Ch. 50 - Fixed Prosthodontics

Fixed ProsthodonticsFixed Prosthodontics

Chapter 50Chapter 50

Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.


Lesson 50.1Lesson 50.1


Learning ObjectivesLearning Objectives

Pronounce, define, and spell the Key Terms.Pronounce, define, and spell the Key Terms. List indications and contraindications for a List indications and contraindications for a

fixed prosthesis. fixed prosthesis. Identify the steps for a diagnostic workup.Identify the steps for a diagnostic workup. Describe the differences among full crowns, Describe the differences among full crowns,

inlays, onlays, and veneer crowns. inlays, onlays, and veneer crowns. Describe the uses of porcelain for fixed Describe the uses of porcelain for fixed

prosthodontics.prosthodontics. Identify the components of a fixed bridge. Identify the components of a fixed bridge.


IntroductionIntroduction

Fixed prosthodontics is the Fixed prosthodontics is the

specialized area of dentistry devoted specialized area of dentistry devoted

to the replacement of missing teeth to the replacement of missing teeth

with cast prostheses that are with cast prostheses that are

permanently cemented in place. permanently cemented in place.


Indications for Fixed Prosthodontics Indications for Fixed Prosthodontics

One or two adjacent teeth are missing in the One or two adjacent teeth are missing in the same arch. same arch.

The supportive tissues are healthy. The supportive tissues are healthy. Suitable abutment teeth are present. Suitable abutment teeth are present. The patient is in good health and wants the The patient is in good health and wants the

prosthesis placed. prosthesis placed. The patient has the skills and motivation to The patient has the skills and motivation to

maintain good oral hygiene. maintain good oral hygiene.


Contraindications for Contraindications for Fixed Prosthodontics Fixed Prosthodontics

The supportive tissues are diseased or The supportive tissues are diseased or missing. missing.

Suitable abutment teeth are not present. Suitable abutment teeth are not present. The patient is in poor health. The patient is in poor health. The patient is not motivated to have the The patient is not motivated to have the

prosthesis placed. prosthesis placed. The patient has poor oral hygiene habits. The patient has poor oral hygiene habits. The patient cannot afford the treatment. The patient cannot afford the treatment.


Types of Cast Restorations Types of Cast Restorations

InlayInlay Covers a portion of the occlusal and proximal Covers a portion of the occlusal and proximal

surface surface Onlay Onlay

Covers proximal surfaces and most or all of the Covers proximal surfaces and most or all of the occlusal surface occlusal surface

Porcelain veneers Porcelain veneers Thin shell-like covering placed to improve the Thin shell-like covering placed to improve the

appearance of anterior teeth.appearance of anterior teeth.(Cont’d)(Cont’d)


Fig. 50-1 Inlay cast restoration.Fig. 50-1 Inlay cast restoration.


Fig. 50-2 Onlay cast restoration.Fig. 50-2 Onlay cast restoration.


Fig. 50-6 A and B Porcelain veneers placed to Fig. 50-6 A and B Porcelain veneers placed to cover hypocalcification defects. cover hypocalcification defects.

(From Roberson T, et al: (From Roberson T, et al: Sturdevant’s art and science of operative dentistrySturdevant’s art and science of operative dentistry , ed 4, St Louis, 2002, Mosby.), ed 4, St Louis, 2002, Mosby.)

A B


Types of Cast RestorationsTypes of Cast Restorations

(Cont’d)(Cont’d)

Full crownFull crown Completely covers the anatomic crown of an Completely covers the anatomic crown of an

individual toothindividual tooth Three-quarter crown Three-quarter crown

Covers the anatomic crown of a tooth except for Covers the anatomic crown of a tooth except for the facial portionthe facial portion

Porcelain Fused to Metal (PFM) crownPorcelain Fused to Metal (PFM) crown Full metal crown with outer surfaces covered with Full metal crown with outer surfaces covered with

a veneer of porcelain. a veneer of porcelain. (Cont’d)(Cont’d)


Fig. 50-8 Anterior PFM crown.Fig. 50-8 Anterior PFM crown.


Types of Cast RestorationsTypes of Cast Restorations


Porcelain jacket crown Porcelain jacket crown Constructed as a thin metal shell covered by Constructed as a thin metal shell covered by

layers of porcelain layers of porcelain Fixed bridge Fixed bridge

A prosthesis for missing teeth within the same A prosthesis for missing teeth within the same arch arch

Resin-bonded bridgeResin-bonded bridge Also known as a Maryland bridge, with winglike Also known as a Maryland bridge, with winglike

extensions coming from the proximal sides extensions coming from the proximal sides


Fig. 50-9 PFM anterior fixed bridge.Fig. 50-9 PFM anterior fixed bridge.


Fig. 50-11 Resin-bonded bridge.Fig. 50-11 Resin-bonded bridge.



Lesson 50.2Lesson 50.2



Describe the preparation and placement of a Describe the preparation and placement of a cast crown.cast crown.

Discuss the uses of core buildups, pins, and Discuss the uses of core buildups, pins, and posts in crown retention. posts in crown retention.

Describe the use of retraction cord before a Describe the use of retraction cord before a final impression is taken.final impression is taken.

Demonstrate the placement and removal of Demonstrate the placement and removal of gingival retraction cord. gingival retraction cord.





Describe the function of provisional coverage Describe the function of provisional coverage for a crown or fixed bridge.for a crown or fixed bridge.

Assist in the preparation procedure of an Assist in the preparation procedure of an indirect restoration.indirect restoration.

Assist in the cementation procedure of an Assist in the cementation procedure of an indirect restoration.indirect restoration.

Identify home-care instructions for a patient Identify home-care instructions for a patient with a permanent fixed prosthesis.with a permanent fixed prosthesis.

Identify the role of the laboratory technician.Identify the role of the laboratory technician.


Overview of a Fixed Overview of a Fixed Prosthodontic ProcedureProsthodontic Procedure

Shade selectionShade selection A shade guide contains samples of all available A shade guide contains samples of all available

shades used to match the natural tooth color.shades used to match the natural tooth color.• Moisture helps achieve a more accurate match. Moisture helps achieve a more accurate match.

• Use natural sunlight. Use natural sunlight.

• Record the shade on the patient record and on the Record the shade on the patient record and on the laboratory prescription. laboratory prescription.





Tooth preparationTooth preparation The tooth is prepared for the cast restoration to The tooth is prepared for the cast restoration to

slide into place and to be able to withstand the slide into place and to be able to withstand the forces of occlusion.forces of occlusion.• Rotary instruments are used to reduce the height and Rotary instruments are used to reduce the height and

contour of the tooth.contour of the tooth.

• Hand-cutting and rotary instruments are used to prepare Hand-cutting and rotary instruments are used to prepare the gingival margins. the gingival margins.





Retention aidsRetention aids These provide additional support for the crown if These provide additional support for the crown if

the tooth is extensively decayed or fractured or the tooth is extensively decayed or fractured or has been endodontically treated. has been endodontically treated. • Core buildupCore buildup

• Pin retention Pin retention

• Post-and-corePost-and-core(Cont’d)(Cont’d)




Gingival retraction and tissue management Gingival retraction and tissue management The cord temporarily displaces the gingival tissue The cord temporarily displaces the gingival tissue

and widens the gingival sulcus so that impression and widens the gingival sulcus so that impression material can flow around all parts of the material can flow around all parts of the preparation. preparation. • Nonimpregnated Nonimpregnated

• ImpregnatedImpregnated(Cont’d)(Cont’d)


Procedure 50-1 Position the cord around the Procedure 50-1 Position the cord around the tooth preparation.tooth preparation.




Final impressionFinal impression Elastomeric impression materials are used to Elastomeric impression materials are used to

create an extremely accurate impression.create an extremely accurate impression.• Light-bodied material is mixed and applied around the Light-bodied material is mixed and applied around the

prepared tooth.prepared tooth.

• Heavy-bodied material is mixed and loaded into a tray to Heavy-bodied material is mixed and loaded into a tray to be seated on the quadrant or arch. be seated on the quadrant or arch.





Bite registrationBite registration Provides the laboratory technician with a Provides the laboratory technician with a

reproduction of a patient’s bite and opposing arch reproduction of a patient’s bite and opposing arch registration for designing the anatomic structures registration for designing the anatomic structures of the fixed prostheticof the fixed prosthetic• Open biteOpen bite

• Closed bite Closed bite (Cont’d)(Cont’d)




Provisional coverageProvisional coverage Used for patient comfort from tooth preparation to Used for patient comfort from tooth preparation to

final cementation of the fixed prosthetic final cementation of the fixed prosthetic • Reduces sensitivity and discomfortReduces sensitivity and discomfort

• Maintains function and aesthetics Maintains function and aesthetics

• Protects the margins Protects the margins

• Prevents shifting Prevents shifting


DeliveryDelivery

When the casting has been fitted and is When the casting has been fitted and is acceptable, the dentist cements the casting.acceptable, the dentist cements the casting. Permanent cementationPermanent cementation Temporary cementation Temporary cementation


Home-Care Instructions for the Home-Care Instructions for the Patient with a Fixed Prosthesis Patient with a Fixed Prosthesis

Good home care is essential to the Good home care is essential to the maintenance of a fixed prosthesis. maintenance of a fixed prosthesis.

A fixed prosthesis and its supporting tissues A fixed prosthesis and its supporting tissues must be brushed carefully every day. must be brushed carefully every day.

A bridge threader is used to thread dental A bridge threader is used to thread dental floss under the pontic and into the sulcus at floss under the pontic and into the sulcus at both abutments of a bridge. both abutments of a bridge.


Laboratory PrescriptionLaboratory Prescription

The laboratory prescription is a detailed and The laboratory prescription is a detailed and

precise written order from the dentist to the precise written order from the dentist to the

laboratory technician bearing the description laboratory technician bearing the description

of the restoration to be fabricated.of the restoration to be fabricated.


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Ch. 50 - Fixed Prosthodontics

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