Introduction to Fixed Prosthodontics

3. Introduction to Fixed Prosthodontics Dr. William Morgan Clinical Professor UCLA School of Dentistry April 3, 2007

4. Faculty • Dr. William Morgan, Course Co-Chair • Dr. Richard Stevenson, Course Co-Chair • Dr. Esteban Bonilla • Dr. Lillian Cheng • Dr. Donald Fisher • Dr. Michael Gritz • Dr. Sue Spackman • Dr. Jay Watson • Dr. Andy Wong

5. Course Requirements • Attend lecture & lab each week • Complete all projects on time • Pass midterm & final practical examinations • One makeup examination • Average 75% or better on all written examinations • Each question on quizzes & examinations count the same • Quizzes each week on reading assignment • Drop one quiz at end of quarter • Examinations cover material since last examination • Fall & Winter final examinations are cumulative

6. Terminology

7. Prosthodontics • The dental specialty concerned with the making of artificial replacements for missing parts of the mouth and jaw. Also prosthetic dentistry or prosthodontia. • Fixed Prosthodontics • Gold crowns-full and partial veneer • Inlays-gold and all ceramic • Porcelain-all porcelain and PFM • Fixed partial dentures • Replace one or more missing teeth

8. Restorative Dentistry • Restorative dentistry covers the range from simple direct restorations to complex full mouth rehabilitation. This will include class I & class II direct restorations, simple indirect restorations like inlays, crowns & veneers, to replacing missing teeth with fixed partial dentures & finally to complete rehabilitation with indirect restorations throughout the mouth. Esthetics & function must also be considered. • Operative Dentistry • Fixed Prosthodontics • Esthetic Dentistry

9. Restorations

10. Full Veneer Crowns Gold casting covers all external walls of the tooth & reinforces remaining tooth structure

11. Partial Veneer CrownMOL Gold Inlay/Onlay Healthy tooth structure is preserved

12. Partial Veneer CrownMOL Gold Inlay/Onlay Minimal facial extension preserves esthetics

13. Partial Veneer CrownMOD Gold Onlay Restoration reinforces remaining tooth & leaves tooth structure at gingival area

14. Gold Inlays Conservative preparation & finishing of the gold margins can provide a restoration that will last many years

15. All Ceramic Onlay Esthetic restoration but is subject to fracture

16. All Ceramic Inlay/Onlay

17. Porcelain Fused To Metal Crown (PFM) Porcelain is baked to a thin cast metal coping

18. Porcelain Veneers &Fixed Partial Denture

19. Porcelain Veneers & Fixed Partial Denture Porcelain Veneers Fixed Partial Denture

20. Fixed Partial Denture Porcelain is baked over a cast metal framework

21. Fixed Partial Denture (PFM) Metal framework for strength & porcelain for esthetics

22. Fixed Partial Denture (Gold)

23. Fixed Partial DenturePier Abutment Pontics

24. Fixed Partial DentureImplants FPD attached to implants

25. Diagnosis • History • Physical/Emotional Health • Premedicate • Allergies • Medications • Physician Consult

26. Diagnosis • TMJ/Occlusal Evaluation • Within Normal Limits? • Maintain Occlusal Relationship • Frequent Head, Neck or Shoulder Pain? • Evaluate Muscles & TMJ • Referral?

27. Diagnosis • Intraoral Examination • General Oral Hygiene • Soft Tissue • Periodontal Health • Probing/Chart Pockets • Mobility • Caries • Examine Old Restorations • Serviceable or failing?

28. Diagnosis • Diagnostic Casts-required for all indirect restorations • Mount With Facebow & Bite Records • Occlusal Evaluation • Diagnosis/Treatment Plan • Diagnostic Wax-Up • Stents For Temporization

29. Diagnosis • Full Mouth Radiographs • Caries-Interproximal & Recurrent • Periapical Lesions? • Quality of Previous Endodontics • Periodontal Health & Alveolar Bone Levels • Crown/Root Ratio • Pathosis

30. Treatment OptionsIntracoronal Restorations • Glass Ionomer • Composite Resin • Simple Amalgam • Complex Amalgam • Gold Foil • Gold Inlay • Ceramic Inlay

31. Treatment OptionsExtracoronal Restorations • Ceramic Onlay • Gold Onlay • Partial Veneer Crowns (3/4, 7/8) • Full Gold Crown • Porcelain/Metal Crown (PFM) • All-Ceramic Crown • Ceramic Veneer

32. Treatment OptionsReasons For Extracoronal Restorations • Previous restoration and/or caries undermines tooth structure, requiring reinforcement that comes from an extracoronal restoration • Discoloration present and patient desires esthetic improvement and tooth has been weakened • Occlusal modifications

33. Casting Full Gold Crown

34. Casting/Crown Fabrication • 1. Tooth Preparation, Including Caries Removal & Build-Up • 2. Temporization (Ready before impression) • 3. Impression • 4. Model (Cast) and Die Fabrication • 5. Wax-Up (Exact shape & size of desired crown) • 6. Investing and Casting • 7. Crown Adjusting and Polishing • 8. Clinical Try-In and Cementation

35. Tooth Preparations

36. Full Gold Crown Preparation • Indicated when restoration or caries significantly weakened tooth • All external walls covered-occlusal & axial with minimal taper of axial walls • Gingival finish line may be subgingival or supragingival • Adequate reduction to provide bulk of gold

37. Porcelain Fused to Metal (PFM) • Indications same as FGC but patient desires more esthetics • All walls covered similar to full gold crown • Additional reduction necessary on facial to accommodate metal & porcelain without being overcontoured

38. 3/4Gold Crown • Facial wall unprepared • Facial cusp minimally reduced occlusally • Grooves placed to prevent lingual displacement of crown • Minimal facial extension interproximally

39. Fixed Partial Denture • Anterior crown preparation (abutment) is a PFM • Posterior crown is a full gold crown

40. Ceramic Onlay • Restoration is all ceramic with no metal • It is bonded to the tooth • Weaker than restorations with metal & can fracture during mastication

41. Build-Ups • Done to replace missing tooth structure & provide retention for final restoration • Types • Pin Retained Amalgam or Composite • Preformed Posts Retaining Buildup • Custom Cast Post and Core

42. Build-Up (Pin retained) • Pin holes drilled into vital tooth • Pins threaded into tooth & retained in dentin • Missing tooth built up with amalgam or non tooth colored composite

43. Build-Up (Pre-formed post) • Endodontically treated tooth is missing significant amount of tooth structure • One or more canals are shaped & pre-formed post is fit into the canal & cemented • Chamber may also be used to provide additional retention for buildup

44. Build-Up (Pre-formed post) • After post is cemented, the tooth is built up with amalgam or composite • Walls of preparation must extend beyond the build up to the tooth structure

45. Build-Up (Custom Cast Dowel Core) • Single rooted endodontically treated tooth with significant amount of tooth structure missing or undermined-not enough to retain a crown

46. Build-Up (Custom Cast Dowel Core) • Canal is shaped & sized with a reamer • Resin pattern is made that is an exact impression of the canal & created the desired coronal “tooth structure” • Pattern is cast into gold

47. Build-Up (Custom Cast Dowel Core) • Cast dowel core is cemented into the canal in the root • Dowel core & tooth are reshaped into final crown preparation • Impression made of preparation & crown fabricated, adjusted & cemented onto tooth

48. Provisional Restorations(Temporaries) • Custom made acrylic • Relined polycarbonate crowns • Pre-formed metal crowns

49. Provisional Restoration (Custom Made Acrylic) • Rough provisional crown causes gingival irritation & difficulty in taking a final impression • Provisional restoration smoothed & polished with much better tissue response after only a few days

50. Provisional Restoration (Custom Made Acrylic) Final restorations