add si$nicantly to the

cement'lm thic8ness in some areas, at least, ofcement'lm thic8ness in some areas, at least, of

the retainer and they all produce lar$e, non'the retainer and they all produce lar$e, non'

undercut lumps of metal on the t surface that doundercut lumps of metal on the t surface that donot contribute to retention but necessitate anot contribute to retention but necessitate a

relati#ely thic8 retainer% They are therefore norelati#ely thic8 retainer% They are therefore no

lon$er used, but patients with this type of brid$elon$er used, but patients with this type of brid$e

may present with the brid$e debonded% It ismay present with the brid$e debonded% It isusually not worth tryin$ to re'attach it%usually not worth tryin$ to re'attach it%

The si9e of the retenti#e features is intermediateThe si9e of the retenti#e features is intermediate

between those of macro' and micromechanicalbetween those of macro' and micromechanical

retenti#e systems%retenti#e systems%


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&icro'mechanical retention&icro'mechanical retention

&icro'mechanical retention is produced&icro'mechanical retention is produced

by castin$ the metal retainer and thenby castin$ the metal retainer and then

etchin$ the t surface by one of twoetchin$ the t surface by one of twomethods"methods"

1lectrolytic etchin$ in acid in the1lectrolytic etchin$ in acid in the

laboratorylaboratory Chemical etchin$ with a hydro;uoric acidChemical etchin$ with a hydro;uoric acid

$el either in the laboratory or at the$el either in the laboratory or at the

chairside%chairside%


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Althou$h these two systems produceAlthou$h these two systems produce

di.erent etch patterns, they are all #erydi.erent etch patterns, they are all #ery

retenti#e% The si9e of the retenti#eretenti#e% The si9e of the retenti#efeatures is approximately one'tenth thatfeatures is approximately one'tenth that

of the medium'mechanical retenti#eof the medium'mechanical retenti#e

systems, and the retenti#e features aresystems, and the retenti#e features are

undercut from the surface% The smallerundercut from the surface% The smaller

si9e of these etch pits and the absence ofsi9e of these etch pits and the absence of

any unnecessary non'retenti#e featuresany unnecessary non'retenti#e features

(as in the medium'mechanical retenti#e(as in the medium'mechanical retenti#esystems) allow thinner metal retainerssystems) allow thinner metal retainers

and a thinner cement lm thic8ness%and a thinner cement lm thic8ness%


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Chemically retenti#eChemically retenti#e

Chemically retenti#e resins are nowChemically retenti#e resins are now

a#ailable% Se#eral ha#e been mar8eted,a#ailable% Se#eral ha#e been mar8eted,

and some (e%$% ana#ia /-) ha#eand some (e%$% ana#ia /-) ha#eperformed well in laboratory and short'performed well in laboratory and short'

term clinical trials% They adhereterm clinical trials% They adhere

chemically to recently sandblasted metalchemically to recently sandblasted metal

surfaces and are retained on the toothsurfaces and are retained on the toothby con#entional acid'etchin$ of theby con#entional acid'etchin$ of the

enamel%enamel%


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A number of laboratory studies andA number of laboratory studies and

clinical trials ha#e shown that micro'clinical trials ha#e shown that micro'

mechanical and chemical adhesi#emechanical and chemical adhesi#esystems are the most retenti#e% Thesystems are the most retenti#e% The

chemical adhesi#e systems ha#e beenchemical adhesi#e systems ha#e been

a#ailable for a number of years and area#ailable for a number of years and arepro#in$ the most successful of thepro#in$ the most successful of the

systems% :owe#er, lon$er'term clinicalsystems% :owe#er, lon$er'term clinical

trials are still necessary% The moretrials are still necessary% The morerecently introduced materials are claimedrecently introduced materials are claimed

to ha#e better retenti#e properties thanto ha#e better retenti#e properties than

earlier materials, but time will tell%earlier materials, but time will tell%


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An ad#anta$e of usin$ the chemicalAn ad#anta$e of usin$ the chemicaladhesi#e materials is that the laboratoryadhesi#e materials is that the laboratoryonly needs a sandblaster rather thanonly needs a sandblaster rather thanetchin$ e?uipment, and the health andetchin$ e?uipment, and the health andsafety ha9ards of etchin$ in an acidsafety ha9ards of etchin$ in an acidsolution or usin$ hydro;uoric acid $el aresolution or usin$ hydro;uoric acid $el area#oided% The adhesi#e cement is easy toa#oided% The adhesi#e cement is easy tomix and use and has a $ood wor8in$ time,mix and use and has a $ood wor8in$ time,so that the brid$e can be fully seatedso that the brid$e can be fully seatedwithout too much hurry% 3ubber damwithout too much hurry% 3ubber damshould always be used and the mar$ins ofshould always be used and the mar$ins ofthe restoration coated with a $el materialthe restoration coated with a $el materialto pre#ent air contactin$ the settin$to pre#ent air contactin$ the settin$cement, since its settin$ is inhibited bycement, since its settin$ is inhibited byoxy$en%oxy$en%


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A disad#anta$e of the micro'mechanicalA disad#anta$e of the micro'mechanical

retention system is that the metalretention system is that the metal

framewor8 should not be tried in theframewor8 should not be tried in the

mouth after the surface has beenmouth after the surface has been

etched% This is because the #ery delicateetched% This is because the #ery delicate

etch pattern may well be dama$ed oretch pattern may well be dama$ed orclo$$ed by deposits from sali#a% Thisclo$$ed by deposits from sali#a% This

means that the ideal is to try'in themeans that the ideal is to try'in the

unetched framewor8 and then eitherunetched framewor8 and then either

return it to the laboratory for etchin$ orreturn it to the laboratory for etchin$ or

etch it at the chairside% This ta8es timeetch it at the chairside% This ta8es time

and therefore adds to the cost%and therefore adds to the cost%


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The macro'mechanical retenti#e desi$nThe macro'mechanical retenti#e desi$n

(3ochette) o#ercomes this problem but(3ochette) o#ercomes this problem butis less retenti#e in most cases, and,is less retenti#e in most cases, and,

because it is cemented with abecause it is cemented with a

con#entional composite (rather thancon#entional composite (rather thanone specically desi$ned for cementin$one specically desi$ned for cementin$

minimal'preparation retainers) and theminimal'preparation retainers) and the

composite comes throu$h thecomposite comes throu$h the

perforations to the mouth, it is prone toperforations to the mouth, it is prone to

de$radation o#er a period of years%de$radation o#er a period of years%

h i d f h


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:owe#er, the main ad#anta$e of the:owe#er, the main ad#anta$e of the3ochette brid$e is that it can be remo#ed3ochette brid$e is that it can be remo#ed

from the mouth fairly easily% Thefrom the mouth fairly easily% Thecomposite is drilled out from the holes,composite is drilled out from the holes,and the brid$e can usually be remo#edand the brid$e can usually be remo#edwithout too much force%without too much force%

For this reason, the 3ochette brid$e isFor this reason, the 3ochette brid$e isstill used when the abutment teeth ha#estill used when the abutment teeth ha#ea poor pro$nosis and when furthera poor pro$nosis and when furthermodications are li8ely to be necessary 'modications are li8ely to be necessary '

for example when one lower incisor isfor example when one lower incisor isbein$ replaced for periodontal reasonsbein$ replaced for periodontal reasonsand the other teeth are still recei#in$and the other teeth are still recei#in$periodontal treatment%periodontal treatment%

Th 3 h tt d i i l d fThe 3ochette desi$n is also used for


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The 3ochette desi$n is also used forThe 3ochette desi$n is also used forimmediate insertion brid$es so that theimmediate insertion brid$es so that thebrid$e can be remo#ed when the tissuesbrid$e can be remo#ed when the tissuesha#e healed and the pontic adapted toha#e healed and the pontic adapted tothe rid$e or the brid$e remade%the rid$e or the brid$e remade%

:istorically, the medium'mechanical:istorically, the medium'mechanical

retenti#e systems were de#eloped afterretenti#e systems were de#eloped afterthe 3ochette and &aryland desi$ns in anthe 3ochette and &aryland desi$ns in anattempt to o#ercome the disad#anta$esattempt to o#ercome the disad#anta$esof these described abo#e% :owe#er, theyof these described abo#e% :owe#er, they

ha#e disad#anta$es of their own in bein$ha#e disad#anta$es of their own in bein$less retenti#e than the micro'mechanicalless retenti#e than the micro'mechanicalsystem and yet ha#in$ thic8er metalsystem and yet ha#in$ thic8er metalretainers and a thic8er cement lm%retainers and a thic8er cement lm%

!isad#anta$es of!isad#anta$es of


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!isad#anta$es of!isad#anta$es of

&inimal'preparation brid$es&inimal'preparation brid$es As the metal plate is added to the surface of theAs the metal plate is added to the surface of the

tooth or only replaces part of it, the thic8ness oftooth or only replaces part of it, the thic8ness ofthe tooth is increased, and may interfere with thethe tooth is increased, and may interfere with theocclusion unless space is created orthodonticallyocclusion unless space is created orthodontically

or by $rindin$ the opposin$ teeth%or by $rindin$ the opposin$ teeth% The mar$in of the retainer ine#itably produces aThe mar$in of the retainer ine#itably produces a

led$e where pla?ue can collect% This is aled$e where pla?ue can collect% This is aproblem, especially in the replacement of lowerproblem, especially in the replacement of lower

incisors% :ere pla?ue and calculus deposits areincisors% :ere pla?ue and calculus deposits arecommon on the lin$ual surface towards thecommon on the lin$ual surface towards the$in$i#al mar$in, and the presence of such a$in$i#al mar$in, and the presence of such aled$e can only ma8e it more di+cult for theled$e can only ma8e it more di+cult for the

patient to clean in this area%patient to clean in this area%


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COMARISONCOMARISONOF VARIOUSOF VARIOUS

!RIDGE!RIDGE

DESIGNDESIGN

i d d


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Fixed'xedFixed'xedAd#anta$es"Ad#anta$es"

CON51NTIONAL 23I!41CON51NTIONAL 23I!41 3obust desi$n with maximum retention3obust desi$n with maximum retention

and stren$thand stren$th

Abutment teeth are splinted to$ether@ thisAbutment teeth are splinted to$ether@ thismay be an ad#anta$e, particularly whenmay be an ad#anta$e, particularly whenteeth are uncomfortably mobile followin$teeth are uncomfortably mobile followin$bone loss throu$h periodontal diseasebone loss throu$h periodontal disease

The desi$n is the most practical for lar$erThe desi$n is the most practical for lar$erbrid$es, particularly when there has beenbrid$es, particularly when there has beenperiodontal diseaseperiodontal disease


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The construction is relati#elyThe construction is relati#ely

strai$htforward in the laboratorystrai$htforward in the laboratory

because there are no mo#able *ointsbecause there are no mo#able *ointsto ma8eto ma8e

Can be used for lon$ spansCan be used for lon$ spans

&INI&AL'31A3ATION 23I!41&INI&AL'31A3ATION 23I!41

A lar$e retenti#e surface areaA lar$e retenti#e surface area

A sin$le castin$ and so relati#elyA sin$le castin$ and so relati#ely

simple in the laboratorysimple in the laboratory

!isad#anta$es"!isad#anta$es"


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CON51NTIONAL 23I!41CON51NTIONAL 23I!41

3e?uires preparations to be parallel, and this3e?uires preparations to be parallel, and this

may mean more tooth reduction than normal,may mean more tooth reduction than normal,

endan$erin$ the pulp and reducin$ retention@endan$erin$ the pulp and reducin$ retention@

the stren$th of the prepared tooth may alsothe stren$th of the prepared tooth may also

be reducedbe reduced reparations are di+cult to carry out,reparations are di+cult to carry out,

particularly if se#eral widely separated teethparticularly if se#eral widely separated teeth

are in#ol#ed@ the preparation is slow and theare in#ol#ed@ the preparation is slow and the

parallelism has to be constantly chec8ed, orparallelism has to be constantly chec8ed, oralternati#ely (and wron$ly) the preparationsalternati#ely (and wron$ly) the preparations

are o#er'tapered to ensure that there are noare o#er'tapered to ensure that there are no

undercuts and so retention is lostundercuts and so retention is lost

All the retainers are ma*or retainers and re?uireAll the retainers are ma*or retainers and re?uiret i d t ti ti f tht i d t ti ti f th


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extensi#e, destructi#e preparations of theextensi#e, destructi#e preparations of theabutment teethabutment teeth

:as to be cemented in one piece, so:as to be cemented in one piece, so

cementation is di+cult%cementation is di+cult%&INI&AL'31A3ATION 23I!41&INI&AL'31A3ATION 23I!41 2ecause part of the occlusal surfaces of both2ecause part of the occlusal surfaces of both

abutment teeth are usually opposed by teethabutment teeth are usually opposed by teeth

in the opposin$ *aw, there is a tendency forin the opposin$ *aw, there is a tendency forthem to be dislod$ed from the retainer, thusthem to be dislod$ed from the retainer, thusdebondin$ the brid$edebondin$ the brid$e

>ith tilted abutments it is sometimes di+cult>ith tilted abutments it is sometimes di+cult

to achie#e an ade?uate retenti#e surfaceto achie#e an ade?uate retenti#e surfacewithout substantial tooth preparation Thewithout substantial tooth preparation Theretention of both retainers should beretention of both retainers should beapproximately e?ual% This is di+cult to achie#eapproximately e?ual% This is di+cult to achie#ewhen one retainer is a molar tooth and thewhen one retainer is a molar tooth and the

other a premolarother a premolar

i d blFi d bl


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Fixed'mo#ableFixed'mo#able Ad#anta$es"Ad#anta$es"

CON51NTIONAL 23I!41CON51NTIONAL 23I!41 reparations do not need to be parallel to eachreparations do not need to be parallel to each

other, so di#er$ent abutment teeth can be used%other, so di#er$ent abutment teeth can be used% 2ecause preparations do not need to be parallel,2ecause preparations do not need to be parallel,

each preparation can be desi$ned to be retenti#eeach preparation can be desi$ned to be retenti#eindependently of the other preparations%independently of the other preparations%

&ore conser#ati#e of tooth tissue because&ore conser#ati#e of tooth tissue becausepreparations for minor retainers are lesspreparations for minor retainers are less

destructi#e than preparations for ma*or retainers%destructi#e than preparations for ma*or retainers% Allows minor mo#ements of teeth%Allows minor mo#ements of teeth% arts can be cemented separately, soarts can be cemented separately, so

cementation is easy%cementation is easy%



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Independent tooth mo#ement is possible,Independent tooth mo#ement is possible,

particularly for the minor abutment toothparticularly for the minor abutment tooth

(with the mo#able *oint)% The ma*or retainer(with the mo#able *oint)% The ma*or retainer

can be desi$ned for optimum retention,can be desi$ned for optimum retention,

sometimes incorporatin$ intra' coronal assometimes incorporatin$ intra' coronal as

well as extra'coronal elements replacin$well as extra'coronal elements replacin$restorations%restorations%

The retention of the minor retainer needThe retention of the minor retainer need

not be substantial, particularly if thenot be substantial, particularly if the

mo#able *oint consists only of a rest seatedmo#able *oint consists only of a rest seated

in a seat on the minor retainer In this casein a seat on the minor retainer In this case

there are few displacin$ forces on thethere are few displacin$ forces on the

minor retainer%minor retainer%

The retention of the two retainers canThe retention of the two retainers can


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The retention of the two retainers canThe retention of the two retainers can

be #ery di.erent, usually with the ma*orbe #ery di.erent, usually with the ma*or

retainer distally and the smaller, minorretainer distally and the smaller, minorretainer attached to a premolar tooth%retainer attached to a premolar tooth%

The retainer can be made #ery small,The retainer can be made #ery small,

and its appearance is similar to a smalland its appearance is similar to a small

amal$am restoration%amal$am restoration%

re#ents a posterior abutment toothre#ents a posterior abutment tooth

tiltin$ as is sometimes the case with atiltin$ as is sometimes the case with a

cantile#er brid$e% The mo#able *ointcantile#er brid$e% The mo#able *oint

merely acts to pre#ent this rather thanmerely acts to pre#ent this rather than

to pro#ide any retention for the brid$eto pro#ide any retention for the brid$e



75/93

$$

CON51NTIONAL 23I!41CON51NTIONAL 23I!41 Len$th of span limited, particularly with mobileLen$th of span limited, particularly with mobile

abutment teethabutment teeth &ore complicated to construct in the laboratory&ore complicated to construct in the laboratory

than xed'xedthan xed'xed !i+cult to ma8e temporary brid$es!i+cult to ma8e temporary brid$es

&INI&AL'31A3ATION 23I!41&INI&AL'31A3ATION 23I!41 Not suitable for anterior brid$esNot suitable for anterior brid$es &ore di+cult to ma8e in the laboratory,&ore di+cult to ma8e in the laboratory,

re?uirin$ two separate castin$sre?uirin$ two separate castin$s

Not suitable for lon$er'span brid$es, where aNot suitable for lon$er'span brid$es, where acon#entional xed'mo#able brid$e would becon#entional xed'mo#able brid$e would besatisfactory% This is because the mo#able *ointsatisfactory% This is because the mo#able *ointis seldom lar$e enou$h to resist lateral forcesis seldom lar$e enou$h to resist lateral forceson the pontic, but will only resist axial forces byon the pontic, but will only resist axial forces by

means of the rest on the minor retainermeans of the rest on the minor retainer

C tilC til


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Cantile#erCantile#er Ad#anta$es"Ad#anta$es"

CON51NTIONAL 23I!41CON51NTIONAL 23I!41 The most conser#ati#e desi$n when only oneThe most conser#ati#e desi$n when only one

abutment tooth is neededabutment tooth is needed

If one abutment tooth is used, there is no needIf one abutment tooth is used, there is no needto ma8e preparations parallel to each other@ ifto ma8e preparations parallel to each other@ iftwo or more abutment teeth are used, they aretwo or more abutment teeth are used, they aread*acent to each other, so it is easier to ma8ead*acent to each other, so it is easier to ma8ethe preparations parallel Construction in thethe preparations parallel Construction in thelaboratory is relati#ely strai$htforwardlaboratory is relati#ely strai$htforward

&ost suitable in replacin$ anterior teeth where,&ost suitable in replacin$ anterior teeth where,if the occlusion is fa#ourable, there is little ris8if the occlusion is fa#ourable, there is little ris8of the abutment tooth tiltin$%of the abutment tooth tiltin$%



77/93

The most conser#ati#e of all desi$ns,The most conser#ati#e of all desi$ns,usually only in#ol#in$ a sin$le minimal'usually only in#ol#in$ a sin$le minimal'

preparation retainer%preparation retainer% Ideal for replacin$ upper lateral incisors,Ideal for replacin$ upper lateral incisors,

usin$ the canine tooth as the abutment,usin$ the canine tooth as the abutment,pro#ided the occlusion is fa#orable%pro#ided the occlusion is fa#orable%

Suitable posteriorly when the span is short%Suitable posteriorly when the span is short% 1asy for the patient to clean with ;oss1asy for the patient to clean with ;oss

passed throu$h the contact point betweenpassed throu$h the contact point between

the pontic and the unrestored ad*acentthe pontic and the unrestored ad*acenttoothtooth

No need to ali$n preparations%No need to ali$n preparations% 1asy laboratory construction%1asy laboratory construction%



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$$

CON51NTIONAL 23I!41CON51NTIONAL 23I!41

>ith small brid$es the len$th of span is limited>ith small brid$es the len$th of span is limited

to one pontic because of the le#era$e forces onto one pontic because of the le#era$e forces onthe abutment teeth@ if more teeth are to bethe abutment teeth@ if more teeth are to be

replaced with a cantile#er brid$e, a lar$ereplaced with a cantile#er brid$e, a lar$e

number of abutments widely spaced round thenumber of abutments widely spaced round the

arch must be usedarch must be used The construction of the brid$e must be ri$id toThe construction of the brid$e must be ri$id to

a#oid distortiona#oid distortion

Occlusal forces on the pontic of small posteriorOcclusal forces on the pontic of small posteriorbrid$es encoura$e tiltin$ of the abutment tooth,brid$es encoura$e tiltin$ of the abutment tooth,

particularly if the abutment tooth is distal to theparticularly if the abutment tooth is distal to the

pontic and is already predisposed to tiltin$pontic and is already predisposed to tiltin$

mesially%mesially%


79/93

&INI&AL'31A3ATION 23I!41&INI&AL'31A3ATION 23I!41 3elati#ely small retenti#e area, and3elati#ely small retenti#e area, and

#ulnerable to debondin$ throu$h#ulnerable to debondin$ throu$h

tor?uin$ forcestor?uin$ forces


80/93

4eneral4eneral

considerationsconsiderations

ti t ttit datient attitude


81/93

atient attitudeatient attitude atients show di.erent de$rees ofatients show di.erent de$rees of

enthusiasm for xed and remo#ableenthusiasm for xed and remo#able

prostheses% nless the patient isprostheses% nless the patient is

particularly anxious to ha#e a brid$e orparticularly anxious to ha#e a brid$e or

implant' retained prosthesis and fullyimplant' retained prosthesis and fullyunderstands the implications, it is oftenunderstands the implications, it is often

better, particularly when a number of teethbetter, particularly when a number of teeth

are missin$, to ma8e a partial denture rstare missin$, to ma8e a partial denture rst

to see how the patient responds% It may beto see how the patient responds% It may be

that the denture is satisfactory, boththat the denture is satisfactory, both

aesthetically and functionally%aesthetically and functionally%

If so, the destructi#e and irre#ersible toothIf so, the destructi#e and irre#ersible tooth


82/93

preparations that may be necessary for apreparations that may be necessary for a

brid$e or sur$ical procedures for implantsbrid$e or sur$ical procedures for implants

can be a#oided, or atleast deferred%can be a#oided, or atleast deferred%Alternati#ely, if the patient is unhappy withAlternati#ely, if the patient is unhappy with

the partial denture, he or she will enterthe partial denture, he or she will enter

into the arran$ements for ma8in$ a brid$einto the arran$ements for ma8in$ a brid$eor implant retained prostheses withor implant retained prostheses with

$reater enthusiasm and commitment%$reater enthusiasm and commitment%

atients should ne#er be persuaded toatients should ne#er be persuaded to

ha#e brid$es or implants a$ainst theirha#e brid$es or implants a$ainst theirwishes, and they must $i#e fully informedwishes, and they must $i#e fully informed

consent, includin$, in most cases, time toconsent, includin$, in most cases, time to

re;ect%re;ect%

A dA d


83/93

A$e and sexA$e and sex

Similar ar$uments apply to brid$es as toSimilar ar$uments apply to brid$es as tocrowns% Sports players and wind'crowns% Sports players and wind'

instrument players ha#e :owe#er,instrument players ha#e :owe#er,

whereas there may be no satisfactorywhereas there may be no satisfactory

alternati#e to a crown for an old or youn$alternati#e to a crown for an old or youn$

patient, a partial denture may ma8e apatient, a partial denture may ma8e a

#ery satisfactory alternati#e to a brid$e#ery satisfactory alternati#e to a brid$e

or implant'retained prostheses% This isor implant'retained prostheses% This isparticularly true for #ery youn$ patients,particularly true for #ery youn$ patients,

who may not fully appreciate the lifelon$who may not fully appreciate the lifelon$

implications of brid$es or implants%implications of brid$es or implants% It is often better to ma8e a minimalIt is often better to ma8e a minimal


84/93

preparation brid$e or partial denture untilpreparation brid$e or partial denture untilthe patient is mature enou$h to assessthe patient is mature enou$h to assess

the relati#e merits of the alternati#es% 2utthe relati#e merits of the alternati#es% 2uta teena$er with a missin$ incisor whoa teena$er with a missin$ incisor whocannot be tted with a minimal'cannot be tted with a minimal'preparation brid$e may be desperatelypreparation brid$e may be desperately

unhappy about wearin$ a partial denture%unhappy about wearin$ a partial denture%In this case, the pro#ision of aIn this case, the pro#ision of acon#entional brid$e or sin$le toothcon#entional brid$e or sin$le toothimplant as early as possible may ma8e aimplant as early as possible may ma8e a

remar8able psycholo$ical di.erence Atremar8able psycholo$ical di.erence Atthe other end of the a$e scale, no patient,the other end of the a$e scale, no patient,howe#er old, should be written o. ashowe#er old, should be written o. asbein$ past brid$ewor8%bein$ past brid$ewor8%

CondenceCondence


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CondenceCondence &any patients feel more condent with a brid$e&any patients feel more condent with a brid$e

than with any form of remo#able appliance%than with any form of remo#able appliance% :owe#er retenti#e a partial denture, some:owe#er retenti#e a partial denture, some

patients ne#er lose the anxiety that it willpatients ne#er lose the anxiety that it will

become dislod$ed durin$ spea8in$ or eatin$%become dislod$ed durin$ spea8in$ or eatin$%

Others are not prepared to remo#e partialOthers are not prepared to remo#e partial

dentures at ni$ht%dentures at ni$ht%

&any patients do tolerate partial dentures #ery&any patients do tolerate partial dentures #ery

well, howe#er, and it is often di+cult to tellwell, howe#er, and it is often di+cult to tellbeforehand what the response will be to eitherbeforehand what the response will be to either

form of treatment% The ma*ority of patients whoform of treatment% The ma*ority of patients who

ha#e had both partial dentures and brid$esha#e had both partial dentures and brid$es

prefer the latter%prefer the latter%

OccupationOccupation


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OccupationOccupation Althou$h sports players should be pro#ided withAlthou$h sports players should be pro#ided with

crowns when necessary, it may be better to defercrowns when necessary, it may be better to deferma8in$ an anterior brid$e or implant'retainedma8in$ an anterior brid$e or implant'retainedprostheses until the patient $i#es up the moreprostheses until the patient $i#es up the more#iolent sports, and meanwhile to pro#ide a partial#iolent sports, and meanwhile to pro#ide a partial

denture%denture%

Althou$h wind'instrument players usually need aAlthou$h wind'instrument players usually need abrid$e replacement for their missin$ anterior teeth,brid$e replacement for their missin$ anterior teeth,there are some who nd that air escapes beneaththere are some who nd that air escapes beneathand between the teeth of a brid$e% They are betterand between the teeth of a brid$e% They are better

able to maintain a seal with a partial dentureable to maintain a seal with a partial denturecarryin$ a buccal ;an$e%carryin$ a buccal ;an$e%

ublic spea8ers and sin$ers who ma8e moreublic spea8ers and sin$ers who ma8e moreextreme mo#ements of the mouth often need theextreme mo#ements of the mouth often need the

condence that comes from wearin$ a brid$e%condence that comes from wearin$ a brid$e%


87/93

4eneral health4eneral health 2oth brid$es and partial dentures are2oth brid$es and partial dentures are

electi#e forms of treatment, and need not beelecti#e forms of treatment, and need not be

pro#ided for people who are ill% >hen toothpro#ided for people who are ill% >hen tooth

replacement is necessary for someone whoreplacement is necessary for someone who

will ha#e di+culty toleratin$ it because ofwill ha#e di+culty toleratin$ it because of

poor health, or when there are medicalpoor health, or when there are medical

complications such as with patients whocomplications such as with patients who

re?uire antibiotic co#er for e#eryre?uire antibiotic co#er for e#eryappointment, it is better to consider theappointment, it is better to consider the

simpler, less time'consumin$ form ofsimpler, less time'consumin$ form of

treatment rst%treatment rst%

AppearanceAppearance


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AppearanceAppearance >hen a tooth is lost, al#eolar bone and>hen a tooth is lost, al#eolar bone and

$in$i#al contour are also lost, and it is$in$i#al contour are also lost, and it is

ne#er possible to dis$uise this factne#er possible to dis$uise this fact

entirely% Thus no articial replacementsentirely% Thus no articial replacements

e#er loo8 exactly li8e the natural teeth,e#er loo8 exactly li8e the natural teeth,althou$h some may be su+cientlyalthou$h some may be su+ciently

realistic to decei#e all except the dentistrealistic to decei#e all except the dentist

with his bri$ht li$ht and mouth mirror% Inwith his bri$ht li$ht and mouth mirror% Insome cases dentures with ;an$es achie#esome cases dentures with ;an$es achie#e

this ob*ect better than brid$es@ in othersthis ob*ect better than brid$es@ in others

brid$es ha#e the better appearance%brid$es ha#e the better appearance%


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>hen a substantial amount of al#eolar>hen a substantial amount of al#eolar

bone is lost in one area, the combinationbone is lost in one area, the combinationof a brid$e with a separate remo#ableof a brid$e with a separate remo#able

buccal ;an$e sometimes $i#es the bestbuccal ;an$e sometimes $i#es the best

appearance%appearance% >hen the loss of al#eolar bone is>hen the loss of al#eolar bone is

si$nicant and the lipline is such that itsi$nicant and the lipline is such that it

shows and is di+cult to dis$uise easily,shows and is di+cult to dis$uise easily,

the rid$e may be au$mented sur$icallythe rid$e may be au$mented sur$ically

and the tooth or teeth replaced by aand the tooth or teeth replaced by a

brid$e or implant%brid$e or implant%


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Ini)a'i*n%+Ini)a'i*n%+

TOOT: '2ON!1! 1!1NTLOSTOOT: '2ON!1! 1!1NTLOS

314IONS314IONS

&O!IFICATION SAC1S&O!IFICATION SAC1SClass lll modication - Class lll modication -

ANT13IO3 &O!IFICATION SAC1SANT13IO3 &O!IFICATION SAC1S


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Contraindications"Contraindications" Bouth or ad#anced a$e of patient%Bouth or ad#anced a$e of patient%

Bouth' lar$e dental pulps and lac8 ofBouth' lar$e dental pulps and lac8 of

clinical crown hei$ht (under a$e -years)clinical crown hei$ht (under a$e -years)

A$ed' reduced life expectancy andA$ed' reduced life expectancy andfre?uently failin$ $eneral health%fre?uently failin$ $eneral health%

4reat len$th of edentulous span%4reat len$th of edentulous span%

1xcessi#e bone loss of residual rid$e%1xcessi#e bone loss of residual rid$e% sycholo$ical problems%sycholo$ical problems%

1conomic considerations%1conomic considerations%


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Documents

78786739 Fixed Partial Denture 1