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IntroductionIntroduction to to
Fixed ProsthodonticsFixed Prosthodontics
Dr. William MorganDr. William MorganClinical ProfessorClinical Professor
UCLA School of DentistryUCLA School of DentistryApril 3, 2007April 3, 2007
FacultyFaculty Dr. William Morgan, Course Co-ChairDr. William Morgan, Course Co-Chair Dr. Richard Stevenson, Course Co-ChairDr. Richard Stevenson, Course Co-Chair
Dr. Esteban BonillaDr. Esteban Bonilla Dr. Lillian ChengDr. Lillian Cheng Dr. Donald FisherDr. Donald Fisher Dr. Michael GritzDr. Michael Gritz Dr. Sue SpackmanDr. Sue Spackman Dr. Jay WatsonDr. Jay Watson Dr. Andy WongDr. Andy Wong
Course RequirementsCourse Requirements Attend lecture & lab each weekAttend lecture & lab each week Complete all projects on timeComplete all projects on time Pass midterm & final practical examinationsPass midterm & final practical examinations
One makeup examinationOne makeup examination Average 75% or better on all written Average 75% or better on all written
examinationsexaminations Each question on quizzes & examinations count the Each question on quizzes & examinations count the
samesame Quizzes each week on reading assignmentQuizzes each week on reading assignment Drop one quiz at end of quarterDrop one quiz at end of quarter Examinations cover material since last examinationExaminations cover material since last examination Fall & Winter final examinations are cumulativeFall & Winter final examinations are cumulative
TerminologyTerminology
ProsthodonticsProsthodontics The dental specialty concerned with the The dental specialty concerned with the
making of artificial replacements for missing making of artificial replacements for missing parts of the mouth and jaw. Also prosthetic parts of the mouth and jaw. Also prosthetic dentistry or prosthodontia.dentistry or prosthodontia.
Fixed ProsthodonticsFixed Prosthodontics Gold crowns-full and partial veneerGold crowns-full and partial veneer Inlays-gold and all ceramicInlays-gold and all ceramic Porcelain-all porcelain and PFMPorcelain-all porcelain and PFM Fixed partial denturesFixed partial dentures
Replace one or more missing teethReplace one or more missing teeth
Restorative DentistryRestorative Dentistry Restorative dentistry covers the range from Restorative dentistry covers the range from
simple direct restorations to complex full simple direct restorations to complex full mouth rehabilitation. This will include class mouth rehabilitation. This will include class I & class II direct restorations, simple I & class II direct restorations, simple indirect restorations like inlays, crowns & indirect restorations like inlays, crowns & veneers, to replacing missing teeth with veneers, to replacing missing teeth with fixed partial dentures & finally to complete fixed partial dentures & finally to complete rehabilitation with indirect restorations rehabilitation with indirect restorations throughout the mouth. Esthetics & function throughout the mouth. Esthetics & function must also be considered.must also be considered.
Operative DentistryOperative Dentistry Fixed ProsthodonticsFixed Prosthodontics Esthetic DentistryEsthetic Dentistry
RestorationsRestorations
Full Veneer CrownsFull Veneer Crowns
Gold casting covers all external walls of the tooth & reinforces remaining tooth structure
Partial Veneer CrownPartial Veneer CrownMOL Gold Inlay/OnlayMOL Gold Inlay/Onlay
Healthy tooth structure is preserved
Partial Veneer CrownPartial Veneer CrownMOL Gold Inlay/OnlayMOL Gold Inlay/Onlay
Minimal facial extension preserves esthetics
Partial Veneer CrownPartial Veneer CrownMOD Gold OnlayMOD Gold Onlay
Restoration reinforces remaining tooth & leaves tooth structure at gingival area
Gold InlaysGold Inlays
Conservative preparation & finishing of the gold margins can provide a restoration that will last many years
All Ceramic OnlayAll Ceramic Onlay
Esthetic restoration but is subject to fracture
All Ceramic Inlay/OnlayAll Ceramic Inlay/Onlay
Porcelain Fused To Metal Porcelain Fused To Metal Crown (PFM)Crown (PFM)
Porcelain is baked to a thin cast metal coping
Porcelain Veneers &Porcelain Veneers &Fixed Partial DentureFixed Partial Denture
Porcelain Veneers & Porcelain Veneers & Fixed Partial DentureFixed Partial Denture
Porcelain Veneers
Fixed Partial Denture
Fixed Partial DentureFixed Partial Denture
Porcelain is baked over a cast metal framework
Fixed Partial Denture Fixed Partial Denture (PFM)(PFM)
Metal framework for strength & porcelain for esthetics
Fixed Partial Denture Fixed Partial Denture (Gold)(Gold)
Fixed Partial DentureFixed Partial DenturePier AbutmentPier Abutment
Pontics
Fixed Partial DentureFixed Partial DentureImplantsImplants
FPD attached to implants
DiagnosisDiagnosis HistoryHistory
Physical/Emotional HealthPhysical/Emotional Health PremedicatePremedicate AllergiesAllergies Medications Medications Physician ConsultPhysician Consult
DiagnosisDiagnosis TMJ/Occlusal EvaluationTMJ/Occlusal Evaluation
Within Normal Limits?Within Normal Limits? Maintain Occlusal RelationshipMaintain Occlusal Relationship
Frequent Head, Neck or Shoulder Frequent Head, Neck or Shoulder Pain?Pain? Evaluate Muscles & TMJEvaluate Muscles & TMJ
Referral? Referral?
DiagnosisDiagnosis Intraoral ExaminationIntraoral Examination
General Oral HygieneGeneral Oral Hygiene Soft TissueSoft Tissue Periodontal HealthPeriodontal Health
Probing/Chart PocketsProbing/Chart Pockets MobilityMobility
CariesCaries Examine Old RestorationsExamine Old Restorations
Serviceable or failing?Serviceable or failing?
DiagnosisDiagnosis Diagnostic Casts-required for all Diagnostic Casts-required for all
indirect restorationsindirect restorations Mount With Facebow & Bite RecordsMount With Facebow & Bite Records Occlusal EvaluationOcclusal Evaluation Diagnosis/Treatment PlanDiagnosis/Treatment Plan Diagnostic Wax-UpDiagnostic Wax-Up Stents For TemporizationStents For Temporization
DiagnosisDiagnosis Full Mouth RadiographsFull Mouth Radiographs
Caries-Interproximal & RecurrentCaries-Interproximal & Recurrent Periapical Lesions?Periapical Lesions? Quality of Previous EndodonticsQuality of Previous Endodontics Periodontal Health & Alveolar Bone Periodontal Health & Alveolar Bone
LevelsLevels Crown/Root RatioCrown/Root Ratio PathosisPathosis
Treatment OptionsTreatment OptionsIntracoronal RestorationsIntracoronal Restorations
Glass IonomerGlass Ionomer Composite ResinComposite Resin Simple AmalgamSimple Amalgam Complex AmalgamComplex Amalgam Gold FoilGold Foil Gold InlayGold Inlay Ceramic InlayCeramic Inlay
Treatment OptionsTreatment OptionsExtracoronal RestorationsExtracoronal Restorations
Ceramic OnlayCeramic Onlay Gold OnlayGold Onlay Partial Veneer Crowns (3/4, 7/8)Partial Veneer Crowns (3/4, 7/8) Full Gold CrownFull Gold Crown Porcelain/Metal Crown (PFM)Porcelain/Metal Crown (PFM) All-Ceramic CrownAll-Ceramic Crown Ceramic VeneerCeramic Veneer
Treatment OptionsTreatment OptionsReasons For Extracoronal Reasons For Extracoronal
RestorationsRestorations Previous restoration and/or caries Previous restoration and/or caries
undermines tooth structure, requiring undermines tooth structure, requiring reinforcement that comes from an reinforcement that comes from an extracoronal restorationextracoronal restoration
Discoloration present and patient desires Discoloration present and patient desires esthetic improvement and tooth has been esthetic improvement and tooth has been weakenedweakened
Occlusal modifications Occlusal modifications
CastingCasting
Full Gold Crown
Casting/Crown Casting/Crown FabricationFabrication 1. Tooth Preparation, Including Caries 1. Tooth Preparation, Including Caries
Removal & Build-UpRemoval & Build-Up 2. Temporization (Ready before impression)2. Temporization (Ready before impression) 3. Impression3. Impression 4. Model (Cast) and Die Fabrication4. Model (Cast) and Die Fabrication 5. Wax-Up (Exact shape & size of desired 5. Wax-Up (Exact shape & size of desired
crown)crown) 6. Investing and Casting6. Investing and Casting 7. Crown Adjusting and Polishing7. Crown Adjusting and Polishing 8. Clinical Try-In and Cementation8. Clinical Try-In and Cementation
Tooth PreparationsTooth Preparations
Full Gold Crown Full Gold Crown PreparationPreparation Indicated when Indicated when
restoration or caries restoration or caries significantly significantly weakened tooth weakened tooth
All external walls All external walls covered-occlusal & covered-occlusal & axial with minimal axial with minimal taper of axial wallstaper of axial walls
Gingival finish line Gingival finish line may be subgingival or may be subgingival or supragingivalsupragingival
Adequate reduction to Adequate reduction to provide bulk of goldprovide bulk of gold
Porcelain Fused to Metal Porcelain Fused to Metal (PFM)(PFM)
Indications same as Indications same as FGC but patient FGC but patient desires more desires more estheticsesthetics
All walls covered All walls covered similar to full gold similar to full gold crowncrown
Additional reduction Additional reduction necessary on facial to necessary on facial to accommodate metal accommodate metal & porcelain without & porcelain without being overcontouredbeing overcontoured
3/43/4 Gold CrownGold Crown Facial wall unpreparedFacial wall unprepared Facial cusp minimally Facial cusp minimally
reduced occlusallyreduced occlusally Grooves placed to Grooves placed to
prevent lingual prevent lingual displacement of crowndisplacement of crown
Minimal facial extension Minimal facial extension interproximallyinterproximally
Fixed Partial DentureFixed Partial Denture Anterior crown Anterior crown
preparation preparation (abutment) is a (abutment) is a PFMPFM
Posterior crown Posterior crown is a full gold is a full gold crowncrown
Ceramic OnlayCeramic Onlay Restoration is all Restoration is all
ceramic with no ceramic with no metalmetal
It is bonded to the It is bonded to the toothtooth
Weaker than Weaker than restorations with restorations with metal & can fracture metal & can fracture during masticationduring mastication
Build-UpsBuild-Ups Done to replace missing tooth Done to replace missing tooth
structure & provide retention for structure & provide retention for final restorationfinal restoration
TypesTypes Pin Retained Amalgam or CompositePin Retained Amalgam or Composite Preformed Posts Retaining BuildupPreformed Posts Retaining Buildup Custom Cast Post and CoreCustom Cast Post and Core
Build-Up (Pin retained)Build-Up (Pin retained) Pin holes drilled Pin holes drilled
into vital toothinto vital tooth Pins threaded into Pins threaded into
tooth & retained in tooth & retained in dentindentin
Missing tooth built Missing tooth built up with amalgam up with amalgam or non tooth or non tooth colored compositecolored composite
Build-Up (Pre-formed Build-Up (Pre-formed post)post)
Endodontically Endodontically treated tooth is treated tooth is missing significant missing significant amount of tooth amount of tooth structurestructure
One or more canals One or more canals are shaped & pre-are shaped & pre-formed post is fit into formed post is fit into the canal & cementedthe canal & cemented
Chamber may also be Chamber may also be used to provide used to provide additional retention additional retention for buildupfor buildup
Build-Up (Pre-formed Build-Up (Pre-formed post)post)
After post is After post is cemented, the tooth cemented, the tooth is built up with is built up with amalgam or amalgam or compositecomposite
Walls of preparation Walls of preparation must extend beyond must extend beyond the build up to the the build up to the tooth structuretooth structure
Build-Up (Custom Cast Dowel Build-Up (Custom Cast Dowel Core)Core)
Single rooted Single rooted endodontically endodontically treated tooth treated tooth with significant with significant amount of tooth amount of tooth structure missing structure missing or undermined-or undermined-not enough to not enough to retain a crownretain a crown
Build-Up (Custom Cast Dowel Build-Up (Custom Cast Dowel Core)Core)
Canal is shaped & sized Canal is shaped & sized with a reamerwith a reamer
Resin pattern is made Resin pattern is made that is an exact that is an exact impression of the canal impression of the canal & created the desired & created the desired coronal “tooth coronal “tooth structure”structure”
Pattern is cast into goldPattern is cast into gold
Build-Up (Custom Cast Dowel Build-Up (Custom Cast Dowel Core)Core)
Cast dowel core is Cast dowel core is cemented into the cemented into the canal in the rootcanal in the root
Dowel core & tooth Dowel core & tooth are reshaped into final are reshaped into final crown preparationcrown preparation
Impression made of Impression made of preparation & crown preparation & crown fabricated, adjusted & fabricated, adjusted & cemented onto toothcemented onto tooth
Provisional RestorationsProvisional Restorations(Temporaries)(Temporaries)
Custom made acrylicCustom made acrylic Relined polycarbonate crownsRelined polycarbonate crowns Pre-formed metal crownsPre-formed metal crowns
Provisional RestorationProvisional Restoration (Custom Made Acrylic) (Custom Made Acrylic)
Rough provisional Rough provisional crown causes crown causes gingival irritation & gingival irritation & difficulty in taking a difficulty in taking a final impressionfinal impression
Provisional Provisional restoration smoothed restoration smoothed & polished with much & polished with much better tissue better tissue response after only a response after only a few daysfew days
Provisional RestorationProvisional Restoration (Custom Made Acrylic) (Custom Made Acrylic)
Final restorations
Provisional Restorations Provisional Restorations (Relined Polycarbonate (Relined Polycarbonate
Crowns)Crowns) Pre-formed Pre-formed
polycarbonate crown polycarbonate crown selected & adjustedselected & adjusted
Polycarbonate crown Polycarbonate crown relined with acrylic, relined with acrylic, adjusted, polished & adjusted, polished & cementedcemented
Provisional Restorations Provisional Restorations (Preformed Metal Crowns)(Preformed Metal Crowns)
Pre-formed soft Pre-formed soft metal crown metal crown selected & adjustedselected & adjusted
Metal crown relined Metal crown relined with acrylic, with acrylic, adjusted, polished adjusted, polished & cemented& cemented
ImpressionsImpressions Full arch impressionsFull arch impressions Double bite impressionsDouble bite impressions Quadrant impressionsQuadrant impressions
Full Arch ImpressionFull Arch Impression
Impression of whole arch using light & heavy body impression material capturing detail with no bubbles
Double Bite ImpressionDouble Bite Impression Impression Impression
of of preparation, preparation, opposing opposing dentition as dentition as well as well as intercuspal intercuspal bitebite
Model (Cast) andModel (Cast) andDie FabricationDie Fabrication
Cast & Die FabricationCast & Die Fabrication
Full arch impression is used to fabricate full arch cast with removable dies
Cast & Die FabricationCast & Die Fabrication Double bite Double bite
impression is impression is used to fabricate used to fabricate mounted casts mounted casts with either a with either a separate die or a separate die or a removable dieremovable die
SeriesSeriesCrown PreparationCrown PreparationCasting FabricationCasting Fabrication
Full Crown Prep #30Full Crown Prep #30
Impression & Cast Impression & Cast FabricationFabrication
Inspect impression for completeness & fabricate cast
Wax Pattern Wax Pattern FabricationFabrication
Fabricate a wax pattern exactly like the desired crown, checking details with the stereo microscope
Invest & Cast CrownInvest & Cast Crown
Finished wax pattern is placed inside ring & investment flowed around it. Pattern is burned out in oven & molten gold flowed into the void in the ring, creating the casting as shown above
Crown CementationCrown Cementation
Crown tried in, adjusted & cemented