Transcript Introduction to Fixed Prosthodontics

Introduction
to
Fixed Prosthodontics
Dr. William Morgan
Clinical Professor
UCLA School of Dentistry
April 3, 2007
Faculty
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Dr. William Morgan, Course Co-Chair
Dr. Richard Stevenson, Course Co-Chair
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Esteban Bonilla
Lillian Cheng
Donald Fisher
Michael Gritz
Sue Spackman
Jay Watson
Andy Wong
Course Requirements
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Attend lecture & lab each week
Complete all projects on time
Pass midterm & final practical examinations
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One makeup examination
Average 75% or better on all written
examinations
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Each question on quizzes & examinations count the
same
Quizzes each week on reading assignment
Drop one quiz at end of quarter
Examinations cover material since last examination
Fall & Winter final examinations are cumulative
Terminology
Prosthodontics
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The dental specialty concerned with the making
of artificial replacements for missing parts of the
mouth and jaw. Also prosthetic dentistry or
prosthodontia.
Fixed Prosthodontics
 Gold crowns-full and partial veneer
 Inlays-gold and all ceramic
 Porcelain-all porcelain and PFM
 Fixed partial dentures
 Replace one or more missing teeth
Restorative Dentistry
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Restorative dentistry covers the range from
simple direct restorations to complex full mouth
rehabilitation. This will include class I & class II
direct restorations, simple indirect restorations
like inlays, crowns & veneers, to replacing
missing teeth with fixed partial dentures & finally
to complete rehabilitation with indirect
restorations throughout the mouth. Esthetics &
function must also be considered.
Operative Dentistry
Fixed Prosthodontics
Esthetic Dentistry
Restorations
Full Veneer Crowns
Gold casting covers all external walls of the
tooth & reinforces remaining tooth structure
Partial Veneer Crown
MOL Gold Inlay/Onlay
Healthy tooth structure is preserved
Partial Veneer Crown
MOL Gold Inlay/Onlay
Minimal facial extension preserves esthetics
Partial Veneer Crown
MOD Gold Onlay
Restoration reinforces remaining tooth &
leaves tooth structure at gingival area
Gold Inlays
Conservative preparation & finishing of the gold margins
can provide a restoration that will last many years
All Ceramic Onlay
Esthetic restoration but is subject to fracture
All Ceramic Inlay/Onlay
Porcelain Fused To Metal
Crown (PFM)
Porcelain is baked to a thin cast metal coping
Porcelain Veneers &
Fixed Partial Denture
Porcelain Veneers &
Fixed Partial Denture
Porcelain Veneers
Fixed Partial Denture
Fixed Partial Denture
Porcelain is baked over a cast metal framework
Fixed Partial Denture (PFM)
Metal framework for strength & porcelain for esthetics
Fixed Partial Denture (Gold)
Fixed Partial Denture
Pier Abutment
Pontics
Fixed Partial Denture
Implants
FPD attached to implants
Diagnosis
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History
Physical/Emotional Health
 Premedicate
 Allergies
 Medications
 Physician Consult
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Diagnosis
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TMJ/Occlusal Evaluation
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Within Normal Limits?
 Maintain
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Frequent Head, Neck or Shoulder Pain?
 Evaluate
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Occlusal Relationship
Referral?
Muscles & TMJ
Diagnosis
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Intraoral Examination
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General Oral Hygiene
Soft Tissue
Periodontal Health
Probing/Chart Pockets
 Mobility
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Caries
Examine Old Restorations
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Serviceable or failing?
Diagnosis
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Diagnostic Casts-required for all
indirect restorations
Mount With Facebow & Bite Records
 Occlusal Evaluation
 Diagnosis/Treatment Plan
 Diagnostic Wax-Up
 Stents For Temporization
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Diagnosis
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Full Mouth Radiographs
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Caries-Interproximal & Recurrent
Periapical Lesions?
Quality of Previous Endodontics
Periodontal Health & Alveolar Bone Levels
Crown/Root Ratio
Pathosis
Treatment Options
Intracoronal Restorations
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Glass Ionomer
Composite Resin
Simple Amalgam
Complex Amalgam
Gold Foil
Gold Inlay
Ceramic Inlay
Treatment Options
Extracoronal Restorations
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Ceramic Onlay
Gold Onlay
Partial Veneer Crowns (3/4, 7/8)
Full Gold Crown
Porcelain/Metal Crown (PFM)
All-Ceramic Crown
Ceramic Veneer
Treatment Options
Reasons For Extracoronal
Restorations
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Previous restoration and/or caries undermines
tooth structure, requiring reinforcement that
comes from an extracoronal restoration
Discoloration present and patient desires
esthetic improvement and tooth has been
weakened
Occlusal modifications
Casting
Full Gold Crown
Casting/Crown Fabrication
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1. Tooth Preparation, Including Caries Removal
& Build-Up
2. Temporization (Ready before impression)
3. Impression
4. Model (Cast) and Die Fabrication
5. Wax-Up (Exact shape & size of desired crown)
6. Investing and Casting
7. Crown Adjusting and Polishing
8. Clinical Try-In and Cementation
Tooth Preparations
Full Gold Crown Preparation
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Indicated when
restoration or caries
significantly weakened
tooth
All external walls
covered-occlusal & axial
with minimal taper of
axial walls
Gingival finish line may
be subgingival or
supragingival
Adequate reduction to
provide bulk of gold
Porcelain Fused to Metal (PFM)
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Indications same as
FGC but patient
desires more esthetics
All walls covered
similar to full gold
crown
Additional reduction
necessary on facial to
accommodate metal
& porcelain without
being overcontoured
3/4 Gold Crown
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Facial wall unprepared
Facial cusp minimally
reduced occlusally
Grooves placed to
prevent lingual
displacement of crown
Minimal facial extension
interproximally
Fixed Partial Denture
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Anterior crown
preparation
(abutment) is a
PFM
Posterior crown is
a full gold crown
Ceramic Onlay
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Restoration is all
ceramic with no metal
It is bonded to the
tooth
Weaker than
restorations with
metal & can fracture
during mastication
Build-Ups
Done to replace missing tooth
structure & provide retention for final
restoration
 Types
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Pin Retained Amalgam or Composite
 Preformed Posts Retaining Buildup
 Custom Cast Post and Core
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Build-Up (Pin retained)
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Pin holes drilled into
vital tooth
Pins threaded into
tooth & retained in
dentin
Missing tooth built up
with amalgam or non
tooth colored
composite
Build-Up (Pre-formed post)
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Endodontically treated
tooth is missing
significant amount of
tooth structure
One or more canals
are shaped & preformed post is fit into
the canal & cemented
Chamber may also be
used to provide
additional retention
for buildup
Build-Up (Pre-formed post)
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After post is
cemented, the tooth
is built up with
amalgam or
composite
Walls of preparation
must extend beyond
the build up to the
tooth structure
Build-Up (Custom Cast Dowel Core)
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Single rooted
endodontically
treated tooth with
significant amount
of tooth structure
missing or
undermined-not
enough to retain
a crown
Build-Up (Custom Cast Dowel Core)
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Canal is shaped & sized
with a reamer
Resin pattern is made
that is an exact
impression of the canal
& created the desired
coronal “tooth
structure”
Pattern is cast into gold
Build-Up (Custom Cast Dowel Core)
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Cast dowel core is
cemented into the canal
in the root
Dowel core & tooth are
reshaped into final
crown preparation
Impression made of
preparation & crown
fabricated, adjusted &
cemented onto tooth
Provisional Restorations
(Temporaries)
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Custom made acrylic
Relined polycarbonate crowns
Pre-formed metal crowns
Provisional Restoration
(Custom Made Acrylic)
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Rough provisional
crown causes gingival
irritation & difficulty in
taking a final
impression
Provisional restoration
smoothed & polished
with much better
tissue response after
only a few days
Provisional Restoration
(Custom Made Acrylic)
Final restorations
Provisional Restorations
(Relined Polycarbonate Crowns)
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Pre-formed
polycarbonate crown
selected & adjusted
Polycarbonate crown
relined with acrylic,
adjusted, polished &
cemented
Provisional Restorations
(Preformed Metal Crowns)
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Pre-formed soft metal
crown selected &
adjusted
Metal crown relined
with acrylic, adjusted,
polished & cemented
Impressions
Full arch impressions
 Double bite impressions
 Quadrant impressions
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Full Arch Impression
Impression of whole arch using
light & heavy body impression
material capturing detail with
no bubbles
Double Bite Impression
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Impression of
preparation,
opposing
dentition as
well as
intercuspal
bite
Model (Cast) and
Die Fabrication
Cast & Die Fabrication
Full arch impression is
used to fabricate full arch
cast with removable dies
Cast & Die Fabrication
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Double bite
impression is used
to fabricate
mounted casts with
either a separate
die or a removable
die
Series
Crown Preparation
Casting Fabrication
Full Crown Prep #30
Impression & Cast Fabrication
Inspect impression for
completeness & fabricate cast
Wax Pattern Fabrication
Fabricate a wax pattern
exactly like the desired
crown, checking details
with the stereo microscope
Invest & Cast Crown
Finished wax pattern is placed
inside ring & investment flowed
around it. Pattern is burned out in
oven & molten gold flowed into the
void in the ring, creating the casting
as shown above
Crown Cementation
Crown tried in, adjusted &
cemented