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Ministry-Of-High-Education-2.docx

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2019-05-12 11:08 UTC Ministry-Of-High-Education-2.docx 38.9% Date: 2019-05-12 10:46 UTC  All sources 100 

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76 pages, 14630 words

PlagLevel: 38.9% selected / 38.9% overall 523 matches from 105 sources, of which 81 are online sources.

Settings Data policy: Compare with web sources, Check against my documents, Check against the Plagiarism Prevention Pool Sensitivity: High Bibliography: Bibliography excluded Citation detection: No detection Whitelist: --

Ministry Of High Education

And Scientific Research

Tishk International University

Faculty of Dentistry

Bone resorption comparison in bridge side and non-bridge side on OPG

By:

Marwa Latif Fatih

Nakhshin Khalid Hamad

Supervised by:

[36]

Marwa Latif Fatih Nakhshin Khalid Hamad Supervised by: [36] Prof.Dr. Jabbar Husain Kamal Project submitted in

Prof.Dr.Jabbar Husain Kamal

Project submitted in Partial Fulfillment of the

Requirements for the degree of

Bachelor in dental surgery (BDS)

Hawler 2018-2019

1

Dedication

……………………

Every challenge work needs self-efforts as well as guidance of elders especially those who were very close to our heart.

Our humble effort we dedicate to our sweet and loving

[36]

Our humble effort we dedicate to our sweet and loving [36] Father & Mother, Whose affection,

Father & Mother,

Whose affection, love, encouragement and prays of day and night make us able to get such success and honor,

Along with all hard working and respected Teachers.

2

ACKNOWLEDGMENTS

Our grateful and deepest thanks to God for giving us the strength and patience to complete this research.

[8]

us the strength and patience to complete this research. [8] Our deepest gratitude and appreciation goes

Our deepest gratitude and appreciation goes to our supervisor Prof. Dr .Jabbar Husain for his helpful comments, advices and kindness throughout our work and writing of this thesis and for being generous with his knowledge and experience and time in supervising this work.

[8]

and experience an d time in supervising this work. [8] [8] We would like to specially

[8]

and experience an d time in supervising this work. [8] [8] We would like to specially

We would like to specially thank Dr.Bzhar for his effort with us, for his great helps and kind advice for improving our thesis.

[8]

great helps an d kind advice for improving our thesis. [8] [35] [6] We would like

[35]

helps an d kind advice for improving our thesis. [8] [35] [6] We would like to

[6]

We would like to thank Dr. Rebaz for statistical analysis.

would like to thank Dr . Rebaz for statistical analysis . [51] [103] We want to

[51]

like to thank Dr . Rebaz for statistical analysis . [51] [103] We want to thank

[103]

We want to thank Dr.Rebuar Fadhil for helping us.

[103] We want to thank Dr .Rebuar Fadhil for helping us . [6] We would like

[6]

We want to thank Dr .Rebuar Fadhil for helping us . [6] We would like to

We would like to thanks Oral radiology and Diagnosis department for their help.

Finally, we would like to express our deep gratitude to our families for their

[8]

to express our deep gratitude to our families for their [8] continuous support, helps which made

continuous support, helps which made everything possible.

3

Abstract

[35]

Abst ract [35] The aim of study: This study designed for find radiographical evaluation of bone

The aim of study: This study designed for find radiographical evaluation of bone resorption around abutment teeth for fixed bridge construction, and evaluation the effects of age, sex, arch and number of missing area and amount of bone resorption.

[6]

number of missing area and amount of bone resorption. [6] Background: Fixed dental bridge, it is

Background: Fixed dental bridge, it is fixed prosthetic restoration used to restore one or more missed teeth and placed on abutment which is natural teeth.

[40]

and placed on abutment whi ch is n atural teeth. [40] Material and method: In the

Material and method: In the present work, the study samples were collected

randomly from patients who had fixed dental bridge and attended to the oral diagnosis and radiology department in College of Tishik International University,

[6]

in College of Tishik International University, [6] in Erbil during the period between ‘ 'October 2018

in Erbil during the period between 'October 2018 March 2019''. At first questioners have been filled for those patients who have posterior dental fixed bridge either they were ( metal or dental PFM or zircon ) all were either single missed or double missed teeth in molar and premolar region , the questioner included two age group which were between (20-39)-(40-60) and all the name ,age, gender, number of missing unit , and location of fixed dental bridge were recorded, and radiographs were viewed on computer and measurement done for all the radiographs by NEWTOM program.

[16]

done for all the radiogra phs by NEWTOM program. [16] Result: In this study 242 cases

Result: In this study 242 cases were recorded from total number of cases which have been done. There were 44.8% male and 55.2% female.

According to age groups from (20-39) was 16.2 % and (40-60) was 83.8%according

[10]

from (20-39) was 16.2 % and (40-60) was 83.8%according [10] to missing unit , one missing

to missing unit , one missing unit 65.6% , two missing unit 34.4% according to the site of the bridge , upper right 29.9 % , upper left 30.7% lower left 14.5% , lower right 24.9% according to non-bridge site , upper right 21.6 % , upper left 2.4% lower left 39.8% , lower right 26.1%.

4

Conclusion: According to this study, bone resorption comparison between bridge side and non-bridge side is significant and higher rate of bone resorption have been recorded in non-bridge side.

Table of Contents

 

List of Table

8

Chapter one:

10

 

Introduction

10

1.1

Aim of study

12

Chapter Two:

13

Literatures Review

13

2.1Terminology:

13

2.2Restoration types:

14

2.2.1-Crown:

14

2.2.2-Bridge

14

 

2.2.3-Inlay

15

2.2.4-Onlay

15

2.2.5-Veneer

15

2.3Dental bridge:

15

2.3.1Advantage:

15

2.3.2Disadvantages:

16

2.3.3Dental bridge Indications

16

2.3.4Contraindications:

17

2.3.5Types of bridge:

17

[0]

[0]

2.4

Case selection and treatment planning:

23

[0]

[0]

2.5Selection and evaluation of abutment teeth:

24

2.6Biomechanical Considerations:

25

[0]

[0]

2.7Types of artificial plastic teeth:

26

[0]

[0]

2.8

A pontic aims

27

[0]

[0]

2.9Types of bridges according to durability:

28

[0]

[0]

2.10Types of bridges according to material:

29

[0]

[0]

2.11Clinical stages of bridgework

30

5

2.12Restoration fabrication

32

2.13Bridge failures

33

[0]

[0]

2.14Problems with

abutment teeth:

34

2.14.1Periodontal disease:

34

[3]

[3]

2.14.2Problem with the pulp:

34

2.14.3Caries:

 

35

[3]

[3]

2.14.4Fracture of the prepared natural crown or root:

35

[0]

[0]

2.14.5Movement of the tooth:

35

2.15Design Failures:

36

2.15.1Inadequate bridge design:

36

2.15.2Under-prescribed bridges:

36

2.15.3Over-prescribed bridges:

36

2.16 Marginal insufficiencies:

38

2.16.1Positive ledge (overhang):

38

2.16.2Negative ledge:

38

2.16.3Defect:

 

39

2.16.4Poor shape or shading :

39

2.16.5Occlusal problem:

40

[0]

[0]

2.17Oral manifestations of bridge failures:

40

2.18Management

options include:

41

2.19Ferrule effect on preparation:

41

2.20Previous study:

42

Chapter Three:

 

45

Materials And Methods

45

3.1

Materails

 

46

Chapter four:

52

Results

52

Chapter five:

 

60

Discussion

60

5.1 descriptive statistics:

60

5.2 inferential statistics:

61

[40]

[40]

5.3

compare to other studies

64

6

Chapter six: conclusion and suggestion

68

6.1-conclusion

68

6.2

Suggestion:

69

References

List of figures

[104] 70
[104]
70

[32]

[32]

Figure 1:orthopantogram:new tom

46

Figure 1 : orthopantogram:new tom 46 [85] 47 47

[85]

47

47

 

Figure 2:NEWTOM

Figure

Figure 4:measurment

[16]

Figure 4:measurment [16] 48 48 [38] 49 50

48

48

Figure 4:measurment [16] 48 48 [38] 49 50

[38]

49

50

Figure 5:measurment of bridge

 

Figure 6:measurment of bridge side and non bridge side

Figure 7:questionary accoridng to age (20-39)

 

Figure 8:questionary according to age (40-60)

51

Figure 9:bone resorption between bridge side and non bridge side

53

[7]

[7]

Figure 10:rate of bone resorption in male patient

54

[35]

[35]

Figure 11:rate of bone resorption in female patient

55

56

56

57

58

Figure 12:rate of bone resorption in bridge site

Figure 13:rate of bone resorption in non-bridge site

Figure 14:rate of bone resorption between each jaw in bridge site

Figure 15:rate of bone resorption bewtween each jaw in non bridge side

58

Figure 16:distribution of case according to

7

List of Table

Table 1:Descriptive data of participant among bridge and non-bridge site Table 2: Comparison of bone resorption between bridge and non-bridge sides

Table 3:Bone resorption of bridge and non-bridge sides for male patients Table 4:Bone resorption of bridge and non-bridge sides for male patients Table 5:: Difference in bone resorption of bridge and non-bridge sides according to age groups of the

[15] 52
[15]
52
53 [94] 54
53
[94]
54

54

55

Table 6:: Difference in bone resorption of bridge and non-bridge sides according to age groups of the

[72]

and non-bridge sides according to age groups of the [72] Table 7: Comparison of bone resorption

Table 7:Comparison of bone resorption in upper and lower jaws among bridge Table 8: Comparison of bone resorption in upper and lower jaws among bridge

57

[81] 57 [0] 58
[81]
57
[0]
58

8

List of abbreviation

ICP

Intercuspal position

PMF

Porcelain fused to metal

CAD

Computer aided drawing

CAM

Computer aided modeling

FDP

Fixed dental prosthesis

OPG

Orthopantogram

LSFDPs

Long-span fixed dental prosthesis

TMJS

Tempromandibular joints

GIC

Glass inomer cement

9

Chapter one: [80]
Chapter one:
[80]

Introduction

Fixed prosthodontics is the science and art of reestablishing harmed teeth with cast metal, metal-artistic, or every single earthenware rebuilding and of

supplanting missing teeth with fixed prostheses utilizing metal-fixed prosthetic

[80]

with fixed prostheses utilizing metal-fixed prosthetic [80] teeth ( pontics ) or metal-ceramic crowns over implant.

teeth ( pontics ) or metal-ceramic crowns over implant. Effectively treating a patient by methods for fixed prosthodontics requires an astute blend of

[5]

for fixed prosthodontics requires an astute blend of [5] numerous parts of dental treatment : patient

numerous parts of dental treatment: patient training and the anticipation of further dental sickness, sound diagnosis, periodontal treatment, operative abilities, occlusal contemplations, and, some of the time, arrangement of removable complete or halfway prostheses and endodontic treatment.

[5]

or halfway prostheses and endodontic treatment . [5] restoration in this field of dentistry can be

restoration in this field of dentistry can be the best administration rendered for

[80]

dentistry can be the best administration rendered for [80] dental patients or the most exceedingly awful

dental patients or the most exceedingly awful insult executed upon them. The way taken relies on one's learning of sound biologic and mechanical standards,

the development of manipulative abilities to actualize the treatment plan, and the

[8]

abilities to actualize the treatment plan, and the [8] advancement o f a b asic eye

advancement of a basic eye and judgment for evaluating subtlety. As in all fields of the mending expressions, there has been gigantic change here of dentistry as

[9]

there has been gigantic change here of dentistry as [9] of late. Improved materials, instruments, and

of late. Improved materials, instruments, and methods have made it feasible for the present administrator with normal aptitudes to give an administration whose

quality is on a standard with that gave just by the most skilled dental specialist of

[13]

gave just by the most skilled dental specialist of [13] [22] years gone . This is

[22]

just by the most skilled dental specialist of [13] [22] years gone . This is possible

years gone. This is possible be that as it may; just if the dentist has an intensive foundation in the standards of remedial dentistry and close information of the

[5]

of remedial d entis try and close information of the [5] systems required . The extent

systems required .The extent of fixed prosthodontics treatment can run from the

[5]

of fixed prosthodontics treatment can run from the [5] restoration of a single tooth to the

restoration of a single tooth to the restoration of the whole occlusion. Single teeth can be reestablished to full capacity, and improvement in feel can be

[5]

to f ull c apacity, and improvement in feel can be [5] accomplished . Missing teeth

accomplished. Missing teeth can be supplanted with fixed prostheses that will improve patient comfort and masticatory capacity, keep up the wellbeing and honesty of the dental arches, and, in numerous cases, raise the patient's mental

[80]

, in numerous cases, raise the patient's mental [80] self portrait. It is likewise possible, using

self portrait. It is likewise possible, using fixed dental prosthetic, and to render an

ideal occlusion that improves the orthopedic dependability of the

10

[15]

[15] temporomandibular joints (TMJs ). Then again, with inappropriate treatment of the occlusion , it is

temporomandibular joints (TMJs). Then again, with inappropriate treatment of the occlusion, it is possible to make disharmony and harm to the stomatognathic

[28]

to ma ke disharmony and harm to the stomatognathic [28] framework. in dentistry, Ante's law alludes

framework. in dentistry, Ante's law alludes to a gathering of recommendations identified with crown-to-root proportion set forth by Irwin H. Risk, in a proposition paper he wrote in 1926.{ Michigan,1926]

[5]

a pr oposition paper he wrote in 1926.{ Michigan,1926] [5] Fixed prosthodontics is worried about reestablishing

Fixed prosthodontics is worried about reestablishing teeth utilizing rebuilding

[6]

worried about reestablishing teeth utilizing rebuilding [6] efforts that are fixed into the patient's mouth .

efforts that are fixed into the patient's mouth. They are ordinarily made in a lab in the wake of taking impressions (molds) for the professional technician to work

[13]

( molds) for the professional technician to work [13] with . They are otherwise called "indirect

with. They are otherwise called "indirect restoration".

Indirect rebuilding efforts can be utilized to reestablish and fix single or various

teeth, and can be utilized to reestablish generally little spaces between the teeth. Indirect rebuilding efforts are generally strong contrasted with fillings that can be

[8]

strong cont raste d with fillings th at can be [8] [8] put at the chair

[8]

strong cont raste d with fillings th at can be [8] [8] put at the chair

put at the chair side. Frequently the aberrant rebuilding efforts can be made to

[28]

the aberran t rebu ilding efforts can be made to [28] look better (more aesthetic). It

look better (more aesthetic). It is hard to state to what extent fixed rebuilding

[36]

is hard to st ate to what extent fixed rebuilding [36] efforts should last. In the

efforts should last. In the event that they are arranged, executed and kept up accurately, they could last anyplace up to 10-12 years, and maybe more. Ante's

[93]

up to 10-12 years, and maybe more. Ante's [93] law hypothesized that: " total area of

law hypothesized that: "total area of abutment teeth should be equal or more

than area of tooth or teeth that should be replaced "Working from this reason,

[5]

should be replaced " Working from t his r eason, [5] later cases were made that:

later cases were made that: "the length of the periodontal membrane attachment of the abutment tooth should to be somewhere around one half to two third of

[5]

should to be somewhere around one half to two third of [5] that of its typical

that of its typical root attachment" ,Because of these to a great extent unverified, experimental ideas, numerous teeth were in this manner rejected from reasonableness as a abutment for fixed partial dentures and twofold abutments

turned into a prevalent methods for conforming to Ante's law. Long-period

[5]

methods for conforming to Ante's law. Long-period [5] clinical preliminari es n eglected to give proof

clinical preliminaries neglected to give proof to Ante's purported "law" and all

things considered, it tends to be reasoned that Ante's law as for teeth has been

[5]

it te nds to be reasoned that Ante's law as for teeth has been [5] refuted[

refuted[ Greenstein G et al., 2007]

11

[9]

[ 9 ] 1. 1 A im of study Radiographically evaluation for the effects of fixed

1.1 Aim of study

Radiographically evaluation for the effects of fixed bridge on bony support around abutment teeth and the relation of age,gender,arch,span in patients who visited dental clinic of Tishik International University of medical science Diagnosis and Oral radiology department ,during 2017-2018.

12

Chapter Two:

Literatures Review

2.1Terminology:

[0]

C hapter T wo: L iteratures Review 2.1 T erminology: [0] Bridge: is fixed dental rebuilding

Bridge: is fixed dental rebuilding (a fixed dental prosthesis) used to supplant one or more ,fixed connect dental prosthesis that is completely joined to normal teeth

[10]

that is completely joined t o norm al teeth [10] and replaces missing teeth . [

and replaces missing teeth.[Mitchell DA et al.,2014]

[0]

replaces missing teeth . [ Mitchell DA et al . ,2014] [0] Abutment: The tooth that

Abutment: The tooth that support and holds a dental prosthesis. [The Glossary of Prosthodontics Terms: Ninth Edition 2017]

[0]

of Prosthodontics Term s: Ninth Edition 2017] [0] Pon c: The artificial tooth that replaces a

Pon c: The artificial tooth that replaces a missing characteristic tooth. [The Glossary of Prosthodontics Terms: Ninth Edition 2017]

[0]

Glossary of Prosthod ontic s Terms: Ninth Edition 2017] [0] [0] Retainer: The part connected to

[0]

of Prosthod ontic s Terms: Ninth Edition 2017] [0] [0] Retainer: The part connected to the

Retainer: The part connected to the abutment for maintenance of the prosthesis.

[0]

to the abutment for maintenance of the prosthesis . [0] Retainers can be major or minor

Retainers can be major or minor. [Planning and Making Crowns and Bridges, Fourth Edition, CRC Press, 2006]

[0 ]

and Bridges, Fourth Edi tion, C RC Press , 2006] [0 ] [0] Unit: Pontics and

[0]

and Bridges, Fourth Edi tion, C RC Press , 2006] [0 ] [0] Unit: Pontics and

Unit: Pontics and abutment teeth are alluded to as units. The all out number of units in an extension is equivalent to the quantity of pontics in addition to the quantity of projection teeth. [Mitchell DA et al., 2014]

[0]

of proje ctio n teeth. [Mitchell DA et al., 2014] [0] Saddle: The region on the

Saddle: The region on the alveolar edge which is edentulous where something like one missing tooth is to be reestablished. [Planning and Making Crowns and Bridges, Fourth Edition, CRC Press, 2006]

[0]

Crowns and Bridges, Fourth Edition, C RC Pr ess, 2006] [0] [0] Connector: Joins the pontic

[0]

and Bridges, Fourth Edition, C RC Pr ess, 2006] [0] [0] Connector: Joins the pontic to

Connector: Joins the pontic to the retainer or two retainers together. Connectors might be fixed or portable. [Planning and Making Crowns and Bridges, Fourth Edition, CRC Press, 2006]

[0]

Crowns and Bridges, Fourth Edition, CRC Pre ss, 2006] [0] Span: The length of the alveolar

Span: The length of the alveolar edge between the normal teeth where the bridge will be set. [Planning and Making Crowns and Bridges, Fourth Edition, CRC Press,

2006]

13

[ 0 ]

[ 0 ] Abutment: The tooth or embed that underpins and holds a dental prosthesis .

Abutment: The tooth or embed that underpins and holds a dental prosthesis. [Planning and Making Crowns and Bridges, Fourth Edition, CRC Press, 2006].

[0]

Crowns and Bridges, Fourth E ditio n, CRC Press, 2006]. [0] [0] Resin bonded bridge :

[0]

and Bridges, Fourth E ditio n, CRC Press, 2006]. [0] [0] Resin bonded bridge : A

Resin bonded bridge: A dental prostheses where the pontic is connected to the surface of natural teeth which are either unprepared or minimally prepared. [ Shilling burg et al., 2014]

2.2Restoration types:

2.2.1-Crown: [11]
2.2.1-Crown:
[11]

A crown is utilized to cover a tooth and might be usually alluded to as a "cap."

[11]

and might be usually alluded to as a " cap." [11] Traditionally, the teeth to be

Traditionally, the teeth to be crowned are set up by a dentist, and records are

[11]

be crowned are set up by a dentist, and records are [11] given to a dental

given to a dental expert to build the prosthesis. The records incorporate models,

which are reproductions of a patient's teeth, and the impressions used to make

[3]

tient 's teeth, and the impressions used to make [3] these models . There are a

these models. There are a wide range of strategies for crown manufacture, each

[13]

wide range of strategies for crown manufacture, each [13] utilizing an alternate material. A few strategies

utilizing an alternate material. A few strategies are very comparable, and use

[6]

A few strategies are very comparable , and use [6] either fundamentally the same as or

either fundamentally the same as or indistinguishable materials. Crowns might be

[11]

as or indistinguishable materials. Crowns might be [11] made of gold or other comparable metals, porcelain,

made of gold or other comparable metals, porcelain, or a mix of the two. Crowns made of Zirconia Oxide are being made increasingly well-known because of its high translucency and toughness instead of chipping hindrances of porcelain crowns.

[11] 2.2.2-Bridge
[11]
2.2.2-Bridge

A dental bridge is utilized to span, or bridge, an edentulous area (space where teeth are missing), more often than not by interfacing with fixed rebuilding efforts

[17]

not by inte rfacing with fixed rebuilding efforts [17] [11] on adjoining teeth. The teeth used

[11]

by inte rfacing with fixed rebuilding efforts [17] [11] on adjoining teeth. The teeth used to

on adjoining teeth. The teeth used to help the bridge are called abutment. A

bridge may also refer to a single-piece multiple unit fixed partial denture (various

[11]

multiple unit fixed partial denture (various [11] single-unit crowns either cast or melded). The piece of

single-unit crowns either cast or melded). The piece of the bridge which replaces a missing tooth and connects to the abutment is known as a "pontic." For numerous missing teeth, a few cases may have a few pontics.

14

[11] 2.2.3-Inlay
[11]
2.2.3-Inlay

[11]

[11] 2.2.3-Inlay [11] An inlay is a restoration which exists in the limits of the cusps

An inlay is a restoration which exists in the limits of the cusps. These rebuilding efforts are viewed as more conservative than onlays or crowns in light of the fact

[13]

than onlays or crowns in light of the fact [13] that less tooth structure is removed

that less tooth structure is removed in tooth preparation as abutment. They are generally utilized when tooth decimation is not exactly a large portion of the

[86]

decimation is not exactly a large portion of the [86] separation between cusp tips. [ Schneider

separation between cusp tips. [Schneider et al., 2010]

2.2.4-Onlay

An onlay is a strategy for tooth rebuilding, which covers, secures or strengthens at least one cusps .Onlays are strategies for reestablishing teeth in a indirectly way. Onlays are regularly utilized when teeth present broad demolition because of caries or to trauma. [Le Courrier du Dentiste, 2012]

[11] 2.2.5-Veneer
[11]
2.2.5-Veneer

A veneer is a light layer of remedial material put over a tooth surface, either to improve the aesthetics of a tooth, or to reestablish a harmed tooth surface.

[11]

of a tooth, or to reestablish a harmed tooth surface. [11] [11] Materials utilized for veneer

[11]

tooth, or to reestablish a harmed tooth surface. [11] [11] Materials utilized for veneer may incorporate

Materials utilized for veneer may incorporate composite and porcelain. At times, evacuation of tooth structure is expected to give adequate space to the veneer, while now and then a rebuilding might be bonded to a tooth without tooth

[30]

might be bonde d to a tooth without tooth [30] surface reduction. [ Mitchell et al

surface reduction. [ Mitchell et al.,2016]

2.3Dental bridge:

2.3.1Advantage: [0]
2.3.1Advantage:
[0]

1) Return aesthetics (particularly important for anterior edentulous areas)

2) Reestablish function (mastication, speech)

3)

adjacent/opposing teeth)

Occlusal

stability

(prevent

tilting,

4) Patients acceptability

drifting,

rotation

and

over-eruption

of

15

2.3.2Disadvantages:

[0]

2 . 3 .2 D isadvantages: [0] 1 ) Damage of tooth tissue (tooth preparation of

1) Damage of tooth tissue (tooth preparation of abutments often requires significant tooth preparation).

[0]

often requires sig nificant tooth preparation ). [0] 2) Pulpal harm ( tooth preparation opens dentinal

2) Pulpal harm (tooth preparation opens dentinal tubules providing a connection between bacteria in the mouth and the pulp, Deep preparations can cause pulpal injury).

[0]

pulp , Deep preparations can cause pulpal inj ury ). [0] 3) Secondary caries (around crown

3) Secondary caries (around crown edges, under deboned retainer wings and tooth).

[0]

edges, under deboned retainer wings and tooth) . [ 0 ] 2.3. 3 D ental bridge

2.3.3Dental bridge Indications

1) Take a place of a single tooth or a small spanning space.

[0]

a place of a single tooth or a small spanning space . [ 0] 2) Goo

2) Good oral health station and impulse of patient to keep up oral healthiness.

[10]

impulse of patient to k eep u p oral healthiness. [10] [0] [ Ibbetson R et

[0]

of patient to k eep u p oral healthiness. [10] [0] [ Ibbetson R et al

[Ibbetson R et al., 2017]

3) Periodontal status of remaining dentition at a firm and acceptable level. [Ibbetson R et al,. 2017]

[0]

firm and acceptable level. [Ib betson R et al,. 2017] [0] 4) Abutment teeth of best

4) Abutment teeth of best quality with slight restorations and enough surface

[69]

quality with slight restorations and enough surface [69] ar ea and enamel current for adhesion. [

area and enamel current for adhesion. [Gulati JS et al.,2016]

[0]

current for adhesion. [ Gulati JS et al . ,2016] [0] 5) Binding of periodontally compromised

5) Binding of periodontally compromised teeth to increase occlusal stability,

[0]

compromised teeth to increase occlusal stability, [0] wellbeing and reduction of mobility. ( Periodontally

wellbeing and reduction of mobility. (Periodontally compromised teeth are also a

contraindication). [ Gulati JS et al.,2016]

[0]

also a co ntraindication ). [ Gulati JS et al.,2016] [0] 6) As a method for

6) As a method for fixed maintenance after orthodontic treatment or extraction. [Gulati JS et al., 2016]

7) Patient with unacceptable for implants construction. This might be because of poor bone proportions, cost or patient don not want to do implants. [Gulati JS et al., 2016]

16

2.3.4Contraindications:

1) Dimension of saddle area excessively too long. [ Dayanik S, 2016]

2) Patients with Para function e.g. bruxism [ Dayanik S, 2016]

3) Mobile tooth raises hazard of de-bonding. [Gulati JS et al., 2016]

4) Maligned teeth causing in poor aesthetics and communal path of insertion. [Gulati JS et al., 2016]

[104]

path of insertion. [Gulat i JS et al., 2016] [104] 5 ) Abutment tooth quality insufficient

5) Abutment tooth quality insufficient for instance may have a diminished surface region, reduced enamel or be deeply restored. [Gulati JS et al., 2016]

[0]

enamel or be deeply restored. [Gulati JS et al., 2016] [0] 6) Increased danger of caries

6) Increased danger of caries because of increased difficulty in maintaining oral hygiene around the bridgework. [Gulati JS et al., 2016]

ene around the bridgework . [Gulati JS et al., 2016] [25] 7) Increased danger of loss

7) Increased danger of loss of vitality.

[0]

2016] [25] 7) Increased danger of loss of vitality . [0] 8) Allergy to base metal

8) Allergy to base metal alloys e.g. nickel. [Gulati JS et al., 2016]

[0]

metal alloys e . g. nickel. [Gulati JS et al., 2016] [0] 9) Poor patient inspiration.

9) Poor patient inspiration. Active dental disease (caries, periodontal disease) and

[5]

dental disease (c aries , periodontal disease) and [5] poor oral clearance. [ Shillingburg et al

poor oral clearance. [ Shillingburg et al.,2014]

2.3.5Types of bridge:

[0]

[ Shillingburg et al . ,2014] 2.3.5 T ypes of bridge: [0] Conventional bridge: Conventional b

Conventional bridge: Conventional bridges are reinforced by full coverage crowns, three-quarter crowns, post-retained crowns, onlays and inlays on the

[0]

post-re tain ed crowns, onlays and inlays on the [0] abutment teeth . In these kinds

abutment teeth. In these kinds of bridges, the abutment teeth need preparation

[0]

kinds of bridges, the abutment teeth need preparation [0] and reduction to provision the prosthesis. Conventional

and reduction to provision the prosthesis. Conventional bridges are named depending on the way the pontic (false teeth) is connected to the retainer.

[0]

the pontic (false teeth) is connected to the retainer . [0] [ Bartlett D, Ricketts D,

[Bartlett D, Ricketts D, 2013]

[0]

to the retainer . [0] [ Bartlett D, Ricketts D, 2013 ] [0] Fixed-fixed bridges: A

Fixed-fixed bridges: A fixed-fixed bridge refers to a pontic which is connected to a

[0]

bridge refers to a pontic which is connected to a [0] retainer at the two sides

retainer at the two sides of the space with only single path of insertion. This sort of design has a rigid connector at each end which connects the abutment to the

[0]

connector at each end which connects the abutment to the [0] pontic . As the abutments

pontic. As the abutments are connected together rigidly it is critical that during tooth preparation the proximal surfaces of the abutment teeth must be prepared

[0]

proximal surfaces of the abutment teeth must be prepared [0] so that they are parallel to

so that they are parallel to each other. [Planning and Making Crowns and Bridges,

2006]

17

[0]

[0] Can lever: A cantilever is a bridge whe re a pontic is only connected to

Can lever: A cantilever is a bridge where a pontic is only connected to a retainer

[0]

whe re a pontic is only connected to a retainer [0] just at one side .

just at one side. The abutment tooth might be mesial or distal to the portion of the pontic. [Planning and Making Crowns and Bridges, 2019]

[ 0

]

. [Planning and Making Crowns a nd Bridg es, 2019] [ 0 ] Spring cantilever: The

Spring cantilever: The pontic and retainer are remote from one another and

[0]

pontic and retainer are remote from one a noth er and [0] associated by a metal

associated by a metal bar. For the most part, a missing anterior tooth is

[0]

bar . For the most part, a missing anterior tooth is [0] exchanged and reinforced by

exchanged and reinforced by a posterior tooth. This design of bridge has been

succeeded. [Planning and Making Crowns and Bridges, 2009]

[0]

[Planning and Making Cr owns and Bridges, 2009] [0] Fixed-movable: The pontic is firmly connected to

Fixed-movable: The pontic is firmly connected to a retainer at one side of the span (major retainer) and connected via a movable joint at the other end (minor retainer).

[0]

a movable joint at the other end (minor re tainer ). [0] A major advantage of

A major advantage of this type of bridge is that the movable joint can lodge the angulation differences in the abutment teeth in long axis, which enables the path

of insertion to be irrespective of the alignment of the abutment tooth. [Bartlett D,

[0]

the alig nme nt of the abutment tooth . [Bartlett D, [0] Ricketts D, 2013] This

Ricketts D, 2013] This enables a more conservative approach as the abutments do

[0]

enables a more conservative approach as the abutments do [0] not require being prepared so those

not require being prepared so those are parallel to one and other. Ideally the rigid

[0]

are parallel to one and other . Ideally the rigid [0] connector should attach the pontic

connector should attach the pontic to the more distal side to the abutment. The movable connector attaches the pontic to the mesial side of the abutment,

[0]

the pontic to the mesial side of the abutment, [0] enabling this abutment tooth limited movement

enabling this abutment tooth limited movement in a vertical direction. [Planning and Making Crowns and Bridges, Fourth Edition, 2006]

[0]

and Making Crowns and Bridges, Fourth Edit ion , 2006] [0] Adhesive bridge: An alternative to

Adhesive bridge: An alternative to the traditional bridge is the adhesive bridge

[0]

to the traditional bridge is the adhesive bri dge [0] [0] (also called a Maryland bridge

[0]

to the traditional bridge is the adhesive bri dge [0] [0] (also called a Maryland bridge

(also called a Maryland bridge). An adhesive bridge used "wings" on the sides of

[0]

bridg e used " wings" on the sides of [0] the pontic which connect it to

the pontic which connect it to the abutment teeth. Abutment teeth require minor

[0]

the abutment t eeth . Abutme nt te eth require minor [0] or no preparation .

or no preparation. They are most often utilized when the abutment teeth are

[0]

are most often utilized when th e ab utment teeth are [0] entire and complete (i.

entire and complete (i.e., no crowns or major fillings). [Shilling burg ET al.2014]

[0]

or major fillings ). [Shi lling burg ET al.2014] [0] Combination Designs: The combin atio n

Combination Designs: The combination of elements of different conventional

[3]

combin atio n of elements of different conventional [3] bridge designs . A popular mixture design

bridge designs. A popular mixture design is the use of a fixed-fixed design with a cantilever. [Planning and Making Crowns and Bridges, Fourth Edition, 2006]

[0]

and Making Crow ns an d Bridges, Fourth Edition, 2006] [0] Hybrid Designs: Bridges that includes

Hybrid Designs: Bridges that includes elements of both conventional and adhesive bridge designs. [Planning and Making Crowns and Bridges, 2006]

18

[0]

[ 0 ] 2.3.5. 1 C onventional Bridge D esigns Fixed-fixed: Advantages: [Planning and Making Crowns

2.3.5.1 Conventional Bridge Designs

Fixed-fixed:

Advantages: [Planning and Making Crowns and Bridges, Fourth Edition,2006]

1) Extreme strength

2) Exact retentive.

3) Most preferable design for elongated spans.

4) Construction is moderately direct.

[0]

elongated spans. 4) Construction is moderately direct. [0] Disadvantages: [Planning and Making Crowns and Bridges,