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Guidelines for Crowns, fixed bridges and implants

These guidelines provide essential information on the restoration of teeth, clinical examinations, treatment planning, implant placement, surgical protocols, tooth conservation, and more to facilitate optimal patient outcomes

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Guidelines for Crowns, fixed bridges and implants

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  1. samuel poole Guidelines for Crowns, fixed bridges and implants

  2. crown, bridge and implant guidelines The British Society for Restorative Dentistry Guidelines for Crowns, Fixed Bridges and Implants Dental Update or BSRD website source material

  3. crown, bridge and implant guidelines Restore form, function and appearance of teeth Cosmetics Reduce risk of # in heavily restored teeth, inc. endodontically treated posterior teeth Alter shape, size, inclination of teeth Why crown?

  4. crown, bridge and implant guidelines What does patient want? Medical issues • Implants - Osteoporosis, bisphosphonates, poorly controlled diabetes, smoking, radiotherapy Control of current disease, risk for progression/development of new disease Clinical exam and special tests Assessment

  5. crown, bridge and implant guidelines Aims of treatment: • Control and prevent further active disease • Minimal intervention • Long term benefit for the patient • Fix patient’s problems Treatment planning

  6. crown, bridge and implant guidelines Facilitated by study casts, diagnostic wax ups, discussing case with specialists or technicians Choice of materials/design • Finances • Allow realisation of patients’ expectations • Technical considerations Treatment planning continued

  7. crown, bridge and implant guidelines Risks and benefits discussed Written? Cost estimates Consent

  8. crown, bridge and implant guidelines Provision of fixed prosthodontics falls within restorative phase of a treatment plan Prior to this phase • Pain control, disease control • Perio, endo, ortho … • Implant placement Order of treatment

  9. crown, bridge and implant guidelines Space • Need enough inter-dentally, inter-occlusally to place implant • Shape of bone (concavities, thin ridges). Bone grafting required? • Anatomical structures - pesky nerves • Enough soft tissue between teeth/implant to allow natural contours Dental Implant Guidelines

  10. crown, bridge and implant guidelines Number of implants • Depends on prosthesis, quality and quantity of bone • Edentulous • Fixed bridges - Maxilla - 6, Mandible - 4 • Overdenture - Maxilla - 4, Mandible 2 Dental Implant Guidelines

  11. crown, bridge and implant guidelines Surgical Protocols • Manufacturer’s instructions - always Single versus two-stage • Two stage = covering implant and uncovering later - where bone augmentation has been carried out, poor initial stability Immediate placement • Healthy bone, no pathologies, at least 5mm of apical bone to allow good stability, better for single rooted teeth Healing times • Mandible 2-3 months, Maxilla 3-4 months Dental Implant Guidelines

  12. crown, bridge and implant guidelines Conservation of tooth tissue Enough space for technician to build restoration Well defined margins on sound tooth tissue 2mm off the top please Preparation of teeth

  13. Accuracy and stability Soft tissue control Opposing arch Stock tray/special tray crown, bridge and implant guidelines Occlusal Registration Impressions • Not always required • To allow opposing casts come together in ICP • Conform or reorganising • Facebows, custom guidance tables

  14. crown, bridge and implant guidelines Restore, protect and maintain position of prepared teeth between appointments Interim prostheses may be used while waiting for implants to integrate “Provisional” vs “Temporary” • Provisional restorations can contour soft tissue, test function or demonstrate aesthetics/form Temporisation

  15. crown, bridge and implant guidelines Communication, communication, communication “24 nhs np post/core + pbc, shade a3 - thanks” For more complex issues… • Photographs, shade matching visits, diagrams, wax ups Lab Prescriptions

  16. crown, bridge and implant guidelines Try in and Fit • Assess quality of lab work prior to patient visiting • Assess fit of prosthesis both inter-occlusally, inter-proximally and marginally • Cement/Luting - material dependant • Implants - cemented or screwed

  17. crown, bridge and implant guidelines High quality fixed prosthodontics is an exacting task Rewarding results for dental team and patient These guidelines are more of a practical reminder of the standards that should be aimed for Conclusions

  18. crown, bridge and implant guidelines * Permission granted for use of clinical photographs in this presentation

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