Fixed Prosthodontics Notes

Abt evaluation
crown-root ratio
root configuration
PDL area

Prosthodontic Diagnostic Index (PDI)

McGarry ACP (American College of Prosthodontists)
intended to help dentists provide appropriate tmt
benefits
consistency
communication
insurance reimbursement
screening tool
standardized criteria
decision to refer
4 diagnostic criteria
location and extent of the edentulous area(s)
cd of abt
occl
residual ridge
3 cd creating a guarded Px
severe oral manifestations of systemic dis
maxillomandibular dyskinesia
refractoriness (pt presenting w/ a persistent complaint after appropriate tx)
Class I
ideal
all 4 diagnostic criteria are favorable
Class II
diagnostic criteria are moderately compromised
need localized adjunctive tx
Class III
diagnostic criteria are substantially compromised
substantial localized adjunctive tx
+ re-establishment of the entire occl (no change in VDO)
Class IV
severely compromised
extensive therapy
re-establishment of the occl w/ a change in VDO

Treatment planning

crown-root ratio
as horizontal bone loss lever arm of the portion out of bone
optimum C/R = 2/3
minimum C/R = 1/1

1
 Antes law the root uf area of the abt teeth has to equal or surpass that of the teeth
being replaced w/ pontics

Biomechanical considerations
long-span FPD
load on the PDL
longer spans are less rigid excessive flexure
bending or deflection is:
proportional to the cube of the span length
inversely proportional to the cube of occluso-gingival thickness
to minimize flexion caused by long spans
connectors should be as bulky as possible
select alloy w/ higher yield strength (e.g., Ni-Cr)
preparation should have resistance (include multiple grooves B + L)
double abt
used to overcome pbm created by unfavorable C/R ratio
criteria for secondary abt (remote from ED space)
must have at least as much root uf area and as favorable C/R ratio as
the primary abt
must be at least as retentive as the retainer on the primary abt
arch curvature
when pontics lie outside the inter-abt axis line, the pontics act as a lever arm, which
can produce a torquing mvt pbm when replacing all 4 Mx incisors
gain additional retention in the opposite direction and at a distance from the inter-
abt axis equal to the length of the lever arm

Pier abt
in normal dentition, buccolingual mvt of teeth is 55 110 m and intrusion 30 m
these mvt create stresses in a long-span prosthesis that are transferred to the abt
nonrigid connector
placed on the D side of the retainer of the middle abt
keyway placed within the middle retainer and key within the D pontic
nonrigid connector on the middle abt isolates force to that segment of the
FPD to which it is applied

Cantilevered FPD
a cantilevered pontic acts as a lever and tends to be depressed under forces
when the pontic is loaded occlusally, the adj abt acts like a fulcrum, w/ a lifting
tendency on the farthest retainer

Single tooth cantilever

long-term Px of the single abt cantilever is poor
forces are best tolerated by PDL when directed along the long axes of the teeth
a cantilever induces lateral forces on the supporting tissues, which may be harmful
and lead to tipping, rotation, or drifting of abt
however, clinical experience w/ RBFPD has shown that single-tooth cantilever
design is preferred, b/c loss of retention is immediately apparent and easily corrected
Briggs, 1996

2
Nyman and Ericsson (1982) have cast doubt on validity of Antes law.
teeth w/ dramatically bone support can be successfully used as FPD abt

Horizontal bone loss the center of rotation moves apically and the lever arm

If both ant and post teeth are to be restored, the ant teeth are uly restored first, b/c they infl the
border mvt of the Md and thus the shape of the occl uf of the post teeth.

Selection criteria for a Rtn mat for a single-tooth Rtn

destruction of tooth str
esthetics
plaque control
financial consideration
retention

occl interference
any tooth contact that inhibits the remaining teeth from achieving stable and
harmonious contacts

occl prematurity any contact of opposing teeth that occurs before the planned intercuspation

Periodontics
Gingival str
marginal gingiva
free gingival groove
attached gingiva
mucogingival junction
alveolar mucosa

Plaque
the main etiologic agent of infm
GP, aerobes, cocci GN, anaerobes, rods and filamentous org, spirochetes

Bone defects named based on remaining osseous topography

Perio tx
surgical therapy aims to or eliminate probing depth
soft tissue procedures
gingivectomy
open debridement (Modified Widman)
mucosal repair
used to zone of attached gingiva
hard tissue procedures
aim at modifying topography of areas where plaque control is
difficult or impossible
bony induction
for 3- and 2-walled defects
degranulation + grafting
osseous resection
for 1-wall defect
creating positive bony architecture
Objectives of periodontal tx
removal and control of all etiologic agents

3
 elimination, or reduction, in pocket depths
functional atraumatic occl and tooth stability
self plaque control and maintenance

Free gingival graft

Laterally positioned pedicle graft
Coronally positioned pedicle flap
Subepithelial CT graft
split thickness CT harvested from the hard palate 1 closure
excellent success

Tooth preparation
Principles of tooth preparation
biologic af the health of oral tissues
mechanical af integrity and durability of Rtn
esthetic af appearance

Optimum Rtn
Biologic considerations
conservation of tooth structure
prevention of dmg during tooth preparation
avoidance of over-contouring
supragingival margins
harmonious occl
protection against tooth Fx
Mechanical considerations
retention form
resistance form
deformation
Esthetic considerations
minimum display of metal
maximum thickness of porcelain
porcelain occl surfaces
subgingival margins

Biologic considerations
conservation of tooth structure
use partial coverage (vs. complete coverage Rtn)
minimum convergence angle (taper)
occl reduction follows anatomic planes
retain max thickness of tooth str around pulp reposition teeth
orthodontically if nec
conservative margin geometry
avoid apical extension

Margins
margin adaptation
casting may fit within 10 m
4
 porcelain margin may fit within 50 m
margin geometry
general guidelines
ease of preparation w/o overextension or unsupported enamel
ease of identification in the imp and on the die
a distinct boundary to which wax pattern can be finished
sufficient bulk of mat
conservation of tooth str
feather edge
avoid b/c does not provide adequate bulk at the margin
historically, used for copper band tch
Goodacre. Tooth preparation for complete crowns: an art form based on
scientific principles. 2001
margin design selection should be based on the type of crown,
aesthetic requirements, ease of formation, and operator experience
Re has not validated greater fit to be @ w/ some margin designs
finish line configuration
knife edge
an acute margin of metal
difficult to accurately wax and cast
susceptible to distortion w/ occlusal forces
can result in overcontoured Rtn
chamfer
experimentally shown to exhibit the least stress, so that the cement
underlying it will have the least likelihood of failure
shoulder
margin of choice for all-ceramic Rtn
wide ledge provides resistance to occl forces and minimizes stresses
that might lead to porcelain Fx
produces space for proper contours and maximum esthetics
more destructive to tooth str than any other margin
radial shoulder
similar to shoulder preparation but w/ a stress-reducing rounded
gingivo-axial angle
Margin design Advantages Disadvantages Indications
Feather edge conserves tooth str does not provide adequate bulk avoid

Knife edge conserves tooth str location of margin difficult to occasionally on tilted teeth
control
Chamfer distinct margin care needed to avoid cast metal Rtn
adequate bulk unsupported lip of enamel lingual margin of PFM
easier to control
Shoulder bulk of restorative mat less conservative of tooth str facial margin of PFM,
all-ceramic crowns
Shoulder w/ bulk of mat, removes less conservative, facial margin of post PFM w/
bevel unsupported enamel, extends preparation apically supragingival margins
allows finishing of metal into the sulcus
Mechanical considerations
3 considerations
retention form dislodgement along the path of insertion
resistance form dislodgement not along the path of insertion
preventing deformation of the Rtn
retention form
5
 improved w/
small taper (parallel walls)
large uf area
type of preparation (full crown vs. partial crown)
rough uf texture
adhesive resin cement
magnitude of dislodging forces
geometry of tooth preparation
taper
angle of convergence is bn two converging walls
compromise bn too small taper having undercuts and too
large taper having no retention (not limiting path of placement)
Jorgensen (1955) Rp bn retention and angle of
convergence is hyperbolic; retention w/ 10 is half that of 5
6 angle of convergence is recommended
surface area
stress concentration
type of preparation
materials being cemented
resistance form
dislodgement (rotation around the gingival margin) by horizontal and
eccentric forces ask how much tooth str needs to break (or how much the crown needs to
deform) in order to dislodge the Rtn?
improved w/
minimum taper
small diameter (!)
long height
type of Rtn (complete vs. partial crown)
adhesive resin cement
influenced by
magnitude and direction of dislodging forces high dislodging forces
require that resistance form be to avoid dislodgement
geometry of tooth preparation
preventing deformation of Rtn
alloy selection use harder alloys
adequate tooth reduction (to permit adequate thickness of metal)
margin design (feather edge margin may distort)

Retention and resistance

retention prevents removal of Rtn along the path of insertion
essential requirement 2 opposing vertical walls
resistance prevents removal of Rtn in oblique direction
taper
angle of convergence = taper
as taper retention
preparation walls are tapered to
visualize preparation walls

6
 prevent undercuts
compensate for inaccuracies in the fabrication process
permit better seating of Rtn during cementation
actual average taper much greater than recommended
19 23 (Olm & Silness, 1978)
freedom of displacement
the shorter the wall, the more imp the inclination
substitution of internal features
internal features such as grooves, boxes, pin holes may be substituted for less
than ideal axial wall height or taper
Re finds that clinical taper of grooves is often sig better than that of axial
walls of those Rtn
path of insertion
def imaginary line along which the Rtn will be placed and removed
should be parallel to the long axis of the tooth

Preservation of the Periodontium

finish line should be placed in an area where the margins of the Rtn can be finished by the
dentist and kept clean by the patient

3 theories of Ideal Contour of Restoration

Gingival Protection (Wheeler)

advocates that excessive contours of Rtn protect the marginal gingiva from mechanical inj

Muscle Actions (Morris)

suggested that overcontouring prevents the normal cleansing action of the musculature

Access for Oral Hygiene

this theory is based on the concept that plaque is the prime etiologic factor in caries and
gingivitis. Thus crown contour should facilitate plaque removal, not hinder it.

The four guidelines to contouring crowns with emphasis on access for OH:
Buccal and lingual contours flat, not fat!
Open embrasures
Locations of contact areas: high
Furcations involvement: furcations that have been exposed should be fluted

Cores

Advantages Disadvantages Recommendation Precautions

Am good strength longer setting time most cores use bonding leakage
bonding w/ 4-META preparation delay use fast set Am
condensation
corrosion
GI rapid setting low strength smaller lesions moisture control
adhesion moisture sensitive use radiopaque mat
F
Comp resin rapid setting thermal expansion smaller lesions moisture control
7
 ease of use setting contraction ZOE concern
bonding delayed expansion
Cast gold highest strength 2-visits extensive lesions pinholes alignment
indirect procedure interim Rtn needed

Liners
placed close to the dental pulp under Rtn
accomplish 3 goals:
stimulation of the dental pulp to form more internal dentin
insulation from thermal changes
seal dental canals and dental pulp from dental materials

Foundation Restorations:
replace coronal tooth structure that was lost
base does not contribute to the overall retention/resistance form
core augments retention and resistance provided by the remaining tooth str

Restoration of endodontically treated tooth

Principle of substitution
preparation may be modified by adding features to enhance retention and resistance

2 rules to avoid excessive tooth destruction

the central core (the pulp + 1 mm dentin) must not be invaded in vital teeth;
any part lying within the vital core should be filled w/ GI
walls of dentin should not be reduced in thickness less than half its height

Pins safest location line angles/corners of the teeth

Bases and cores

bases
used to protect the pulp and to eliminate undercuts in defects in tooth str
GI and carboxylate cements
have adhesive properties to avoid dislodgement during subsequent preparation
do not have sufficient strength to effectively replace missing walls

Crown lengthening produces

long, unaesthetic crown
sig C/R ratio

Orthodontic extrusion
normal, aesthetic crown
slightly C/R ratio
ortho extrusion is preferred b/c the crown is not lengthened (i.e., unfavorable C/R
ratio is more significantly w/ CL)

Sorensen & Martinoff (1984)

ant teeth
post = no post
PFM = no PFM
post teeth
PFM better 94% vs. 56%

8
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Choice of tch influenced by

type of tooth (ant vs. post)
amount of remaining tooth str most imp Px factor

Core replaces any lost coronal str, allowing optimal tooth preparation geometry

Post teeth are subjected to greater loading b/c of closer proximity to transverse horizontal axis.

post retention is affected by

preparation geometry
threaded posts are not rec b/c of residual stress in the dentin
parallel sided posts are more retentive than tapered posts
post length
post diameter
excessive weakens the root
post diameter should be < 1/3 root diameter
post uf texture
serrated posts retention
luting agent
no diff among traditional cements
choice of cement probably more imp in cementation of poorly fitting posts

Cast P/C methods of fabrication

direct pattern
fabricated in the pts mouth
w/ autopolymerizing resins
for single canals w/ good clinical access
indirect pattern
fabricated in the lab
imp w/ elastomeric mat w/ a wire reinforcement
for multiple canals or when access is problematic

Cast P/C should fit loosely in the canal casting should be undersized
done by restricting expansion of the inv (i.e., by omitting the usual ring liner)
Choosing the final Rtn
amount of remaining sound tooth str
occlusal fn
opposing dentition
ptn of the tooth in the arch
length and width of the roots
curvature of the roots
Cast restorations
Full veneer crowns
FMC
PFM
All-ceramic crown
Partial veneer crowns
post crown
ant crown
pin-modified crown

9
Complete cast crown
indications
extensive destruction from cR or trauma
endodontically treated teeth
existing Rtn
max retention and strength
to provide contours to receive RPD
correction of axial contours is not possible w/ a more conservative tch
correction of occl plane
contraindications
tx objectives can be met w/ more conservative means
less than max retention nec
adequate contours can be obtained through enamoplasty
esthetics
adv
best longevity of all fixed Rtn
strong
good retention
option to modify form (axial contours) and occl
disadv
removal of large amount of tooth str
adverse effects on tissue (pulp and periodontium)
vitality testing not feasible
display of metal
dimensions
functional cusp 1.5 mm
non-functional cusp 1 mm
chamfer 0.5 mm
6 convergence
reduction should
follow normal anatomic configuration of occl uf
parallel to long axis
rounding of sharp line angles

Metal ceramic crown

indications
aesthetics
if all-ceramic crown is contraindicated
similar to cast metal Rtn
contraindications
large pulp chamber
intact B wall
when more conservative tx is possible
pts w/ active cR or PDD
adv
combines strength of a cast metal Rtn w/ the esthetics of an all-ceramic Rtn
superior aesthetics in comparison w/ complete cast crown
better marginal fit than all-ceramic crown
can serve as an RPD abt (can accommodate a rest vs. all-ceramic, which cant)
disadv
removal of substantial tooth str
subject to Fx b/c porcelain is brittle
10
 difficult to obtain accurate occl in glazed porcelain
inferior aesthetics in comparison w/ all-ceramic crown
expensive
dimensions
incisal reduction 1.5 2 mm in intercuspal ptn and all excursions

All-ceramic crown
indications
high aesthetic requirement, not obtainable w/ a more conservative Rtn
considerable proximal cR
incisal edge reasonably intact thickness of porcelain should not exceed 2
mm; otherwise Fx would occur
favorable distribution of occl load
contraindications
when superior strength is warranted
when a more conservative Rtn could accomplish the same goals
high cR index
insufficient coronal tooth str for support
thin teeth facio-lingually
unfavorable distribution of occl load
bruxism
adv
best aesthetics
translucency similar to natural tooth
good tissue response even for subgingival margins
disadv
strength compared to metal-ceramic crown
proper preparation is critical
least conservative preparations
brittle nature of mat
can be used only as single Rtn
dimensions
centric contacts should occur where the porcelain is supported by tooth str (in
the middle third of the lingual uf)
margin design should result in favorable stress distribution
a sloping shoulder is not recommend b/c it does not support the
porcelain; incisal loading leads to tensile stresses near the margin
90 margin is recommended
rounded internal line angles
Porcelain veneers
indications
discolored or dmgd ant teeth
contraindications
high cR index
poor plaque control
extensive existing Rtn
bruxism
adv
superior aesthetics
conservative of tooth str (vs. full crown Rtn) only 0.5 mm reduction
wear and stain resistant
disadv
11
 increased tooth contours (maybe over-contoured)
expensive
Inlay
indications
small cR lesions in otherwise sound tooth
adequate dentinal support
low cR rate
pts request for gold instead of Am or comp
contraindications
high cR rate
poor OH
small teeth
adolescents
poor dentinal support necessitating a wide preparation
adv
superior mat properties
longevity
disadv
less conservative than Am
gingival extension beyond ideal
wedge retention
Partial veneer crown
adv
tooth str is spared
some margin is accessible to the dentist for finishing and to pt for cleaning
less margin is in proximity to the gingival crevice
more easily seated completely during cementation
some of the margin visible complete seating is more easily verified
electric pulp testing can be conducted b/c a portion of enamel is accessible

Impression mat

reversible hydrocolloid

polysulfide dimensional instability due to mode of polymerization

condensation gives off water and alcohol
condensation silicone
evaporation dimensional contraction
polyether (Impregum)
long term dimensional stability
addition silicone (Aquasil)

Fluid control
antisialagogues
Glycopyrolate 1-2 mg
anti-cholinergic secretions, incl saliva
adverse ef
drowsiness
blurred vision
bad aftertaste
contraindications

12
 glaucoma
asthma
hypersensitivity to the drugs
CHF
Clonidine 0.5 mg 1 h before
anti-HT
safer than above
adverse ef
drowsiness
contraindications
pts receiving other anti-hypertensive meds
Electrosurgery
controlled tissue destruction to achieve a surgical result
current flows from a small cutting electrode that produces a high current density and
a rapid T at its point of contact w/ the tissue
types of current
diff wave forms diff tissue response
currents
fully rectifies, filtered best

Prerequisites for impression

tissue health
dry field
displacement of gingival tissues
Requirements for imp for cast Rtn
exact duplication of prepared tooth
exact duplication of other teeth and tissue adj to the prepared tooth
free of bubbles and distortions
Wettability
hydrophilic
readily wettable (by gypsum)
IH, RH, and polyether
hydrophobic
all other elastomers (but esp condensation silicone)
high contact angle
air entrapment during pouring +
repelled by hemorrhage in the gingival sulcus\
surfactant contact angle
Viscosity
thixotropic ability to viscosity when shear rate is (e.g., by expressing from a syringe)
shear thinning

Desirable qualities of imp mat

pleasant odor, taste and color
adequate shelf life
setting chr meet clinical requirements
satisfactory consistency and texture
readily wets oral tissue
elastic properties, no permanent deformation after strain
adequate strength so it will not tear on removal from mouth
dimensional stability
compatibility with cast and die mat

13
 readily disinfected

Choice of imp mat depends on

personal preference
ease of manipulation
economics
accuracy is not a consideration they are all accurate

Reversible hydrocolloid
(elastic) gel T (100 C) (viscous fluid) sol
Rn reversed at body T
conditioning equipment 3 thermal baths
1) liquefaction bath 100 C boiling to convert gel to sol
2) storage 65 C maintains liquefied material until needed
3) tempering 40 C T of imp mat to avoid tissue dmg
water cooled impression trays
lacks dimensional stability d/t water release (syneresis) and water absorption
(imbibition)
accuracy improved w/ bulk (low surface area / volume ratio)
vs. elastomeric impression mat accuracy is improved w/ bulk
components
85% water
agar (polysaccharide)
sodium tetraborate strength and viscosity
potassium sulfate to accelerate and harden stone in contact w/ RH
thymol bactericidal
Polysulfide (rubber base)
a.k.a. mercaptan, Thiokol
2 tubes
base liquid polysulfide polymer + filler
accelerator lead dioxide (oxidation initiator on thiol groups on the
polymer)
Rn
polymer chains are lengthened and cross-linked through the oxidized thiol
groups
radiopaque (d/t presence of lead dioxide)
pbm
unpleasant sulfide odor
long setting time (10 min)
does not have snap set
pour within 1 h
poor dimensional stability (b/c of water loss on setting)

Condensation silicone
base liquid silicone polymer (w/ terminal hydroxyl groups) + filler
reactor ethyl silicate (cross-linking agent) + tin octoate (activator)
Rn
cross-linked by a Rn bn terminal hydroxyl groups on the polymer and ethyl
silicate
condensation Rn elimination of alcohol
alcohol evaporation shrinkage + poor dimensional stability

14
 adv overcomes pbm w/ polysulfide
odorless
setting time (6-8 min)
disadv
extremely hydrophobic
pour within 1 h
limited shelf life (1 y most other mat are 2 y)
Polyether
Impregum
Rn
copolymer of 1,2 epoxyethane and tetrahydrofuran is reacted w/
unsaturated acid (crotonic acid) to produce esterification of the terminal
hydroxyl groups
double bonds are reacted w/ ethylene amine to produce the final polymer
aromatic sulfonate (catalyst) produces cross-linking
adv
dimensional stability
unique polymerization mech (no water by-product)
low polymerization shrinkage
short setting time (5 min)
thixotropic
hydrophilic (all other elastomeric imp mat are hydrophobic)
disadv
very rigid/stiff (must block out undercuts)
must be stored dry (b/c absorbs moisture)
Addition silicone (= polyvinyl siloxane)
Aquasil
2 pastes
silicone w/ terminal silane hydrogen groups + filler
silicone w/ terminal vinyl groups + chloroplatinic acid catalyst + filler
Rn
addition of silane hydrogen groups across vinyl double bonds and no by-
products
adv
least affected by pouring delays
less polymerization shrinkage
low distortion
fast recovery from deformation
moderately high tear strength
pbm
latex setting inhibition ( use vinyl gloves)
gas production (not w/ modern formulations) porosity in cast

Custom trays
helpful b/c uneven thickness of mat obtained w/ stock trays leads to distortion
improves accuracy of elastomeric impressions by limiting volume of mat
stress on removal
contraction
autopolymerizing resin
thermoplastic resin
photopolymerizing resin

15
Disinfection
glutaraldehyde 2% (10 min soak)
iodophors 1%
chlorine compounds (1:10 dilution of commercial bleach)
phenols
following removal from pts mouth, imp is immediately rinsed w/ tap water and dried
then, suitable chemical is used

Disinfection of Alginate:
For diagnostic casts: soak for 10 minutes in glutaraldehyde
For final impressions:
dip in glutaraldehyde 2%, rinse in sterile water, dip again and stand under damp gauze for 10 min

Interim Fixed Restorations

Interim Rtn requirements biologic, mechanical, aesthetic

Biologic requirements
- pulpal protection
- periodontal health
- occlusal stability
- maintain tooth ptn
- protect against tooth Fx
Mechanical requirements
- resist functional loads
- resist removal forces (but can be easily removed and reused)
- maintain inter-abutment alignment
Aesthetic requirements
- easily contoured
- color compatibility
- translucency
- color stability (does not discolor over time)
- used as a guide to achieve optimal aesthetics in the final Rtn, occl scheme and ant guidance
Types of provisional Rtn
prefabricated vs. custom
direct vs. indirect

External surface form (ESF) Tissue (internal) surface form (TSF)

custom indirect
preformed direct
indirect-direct

Custom
irreversible hydrocolloid

16
 silicone putty
thermoplastic sheet (0.5 mm)

Preformed
need some modification (e.g., reline, re-contouring) when extensive modification required, a
custom ESF is superior because it is less time consuming
useful for single Rtn because cannot use them to make pontics
polycarbonate (natural appearance)
cellulose acetate
aluminum and tin-sliver (highly ductile)
Ni-Cr

Tissue (inside) surface form indirect, direct, indirect-direct

Indirect procedure
an imp is made of the teeth and tissues and poured in fast setting gypsum
interim Rtn fabricated outside of the mouth
indirect tch is preferred
no contact of free monomer w/ prepared teeth or gingiva
prepared teeth are not subject to heat from polymerizing resin
accuracy is improved and fit is improved
marginal fit of interim Rtn that has polymerized undisturbed on stone
cast is significantly better
why?
stone restricts resin shrinkage
separating resin from the tooth causes distortion
frees the dentist to do other tasks (trained auxiliaries can perform lab tasks)
can be done in the absence of the pt

Direct procedure
pts prepared teeth directly provide the TSF
disadvantages
potential tissue trauma from the polymerizing resin
inherently poorer marginal fit

Indirect-direct procedure
dentist fabricates a custom ESF w/ an underprepared diagnostic cast as the TSF
the resulting mold forms a shell that, after tooth preparation, is relined I/O w/ resin
advantages (relative to direct procedure)
chairtime
most of the procedure has been completed before the pts visit
less heat is generated b/c the volume of resin used for relining is small
contact bn resin monomer and ST is b/c pontic areas are not relined

choosing the material

direct tch mat w/ least toxicity and least polymerization shrinkage
long-span prosthesis high strength required

Free radical polymerization

complete chemical conversion of monomer to a biologically inert polymer is desirable
mechanical properties are affected if polymerization process is incomplete
17
 polymerization shrinkage d/t
density of polymer is substantially greater than that of monomer
additional contraction occurs on cooling of the Rtn (polymerization is exothermic)
components
initiator
benzoyl peroxide
camphoroquinone
activator
heat
tertiary amine
light
monomer
determines primary properties
filler
added to improve mechanical properties
filler content reduces the amount of heat generated + strength
incorporate as much filler as possible
pigments
INITIATION
activation free radical polymerization begins w/ formation of a free radical
free radicals are formed by the decomposition of the initiator
benzoyl peroxide decomposes to free radicals by
thermal activation
chemical activation (catalyzed by tertiary amine)
camphoroquinone
visible light activation
PROPAGATION
polymerization continues by including more monomer mlc in the growing molecular chain
TERMINATION

Visible light activation

adv
porosity (b/c mat mixed by manufacturer)
control over working time
disadv
depth of visible light penetration

Cementation
primary function
provide seal (preventing marginal leakage and irritation), not retention
low strength
ZOE zinc oxide Eugenol
weak
obtundent ef
sealing properties
but, free eugenol is a plasticizer (softener) of methacrylate resins
surface hardness, strength, and makes relines and repairs more
difficult (b/c new resin applied over polymerized resin previously in
contact w/ free eugenol results in softening of the added resin)
free Eugenol must be present to cause pbm
when using ZOE, mix correct proportions

18
 if resin luting cement is planned for permanent Rtn, use non-eugenol
cement

Materials
gypsum calcium sulfate hemihydrate
resin
electroplating
flexible die mat

Gypsum
adv
dimensional accuracy
abrasion resistance
inexpensive
easy to use
types I to V chemically identical
impression plaster diff d/t calcination
model plaster (-form) improved physical properties
dental stone (-form) b/c less water is required to
high strength dental stone obtain sufficiently liquid mix
high strength, high expansion stone

setting Rn: hydration of calcium sulfate hemihydrate

CaSO4 + H2O + 1 H2O CaSO4 x 2 H2O + heat
hemihydrate is manufactured by heating dihydrate under controlled cd to drive off
some water (process called calcination)
accelerators potassium sulfate, gypsum
retarders borax, potassium citrate

dental plaster
-form
large, porous, low density, less crystalline, irregular in shape
dental stone
-form
smaller, more crystalline, less porous, more dense than the -form
superior physical properties
properties of gypsum depend on accurate measurement of water/powder ratio
100 g plaster 45-50 ml water
100 g dental stone 30-35 ml water
100 g die stone 20-25 ml water
theoretically, stoichiometric amount of water needed 18.6 ml
vacuum mixing porosity strength

variables
W/P weaker (less strength), thinner mix, less expansion (less crystal
growth contact), longer setting time
spatulation/mixing time (speed or time) setting time, expansion, no
ef on strength
19
 T setting time (b/c Rn rate), expansion, no ef on strength
Agar, alginate and biological fluids retard the setting
Terra alba (ground, set gypsum) used as an accelerator setting time
if leave setting mat in contact w/ water hygroscopic expansion
to improve abrasion resistance gypsums greatest disadv
impregnate surface of the die w/ low viscosity resin (e.g., cyanoacrylate)

Resin
used to overcome low strength and abrasion resistance of die stone
resin die mat
epoxy resin
polyurethane
significantly more abrasion resistant than gypsum
recommended use all-ceramic crowns
disadv
more expensive
some shrinkage during polymerization prostheses fit more tightly
incompatible w/ some imp mat

Electroplating
deposition of a coat of pure silver or copper on the imp by electrolysis and then
supported w/ type IV stone
recommended use all-ceramic crowns
disadv
silver plating requires cyanide (extremely toxic) major pbm
time consuming
requires special equipment
incompatible w/ many imp mat

Flexible die mat

similar to heavy bodied silicone or polyether imp mat
can be used to make interim Rtn or indirect comp resin inlays or onlays chairside
adv
rapid setting
ease of removal of interim Rtn or inlay

Selection criteria for die material

dimensionally accurate cast, strong and resistant to abrasion
easy to section and easy to trim w/ routinely available equipment
compatible w/ separating agent used to prevent wax pattern from sticking
reproduce detail accurately
available in a color that contrasts w/ wax
easily wettable by wax
compatible w/ the imp mat
type of final Rtn must be considered

Cast-and-die systems
removable dies (working cast w/ removable dies)
solid cast w/ individual dies (working cast + separate dies)

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Removable dies
the die is an integral part of the definitive cast and can be lifted to facilitate access
precise relocation of the die in the definite cast is crucial and is accomplished by
single dowels or multiple dowels Pindex system
adv
less manipulation of the wax pattern ( chance of breakage during transfer)
disadv
cast fabrication is technically more demanding
difficulty sawing the die out of the cast may dmg margins
extra equipment needed for Pindex
cast is made in 2 pours of contrasting colors
1st forms the teeth
2nd forms the base of the cast
areas to be separated are coated w/ separating agent
other areas get undercuts to prevent unwanted separation

Solid cast w/ individual dies

2 pours
1st only of the preparations
trimmed into individual dies w/ a handle
2nd entire arch
mounted on articulator
wax pattern is started on the initial pour (individual dies) and then transferred
to the articulated cast for refinement of axial contours and occl anatomy
adv
simple
precludes errors caused by incomplete seating of a removable die
disadv
difficult to transfer complex or fragile patterns from cast to die
awkward wax and porcelain application

Wax
Lost wax tch
obtain imp of the prepared tooth and make a cast
a wax pattern of the final Rtn is made
a mold is made around the wax pattern w/ a refractory investment mat
the wax is vaporized
the hollow mold is filled w/ molten cast alloy
the casting is retrieved, excess metal is removed, polishing

As solidifying metal (casting) cools to room T, it shrinks. Dimensional accuracy of the casting is
achieved by balancing this shrinkage against the carefully controlled expansion of the mold.

Ideal dimension of luting agent space 20 40 m

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Increasing the luting agent space
shrinkage of the imp mat larger die crown fits loosely
use of a die spacer
evaporation of solvent from die spacer thicker mix excessive thickness
expansion of the investment mold larger crown crown fits loosely
removal of metal from the fitting uf (by grinding, etching, or air abrasion)

Decreasing the luting agent space

all of the above in reverse +
use of resin or electroplated dies (they are slightly smaller than stone dies)

composition of inlay wax (used for all casting)

paraffin: 40 80 % (pbm flakes when trimmed)
dammar resin (to shrinkage, flakiness, smoothness)
carnauba wax (to melting T)
dyes
2 types
type I medium wax for direct tch
used for direct patterns in the oral cavity
type II soft wax for indirect tch
softer wax
used for indirect fabrication of castings
wax has elastic memory tendency to return to original shape
invest pattern immediately upon completion never leave the pattern off the dies
wax has a high coefficient of thermal expansion
changes dimensions as air T changes
pattern tends to release its incorporated strain (residual stresses)

Good inlay wax

flows readily when heated
rigid when cooled
can be carved precisely and smoothly (no chipping)

Contacts
occl 1/3
Mx progressively more occl and buccal as you move anteriorly
Md central

Emergence profile
axial contour that extends from the base of the gingival sulcus past the free margin
and to the height of contour, producing a straight profile in the gingival 1/3 of the Rtn
flat or slightly concave

Dental Wax: a low molecular-weight ester of fatty acids that softens at a relatively low T
Desired properties: no flakiness; ability to carve to margins; ability to be eliminated from mold
w/o traces of residues by burn out

Occl scheme
cusp-margiNal ridge
Natural dentition
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 buccal cusps of Md PM and the mesiobuccal cusps of Md molars contact the
embrasures bn the Mx teeth
each tooth contacts 2 teeth
occl contacts on opposing teeth are in marginal ridges and occlusal fossae
cusp-fossa
Md functional cusps contact further distally into the fossa of the Mx tooth
each tooth contacts only 1 tooth
occl contacts on opposing teeth are in occlusal fossae only
tripod contact minimal wear

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