Tutorial 2

Skenario 2

Topic :fixed denture

Question :

1. What are definition of fixed denture ?

Is a prosthetic appliance permanently attached to remaining teeth

which replaces one or more missing teeth

Denture is permanently attached to natural teeth or tooth root

for support

2. What are types of fixed denture?

1.Simple fixed bridge
o Rigid fixed bridge : that also called stationary fixed
bridge
Is connected by two rigid connectors
o Semi fixed bridge: that also called limited stationary or
broken stress bridge
Is connected by a flexible connector and a rigid
connector
o Cantilever bridge : is bridge that has one abutment
tooth for one missing tooth
 2. Compound fixed bridge : is combination of two or more
fixed bridge
3.Spring bridge : is when the pontic have long space with
retainer and connected by palatal bar.
disadvantage: usually the patient uncomfortable because
the are a bar
4.Marryland bridge : bridge that using retainer, behind
abutment tooth ( palatal or lingual )

3. What are component of fixed denture?

a. Pontic: is artificial crown use to restore the missing tooth or
teeth in the arch.
b. Retainer: is an artificial crown or crowns use to attach the
bridge to the abutment tooth.
Classification :
1.intracoronal: retainer is inside tooth crown
2.extracoronal: retainer is outside tooth crown
3.radicular : retainer is inside tooth root
c. Abutment teeth: is the selected remaining tooth or teeth
where a crown or a bridge is attached .
d. Connector : is to connect and to retainer on one side to the
other retainer or the other side of the bridge.as well as unit all
the other part of the bridge.
Is divided into two :
1.Rigid
2.non rigid : the are two part : male and female component
4. What are the material to make fixed denture
 Porcelen or porcelain fused metal
 Metal ( gold)
 Acrylic
 Sirkon : to use sirkon we have CAD CAM ,but the price is
expensive.
 Plastic attached to metal
 All plastic
5. What are the factors that influence the component selection of
fixed denture ?
a. Abutment: with vital pulp ,normal amount a periodontal
attachment, capable or supporting additional forces to which it
will be subjected as a fixed denture
The teeth can the non vital , but it should do the root canal
treatment first, free or caries ( do the filling first if there is a
caries ).
b. Retainer : is should be design it has sufficient strength, does
not corrode or tarnish. It should not discolor ,esthetic.
c. Connector : it should be approximately 2 mm in size.
d. Pontic : no irritation to gingival tissue ,easily cleanable ,
strength ,color stable , and esthetic

6. What are the aims of fixed denture treatment ?

 Maintain the health and integrity of dental arch
 Restore the function in mastication, fonation and esthetic
 Confidence
 Maintain occlusal relationship and proper occlusal function
  Protect and preserve the remaining structure

7. What are the indication or contraindication of fixed denture ?

indication contraindication
Short span edentulous arches Long span edentulous span
Some cases with ridge Large amount of bone lossas in
resorption where a removable trauma
partial denture can not be
stable or retentive
Mentally compromised or Medically compromised
physically handicap patient who patients like leukimia
can not maintain the removable
partial denture
Restoring teeth with high Treatment of partial edentulous
degree of abrasion is there is not enough support
Replacement of old and poor oral hygiene
inadequate restoration
Good OHI Suitable abutment teeth are not
present and the necessary
supportive tissue are diseased

Deep bite Patient that has not full teeth

eruption
Abnormal diastema
Have a health ligament
periodontal
8. What are the complication of fixed denture in periodontal tissue ?
 Abutment discart healthy periodontal tissue
 Distract ligament periodontal tissue if the abutment less
than the pontic
 Type of pontic is influence the heatlh of periodontal tissue,
foe example pontic enter the sulcus.

9. Why in the scenario the patient is suggested to the radiograph

examination ?

Because to look the abutment teeth how strong and how long the
root, and to look the status of ligament periodontal

To look the periapical status .

10. How to design fixed denture in the scenario

 First

11. How to maintain the fixed denture



12. How is the procedure to make fixed denture

a. Anesthesia
b. Tooth preparation
c. Gingival retraction
d. Making impression
 e. Temporary restoration fabrication
f. Gypsum cast fabrication n
g. Work pattern fabrication
h. Casting metal framework
i. Correction ready metal framework on the case model
j. Try in to oral cavity and shade selection
k. Acrylic veneering
l. Correction of ready crown on the cast model
m. Try in to oral cavity
n. Finishing and polishing
o. Try in oral cavity and cementation

13. What are the type of pontic

 Contact with the mucosa:
There are three design :
1. Ridge lap or saddle pontic: surface of pontic attach to the
ridge
2. Conical pontic: there is a one point attach to mucosa
3. Ovate pontic : pontic inserted into the ridge
 Non contach with the mucosa:
 Combination :

14. What are advantage and disadvantage of fixed denture

Advantage Disadvantage
Improve esthetic , speech and In may cause damage tooth and
ability to eat
Occlusal or bite stability
Space maintainance
pulp
Secondary tooth decay due to
faulty design of dental bridge of
oral hygiene
Failure of bridge
Increase plaque accumulation
More expensive than removable
partial denture

LO

1.ANTES law , calculation and example and How to design fixed

denture

ANTE’S LAW is the sum of pericemental area of abutment teeth

should be equal to or surpass that of teeth being replace.
Pericemental area of each teeth and percentage:
Upper jaw: incicivus centralis 204 /10
Incisivus lateralis :179/9
Caninus : 273/14
First premolar : 234/12
Second premolar : 220/11
First molar : 433/22
Second molar : 431/22
Lower jaw :
Incisivus centralis : 154/8
Incisivus lateralis: 168/9
Caninus : 268/15
First premolar : 180/10
Second premolar :207/11
Fist molar : 431/24
Second molar : 426/23

Calculation the lost tooth percentage is higher we just need one

abutment.

The percentage is lower we need two abutment

2. Procedure tooth prepation for abutment based on the type of

fixed denture and what bur you use

Preparation for abutmnet tooth wear fix denture :

instrument that we use is tapper bur or diamond, usually use for
occlusal guiding groovr and for additional retentive feature.
Tapper diamond for diameter 0,8 mm sually use for axial
alignment groove , axial reduction, champer reparation.
High and low speed friction grip contra angel.

Preparation step :
1. Make groove for occlusal reduction usingthe tapper carbide or
diamond with minimum clearance 1 mm
2. Functional cusp bevel using tapper carbide or diamond with
minimum mclerance on centric cusp 1,5 mm
3. Occlusal reduction using regular grip or round tipped diamond
4. Alignment groove for axial reduction using tapper diamond and
follow the normal anatomi configuration of occlusal surface
5. Axial reduction using tapper diamond , champer allow 0,5 mm
of thickness of wax at the margin
6. Finishing of champer using tapper diamond , it reduce perform
paralel to long axis
7. Additional retentive feature using wide , round tipped diamond
or carbide to smoothen the mesio distal and buccolingual
resistance
8. Finishing using tapper carbide for groove , boxes , and pinhole,
and fine grit diamond or carbide to arounding of all sharp line
angel .

3.What are the material to make fixed denture

Litium disilicate
zirconia : were provent to be a biomaterial of choice and also
osteoconductive material that facility bone formation .
cobaltonium metal
Ceramic , all porcelain : for Artificial teeth
Metal or alloy : for sealing

Impression material to make fixed denture :

Elastomer : polyvinyl siloxan , polieter
Dental gyps
Alginate

Material for cementation :

Zink phosphate :
Adhesive resin
GIC type 1
Resin

4.What are the complication of fixed denture in periodontal tissue?

Is not only in the periodontal general
1. Gagling
2. Poor speaking
3. For chewing, tastng, eating
4. Poor stability
5. Accelerate bone loss and
6. Loosening teeth because of pressure of denture
7. Increase of plaque if we use subgingival margin . there are some
cases such as esthetic consideration , subgingival caries and
servical restoration .
8. Traumatic ulcer
9. Denture related hyperplasia : the clicinal is enlargmnet of oral
mucus
10. Denture stomatitis : usually cause by candida ,
staphylococcus , streptococcus , irritation from medication .
11. Gingival inflammation because of pontic, the kind is ridge
lap.
5.How to maintain the fixed denture
1. patient should brush daily with soft brush
2. control every 3 month ,

6.How is the detail procedure to make fixed denture

Anesthesia : with block anesthesia
Tooth preparation
a. Make groove for occlusal reduction usingthe tapper
carbide or diamond with minimum clearance 1 mm
b. Functional cusp bevel using tapper carbide or diamond
with minimum mclerance on centric cusp 1,5 mm
c. Occlusal reduction using regular grip or round tipped
diamond
d. Alignment groove for axial reduction using tapper
diamond and follow the normal anatomi configuration of
occlusal surface
e. Axial reduction using tapper diamond , champer allow 0,5
mm of thickness of wax at the margin
f. Finishing of champer using tapper diamond , it reduce
perform paralel to long axis
 g. Additional retentive feature using wide , round tipped
diamond or carbide to smoothen the mesio distal and
buccolingual resistance
h. Finishing using tapper carbide for groove , boxes , and
pinhole, and fine grit diamond or carbide to arounding of
all sharp line angel .

Gingival retraction : using adrenalin ( retraction cord )

Making impression
Elastomer : polyvinyl siloxan , polieter
Dental gyps
Alginate
Using partial tray

Temporary restoration fabrication : the cementation using zink

phosphate .
Gypsum cast fabrication : using articulator
Work pattern fabrication : using elastomer because more
stable
Make a wax model to make the pontic
Casting metal framework
Correction ready metal framework on the case model
Try in to oral cavity and shade selection
Acrylic veneering
Correction of ready crown on the cast model
Try in to oral cavity
Finishing and polishing
 Try in oral cavity and cementation

7.What are advantage and disadvantage of fixed denture

Advantage Disadvantage
Great esthetic Destructive
Protective Damage nerve
Long lasting Expensive
Less invasive than implant Difficult to clean
Long appointment