A prosthodontist is a dentist with an additional 3 years of specialized training.
Fixed prosthodontics is also known as “crown and bridge.” Fixed prosthetics require good home care by the patient. The supportive tissues must be healthy, because they will be supporting the bridge.
Would a patient with severe periodontal disease be good candidates for fixed prostheses? Why or why not? If suitable abutment teeth are not present, what is another option for the patient? (Removable prosthesis or implants.)
Cast restorations are also known as indirect restorations. They are fabricated outside the patient’s mouth, in a dental laboratory. Where is the proximal surface? Why can’t veneers be placed on posterior teeth?
An inlay involves the proximal surface and only a portion of the occlusal surface.
An onlay involves the proximal surface and most or all of the occlusal surface. Cusp tips are involved.
Veneers are placed to cover defects such as hypocalcification and intrinsic stains. What is an intrinsic stain? (A stain that comes from the inside.) An opaquer may be used to block out any underlying color or structural defects. The cement used for veneers may also be shaded to enhance the color match. What is the best lighting for shade selection?
Full crowns are used when a tooth has decay so severe that reconstruction cannot be performed with the use of a direct restoration. The facial surface is not involved in the preparation of three-quarter crowns; this technique is not commonly used. With a PFM, porcelain is added for aesthetic reasons and matched to natural teeth.
Which anterior tooth might this be? (Canine.) The metal “ring” is healthier for the gum tissue because it is not as “bulky” as the porcelain fused to metal.
A porcelain jacket crown is a very thin metal shell covered by layers of porcelain to resemble the shading and translucence of the enamel of a natural tooth. A fixed bridge contains a series of two or more units and is cemented permanently in place. Winglike extensions of the resin-bonded bridge are bonded onto the lingual surfaces of the teeth adjacent to the missing tooth.
How many units are involved in this bridge? What are the components of the bridge? ( Two pontics, two abutments. ) Which teeth are being replaced?
This is an example of a Maryland bridge. Wings are bonded onto the lingual surfaces of the adjacent teeth. Would a Maryland bridge be placed on the posterior teeth? Why or why not?
Shade selection should be performed before anesthetic is administered. Unfortunately, there are times when the initial shade selection does not match at the final appointment. Reselection of a shade must be done. Some dental labs have the patient come to the lab for a custom shade.
The gingival margins are designed to provide a smooth junction of the edge of the restoration to the tooth. What is a bevel? What is a chamfer? What is a shoulder?
Pins are placed before the core buildup. Post-and-core can only be used on teeth that have been endodontically treated. A cast post is made from an acrylic pattern and fabricated by a dental lab technician. Not all teeth require pin retention for a core buildup. What material is used for a core buildup? What is a prefabricated post made of? (Titanium and titanium alloys.)
Gingival retraction cords come in a variety of sizes (thicknesses). They are available twisted, untwisted, and braided. Impregnated cords contain a vasoconstrictor. What is a vasoconstrictor? What medical conditions would contraindicate the use of impregnated retraction cord? A hemostatic solution is used to control bleeding.
Retraction cord is positioned around the prepared tooth. Transfer is performed with the use of cotton pliers. Packing is easier when the tissues are dry. Typically, hemostatic solution is placed after the cord has been successfully packed, but sometimes bleeding needs to be controlled before placement of the cord or as the cord is being placed. Some cords come presoaked in a hemostatic agent.
The final impression must be accurate to prevent the dental laboratory technicians from fabricating the restoration according to an inaccurate impression (which will require additional appointments for the patient). Always ask the dentist which type of elastomeric material will be used for the final impression. Dentists usually use one to three types of material (one or two for crown and bridge impressions and one for denture impressions).
Why is it necessary to obtain a bite registration? (To show the dental laboratory technicians the relationship between the arches.)
The temporary is made to last long enough for the dental laboratory technicians to fabricate the permanent restoration. Good contact and occlusion are important in the fabrication of a provisional restoration. What might happen if the provisional temporary does not have good contact with the adjacent teeth? ( Drifting. ) What are the postoperative instructions for care of the provisional temporary?
The shade should be checked before cementation. The cement is placed on the inside of the restoration and transferred to the dentist for placement. What types of cement are used? Why would the restoration be cemented temporarily?
Fixed prosthetics must be taken care of just as normal teeth are. If symptoms do not subside, the patient should be instructed to contact the office immediately. Is it normal for a patient to experience slight temperature sensitivity after the crown has been placed?
Lab slips may be filled out by the dental assistant. Always have the dentist check the slip before sending it out to the dental laboratory. The slip should be filled out completely.