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Bridge and Veneers (Porcelain Veneers (Problems with veneering:
…
Bridge and Veneers
Porcelain Veneers
Problems with veneering:
- Discolouration at margin
- Breakage
- Debonding
Indications for vennering:
- Tooth should be vital
- Enhancing ortho tx
- Creating a juvenile smile
- covering exposed root surfaces
- reduction of black triangles
Preparation = Only on Enamel
- Design Types:
- The window
- The feather edge
- The Butt joint
- The palatal chamfer
~0.5mm labial chamfer
~1.5mm incisal reduction
Cautions in Preparation:
- Incisal margins (influence stress distribution)
- Never prep palatal surface (will weaken tooth)
- Placement of restiration
- Ie: Tooth strength – incisal edge < chamfer edge <butt joint = tooth unprepped
Contraindications for veneering:
- Teeth that are exposing too much root surface as aesthetically they are likely to fail
Proximal surface preparation:
Must break the proximal contact
- enhance aesthetic result (emergence profile and form)
- facilitates placement of resoration
- preserves enamel
Occlusion
Definition
"Occlusion embraces the dynamic and functional relation between all the components of the masticatory system"
Concepts
1.) Dental Occlusion
- Shape of teeth and then way forces are directed (fossas), tooth eruption, stabilized occlusal interface
- Determined by: bone Growth, dental dev., Neuromusc maturation
2.) TMJ
- Form & function
- Determined by: Anatomy, function/dysfunction, disease
3.) PDL
- How teeth are supported in the alveolus
-
Types
Centric Relation (CR)
-
Reproducible, stable, True w/ varying OVD
Centric Occlusion (CO)
Used to characterize an occlusion of opposing teeth, similar to MI when there is a full complement of opposing teeth
Optimal Occlusal Scheme
Aiming to provide this for our patients
= simultaneous contact on posterior teeth in CR where forces are directed axially (utilizing PDL) along each tooth
= Adequate tooth-guided contacts on the working side, discluding non-working teeth immediately (ie Canine guidance #1)
-
Resin-Bonded Bridges
Indications:
- Replacement of lateral incisors and Mdb centrals
- Poor root angulation
- Insufficient bone for implant
- Light/no occlusal forces
- Periodontal splints
Contraindications:
- Extensive restorative hx
- Heavy occlusal load
- Limited bonding surface
- Poor tooth morphology
Advantages:
• Reduced cost
• Conservative tooth preparation
• Supragingival margins
• Cantilever design 91% - 5 year survival
Disadvantages:
Careful case selection
• Irreversible
• No space/shape correction
• No alignment correction
• Difficult to provisionalise
Maryland Bridge
- Metal framed w/ fibre-reinforced composite
- Or All cermaics w/ Comp
Prospective RCT Study
= 2 Unit resin-bonded FDP had better survival and success than 3 Unit resin-bonded RFPD
Implant Dentistry
Endosteal Implant
= Surgically placed within the alveolar/basal bone
- One Stage
- connector placed at time of surgery and protrudes through tissue (atraumatic is best)
- Two Stage
- Implant placed and cover screw also placed, then uncovered during separate appt and connector placed (allows bone to settle)
Case Planning
Patient Assessment
- Valid choice for your pt
Evaluation of range of prosthesis
- pros/cons considered
Biological Cost
- Minor surgical procedure
Diagnostic Wax up & Surgical Stent
- CBCT + Interdisciplinary management
Abutment Selection
Provisional + definitive restorations
Bridge-Design
Considerations
Biologic Considerations
Abutment = Prevent damage; conserve tooth structure
Pontic = Cleansibility, access to abutment, nil pressure
Mechanical Considerations
Abutment = Retention & Resistance form
Pontic = Rigid, strong
--> Bridge can only exert 40% of the force produced by natural teeth
Selection of Abutments
Endo Tx teeth?
- Complex restorative hx
- residual dentine thickness
- Are we able to get a ferrule/retention form
Mesially Tilted?
- Enusure there is only one single path of insertion
-
Edentulous Span
Span length?
- need more RDT
- Greater resistance prep design
- More occlusal considerations
- More rigid connectors
Aesthetic Considerations
= Emergence profile, space for porcelain
-