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![• Congenitally malformed teeth which do not
have adequate tooth structure[amelogenesis
imperfecta,dentinogenesis imperfecta]
• Medically compromised patients like
hypertension,bleeding disorders,leukemia etc,
• Mentally sensitive patients,very old patients.](https://image.slidesharecdn.com/fixedpartialdentures-copy-220319061814/85/FIXED-PARTIAL-DENTURES-Dr-PRASAD-ARAVIND-19-320.jpg)
![• Width of periodontal ligament space[increased
in trauma from occlusion]
• Root stumps
• Impacted tooth
• Any other pathology like cysts
• Thickness of soft tissues](https://image.slidesharecdn.com/fixedpartialdentures-copy-220319061814/85/FIXED-PARTIAL-DENTURES-Dr-PRASAD-ARAVIND-45-320.jpg)
![Periodontal ligament area
• Antes law
• Any fpd with more than two teeth are high risk
• Possible to do fpd repacing more than two
teeth
• Teeth with low perio support can serve as
support in selected cases[splinting]
• Avoid herodontics
• Advice good post op recall and checkup](https://image.slidesharecdn.com/fixedpartialdentures-copy-220319061814/85/FIXED-PARTIAL-DENTURES-Dr-PRASAD-ARAVIND-58-320.jpg)
![• Portion of pontic touching the ridge should be
as convex as possible
• Tip of pontic should not extend past the
mucogingival junction[ulcer]
• There should not be a space between the
pontic and the ridge on the facial surface of
the ridge](https://image.slidesharecdn.com/fixedpartialdentures-copy-220319061814/85/FIXED-PARTIAL-DENTURES-Dr-PRASAD-ARAVIND-137-320.jpg)
![• Pontic has no contact with the ridge
• Used in nonappearance zone[mandibular 1st
molars]
• It restores occlusal function and stabilizes
adjacent and opposing teeth
• If esthetics is not required it can be made of
metal](https://image.slidesharecdn.com/fixedpartialdentures-copy-220319061814/85/FIXED-PARTIAL-DENTURES-Dr-PRASAD-ARAVIND-152-320.jpg)
![• Occlusogingival thickness of the pontic should
be no less than 3mm
• Adequate space under the pontic to help easy
cleaning
• All convex design both faciolingually and
mesiodistally[conventional fish belly
appearance]](https://image.slidesharecdn.com/fixedpartialdentures-copy-220319061814/85/FIXED-PARTIAL-DENTURES-Dr-PRASAD-ARAVIND-153-320.jpg)
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FIXED PARTIAL DENTURES (Dr.PRASAD ARAVIND)
- 2. Diagnosis and treatmentplannig in FPD Dr.Prasad Aravind MDS Department of Prosthodontics
- 3. Objectives • Functions ofa crown and how the fpd replaces the lost teeth and tissues • To arrive at a diagnosis based on the examination of the soft tissues and hard tissues of the mouth • What type of designs various situations demands
- 4. Contents and Body •What is a fixed partial denture? • Criteria for giving an fpd • Definition • Parts • Types • Uses • Indications,contraindications of an fpd
- 5.
- 6. Definition A restoration orreplacement which is attached by a cementing medium to natural teeth,roots or implants.
- 7. Abutment Any tooth,root orimplant which gives attachment and support to the fixed partial denture
- 8.
- 9. Crown It is acemented extracoronal restoration that covers or veneers the outer surface of the clinical crown
- 10. Retainer Retainer is apart of the fixed partial denture which unites the abutments to the remainder of the restoration
- 11. Pontic The artificial tooththat replaces a missing tooth in a fixed partial denture
- 12. Connector Connection that exists betweenthe pontic and the retainer
- 13.
- 16. Functions of acrown • Primary function of a crown is to protect the underlying tooth structure and restore function form and esthetics • A full veneer crown covers all five surfaces of the clinical crown • If the prosthetic crown does not cover the entire clinical crown it is refered to as a partial veneer crown
- 17. Indications of fpd •Short span edentulous arches • Presence of sound teeth that can offer sufficient support adjacent to the edentulous space • RRR where rpd will not be stable or retentive • Mentally compromised and physically handicapped patients who cannot maintain an rpd.
- 18. Contraindications • Cases wherethere is large amount of bone loss as in a trauma • Young patients with large pulp chambers • Periodontally compromised abutment • Long span edentulous spaces • Bilateral edentulous spaces that require cross arch stabilization
- 19. • Congenitally malformedteeth which do not have adequate tooth structure[amelogenesis imperfecta,dentinogenesis imperfecta] • Medically compromised patients like hypertension,bleeding disorders,leukemia etc, • Mentally sensitive patients,very old patients.
- 21. Advantages • Less bulkyso increased patient comfort • More natural feel • Biting efficiency and chewing force generated is more • Need not remove the prosthesis at night
- 22. Disadvantages • Tooth preparationmay damage pulp • May require Rct if tooth becomes nonvital • Teeth preparation involves a lot of chair side time • Difficult to do procedure on medically compromised patients • Expensive procedure • If ceramic fractures difficult to retrieve the prosthesis
- 23. • If ceramicfractures its difficult to repair it without cutting open the fpd from the mouth • So Expense doubles for repair
- 27. Diagnosis and treatmentplanning
- 28. Diagnosis and treatment planning •Fpd success depends on the health of the abutment • Factors like dental caries,periodontal disease etc can affect the health of the abutment and in turn effect the outcome of the treatment.
- 29. Important for arrivingat a diagnosis • Extra oral Examination • History taking • Clinical Examination • radiological examination • study of the mounted diagnostic casts are absolutely essential
- 30.
- 31.
- 32. Palpating the muscle tocheck for its tonicity
- 34. History • Diabetes:chances ofperiodontal problems are high and also increases the risk of abutment failure • Xerostomia:leads to caries[vitaminA deficiency,salivary gland disease,anticholinergic drugs,antihypertensives • Chose alternate option
- 35. • Cardiovascular:patients withpacemakers avoid all electrosurgical procedures • Adrenaline to be avoided in local anesthesia • Gingival retraction cord to be free of adrenaline • Enquire about drug allergy,nickel sensitivity
- 36. Clinical examination • Systemicexamination: A thorough check up should be made to rule out the presence of any systemic disease • Local examination:extraoral and intraoral • Extraoral check for the muscles of mastication and tmj • Intraoral check the hard tissue and soft tissue • Oral hygiene,attached gingiva,dental caries,periodontal disease,faulty occlusion etc
- 37. Diagnostic casts • Mountedusing semiadjustable articulator using a face bow transfer • Helps to assess the dimensions of edentulous space • Height,rotations,inclinations of the abutment teeth,supraeruption etc • Wear facets • Type of occlusion can be understood
- 40. Summary • Checking themuscles for tonicity • History • Clinical examination • Diagnostic casts
- 42. Radiographic examination • Fullmouth xray , opg • Carious teeth • Caries beneath restoration • Level of bone • Crown root morphology • Crown root ratio of abutment • Quality of endo treatment
- 43.
- 44. Widening of periodontalspace in trauma from occlusion
- 45. • Width ofperiodontal ligament space[increased in trauma from occlusion] • Root stumps • Impacted tooth • Any other pathology like cysts • Thickness of soft tissues
- 47.
- 48.
- 49. Treatment planning inFpd part 1 • Evaluation of abutments • Biomechanical considerations
- 50.
- 51. Abutment evaluation • Abutmentshould withstand constant occlusal forces • Forces are transmitted via the retainer,pontic and connector to the abutment teeth • Ideal abutments should be vital • If endo treated check if treatment is complete and tooth has adequate bulk • Post and core better if coronal tooth structure is less
- 52. Factors in theselection of an abutment • Crown root ratio • Root configuration • Periodontal ligament area
- 53. Crown-root ratio • Optimumcrown-root ratio is 2:3 • Minimum acceptable ratio is 1:1 • More lateral forces if ratio is greater than1:1 • If the opposing occlusion is not natural teeth then less than1:1ratio may also be enough as forces will be less • Natural teeth 150lbs,Rpd- 26lbs,Fpd-54.5 lbs
- 54.
- 55. Root configuration • Rootsthat are broader labiolingually than mesio distally eg premolar better than centrals. • Multirooted posterior teeth with widely separated roots will offer better periodontal support than roots that are fused • Teeth with Conical roots can be used for short span fpd • Single rooted tooth with irregular configuration or with curvature in the apical third is better than a root with a perfect taper
- 56.
- 57.
- 58. Periodontal ligament area •Antes law • Any fpd with more than two teeth are high risk • Possible to do fpd repacing more than two teeth • Teeth with low perio support can serve as support in selected cases[splinting] • Avoid herodontics • Advice good post op recall and checkup
- 64.
- 65.
- 71. Biomechanical considerations • Longerpontic spans have a potential for more torquing forces on the fpd,esspecially on the weaker abutment • A secondary abutment must have at least as much as root surface area and a favourable crown-root ratio as the primary abutment[canine ok as a secondary abutment for a first premolar but its unwise to use a lateral incisor as a secondary abutment for a canine
- 72. The retainers onsecondary abutments will be placed in tension when the pontics flex with the primary abutments acting as fulcrums
- 73. • The retainerson the secondary abutments must be at least as retentive as the retainers on the primary abutments • When pontic flexes,the tensile forces will be applied to the retainers on the secondary abutments • Also there should be sufficient crown length and space between adjacent abutments to prevent impingement on the gingiva under the connector
- 74. Arch curvature • Ifpontics lie outside the interabutment axis line,it act as a lever arm producing torquing movement • The first premolars are used sometimes as secondary abutments for a maxillary four pontic canine to canine fpd • As tensile forces will be applied to the premolar retainers they must have exellent retention
- 76. walls of thefacial and lingual grooves counteract mesiodistal torque resulting from the force applied to the pontic
- 78. Pier abutment • Alone standing abutment with edentulous space on both sides is called as a pier abutment • Teeth in different segments of the arch move in different directions • Physiologic tooth movement,arch position of the abutment and a disparity in the retentive capacity of the retainers makes a 5 unit fpd a difficult choice
- 79.
- 80.
- 82. • Due tothe curvature of the arch,the faciolingual movement of an anterior tooth occurs at a considerable angle to the faciolingual movement of a molar • These movements in diverse directions can create stresses in a long span prosthesis that will be transferred to the abutments
- 83. • As theprosthesis can flex stress can be concentrated around the abutment teeth as well as between the retainers and the abutments • The middle abutment can act as a fulcrum causing failure of the weaker retainer.small retainers will have weak retention. • The loosened retainer will cause caries
- 84. • So thereshould be some means to neutralize the effects of those forces • A non rigid connector can be used for that purpose • Most common type of nonrigid connector is a T-shaped key that is attached to the pontic and a dovetail keyway placed within the retainer
- 85.
- 86. • The stressbreaking device in a five unit pier abutment fpd is located on the middle abutment • If it is placed on the terminal abutment it could result in the pontic acting as a lever arm • Keyway is placed within the distal contours of the pier abutment • Key is placed on the mesial side of the distal pontic
- 87. • The longaxis of the posterior teeth usually lean slightly in a mesial direction and vertically applied forces produces futher movement in this direction • 98 % of posterior teeth tilt mesially when subjected to occlusal forces • If keyway placed on the distal side of the pier abutment mesial movement seats the key into the keyway
- 88.
- 91. • If thekeyway is placed on the mesial side causes the key to be unseated during its mesial movement • This can cause a pathologic mobility in the canine or the failure of the canine retainer
- 92.
- 93. Tilted molar abutment •Usually seen with mandibular second molar abutments • It tilts mesially into the space occupied by the first molars • It becomes impossible to prepare the abutment for an fpd along the long axes of the respective teeth and achieve a common path of insertion
- 95. • Its furthercomplicated if the third molar is present • It will drift and tilt with the second molar • The mesial surface of the tipped third molar will encroach upon the path of insertion of the fpd thereby preventing it from seating completely
- 96.
- 97. • Uprighting ofthe molar by orthodontic treatment is the treatment of choice • Fixed appliance can be used to achieve this • Three months is the average time required for uprighting • The third molar if present is often removed to facilitate the distal movement of the second molar
- 98. • In casethe encroachment is slight the problem can be remedied by recontouring or restoring the mesial surface of the third molar • Additional groves to be given for the overtapered second molar to enhance retention • If tilting is severe more corrective measures are used
- 99. • The secondmolar will arc occlusally as it moves distally so it must be watched closely and ground out of occlusion to allow it to continue moving • Immediately after removing the appliance the teeth are prepared and a temporary fpd is prepared to prevent post treatment relapse
- 100.
- 101. • If orthodontictreatment is not possible a proximal half crown can be used as a retainer on the distal abutment • This can be used only if the distal surface is untouched by caries or decalcification • Also the patient should be able to maintain good oral hygiene
- 102.
- 103. Telescopic crown • Atelescopic crown and coping can also be used as a retainer on the distal abutment • A full crown preparation is made along the long axis of the tilted molar • An inner coping is made to fit the tooth preparation,and the proximal half crown will serve as the retainer for the fpd fitted over the coping
- 105.
- 106.
- 107. Implant supported fpd •Less number of available abutments • Long edentulous span • Absence of distal abutments but good bone • Broad flat ridge configurations • Single tooth replacement • High caries risk patients • Young adults
- 109.
- 114.
- 115.
- 116. Pontic size shouldbe small in case of posterior cantelever
- 117. Resin bonded fpd •Defect free abutments • Single missing anterior tooth or premolar • Single missing molar with minimal opposing occlusal load • Sound abutments on either side of edentulous space • Young patients • Abutments with less than 15* angulation • Absence of deep vertical overlap
- 119.
- 121. Take up oneidea.Make that one idea your life-think of it,dream of it,live on that idea.Let the brain,muscles,nerves,every part of your body,be full of that idea,and just leave every other idea alone.This is the way to success.
- 122. We are whatour thoughts have made us;so take care about what you think.Words are secondary.Thoughts live;they travel far.
- 123. The whole secretof existence is to have no fear.Never fear what will become of you,depend on no one.Only the moment you reject all help are you freed.
- 124. Never think thereis anything impossible for the soul.It is the greatest heresy to think so.If there is sin,this is the only sin;to say that you are weak,or others are weak.
- 125. Condemn none:if youcan stretch out a helping hand,do so.If you cannot,fold your hands,bless your brothers,and let them go their own way.
- 126. Be like thelotus,spreading its fragrance;unaffected by the slush in which it is born nor by the water that sustains it.
- 127. That man hasreached immortality who is disturbed by nothing material.
- 128. If faith inourselves had been more extensively taught and practiced,iam sure a very large portion of the evils and miseries that we have would have vanished.
- 129. Holding on toanger is like grasping a hot coal with the intent of throwing it at someone else;you are the one who gets burned.
- 130. Budha It is betterto conquer yourself than to win a thousand battle.Then the victory is yours.It cannot be taken from you,not by angels or by demons,heaven or hell.
- 131.
- 132.
- 133. • Design ofpontic should be matching with • Esthetics • Function • Ease of cleaning • Maintenance of healthy tissue on the ridge • Patient comfort
- 134. Material • All metal •Metal ceramic • Metal free ceramic • Metal with resin • Ideally glazed ceramic is best suited because of its polished nature goes well with gingiva
- 135.
- 136. Tip of ponticto rest on keratinized gingiva
- 137. • Portion ofpontic touching the ridge should be as convex as possible • Tip of pontic should not extend past the mucogingival junction[ulcer] • There should not be a space between the pontic and the ridge on the facial surface of the ridge
- 138. Types of pontics •Conical • Ovate • Saddle or ridge lap • Sanitary or hygienic • Modified sanitary
- 139.
- 140. Conical pontic • Roundedand cleanable • Similar to the sanitary dummy by Tinker 1918 • Tip is small in relation to the overall size of the pontic • Ideal for use in a thin mandibular ridge • When used in broad flat ridges the large triangular embrasures will collect debris • Use limited to thin ridges in nonappearance zone
- 141.
- 142. Ovate pontic • Usedwhen esthetics is of prime concern • The tissue contact segment of the pontic is bluntly rounded and it is set into the concavity • Good in broad flat ridge giving appearance that it is growing from the ridge • Easily flossable • Concavity can b created surgically or at the time of giving provisional restoration
- 144.
- 145. Saddle pontic • Thistype of pontic Looks most like a tooth replacing all the contours of the missing tooth • Forms a large concave contact with the ridge • Obliterates the facial,lingual and proximal embrasures • Also called as ridge lap
- 146. • Saddle ponticis difficult to clean • The floss cannot traverse the tisue facing area of the pontic • Saddle pontic is difficult to maintain because of its design and will cause inflammation,so it should not be used
- 147.
- 148. • It givesthe illusion of a tooth • This design with a ceramic veneer is the most commonly used pontic design in the appearance zone for both maxillary and mandibular fpd • Ridge contact must extend no farther lingually than the midline of the ridge • Contour of the tissue contacting area should be convex
- 149. • The nearlyall convex surface of the pontic helps to prevent food impaction and plaque accumilation • Tissue contact should be narrow mesiodistally and faciolingually for better tissue response
- 150. Hygienic pontic orsanitary pontic
- 151. Sanitary or hygienicpontic
- 152. • Pontic hasno contact with the ridge • Used in nonappearance zone[mandibular 1st molars] • It restores occlusal function and stabilizes adjacent and opposing teeth • If esthetics is not required it can be made of metal
- 153. • Occlusogingival thicknessof the pontic should be no less than 3mm • Adequate space under the pontic to help easy cleaning • All convex design both faciolingually and mesiodistally[conventional fish belly appearance]
- 154. • Another designhas the pontic like a concave archway mesiodistally • Undersurface is convex faciolingually • Hyperbolic paraboloid • Added bulk for connectors making it strong • Access for cleaning is good
- 155. • Stress isreduced in the connectors • An esthetic version of this pontic can be created by veneering with porcelain those parts of the pontic that are likely to be visible,the occlusal half and the occlusal surface of the facial surface • This design is called arc-fixed partial denture • Modified sanitary pontic or perel pontic
- 156.
- 157. Rounded angles betterfor easy cleaning
- 158.
- 161. Swami vivekananda All thepowers in the universe are already ours.It is we who have put our hands before our eyes and cry that it is dark.
- 162. References 1. Contemporary fixedprosthodontics – 3rd edition Stephen F. Rosensteil, Martin F. Land. 1. Fundaments of fixed prosthodontics – 3rd edition Herbert T. Shillingburg, Sumiyo Hobo. 1. Tylman’s theory & practice of fixed prosthodontics - 8th edition, 1989 – William F.P. Malone, David L. Koth. 1. Planning & making crowns & bridges - Bernard G.N. Smith – 3rd edition 1998. 1. Fixed prosthodontics – Keith E. Thayer.