Chapter 50

Fixed Prosthodontics
Copyright 2003, Elsevier Science (USA).
All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher.
PowerPoint presentation slides may be displayed and may be reproduced in print form for instructional purposes only, provided a proper copyright notice appears on the last page of each print-out. Produced in the United States of America ISBN 0-7216-9770-4

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.

Copyright 2003, Elsevier Science (USA). All rights reserved.

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.

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.

Copyright 2003, Elsevier Science (USA). All rights reserved.

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.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Types of Cast Restorations- contd

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.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Types of Cast Restorations- contd

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.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Table 50-1 Components of a Fixed Bridge

Copyright 2003, Elsevier Science (USA). All rights reserved.

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.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Tooth Preparation
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.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Retention Aids
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

Copyright 2003, Elsevier Science (USA). All rights reserved.

Gingival Retraction and Tissue Management

Cord temporarily displaces the gingival tissue
and widens the gingival sulcus so impression material can flow around all parts of the preparation. Nonimpregnated Impregnated

Copyright 2003, Elsevier Science (USA). All rights reserved.

Final Impression
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 heavybodied material to be seated onto the quadrant or arch.

Copyright 2003, Elsevier Science (USA). All rights reserved.

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

Copyright 2003, Elsevier Science (USA). All rights reserved.

Provisional Coverage
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.

Copyright 2003, Elsevier Science (USA). All rights reserved.

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

Copyright 2003, Elsevier Science (USA). All rights reserved.

Fig. 50-18 Laboratory prescription.

Copyright 2003, Elsevier Science (USA). All rights reserved.

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

Copyright 2003, Elsevier Science (USA). All rights reserved.

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.

Copyright 2003, Elsevier Science (USA). All rights reserved.