Copyright 2003, Elsevier Science (USA). All rights reserved. Fixed Prosthodontics Chapter 50 Copyright 2003, Elsevier Science (USA). All rights reserved

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

Fixed ProsthodonticsFixed ProsthodonticsChapter 50Chapter 50

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.

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ISBN 0-7216-9770-4


IntroductionIntroduction Fixed prosthodontics is the specialized

area of dentistry involved in the replacement of missing teeth with a cast prosthesis permanently cemented in place.

Fixed prosthodontics is the specialized area of dentistry involved in the replacement of missing teeth with a cast prosthesis permanently cemented in place.


Indications for Fixed Prosthodontics 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.

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.


Contraindications for Fixed Prosthodontics 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.

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.


Types of Cast Restorations 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.

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.


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.

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.

Types of Cast Restorations cont’d Types of Cast Restorations cont’d


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.

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.

Types of Cast Restorations cont’d Types of Cast Restorations cont’d


Table 50-1 Components of a Fixed Bridge Table 50-1 Components of a Fixed Bridge


Overview of a Fixed Prosthodontic ProcedureOverview 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.

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.


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.

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.

Tooth PreparationTooth Preparation


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

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

Retention AidsRetention Aids


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

• Nonimpregnated • Impregnated

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

• Nonimpregnated • Impregnated

Gingival Retraction and Tissue ManagementGingival Retraction and Tissue Management


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 heavy-bodied material to be seated onto the quadrant or arch.

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 heavy-bodied material to be seated onto the quadrant or arch.

Final ImpressionFinal Impression


Provides the laboratory technician with a reproduction of a patient’s bite and opposing arch registration for designing the anatomic structures of the fixed prosthetic.

• Open bite• Closed bite

Provides the laboratory technician with a reproduction of a patient’s bite and opposing arch registration for designing the anatomic structures of the fixed prosthetic.

• Open bite• Closed bite

Bite RegistrationBite Registration


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.

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.

Provisional Coverage Provisional Coverage


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

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

Laboratory PrescriptionLaboratory Prescription


Fig. 50-18 Laboratory prescription. Fig. 50-18 Laboratory prescription.


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

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

DeliveryDelivery


Home Care Instructions for the Patient with a Fixed Prosthesis 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.

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.

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Copyright 2003, Elsevier Science (USA). All rights reserved. Fixed Prosthodontics Chapter 50 Copyright 2003, Elsevier Science (USA). All rights reserved