Scope and limitations in fdp / orthodontics training courses

SCOPE AND SCOPE AND LIMITATIONS OF LIMITATIONS OF FIXED PARTIAL FIXED PARTIAL

DENTURESDENTURESINDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

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IntroductionIntroduction ScopeScope HistoryHistory IndicationsIndications LimitationsLimitations Latest conceptsLatest concepts conclusionconclusion


IntroductionIntroduction



Fixed prosthodontics is the art and Fixed prosthodontics is the art and science of restoring damaged teeth with science of restoring damaged teeth with cast metal or porcelain restorations and cast metal or porcelain restorations and of replacing missing teeth with fixed or of replacing missing teeth with fixed or cemented prosthesiscemented prosthesis

A FPD is that which is luted or otherwise A FPD is that which is luted or otherwise securely retained to natural teeth or securely retained to natural teeth or dental implant abutments that furnish dental implant abutments that furnish the primary support for the prosthesisthe primary support for the prosthesis


Fixed prosthodontics is predicated on Fixed prosthodontics is predicated on accomplishing precise and clinically accomplishing precise and clinically accurate operative techniques based on accurate operative techniques based on sound biological and mechanical sound biological and mechanical principles.principles.

Clinical decisions must be made to Clinical decisions must be made to

achieve sound aesthetic and functional achieve sound aesthetic and functional goals within the limitations of available goals within the limitations of available restorative materialsrestorative materials


SCOPESCOPE


The scope of fixed prosthodontic The scope of fixed prosthodontic treatment can range from the treatment can range from the restoration of a single tooth to the restoration of a single tooth to the rehabilitation of entire occlusion.rehabilitation of entire occlusion.

A single tooth can be restored to full A single tooth can be restored to full function and improvement in function and improvement in cosmetic effect can be achievedcosmetic effect can be achieved



Replacement of missing tooth with Replacement of missing tooth with fixed prosthesis improvesfixed prosthesis improves

-patient comfort-patient comfort

-masticatory ability-masticatory ability

-elevates patient self image-elevates patient self image

-occlusal harmony-occlusal harmony


Fixed restorations render Fixed restorations render supportive and long range corrective supportive and long range corrective measures for the treatment of measures for the treatment of problems related to TMJ and its problems related to TMJ and its neuromuscular components.neuromuscular components.


HISTORYHISTORY


Around 300 B.C. [Saida], it was found Around 300 B.C. [Saida], it was found an exact phoenician specimen an exact phoenician specimen consisting of gold wire fastened consisting of gold wire fastened around six lower anterior teeth with around six lower anterior teeth with two incisors being pontics and extra two incisors being pontics and extra wires passing through the roots of wires passing through the roots of natural teeth while another set of wires natural teeth while another set of wires band together the incisor edges to the band together the incisor edges to the end of the root and attaching an end of the root and attaching an artificial tooth to it.artificial tooth to it.



Pierre Fauchard, Father of Modern Pierre Fauchard, Father of Modern Dentistry, used single tooth to full set , Dentistry, used single tooth to full set , called tendons, like pivots or dowels called tendons, like pivots or dowels screwed into root to retain bridgescrewed into root to retain bridge

In late 1850s-Crown and Bridge-FrenchIn late 1850s-Crown and Bridge-French

B.J. Bing in 1871 -an artificial porcelain B.J. Bing in 1871 -an artificial porcelain tooth, with a platinum bar extended tooth, with a platinum bar extended from each lateral side and the ends from each lateral side and the ends were anchored in fillings of adjacent were anchored in fillings of adjacent natural teethnatural teeth


J.B. Beers in 1873 patented a gold J.B. Beers in 1873 patented a gold banded crown and swaged cusps banded crown and swaged cusps

A.E. Mattesson in 1878 - open faced A.E. Mattesson in 1878 - open faced crowncrown

In 1886, ion fusing porcelain fixed in In 1886, ion fusing porcelain fixed in a gold matrix a gold matrix

C.H. Land of detroit in 1889 - method C.H. Land of detroit in 1889 - method of construction of full porcelain of construction of full porcelain veneer crownsveneer crowns


In 1900’s high fusing porcelain was In 1900’s high fusing porcelain was employed.employed.


Early developments of 20Early developments of 20thth centurycentury

In 1906 Car Michael - Partial veneer In 1906 Car Michael - Partial veneer gold crowngold crown

William H. Taggart in 1907 -method William H. Taggart in 1907 -method of making gold castings using a of making gold castings using a disappearing wax pattern method disappearing wax pattern method and made possible exceptional and made possible exceptional refinements in the construction of refinements in the construction of FPDsFPDs


By 1910 -the casting method was in By 1910 -the casting method was in general use and largely facilitated the general use and largely facilitated the development of ¾ veneer gold crown development of ¾ veneer gold crown which became popular as anterior which became popular as anterior bridge retainer bridge retainer

Karl K. in 1918 - crown and bridge Karl K. in 1918 - crown and bridge work for preserving the normal work for preserving the normal function of the organs and of all the function of the organs and of all the individual teeth and its success to a individual teeth and its success to a normal functionnormal function


Mauk in 1919 - the various principles Mauk in 1919 - the various principles upon which crown and bridge work upon which crown and bridge work type treatment is to be constructedtype treatment is to be constructed

Forrest H. Orton in 1919 - the Forrest H. Orton in 1919 - the importance of occlusion and importance of occlusion and anatomic form in the construction of anatomic form in the construction of prosthesisprosthesis


Further developmentsFurther developments

C.H. Schreau in 1932 -33 - a technique C.H. Schreau in 1932 -33 - a technique employing hygroscopic expansion of employing hygroscopic expansion of investment to compensate for casting investment to compensate for casting shrinkage shrinkage

Volland, Schean, Hollenbach in 1935-40 Volland, Schean, Hollenbach in 1935-40 -culminated , our present hygroscopic -culminated , our present hygroscopic expansion technique employing vacuum expansion technique employing vacuum for mixing and investing inlaysfor mixing and investing inlays


H. Spiro in 1933 - the hydrocolloid H. Spiro in 1933 - the hydrocolloid impression technique for inlays, impression technique for inlays, crowns and FPDscrowns and FPDs

Sears, Thompson, Skinner, Cropper Sears, Thompson, Skinner, Cropper and Beck conducted further and Beck conducted further research and resulted in our present research and resulted in our present day indirect techniques for crown day indirect techniques for crown and bridgeand bridge


In 1951-64 -Introduction of mercaptan In 1951-64 -Introduction of mercaptan and silicon impression materials, and silicon impression materials, carbide burrs, ultra high speed hand carbide burrs, ultra high speed hand piece and Girotors.piece and Girotors.

In 1965-70 In 1965-70 - Refinement of methods for pin type of Refinement of methods for pin type of

retainersretainers- Improved crystals for cast gold alloyImproved crystals for cast gold alloy- Development of increased temperature Development of increased temperature

refractory die materials and aluminous refractory die materials and aluminous porcelainporcelain


- Improvements in vacuum fixed ceramicsImprovements in vacuum fixed ceramics

- Improvements in gnathologic Improvements in gnathologic instruments and techniquesinstruments and techniques

The 1990s :The 1990s :- All ceramic systems for complete and All ceramic systems for complete and

partial coverage restorations partial coverage restorations

- The movement away from a polysulfide The movement away from a polysulfide rubber base to polyether and addition rubber base to polyether and addition siliconessilicones


IndicationsIndications


General considerations:General considerations:

-Attitude of the patient to dentistry-Attitude of the patient to dentistry

It is the most important factor in It is the most important factor in deciding whether or not a bridge deciding whether or not a bridge should be placed for patientsshould be placed for patients

-Oral hygiene-Oral hygiene

Poor oral hygiene indicates an Poor oral hygiene indicates an

indifferent attitude to dentistryindifferent attitude to dentistry


General Indications:General Indications:

-psychological-psychological

Wearing a denture is felt by many to be a Wearing a denture is felt by many to be a sign of increasing agesign of increasing age

The fitting of a bridge will bring The fitting of a bridge will bring psychological benefit to these patients psychological benefit to these patients and can vastly improve the esthetic or and can vastly improve the esthetic or functional needsfunctional needs


-Systemic disease-Systemic disease

When a patient is suffering from When a patient is suffering from sudden bouts of unconsciousness, as sudden bouts of unconsciousness, as in epilepsy, any form of removable in epilepsy, any form of removable appliance is contraindicatedappliance is contraindicated


-Orthodontic considerations-Orthodontic considerations

Orthodontics is of value in Orthodontics is of value in repositioning teeth prior to repositioning teeth prior to placement of prosthesis and placement of prosthesis and provides a more positive location of provides a more positive location of teeth than any other methodteeth than any other method


Periodontal reasons:Periodontal reasons: Teeth which are mobile or tending to Teeth which are mobile or tending to

drift, the ideal way of achieving their drift, the ideal way of achieving their stabilization is by using fixed splintstabilization is by using fixed splint

It avoids supraeruption, resultant It avoids supraeruption, resultant bone loss and evenly distributes the bone loss and evenly distributes the forces over several teethforces over several teeth

Mobile teeth have been prepared with cingulum rests to help support an extracoronal

composite-resin-based splint

A composite -resin-based splint has been fabricated from DiamondCrown material.

Diamond Crown splint has been cemented (bonded) under rubber dam isolation.


SpeechSpeech

Replacement of one or more of the Replacement of one or more of the missing teeth by any prosthesis may missing teeth by any prosthesis may assist in correction of a speech defect, assist in correction of a speech defect, but the bulk of a removable prosthesis is but the bulk of a removable prosthesis is often such that it may induce further often such that it may induce further difficulties in this respectdifficulties in this respect

With a bridge the size of the prosthesis is With a bridge the size of the prosthesis is usually very similar to that of teeth it usually very similar to that of teeth it replaces and rarely causes any speech replaces and rarely causes any speech problemproblem


Function and StabilityFunction and Stability

Greater stability imparted to Greater stability imparted to prosthesis by being positively fixed prosthesis by being positively fixed is of considerable benefit to the is of considerable benefit to the patient psychologically. It also patient psychologically. It also provides them better function than provides them better function than with most removable applianceswith most removable appliances


Local indications:Local indications:

Teeth suitable for abutments which Teeth suitable for abutments which require restorationrequire restoration

Where teeth which would be suitable as Where teeth which would be suitable as bridge abutments require restorations bridge abutments require restorations possibly by crowning a bridge may be possibly by crowning a bridge may be indicated. They must be the teeth most indicated. They must be the teeth most suitable for the purpose with no doubts suitable for the purpose with no doubts regarding their prognosisregarding their prognosis


-Lack of space for suitable replacement-Lack of space for suitable replacement

Loss of space due to drifting of adjacent Loss of space due to drifting of adjacent teeth may render the placing of an teeth may render the placing of an esthetically satisfactory prosthesis esthetically satisfactory prosthesis extremely difficult. However, with a extremely difficult. However, with a bridge particularly if the abutment teeth bridge particularly if the abutment teeth are to be crowned, some space may be are to be crowned, some space may be regained by reducing the size or altering regained by reducing the size or altering the shape and thus allowing more room the shape and thus allowing more room for a satisfactory ponticfor a satisfactory pontic


-Abutment teeth morphology to be -Abutment teeth morphology to be changedchanged

In this case bridge is normally indicatedIn this case bridge is normally indicated

-Unfavorable angulation of teeth for -Unfavorable angulation of teeth for removable prosthesisremovable prosthesis

When teeth are badly fitted a removable When teeth are badly fitted a removable prosthesis may be contraindicated as it prosthesis may be contraindicated as it does not fill the resultant undercuts does not fill the resultant undercuts and will give rise to food stagnationand will give rise to food stagnation


LimitationsLimitations

-General Limitations-General Limitations Inability of patient to cooperateInability of patient to cooperatePatient may be unable to withstand Patient may be unable to withstand

prolonged operative procedures due to prolonged operative procedures due to psychological or medical reasonspsychological or medical reasons

Age of the patientAge of the patientToo young or too old patient is usually not Too young or too old patient is usually not

selected for FPD treatment. In young selected for FPD treatment. In young patients prognosis is poor because of patients prognosis is poor because of short clinical crowns and large pulp short clinical crowns and large pulp chamberschambers


In case of very old ,it is very difficult In case of very old ,it is very difficult to conduct prolonged operative to conduct prolonged operative procedures. However, there are procedures. However, there are certain conditions affecting FPD certain conditions affecting FPD treatment for older adults and treatment for older adults and treatment plan has to be modified treatment plan has to be modified accordinglyaccordingly

-Patients with contraindications to -Patients with contraindications to local analgesialocal analgesia

-High caries rate-High caries ratewww.indiandentalacademy.com

-Gingival and Periodontal -Gingival and Periodontal considerationsconsiderations

Fixed prosthodontic treatment is Fixed prosthodontic treatment is contraindicated in patients suffering contraindicated in patients suffering from gingival hyperplasia such as from gingival hyperplasia such as those caused by dilantin, because those caused by dilantin, because proliferation of gingival tissues proliferation of gingival tissues around the bridge invariably occursaround the bridge invariably occurs


Usually supragingival margins are advocated for Usually supragingival margins are advocated for crowns. But subgingival margins are justified crowns. But subgingival margins are justified sometimes for several reasons such assometimes for several reasons such as

Subgingival cariesSubgingival caries Extension of margins on sound tooth structure Extension of margins on sound tooth structure

beyond existing restorations or abrasion beyond existing restorations or abrasion cavitiescavities

To increase resistance and retention form for To increase resistance and retention form for short clinical crownsshort clinical crowns

For esthetic reasonsFor esthetic reasons


-Local factors limiting the use of a bridge:-Local factors limiting the use of a bridge: Prognosis of abutment teeth:Prognosis of abutment teeth:

Factors can be divided into those affecting Factors can be divided into those affecting the crown and those concerning the rootthe crown and those concerning the root

Factors affecting the crown include:Factors affecting the crown include:

Strength of the crown,extent and position of Strength of the crown,extent and position of caries and its restorability,whether caries and its restorability,whether adequate retention can be obtained which adequate retention can be obtained which depends on length,shape and size of the depends on length,shape and size of the crown.crown.


Factors concerning the root includeFactors concerning the root includeApical conditionApical conditionEffective root surface areaEffective root surface areaPeriodontal condition of the toothPeriodontal condition of the tooth Length of spanLength of spanThe longer the span, the greater the The longer the span, the greater the

load which will be placed on the load which will be placed on the abutment teeth and obviously there abutment teeth and obviously there comes a stage where a removable comes a stage where a removable prosthesis is indicated so as to attain prosthesis is indicated so as to attain some degree of tissue supportsome degree of tissue supportwww.indiandentalacademy.com

Possibility of further tooth loss in the Possibility of further tooth loss in the same archsame arch

Ridge form and tissue lossRidge form and tissue loss Unfavorable fitting or rotation of the Unfavorable fitting or rotation of the

teethteeth Maintenance and repairMaintenance and repair


Latest ConceptsLatest Concepts

The scope of FPD treatment has The scope of FPD treatment has reached new heights as refinements reached new heights as refinements continue to take place with materials continue to take place with materials in our present fixed prosthodontic in our present fixed prosthodontic inventoryinventory

These refinements have widened the These refinements have widened the dentist treatment options for dentist treatment options for patients who otherwise would have patients who otherwise would have been a handicap for FPD service and been a handicap for FPD service and resort to other alternativesresort to other alternatives


Introduction of implants:Introduction of implants: Partial edentulism has traditionally been Partial edentulism has traditionally been

treated with removable partial dentures when treated with removable partial dentures when the natural dentition is insufficient to support the natural dentition is insufficient to support the conventional fixed prosthesisthe conventional fixed prosthesis

RPDs increase the potential for tissue RPDs increase the potential for tissue irritation because of prosthesis movement, irritation because of prosthesis movement, nonphysiological forces generated on tooth nonphysiological forces generated on tooth abutments, esthetics compromise caused by abutments, esthetics compromise caused by retentive elements and psychological retentive elements and psychological adjustments to wearing a removable adjustments to wearing a removable prosthesisprosthesis


The fixed implant retained The fixed implant retained prosthesis compensates for the prosthesis compensates for the disadvantages of an RPD by disadvantages of an RPD by eliminating prosthesis movement, eliminating prosthesis movement, dependency on natural dentition for dependency on natural dentition for retention and stigma of a removable retention and stigma of a removable prosthesisprosthesis


Tooth supported FPDs also provides Tooth supported FPDs also provides functional and esthetic replacements functional and esthetic replacements for the missing. Fixed implant for the missing. Fixed implant retained prosthesis spares sound retained prosthesis spares sound teeth from preparation and is not teeth from preparation and is not susceptible to decay. However, susceptible to decay. However, implant loss and component implant loss and component breakage are possible complications breakage are possible complications of this.of this.


Newer materials like Titanium and their Newer materials like Titanium and their alloys, Palladium-gallium-silver, Palladium-alloys, Palladium-gallium-silver, Palladium-gallium, silver-gold alloys and Aluminum-gallium, silver-gold alloys and Aluminum-bronze alloys have been introducedbronze alloys have been introduced

The use of titanium as an economical and The use of titanium as an economical and biocompatible replacement for the existing biocompatible replacement for the existing alloys because of its excellent alloys because of its excellent biocompatibility, biocompatibility,

corrosion resistance and desirable physical corrosion resistance and desirable physical and mechanical properties ,have decreased and mechanical properties ,have decreased the use of other alloys especially the Nickel-the use of other alloys especially the Nickel-containing alloys which tends to cause containing alloys which tends to cause allergic reactions in some patientsallergic reactions in some patients


Intoduction of lasers have given new Intoduction of lasers have given new scope for tissue management and scope for tissue management and biomechanical preparations of crownsbiomechanical preparations of crowns

Most recent alternatives to cast metal Most recent alternatives to cast metal technology has been CAD-CAM technology has been CAD-CAM process which has been introduced process which has been introduced for imaging of prepared for imaging of prepared teeth,determine shape and size of teeth,determine shape and size of restorations for crown peparationsrestorations for crown peparations


ConclusionConclusion Any restoration aiming to fulfill one’s Any restoration aiming to fulfill one’s

highest conception must become an highest conception must become an accurate physiological, anatomical and accurate physiological, anatomical and biological as well as mechanical substitute biological as well as mechanical substitute for lost membersfor lost members

The ideal restoration is one which restores The ideal restoration is one which restores natural function, health, anatomy and natural function, health, anatomy and appearance of lost structures .The fixed appearance of lost structures .The fixed bridge can more nearly approach this ideal bridge can more nearly approach this ideal than any other prosthetic restorationthan any other prosthetic restoration



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Scope and limitations in fdp / orthodontics training courses