Fixed dentures are dentures that are permanently fixed in the oral cavity and cannot be removed without help from a dentist. They can be permanently cemented to a patient's own teeth or implanted abutments, or mounted on pillar implants with screws allowing for removal. Common types of fixed dentures include crown inlays, cast dowel crowns, veneers, crowns, and prosthetic bridges. Proper preparation of abutment teeth is important for fixed dentures and involves reducing tooth tissues while maintaining anatomical shape and creating parallel axial walls slightly converging at the chamfer.

1. Fixed dentures
Nazima (Nena), Daria, Mehrpooya (Pooya), Zohaa

2. FIXED DENTURES
Fixed dentures are dentures permanently fixed in the oral cavity so that the patient is not able to remove the
permanent dentures from the oral cavity without the help of a doctor. Permanent dentures are permanently
fixed with cements on the patient's own teeth or on implanted abutments. They can also be mounted on
pillar implants with screws, which makes it possible to remove them, e.g. for the purpose of making
corrections or hygienization treatments

3. FIXED DENTURES
A. Crown inlays,
B. Cast dowel crowns
C. Veneers,
D. Crowns
E. Prosthetic bridges.

4. CROWN INLAYS
● By crown inlays we replace lost or damaged hard tissues of the tooth crown, which are impossible to
rebuild with the usage of conservative methods.
● Inserts are most often made of gold, silver-palladium alloys, compound materials and ceramics.
● The contemporary scope of application of crown inlays has significantly narrowed down, as the latest
generations of composite materials are largely matched by the durability requirements and aesthetics
of reconstructive tooth crowns after significant damage.

6. CAST DOWEL CROWNS
• These are structures used in cases of a significant degree of damage or complete destruction of natural
tooth crowns. They are fixed in a specially prepared root canal.
• The most important condition for their application is the endodontic treatment and lack of the pathological
periapical changes.
• They are most often used to fix crowns because of that they can be made of any type of material which is
approved in prosthetics and had strength requirements.
• Individually cast dowel crowns are partially replaced with ready-made stiffnesses.
• Ready-made sticks are the scaffolding for rebuild crown part with the usage of glass fibers.

7. INDICATIONS
1. Structure destroyed completely or in more than 50%
2. They are especially recommended for tooth reconstruction, in which the degree of deterioration does not
prevent good retention of the prosthetic crown, bridge or further reconstruction with removable dentures is
planned.

8. CONTRAINDICATIONS
1. Teeth with short roots, the length of which is less than the length of the future crown,
2. Teeth with narrow roots,
3. Teeth cracked along the root 4. Loose teeth II and III degree, with pathological changes in the periodontal
tissues
5. Around the teeth where the degree of alveolar process decay exceeds 50%,
6. Teeth incorrectly treated endodontically,
7. Teeth with periapical changes on X-ray

9. THE TOOTH TRANSFERRED TO THE
ADDITION BY MEANS OF AN INSERT
SHOULD,
1. Be properly treated endodontically, show no inflammatory changes in tissues,
2. Be well fixed in the socket,
3. Have a straight root 2/3 of its length,
4. Have an undamaged root surface below the edge of the alveolar process

10. CROWNS
• In the case of significant destruction of natural crowns, when they cannot be rebuilt using conservative
methods, we use prothetic crowns.
• We use p. crowns on polished teeth with preserved pulp or after endodontic treatment.
• It is a prosthetic restoration that recreates quality defects in the hard tissues of the tooth crown. It is a
complete, metal, solid, gingival, stepped restoration.
• Prosthetic crowns completely or partially cover the part of the tooth remaining after grinding.
• We can use crowns to fix prosthetic bridges.

11. INDICATIONS
1. Reconstruction of posterior teeth in invisible sections of the dental arches
2. Reconstruction of the clinical part of the crown significantly damaged by caries
3. Reconstruction of occlusal surfaces while lifting the occlusion
4. Protection against pathological wear
5. Reconstruction of contact points
6. The element connecting the shaft of the bridge with the filler
7. Improvement of the retention shape of the clinical crown under the denture clamp

12. CONTRAINDICATIONS
1. Aesthetic reasons - teeth in the anterior region
2. 3rd degree tooth softening according to Kontorowicz
3. The young age of the patient
4. Caries tendency

13. MATERIALS
Metal crowns can be made of:
• Gold alloy, e.g. Degudent H,
• Silver-palladium alloy, e.g. Supranium
• Cabalt-chrome alloys, eg Girobond
• Titanium, eg Rematitan

14. CLINICAL PROCESS
1. Examination and treatment planning
2. Tooth preparation
3. Gingiva retraction
4. Impression with elasomer masses
5. Impression of opposing teeth
6. Short circuit registration
7. Facebow registration
8. Tooth protection with a temporary crown

15. GRINDING METAL CROWNS
1. Preparation for metal crowns begins with the development of the occlusal surface, on which we mark 1.0-1.5 mm
orientation grooves.
2. Then we reduce the tooth tissues between the cavities made, while maintaining the anatomical shape of the
occlusal surface.
3. Grind down the functional nodule at an angle of 45 <. The axial walls should be parallel, slightly converging
4. The light chamfer must have a smooth, uninterrupted course along its entire length. The depth of the step is 0.5-0.8
mm. The preparation for the metal crown can be over or gingival.
5. The next steps are smoothing the preparation and rounding the edges. On the cheek surface of the lower teeth.

17. BRIDGES
• A bridge is a permanent, plaque-free prosthetic restoration, permanently embedded in the oral cavity,
recreating one or more lost teeth.
• The basic condition for making a bridge is the presence of pillars in the oral cavity to which a permanent
denture can be attached. Crowns of natural teeth can be used as pillars, their roots rebuilt with crown-root
inlays or pillar implants.
• Bridges are made to restore the missing dentition to restore its function: chewing efficiency, occlusion
stability, Correct pronunciation and facial aesthetics

18. BRIDGES
• The bridge consists of a pontics,spans-element that replaces lost teeth and fastening elements-pillars that
can hold the bridge on dental or implantological abutments. Spans are usually made of the same materials as
the crowns. Its design depends on the extent of the deficiencies and their location in the dental arch.
• The occlusal forces from the span are transferred entirely to the periodontium of the abutment teeth,
therefore the indication for bridges is limited by the efficiency of periodontal tissues.
• Dental bridges can be fabricated in metal-ceramic combination or can be all porcelain or all metal. The
metal used can be an alloy of base metals such as cobalt and Chromium, high Noble/ Noble metal alloy such
as palladium, silver and gold.

19. BRIDGES
• Natural tooth pillars should have periodontal condition, sufficient strength of residual tissues and
mechanical retention ensuring permanent fixation of the crown.
• Implantological abutments integrated with the surrounding tissues should ensure stabilization during
occlusal loads in order to avoid fracture due to fatigue or loosening of the screw connection and trouble-free
replacement of abutment elements that have been damaged or worn

20. INDICATIONS
1. Partial, limited interdental deficiencies Class II and IV (GalasińskaLandsbergerowska) or III and IV Kennedys
However, simply recognizing the missing tooth class is not sufficient to qualify a patient for bridge treatment.
In addition, there must be appropriate local conditions:
1. The right number of pillars,
2. Appropriate placement of pillars,
3. Proper fixing of the pillars in the sockets,
4. Parallelism of the long axes of the teeth of the pillars If these conditions are not met, it may be necessary
to prepare the oral cavity for prosthetic treatment.

21. CONTRAINDICATIONS
1. Insufficient number of pillars,
2. No pillars flanking the gap,
3. Situations when the gap left by the lost teeth is too large or has a semicircular course,
4. Unstable pillars, 3rd degree,
5. Pillars with pathological periapical changes,
6. Significant loss of the alveolar process,
7. Pillars too short,
8. No short circuit space,
9. Inadequate oral hygiene

22. CLINICAL MANAGEMENT
1. Personal and physical examination,
2. Analysis of diagnostic models,
3. Treatment planning,
4. Preparation of the base for prosthetic treatment,
5. Preparation of abutment teeth,
6. Two-layer impression with emollient mass,
7. Impression of opposing teeth with alginate mass,
8. Occlusion recording,
9. Selection of tooth colors,
10.Temporary protection of tooth preparations,
11. Bridge foundation check,
12. Inspection and final cementation of the bridges

23. ADVANTAGE
1. Hardness,
2. Strength,
3. Good aesthetic effect,
4. Efficient transmission of short-circuit loads

24. DISADVANTAGE
1. The need to prepare abutment teeth related to irreversible damage to hard tissues and the possibility of
postoperative complications,
2. Problematic repair in case of damage,
3. Difficulty in maintaining oral hygiene

27. VENEERS
• In dentistry, a veneer is a layer of material placed over buccal or labial part of a tooth. Veneers can improve
the aesthetics of a smile and protect the tooth's surface from damage.
• They are made of ceramic materials after the sparing preparation of the teeth and fixed after etching the
enamel with the use of adhesive cements.
• They are recommended in the case of confirmed resistance to caries and a slight degree of damage to the
natural clinical crowns or their permanent discoloration on the visible side. Mainly used in the anterior
segment in order to improve the visual aesthetics.

28. INDICATIONS
1. Change in color of teeth resistant to whitening,
2. Discoloration after treatment with tetracycline,
3. Change of diastem,
4. Crown elongation,
5. Restoration of occlusion of worn teeth,
6. Tooth reconstruction with enamel erosion,
7. Correction of slight tooth rotations

29. CONTRAINDICATIONS
1. Bruxism - too high clamping forces,
2. Teeth insufficiently covered with enamel,
3. Unstable periodontal periodontopathy

31. Comparison between a
porcelain-metal dental crown, an
all-porcelain dental crown and a
porcelain veneer laminate

32. GENERAL PRINCIPLES OF TOOTH
PREPARATION FOR PERMANENT DENTURES
A. Saving the tooth's own tissues
B. Protecting the periodontium
C. Creating conditions for the retention
D. Stability of the denture and its integration with the surrounding tissues

34. PART DIAGRAM OF GRINDING ABUTMENT
TEETH FOR CROWNS AND PROSTHETIC
BRIDGES:
A, B - when grinding the peripheral surfaces, the preparation instrument is first guided parallel to the long
axis of the tooth, and then slightly taper to the occlusal surface or incisal edge (5-6 °). This also applies to the
tilted bridge pillars
(B), whereby a common insertion path for all pillars must then be obtained by appropriate corrective
grinding. When grinding the chewing (and incisal) surfaces, consider the course of the chamber and the
anatomical outline of the surface as well as the appropriate amount of space in the occlusion.
C - if the general outline of the preparation with a coarse-grained diamond is obtained, then further
treatments include: preparation of depressions, furrows and smoothing the edges of the transition between
individual surfaces and smoothing with finishes.

35. PART DIAGRAM OF GRINDING ABUTMENT
TEETH FOR CROWNS AND PROSTHETIC
BRIDGES:
D - sometimes it is necessary to make a leveling cut in the subgingival area, which provides the crown with
better marginal tightness. Before the gingival preparation, shrink sutures must be placed to protect the
periodontium.
E, F - inspection of the polished stumps (ie assessment of the amount of space for the correct structure of the
crown) is performed in all occlusal positions of the mandible. In the areas between the contact surfaces, for
example, wax or silicone can be introduced and its thickness can be checked outside the oral cavity. After the
preparation is checked, smooth all surfaces.

37. Sample grinding set with diamond coating

38. The walls are allowed to have a slope of
0.5-0.6 mm

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