1)Indications for Crown & bridges.pdf

Crown and Bridge 1

Crown and bridge Page 1

Crown and Bridge 1


The Dr starts the Lec reminding us about the introduction lecture

we spoke about the definition of dentistry

we spoke about the rationale behind the studying dentistry

we saw that ppl never like to go to dentist

They never like to have their teeth drilled,

we learn how to make the right and easy for your pt

how your pt will accept you

so the dentistry is about passion

is about rapport between you and your pt

is about pain free

is not sense that pt feel pain

I mention that last time that the pt you have to treat him as member is

your family (like your sister and your father)

You treat the pt as one member of your family and you will not except to

not to work as best as you can.

Dentist is not an artist cuz the skills that he should have is an acquired,

you have to follow principles and rules, read books, you have to see the

dentists who have an experience and they are better that you, later on

you will have your own way.

Dentistry is about dexterity and technology

You have to have best equipment and material that are good enough to

deal with, then better surface to work on.

time.

environment.

the compliance of the pt.

The purpose is not just to finish, you have to give yourself time and your

pt time, don’t rash in things talk to your pt,

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ask him about his name and his occupation if he feels ok etc.

then you start your work “drilling”

The text book of this course is “planning and making crowns and bridges

“3rd edition.

However the dr. copied the chapters and he will give it to us.

Indications and Contraindications For Crown & Bridge

We will see next what’s crown means, and what’s types of crown we

have.

The type of material that we use to manufacture this crown when we use

them

As general speaking,

CROWN: is prosthesis to restore

=Function

=aesthetic

=occlusion of the tooth

BRIDGE: is prosthesis to replace missing tooth.

The life cycle of the dental pain : teeth in the

human being start with bacteria destroyed teeth

cuz of food, poor oral hygiene, end up with caries.

This is the G V plaque the father of caries

You end up doing filling for pt

or may you do cast in the lab and you do thing called

INLAY, ONLAY, OVERLAY

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If you are an endodentist and you do good endo, the pt will not notice it,

he can’t see the canals, or full operation.

If u do filling with very well carved the pt will not notice it.

but when you do a crown he will notice the appearance of it,

and he will comment on it, is it look nice or bad?

So you have to be meticulous, and do good planning for treatment.

If u want to collect money, the most branches of dentistry will do that, are

the ortho and crown and bridge. These are the courses that will do that :D

If you interest in donning something nice, to change ugly teeth to

beautiful teeth, you have to study crown and bridge.

You have very interesting Lec, about esthetic dentistry ” porcelian limited

veneer” ,and all ceramics.

So rather than doing cavity we might do cast restoration in the lab we

called “INLAY”

If we go MOD more than this and a little bit covered the cusps we called it

“ONLAY”

If it covered the whole cusps we called it ” OVERLAY”

Any pt have destroyed teeth so it has problem in:

= Esthetic

From the pic we can tell that the pt has esthetic problem.

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= Occlusion “if the pt has attrition and he will lose the vertical dimension”

“Define the Vertical Dimension”

= Function

Crown versus fillings in the treatment of caries :

not every single tooth should be replaced.

if the missing tooth doesn’t do esthetic problem, or doesn’t effect on

the function or occlusion, “like lower 6 or 7 extracted for long time and

the patient is okay with it”

Incipient Cary: If you have pt with incipient caries “we do oral hygiene

instruction and follow up “

Class 1: If the caries extend to dentine the restoration will be class 1.

Class 2: if it massive may be we go for class 2.

Crown: If there was not enough tooth structure, when the caries is

aggressive and massive, here we need something to retained and protect

the tooth which is the “crown”.

What is the difference between the filling and the cast of

restoration

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When we do the filling we should have enough tooth structure

cuz the filling is just restore the missing part of the tooth structure

,If the is not enough tooth structure the filling will broke and fall

down.

So the 1st indication for crown is for a cavity that is too

large to be restored with a filling " badly broken-down

teeth " .

There is no set of rules clear to decide if this cavity is indicated for

filling or crown, this become with experience and more knowledge.

This course gives u just general concept.

**Look at this pic the cavity is big so I have to do something to

protect the remaining of tooth structure so I do “crown”

if you have pt has filling need to change you should ask yourself can

I make better than the old one.

I said before from the 1st week you see your filling is excellent and

by time” after month or a year” it becomes bad.

so don’t rash in judgment of your work.

We have a lots of factors that affect we will discuss it later on.

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2) FRACTURE:

U have to judge the fracture, “ would this composite lasts in this fracture”

Again nobody can give perfect answer but for me I think composite is not

suitable here.

We are talking about crown fracture , how ever ,Fracture in the root, you

have to extract the tooth as you know.

So generally You have to JUDGE if:

# The filling is massive.

#The caries is massive.

#The fracture is massive.

so we indicate crown for restoration.

((about fracture you can’t judge easily cuz you have to know is

the pt feeling pain and do some diagnostic test in the upper 3rd part

of the tooth(crown), you have to take X-ray … etc. ))

3 ) tooth wear :

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#Attrition:

is the loss of teeth structure by mechanical forces from opposing teeth.

#Abrasion:

is the loss of tooth structure by mechanical forces from a foreign element

toothbrushes, toothpicks, floss

#Erosion:

is the irreversible loss of tooth structure due to chemical dissolution

by Acidics “problem in pt stomach”.

When you have aggressive tooth wear no single filling will withstand in

this case.

you have to do diagnosis you have to do preventive manager by the

end of the day you will end with crown, filling can’t have place here cuz it

will go out.

If you drill a teeth suffer from tooth wear then you do a conservative

dentistry, here you destroyed the pt teeth ”you do huge mistake”.

also The teeth will be harmed if we do 2 crown for it.

So when we think about crown you have to think about something :

costy , needs time , extra visit for pt

http://en.wikipedia.org/wiki/Teeth

http://en.wikipedia.org/wiki/Tooth

http://en.wikipedia.org/wiki/Toothbrush

http://en.wikipedia.org/wiki/Toothpick

http://en.wikipedia.org/wiki/Dental_floss

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Also we have general indications for crown like:

- ((hypoplastic indication)) like amelogensis imperfecta

dentinogensis imperfecta

anything will affect the appearance of the teeth will needs crown

fluorosis, tetracycline staining

- To alter shape or size or inclination of the teeth : # like peg

lateral , anything odd .

- To alter the occlusion :

=Occlusion and Vertical Dimension:

To correct the occlusion and vertical dimension .

- As a part of other restoration : Crown is part of the bridge we

will see pic and you will understand it.

= Crown could be part of another restoration

we will explain with details about bridges.

- combined indications.

- Appearance.

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BRIDGE:

When we have missing tooth with 2 sound teeth.

You prepare the sound teeth, then take impression and sent it to the lab.

Lab will make crowns on the prepared teeth + pontic.

So crown is part of a bridge.

*We call it Crown when it’s alone.

*When it is part of the bridge, we call it RETAINER.

* what are the alternatives to anterior crowns ?

1) bleaching :

Sometime pt has fluorosis or tetracycline staining, but the teeth are

sound.

So what shall I do? You will say bleaching,

yes I can do bleaching.

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BLEACHING:

what's Good and what’s bad about bleaching ?

“”this is what we call decision making””

In bleaching we use certain material like

hydrogen broxid, bromid … to make teeth white it could be done

with “single visit” or “home visit” you have to read about this.

The Advantage of Bleaching:

It is conservative, you don’t remove tooth structure.

The Disadvantage of Bleaching:

It is recurrent the pt needs something permanent, almost in 6

month there will be relapse.

2 )Resin composite or glass inomar restoration:

we can do composite facing, but again we have to decide if it is

satisfactory in term of esthetic.

3 ) gold or porcelian (inlay and onlay).

4) VENEER:

like lenses or nails . very thin !

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I can do porcelian laminate veneer. VENEER very thin porcelian, exactly

like the nail of finger. You have to remove very thin layer of enamel, you

cement it the pt mouth. It is very aesthetic, even the dentist will not notice

the veneer.

**This is the pic about bleaching before and after**

5 )Aesthetic Filling:

Composite, if there is enough tooth structure

These teeth is sound (pic), what did you do?

A Crown and you will remove too much of tooth structure>> NO Veneer

which is 0.5 mm thin and more conservative>>the right choice.

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INLAYS:

metal restoration rather than doing filling

6 )IMPLANT:

when you have missing tooth you go for implant.

Types OF Crowns:

the type is basic on 2 things “material / finish line”

1- Full ceramic crown.

2- Full metal crown.

3- Ceramometal.

When we do a filling, you have to think which filling should be the choice

(amalgam, composite).

There are many factors affect the choice like:

*moisture control

*enough tooth structure

*Aesthetic

*Vision zone

*occlusion

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*costy (amalgam the least costy, then GI, then inlays , partial

crown, full crowns)

** now the doctor is giving us information about general but really

important terminology :

BRIDGES:

If I have missing tooth, shall I have do bridge directly or shall I think of

something else (like implant, partial denture)??

==Taking Decision more important than Making Restoration==

Some Terms:

Bridges:

Is prosthesis to replace a missing tooth using adjacent teeth so we have to

prepare the adjacent teeth.

Abutment: The tooth which is prepared(adjacent teeth) we call it

Abutment.

Retainer :The crown over the prepared teeth we call it Retainer.

Pontic: The prosthesis that replace the missing tooth we call it Pontic.

Connecter: The attachment between the Retainer and Pontic we call it

Connecter.

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In bridge also we have

-full ceramic

-full metal

- ceramometal

-resin bonded bridge

we don’t prepare the whole tooth (the best choice after the

implant)

Implant:

Is titanium metal, drilled by the surgeon inside the bone. we leave it for 3

mon to reach the osteointegration, (the bone and titanium integrate

together) after that you do crown or bridge.

In implant I don’t need to prepare the adjacent teeth..

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Some pt will refuse to put partial denture so we go for implants then fixed

bridges.

Year by year partial denture is disappearing.

Other classification of bridge:

1st type of bridge Fixed Fixed

one unite connect to each other.

2nd type of bridge Fixed Movable

2 pieces attached to each other… here we have

attachment, and we have several type of attachment

(rational attachment, stress breaker…)

3rd type of bridge Resin bonded bridge

cuz it is cemented with resin cement

or called Minimal Preparation of Bridge (not accurate

name cuz some theories said that we can do it without bridge !!

some books call it marinnan.

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The advantage of Resin Bonded Bridge that when we have sound teeth

and I want to prepare it to make bridge we do minimal preparation for

the teeth in the palatal side, the shape of it is metal wing, metal wing like

butterfly on the palatal side.

The advantage of replacing missing teeth:

1st appearance by replacing the missing teeth

2nd occlusal stability:

if we extract for ex lower 6, the lower 7 and 5 will have drifting

and the upper opposing teeth they will have supra eruption

This is what we call occlusal instability to prevent that happened we

make bridge for the missing tooth.

Sometime the pt have occlusal stability and he have a missing teeth

and he doesn’t have TMJ problem, he looks fine

in this case he doesn’t have to put bridge

3rd The Ability to Eat

4th speak and phonetics >>

when you do crown and bridge for anterior teeth and you

don’t be meticulous and you and the dental laboratory don’t

work in perfect manner especially in the palatal side over

contoured.

5th periodontal splinting:

Ex canine is sound and lateral is mobile

some dentists connect the 2 teeth together to prevent the

mobility. The dr don’t agree in this. but it is in many books

and some dentists do that .

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6th feeling of competence:

to be the set of teeth complete this help the pt to be comfortable

when he speak and laugh …

7th orthodontic retention:

suppose canine not in the right position and you distalized it (send it

distally)

may be relapse would happened you can do bridge between

centrals and canine to prevent any canine movement

8th to restore the vertical dimension

Freeway space is more than normal we may need crowns

9th wind instrument (who play on xylophone )

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we finish the advantage , Now what are the disadvantage?

Disadvantage Of Crown And Bridge:

1st preparing the teeth

It may lead to pulp exposer.

((you have to be responsible when you treat your pt if you see a

filling before you remove it. Ask yourself can I make better than the

old one if you’re not you will waste the time, take extra tooth

structure and extra money for nothing))

2nd artificial margins:

When we put the crown we will have artificial margins which may

accumulate the black leads to caries.

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3rd Failures:

May be immediate failure or later (if later then you do something

excepted to failed )

4th effect on the periodontum:

(if you remember the fatal mistake in amalgam is OVER HANG “not

carving” the reason in almost cases is the student don’t put the wedge ))

5th cost and discomfort:

In Britain the cost of one bridge is 350 bound

if the pt has more than one bridge the cost will be high for him and

failure will not be acceptable for him.

you have destroy his teeth and his pocket here he was have a

problem and you make it bigger .. the pt when he bite.. he had pain

cuz of high spot you made it.

The Choice Between The Removable And Fixed Prosthesis:

both are prostheses the pt is the one who will drive the factors for

the right choice

1st factor pt care:

Some pt doesn’t care of appearance other pt they care

2nd factor age and gender:

some thinks said that female who look for something fixed

and nice

Also male after age of 18 (philosophy of growth )!!

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3rd confidant:

like person on TV (interviewer).

4th oral hygiene:

Pt who has poor oral hygiene we give him oral hygiene

instruction

If you have to choice bt the denture and bridge the choice will

be the bridge cuz

The denture covers more soft tissue while bridge will cover

less area

5th local (!) consideration

if I have mobile teeth the choice may be removable every

single case has its own way to solve.

>>> Done By Seba Hawass

Documents

1)Indications for Crown & bridges.pdf