U NI V E R S I T Y O F M O S U L

C OL L E G E O F D E N TI S T RY

2021-2022

Clinical consideration
5 th YEAR
before bridge construction

Department of
Conservative
Dentistry

By: P.h.D. Lec. Maha Anwer Hussein

A-General factors

Patient aspirations and motivation.

 Age and general health of the patient.
Ability and training of the dentist and
technician.
Economic factors.
B-Local factors
 Evaluation of Abutment Teeth
1-Radiograph are made
1 2 3

5 6
4
2-pulpal health is assessed by evaluating the
response to thermal and electrical stimulation.
3- Existing restorations, cavity liners, and
residual caries are removed and a careful check is
made for possible pulpal exposure.
4-Teeth in which pulpal health is doubtful should
be endodontically treated before the initiation of
fixed prosthodontics.
 Abutment teeth and factors that
influence on selection
1-Unrestored Abutments

2-Endodontically Treated Abutments

 3-Tilted molar abutments
Early loss of a mandibular first molar ???
 Mesial tilting and drifting of the second and third molars.

 Impossible to achieve common path of insertion.

2

 In an attempt to do excessive preparation has to be done Path of insertion

or mesially tilted 3rd molar will not allow seating of

3
prosthesis
 Treatment modality
1-Extract the third molar and upright the tilted 2nd molar
orthodontically
2-Fixed appliance – premolars and the canine are banded
and tied to a passive stabilizing wire .
3-A helical uprighting spring is inserted into a tube on
the banded molar.
4-activated by hooking it over the wire on the anterior 1
segment.
 
Non-rigid
2-Modified preparation design if orthodontic
is impossible.
 Proximal half crown : ¾ crown that has been rotated
90 degree the distal surface is uncovered.
 Non-rigid connector on the distal aspect of the 2
premolar retainer compensates for the inclination of
A modified partial veneer crown
the tilted molar.
can be used when a single path of
insertion is required with minimal
tooth preparation
 3-Telescopic crown

Telescopic crown acoping or retainer is fabricated over

the tooth so that it alters the contour of the crown. This
crown should be fabricated with vertical slots so that it can
receive a second crown in a vertical direction,so Telescopic
crown used as a retainer on the distal abutment .
 A full crown preparation with heavy reduction is made to
follow the long axis of the tilted molar.
 Inner coping is made to fit the tooth preparation
 The proximal half crown that will serve as the retainer for
the fixed partial denture is fitted over the coping.
4-Root surface area of abutment
Ante’s law ''The abutment teeth should have a combined pericemental area equal to or
greater in pericemental area than the tooth or teeth to be replaced
Area in quadrant Root surface Percentage of
area (nm)2 root surface
5-Root Shape and Angulation.

Roots with greater labiolingual widths Roots with irregular curvatures are preferred

Teeth with longer roots serve as better abutments

6-Root Support
 One third of the root length has been exposed, half the
supporting area is lost. In addition, the forces applied to the
supporting bone are magnified because of the greater leverage
associated with the lengthened clinical crown

The abutment should have sufficient bone support. The alveolar

bone should show good trabecular pattern
 5-Replacing Multiple Anterior Teeth.

 The four mandibular incisors can usually be replaced by a simple FDP with retainers on each canine
tooth. It is not usually necessary to include the first premolars.
 If a lone incisor remains, it should be removed because its retention unnecessarily complicates the
FDP design and fabrication and can jeopardize the long-term prognosis.Mandibular incisors, because
of their small size, generally are poor abutment teeth. It is particularly important not to have
overcontoured restorations on these teeth because plaque control may become nearly impossible.
The clinician may have to make a choice among :
(1) compromised esthetics from too thin a ceramic veneer.
(2) pulpal exposure during tooth preparation.
(3) selective tooth removal.
 Because of the curvature of the dental arch, forces directed against a maxillary incisor pontic tend to
tip the abutment teeth outward. Unlike the mandibular incisors, the maxillary incisors are not
positioned in a straight line (particularly in patients with narrow or pointed dental arches). These
tipping forces must be resisted by means of additional abutment teeth at each end of a long-span
anterior FDP. Thus in general, when the four maxillary incisors are replaced, the canine teeth and
first premolars should be used as abutment teeth.
6-Pier abutment
A Pier abutment is a single tooth with two adjacent
edentulous spaces on either side. In this case, the single
tooth will have to act as an abutment for both the edentulous
spaces
 What are the problem???

 Rocking of retainer
 Bending of retainer
 Tension between abutment and retainer
 Intrusion of retainer on abutment
Two alternatives are there to minimizes the stress
a. Non rigid connector:
broken stress mechanical union
of retainer (dovetail keyway) and pontics (T -shaped key).

A nonrigid connector on
the pier abutment isolates
force to that segment of
1 the fixed partial denture
b. Cantilever to which it is applied

2
 7-Span length
Span length is the distance between abutments affects the viability of
placing fixed prostheses

Ideal for one missing teeth

 loss of 2-3 adjacent teeth requires careful evaluation
of other factors (crownroot ratio, root length and
form, periodontal health, tooth mobility, occlusal
force and biomechanical factor)

Excessive flexing under occlusal loads may cause

1-Failure of a long-span FDP. It can lead to fracture of a
porcelain veneer
2-Breakage of a connector
3-Loosening of a retainer, or an unfavorable soft tissue
response and thus render a prosthesis useless.
 The longer the span, the greater the flexing. The relationship
between deflection and length of span is not simply linear but
varies with the cube of the length of the span .
 Bending or deflection varies directly with the cube of the length
and inversely with the cube of the occlusogingival thickness of
the pontic. more toruquing forces on the abutment.
 If a span of a single pontic is deflected a certain amount, a span
of two similar pontics will move eight times as much, and a span
of three will move 27 times as much.
When long span F.P.D. fabricated:
1) Using double abutments to enhance retention and support
for long span FPD (anterior & posterior abutments should
have nearly the same retention and resistance ).
2) Pontics & connectors should be made as bulk as possible
to ensure optimum rigidity without jeopardizing gingival
health.
3) The prosthesis should made be of a material that has high
strength & rigidity.
 References:
1-Contemporary fixed prosthodontics UNIVERSITY OF MOSUL

2-Textbook of Prosthodontics
C O L L E G E O F D E N T I S T RY

2021-2022

Thank you for your nice attention