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

Fixed Prosthodontics
Chapter 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.

PowerPoint

presentation slides may be displayed and may be reproduced in print

form for instructional purposes only, provided a proper copyright notice appears on
the last page of each print-out.

Produced in the United States of America

ISBN 0-7216-9770-4
Copyright 2003, Elsevier Science (USA). All rights reserved.
I ntroduction
Fixed prosthodontics is the specialized area of
dentistry involved in the replacement of missing
teeth with a cast prosthesis permanently
cemented in place.
Copyright 2003, Elsevier Science (USA). All rights reserved.
I ndications 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.
Copyright 2003, Elsevier Science (USA). All rights reserved.
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.
Copyright 2003, Elsevier Science (USA). All rights reserved.
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.

Copyright 2003, Elsevier Science (USA). All rights reserved.
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 contd
Copyright 2003, Elsevier Science (USA). All rights reserved.
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 contd
Copyright 2003, Elsevier Science (USA). All rights reserved.
Table 50-1 Components of a Fixed Bridge
Copyright 2003, Elsevier Science (USA). All rights reserved.
Overview 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.
Copyright 2003, Elsevier Science (USA). All rights reserved.

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 Preparation
Copyright 2003, Elsevier Science (USA). All rights reserved.
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 Aids
Copyright 2003, Elsevier Science (USA). All rights reserved.
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
Management
Copyright 2003, Elsevier Science (USA). All rights reserved.
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 I mpression
Copyright 2003, Elsevier Science (USA). All rights reserved.
Provides the laboratory technician with a
reproduction of a patients bite and
opposing arch registration for designing the
anatomic structures of the fixed prosthetic.
Open bite
Closed bite
Bite Registration

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

Copyright 2003, Elsevier Science (USA). All rights reserved.
A detailed and precise written order from
the dentist to the laboratory technician with
the description of the restoration to be
fabricated.


Laboratory Prescription
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 50-18 Laboratory prescription.
Copyright 2003, Elsevier Science (USA). All rights reserved.
When the casting has been fitted and is
acceptable, the dentist cements it to the tooth.
Permanent cementation
Temporary cementation
Delivery
Copyright 2003, Elsevier Science (USA). All rights reserved.
Home Care I nstructions 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.