prosthodontic

1. Copyright 2003, Elsevier Science (USA). All rights reserved.
Fixed Prosthodontics
Chapter 50
Copyright 2003, Elsevier Science (USA).
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2. Copyright 2003, Elsevier Science (USA). All rights reserved.
Introduction
Fixed prosthodontics is the specialized area of
dentistry involved in the replacement of missing
teeth with a cast prosthesis permanently
cemented in place.

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Indications for Fixed Prosthodontics
 One or two adjacent teeth are missing in the
same arch.
 The supportive tissues are healthy.
 Suitable abutment teeth are present.
 The patient is in good health and wants to
have the prosthesis placed.
 The patient has the skills and motivation to
maintain good oral hygiene.

4. Copyright 2003, Elsevier Science (USA). All rights reserved.
Contraindications for Fixed Prosthodontics
 Necessary supportive tissues are diseased or
missing.
 Suitable abutment teeth are not present.
 The patient is in poor health.
 The patient is not motivated to have the
prosthesis placed.
 The patient has poor oral hygiene habits.
 The patient cannot afford the treatment.

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Types of Cast Restorations
 Inlay
• Covers a portion of the occlusal and
proximal surface.
 Onlay
• Covers the proximal surfaces and most or all
of the occlusal surface.
 Porcelain Veneers
• Thin shell-like covering placed to improve
the appearance of anterior teeth.

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 Full crown
• Completely covers the anatomic crown of
an individual tooth.
 Three-quarter crown
• Covers the anatomic crown of a tooth
except for the facial portion.
 Porcelain-fused-to-metal crown (PFM)
• Full metal crown with outer surfaces
covered with a veneer of porcelain.
Types of Cast Restorations- cont’d

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 Porcelain jacket crowns
• Constructed as a thin metal shell covered by
layers of porcelain.
 Fixed bridge
• A prosthesis for or more missing teeth within
the same arch.
 Resin-bonded bridge
• Also known as a Maryland bridge, with
winglike extensions coming from the proximal
sides.
Types of Cast Restorations- cont’d

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Table 50-1 Components of a Fixed Bridge

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Overview of a Fixed Prosthodontic
Procedure
 Shade selection
 A shade guide contains samples of all
available shades and is used to match the
natural tooth color.
• Moisture helps achieve a more accurate
match.
• Use natural sunlight.
• Record the shade on the patient's chart and
on the laboratory prescription.

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 The tooth is prepared so the cast restoration
can slide into place and be able to withstand
the forces of occlusion.
• Rotary instruments are used to reduce
the height and contour of the tooth.
• Hand cutting and rotary instruments
prepare the gingival margins.
Tooth Preparation

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 It may be necessary to provide additional
support for the crown if the tooth is
extensively decayed, fractured, or has been
endodontically treated.
• Core buildup
• Pin retention
• Post and core
Retention Aids

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 Cord temporarily displaces the gingival tissue
and widens the gingival sulcus so impression
material can flow around all parts of the
preparation.
• Nonimpregnated
• Impregnated
Gingival Retraction and Tissue
Management

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 Elastomeric impression materials are used
to create these extremely accurate
impressions.
• Mixing and application of light-bodied
material around the prepared tooth.
• Mixing and loading of tray with heavy-
bodied material to be seated onto the
quadrant or arch.
Final Impression

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 Provides the laboratory technician with a
reproduction of a patient’s bite and
opposing arch registration for designing the
anatomic structures of the fixed prosthetic.
• Open bite
• Closed bite
Bite Registration

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 Used to keep the patient comfortable during
the period from tooth preparation to final
cementation of the fixed prosthetic.
• Reduces sensitivity and discomfort.
• Maintains the function and esthetics.
• Protects the margins.
• Prevents shifting.
Provisional Coverage

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 A detailed and precise written order from
the dentist to the laboratory technician with
the description of the restoration to be
fabricated.
Laboratory Prescription

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Fig. 50-18 Laboratory prescription.

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 When the casting has been fitted and is
acceptable, the dentist cements it to the tooth.
• Permanent cementation
• Temporary cementation
Delivery

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Home Care Instructions for the
Patient with a Fixed Prosthesis
 Good home care is essential to the maintenance
of a fixed prosthesis.
 A fixed prosthesis and its supporting tissues must
be brushed carefully daily.
 A bridge threader is used to thread dental floss
under the pontic and down into the sulcus at
both abutments of a bridge.