6/25/2013

Dr Haroon Rashid Baloch

Department of Prosthodontics,
Ziauddin College of Dentistry.

KEY TEXT:
Planning and making crowns and bridges.
Bernard GN Smith. 3rd Edition.

REFERENCE:
Fundamentals of fixed prosthodontics.
Schillingburg HT. 3rd Edition.

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CROWN: A prosthetic
appliance or a prosthesis
which is permanently
attached to teeth and
replaces a single tooth
individually.
Cannot be removed by the
patient.

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BRIDGE: A prosthetic
appliance or prosthesis
which is permanently
attached to teeth and
replaces one or several
teeth.
Cannot be removed by the
patient.

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Abutment: It is a term
used for the supporting
structure of a crown or a
bridge.
A natural tooth or an
implanted tooth
substitute used to support
or anchor a dental
prosthesis.
The prepared tooth is
usually the abutment.

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Pontic: Part of a bridge.

It is the term used for an
artificial tooth on a fixed
bridge.
The portion of the dental
bridge that substitutes for
an absent tooth.

Ridge Lap pontic.

Modified ridge lap pontic.
Hygienic pontic / Self Cleansing pontic.
Conical / Bullet shaped pontic.

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Known as ridge lap because it

overlaps the facial and lingual
aspects of the ridge.
Causes most damage to
periodontal tissue.
Forms a large concave
contact with the ridge.
Used for a long time but
contraindicated due to
hygiene reasons.
Causes tissue inflammation.

Gives an illusion of the tooth.

Ease of cleaning by
permitting access for plaque
control from the lingual side.
Minimized plaque retention.
Commonly used pontic
design used for both
maxillary and mandibular
replacements.

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These pontics have no

contact with the ridge.
Used where aesthetics is not
an issue.
Used in non-appearance
zones particularly for
posterior replacements.
Occluso-gingival thickness
should be no less than 3mm
and adequate space should
be there to facilitate cleaning.

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Function (Mastication).
Aesthetics (Appearance).
Phonetics (Speech).
Retention (fixed).
Plaque Control.
Patient confidence and comfort.
Longevity ?

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Rounded and cleanable.

Smaller tip as compared
to the overall size of the
pontic.
Well suited for thin
mandibular ridges.
Provides good access for
plaque control.
More suitable for
posterior regions.

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Less conservative.
Requires careful treatment planning and skills
of the operator.
Technician Skills.
Maintenance.
Cost ?

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Patient tolerance to treatment and

maintenance ?
My own skills: am I skillful enough ?
Periodontal tissues intact ?
Occlusion ?
Endodontic status ?

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A difficult question to face up to but it is a

question that should be answered honestly.
Knowledge, skills and experience ?
Laboratory technician skills ?
Adequate treatment facilities, materials ?
Ultimately the decision is yours !!

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Occlusion:
A few basic checks should be performed.
Type of occlusion ?
Crowding if yes Plaque retention ?
Seems complex but are readily checked and
have a significant impact on prognosis of the
restoration.
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Anesthesia during treatment ?

Can the patient lie flat for a long term?
Mouth opening ?
Hygiene Maintenance ?
Night grinding ?

Periodontal Tissues:
If the periodontal status
is not good, restoring
teeth with crowns and
bridges is not indicated.
Always perform check
prior to planning to see if
the plaque control is
good enough.

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Endodontic Status:
Pulp is a alive and
everyones life is easier
where it remains a living
tissue.
Healthy pulp is
important for the success
of crowns.

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No crown or a bridge can really be regarded

as permanent. If we lived for long enough,
wear and tear, disease and the realities of
intra-oral existence mean that even the most
carefully constructed and cemented crown
would probably eventually fail.
We should though expect to get many useful
years from our crowns, and should plan to
have a situation we can recover, if and when
they eventually fail.
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Fin

as they say at the end of all French films.

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