Resin bonded prosthesis /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
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Resin bonded prosthesis /certified fixed orthodontic courses by Indian dental academy

  1. 1. RESIN BONDED PROSTHESIS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Contents Introduction Acid etching of enamel Evolution of Resin Bonded Prosthesis 1. Bonded pontics 2. Cast perforated-fpd 3. Etched cast fpd 4. Macro mehanical retention fpd 5. Cast mesh fpd 6. Adhesion bridges 7. Fibre reinforced composite resin fpd 8. Fung shells www.indiandentalacademy.com
  3. 3. Advantages Disadvantages Indications Contraindications Design concepts Selection of abutments Impression procedure Lab procedure Bonding Cements Longevity and scope Summary and conclusion Refrences www.indiandentalacademy.com
  4. 4. Introduction www.indiandentalacademy.com
  5. 5. Acid etching of enamel Buonocore (1955)-showed that acrylic resin can be attached to human enamel in-vivo simply by acid etching enamel with 85% phosphoric acid for 30 secs  Larege increase in surface area  Exposure of organic frame work  Removal of inert enamel  Absorbed layer of highly polar phosphate groups www.indiandentalacademy.com
  6. 6. SILVERSTONE: Loss of surface contour & Creation of a porous subsurface layer Use of acid of strength 30-40% 10 micron loss of surface contour and 20 micron depth of histologic change www.indiandentalacademy.com
  7. 7. Types of etching patterns www.indiandentalacademy.com
  8. 8. EVOLUTION OF RESIN BONDED PROSTHESIS        Bonded Pontics Cast Perforated Resin Retained FPD’s Etched Cast Resin Retained FPD’s Macroscopic Mechanical Retention Resin Retained FPD’s Cast Mesh FPD’s Chemical Bonding Resin Retained FPD’s Fibre Reinforced Composite Resin FPD’s www.indiandentalacademy.com
  9. 9. Bonded Pontics ACRYLIC RESIN DENTURE TOOTH Advocated by Ibsen (1974) and Buonocore in (1975) www.indiandentalacademy.com
  10. 10.  Composite resin crowns SIMONSEN :1978 www.indiandentalacademy.com
  11. 11. Natural Tooth Pontic Simonsen, Davilla and Gwinnet www.indiandentalacademy.com
  12. 12. Disadvantages     Composite resins were brittle They required supporting wire or stainless steel mesh framework. Their use is limited to short anterior spans. Limited lifetime with debonding of resin and subsequent fracture. www.indiandentalacademy.com
  13. 13. CAST PERFORATED RESIN BONDED FPD (ROCHETTE BRIDGE) www.indiandentalacademy.com
  14. 14. HOWE AND DENEHY (1977)   Perforated lingual coverage . Mechanical retention www.indiandentalacademy.com
  15. 15.  Replacement of posterior teeth –Livaditis  Extension – interproximally and onto occlusal surfaces.  Tooth modification  Survival rate -3 years www.indiandentalacademy.com
  16. 16. Drawbacks     Failure through the resin projections into the perforations Wear of composite resin Weakening of alloy framework Thick lingual retainers www.indiandentalacademy.com
  17. 17. Etched Cast Resin Retained FPDs (Maryland Bridge) Dunn Reisbick (1976)  Tanaka et al (1979)  Livaditis and Thompson (1980)…University of Maryland  www.indiandentalacademy.com
  18. 18.        Livaditis and Thompson in 1980 at the university of Maryland. Study for etching conditions of non berrylium Ni-Cr alloys. Nitric acid : 0.5 N Current : 250 mA/sq cm Time : 5 minutes Immersion in 18% Hcl for 10 minutes Micromechanical retention www.indiandentalacademy.com
  19. 19. Resin-alloy bond strength:27.3 M pa www.indiandentalacademy.com
  20. 20. Etching apparatus  Electrodes: 0.036 inches stainless steel orthodontic wire or a copper wire 12-14 gauge  Electrolytes used vary according to metal type. Ni-Cr Be alloys : 10% sulphuric acid. Ni-Cr/Co-Cr : 3.5% nitric acid.  D.C. power supply www.indiandentalacademy.com
  21. 21. Etching Process     Two step etching technique. Insulation of areas not being etched. Electrode assembly submerged in a bath of electrolyte. The current is adjusted to the calculated level. www.indiandentalacademy.com
  22. 22.  . Etching process www.indiandentalacademy.com
  23. 23. www.indiandentalacademy.com
  24. 24. One step etching process       Proposed by Mclaughlin Electrolyte and cleaning solution were both combined and placed in the ultra sonic bath. Time saving – 110 secs Less equipment required Etched metal surface was brighter No difference in bond strength. www.indiandentalacademy.com
  25. 25. DRAWBACKS      Technique sensitive Lab dependent Varies with metal type Prone to contamination Cannot be done with noble metal alloys www.indiandentalacademy.com
  26. 26. Chemical Etching     Livaditis suggested a non electrolytic technique for etching a nickel-chromium beryllium alloy Placed in an etching solution for one hour in a water bath at 70 degrees centigrade Doukoudakis proposed the use of a stable aqua regia gel Advantage – no special equipment www.indiandentalacademy.com
  27. 27. Macroscopic Mechanical Retention Resin Retained FPDs        Developed by Moon & Hudgins et al Virginia Commonwealth university school of dentistry also called the Virginia bridge Lost salt technique Salt crystal size 150-250 microns Adequate bond strength Any metal ceramic alloy Increased thickness of retainers www.indiandentalacademy.com
  28. 28. Cast Mesh FPD www.indiandentalacademy.com
  29. 29. Chemical Bonding Resin Retained FPDs        Adhesion bridges Surface treatment of metals Sand blasting Tiller et al (1985) Used alumina (50 microns) for sand blasting Concluded sandblasting results in a highly activated metal surface Demonstrated increased wettability of the surface www.indiandentalacademy.com
  30. 30. Silicoater Classical        Tiller et al (1984) Procedure – sand blasting of alloy Flame coating of silicon oxide for 5 minutes Disadvantage – expensive Uneven distribution of flame Chemically unstable silica layers Protection of the layer formed www.indiandentalacademy.com
  31. 31. Silicoater MD (metal dotted)  Tiller et al (1990)  Baking of chromium oxide dotted silica layer www.indiandentalacademy.com
  32. 32. Rocatec System       Introduced in 1989 Tribochemical application of silica layer by sand blasting Sand blasting with 110 microns alumina at a pressure of 0.25 Mpa Sand blasting with 110 microns aluminium oxide modified with silicic acid Speed and accuracy thermal stressing avoided www.indiandentalacademy.com
  33. 33. www.indiandentalacademy.com
  34. 34. Tin Plating    Done on noble metal alloys Requires particle abrasion of the alloy surface Uses a tin amide solution www.indiandentalacademy.com
  35. 35. Fiber Reinforced Composite Resin FPD     Consists of a fibre reinforced substructure Veneered with composite material Increased flexural strength , fracture resistance & increased tensile strength Transluscent www.indiandentalacademy.com
  36. 36. Types Of Fibres  Glass  Polyethylene  Polypropylene  carbon www.indiandentalacademy.com
  37. 37. Orientation of the fibre  Unidirectional  Braided  Woven www.indiandentalacademy.com
  38. 38. Non impregnated materials  Polyethylene weaves- ribbond & connect  Glass weaves- glasspan  Hand formed Pre impregnated & machine formed  Uni directional & woven glass eg vectris Pre impregnated & hand formed  Uni directional glass eg fiberkor www.indiandentalacademy.com
  39. 39. www.indiandentalacademy.com
  40. 40. Procedure      Preparation of abutment teeth Measurement of fiber length Moistening of fiber Fiber bar pressed into the preparation & polymerised with resin Pontic build up & curing www.indiandentalacademy.com
  41. 41. www.indiandentalacademy.com
  42. 42. Fung shells www.indiandentalacademy.com
  43. 43. www.indiandentalacademy.com
  44. 44.     The slots in the proximal surface of adjacent teeth are prepared 1.5 mm towards pulp cavity and 0.5 mm gingivally as an interlocking mechanism. This type of preparation will prevent gingival movement of the bridge as well as provide retention. The bridge post is then inserted into the pontic channel in the fung shell provided and slide into the prepared abutment teeth, and adjustments are made accordingly. The fung shell can be adjusted for proper contact with tissues with a bur. The fung shell bridge is cemented using light curing composite, and finished and polished. www.indiandentalacademy.com
  45. 45. Advantages       It is of lower cost compared to custom made resin – bonded bridges. Simple to make, not time consuming hardly takes a few minutes. No need of impression making and laboratory work. Can be given to patient in a single appointment. Good esthetics no exposure of metal in proximal areas. Longevity comparable to resin bonded bridges www.indiandentalacademy.com
  46. 46. Advantages of resin bonded prosthesis  Conservation of tooth structure  Lack of pulpal involvement  No anaesthesia required  Minimum periodontal involvement www.indiandentalacademy.com
  47. 47.  Simplified impression procedures  Improved esthetics  Provisionals not usually required  Possibility of rebonding www.indiandentalacademy.com
  48. 48. Disadvantages  Irreversible  Uncertain longevity  No space corrections  Good alignment of abutments is required www.indiandentalacademy.com
  49. 49.  Plaque accumulation  Esthetics compromised on posterior teeth  Incisal graying  Dependence on laboratory www.indiandentalacademy.com
  50. 50. Indications  Replacement of missing anterior teeth in children and adolescents  Caries free abutment teeth or unrestored abutments  Mandibular incisor replacement www.indiandentalacademy.com
  51. 51.  Maxillary incisor replacement  Periodontal splints  Post orthodontic stabilisation  Prolonged placement of interim prosthesis www.indiandentalacademy.com
  52. 52.  Prolonged placement of interim prosthesis  Single posterior tooth replacement  Significant clinical crown length  Excellent moisture control www.indiandentalacademy.com
  53. 53. Contraindications  Parafunctional habits  Long edentulous span  Extensive caries  Restored or damaged abutments www.indiandentalacademy.com
  54. 54.  Compromised enamel  Nickel sensitivity  Deep vertical overbite  Incisors with thin faciolingual dimensions www.indiandentalacademy.com
  55. 55. Abutment selection  Caries free  Periodontally sound  Adequate thickness of enamel  One abutment on either side www.indiandentalacademy.com
  56. 56. Posterior design principles  Distinct path of insertion  Proximal resistance form  Proximal wrap around  Maximum bonding area  Occlusal rest  Definite gingival margin www.indiandentalacademy.com
  57. 57.  2 plane reduction for maxillary molars  Extension of casting onto occlusal surfaces  Lingual cusp coverage  Onlay on tilted molars www.indiandentalacademy.com
  58. 58. www.indiandentalacademy.com
  59. 59. Posterior preparation sequence www.indiandentalacademy.com
  60. 60. Anterior design principles  Vertical path of insertion www.indiandentalacademy.com
  61. 61.       Proximal wrap around Extension of framework onto uninvolved marginal ridge Definite finish line Cingulum notches or counter sinks Grooves Existing restorations may be incorporated www.indiandentalacademy.com
  62. 62. Anterior preparation sequence www.indiandentalacademy.com
  63. 63. www.indiandentalacademy.com
  64. 64. Accurate impression procedure Temporary occlusal stops www.indiandentalacademy.com
  65. 65. Framework fabrication   Duplication of master cast Resin coping fabrication www.indiandentalacademy.com
  66. 66. www.indiandentalacademy.com
  67. 67. Bonding Procedure www.indiandentalacademy.com
  68. 68. Resin Cements  Greater cohesive strength 5000-10,000 psi  Insoluble in oral fluids  Higher film thickness www.indiandentalacademy.com
  69. 69. Two layer system  Unfilled resin monomer  Filled resin Commonly used resin cements  Epoxylite cba 9080  Comspan  Retain  Conclude Single paste composites www.indiandentalacademy.com
  70. 70. Cements with adhesion promoters PANAVIA Components: low viscosity paste, radio opaque composite resin paste Universal and catalyst Composition : Bisphenol-A-Polyethoxy dimetharyclate, MDP or 10-Methacrloxydecyl dihydrogen phosphate, 77%silanated organic fillers. www.indiandentalacademy.com
  71. 71. ED PRIMER: A and B liquids MDP,HEMA & 5NMSA OXYGUARD IIPolyethylene Glycol PANAVIA ETCHING AGENT Phosphoric acid gel www.indiandentalacademy.com
  72. 72.  Mixing time : 20-30 sces  Film thickness: 19 microns  Metal surface must be sandblasted or tin coated.  Recent version – PANAVIA F www.indiandentalacademy.com
  73. 73. C&B METABOND COMPOSITION: Methylmethacrylate polymer powder Mma liquid modified with 4-META or 4 Methacryloxyethyl Trimellitic Anhydride. Tri-n-Butyl Borane catalyst. Disadvantage-poor hydrolytic stability www.indiandentalacademy.com
  74. 74. Post operative care  Regular recall visits  Check for any debonding  Caries  Periodontal health www.indiandentalacademy.com
  75. 75. Longevity and scope The most common resin- bonded prosthesis complications are shown below. Nature of failure Mean incidence Debonding Tooth discoloration Caries Porcelain fracture Periodontal disease No. of prosthesis studied/affected 7029/1481 21% 343/62 18% 3426/242 7% 1126/38 3% 748/0 0% www.indiandentalacademy.com
  76. 76. Summary  Patient selection  Tooth preparation  Accurate impression  Careful laboratory technique  Use of a good adhesive agent www.indiandentalacademy.com
  77. 77. Conclusion One of the basic principles of tooth preparation for fixed prosthodontics is conservation of tooth struc­ture. This is the primary advantage of resin-retained fixed partial dentures. Precision and attention to de­tail are just as important in the success of the prosthesis. www.indiandentalacademy.com
  78. 78. Refrences    Malone W.F.P, Roth D.I. Tylman’s Theory and Practice of fixed Prosthodontics. VIII Edition, AIPD publications, page 219. T. Shillinburg. Fundamentals of Fixed Prosthodontics, II edition, Quintessence publication, 2001, page 565. Rosenstiel, Land, Fujimoto. Contemperory Fixed Prosthodontics, III edition, Mosby Company, 2001, page 673. www.indiandentalacademy.com
  79. 79.    Goodacre C.J, Bernad G, et al. Clinical complications in Fixed Prosthodontics. J. Prosthet Dent. 2003; 90, 31-41. Livaditis G.A. Chemical etching system for creating micromechanical retention in resinbonded retainers. J Prosthet Dent 1987; 56, 181 Salam Sakal M.A et al. Effect of tooth preparation design on bond strengths of RBP.J Prosthet Dent 1997; 77, 243. www.indiandentalacademy.com
  80. 80.     Livaditis G.A. Chemical etching system for creating micromechanical retention in resin- bonded retainers. J Prosthet Dent 1987; 56, 181. Doukoudakis A et al. A new chemical method for etching metal frameworks of acid etched prosthesis. J Prosthet Dent 1987; 58, 421 Richard simonsen. Van thompson.gerald barrack. Etched cast restorations clinical and laboratory technique Gerald mclaughlin:direct bonded retainers www.indiandentalacademy.com
  81. 81. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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