SORIANO, ESPERLYN J.

DEN182 06/01/21

PROSTHODONTICS 1 TOOLKIT

In order for you to be successful in this field, you should come to the clinic prepared to relate to the procedures of the day -- mentally and
physically. Using your prescribed text as a reference, we will be consolidating an evidence-based toolkit that aims to help you have a deeper
understanding of the procedures that you can utilize during your clinicals, board exam and your future practice.

Objectives:

1. To equip you, the students, with knowledge of different kinds of fixed partial denture restoration & preparation and their prescribed uses
and contraindications.

2. To help you identify correct FPD options that will best suit your patients to restore function, esthetics and comfort.

3. To help you communicate the treatment options to your patients.

4. To develop your diagnosis, treatment planning and clinical decision-making skills.

 ASYNCHRONOUS ACTIVITY # 1
The Different Types of FPD Restoration & Preparation

Directions: Accomplish the worksheet comparing the different types of FPD restoration according to the criteria listed on the first column. Write your answers in bullet
form, no paragraphs. Submit the document through the thread on or before June 1, 5 PM , You may add drawings or images.

COMPLETE CAST CROWN METAL-CERAMIC CROWN COMPLETE CERAMIC CROWNS

 restoration for badly damaged  used in bridges plus crown and bridge  relatively even thickness
posterior teeth cases circumferentially

 best longevity of all fixed restorations  less than attractive  most esthetically pleasing fixed
restoration
Description  used to rebuild a single tooth or as a  also called as ‘porcelain fused to metal’
retainer for a fixed dental prosthesis crown  used as single restoration on upper or
lower incisors
 consist of a metal interior or base which
is fused to porcelain crowns

 Strong  Superior esthetics in comparison with  Esthetically unsurpassed

complete cast crown
 High retention and resistance form  Good tissue response even for
subgingival margin
 Easy to obtain adequate resistance
form  Slightly more conservative of facial
wall than metal ceramic
 Option to modify form and occlusion
Advantages
especially for supraerupted teeth

 Less easily to deform

 Cylinder-like configuration encircles

tooth and is reinforced by a
corrugated occlusal surface

 Removal of large amount of tooth  Removal of substantial tooth structure  Reduced strength compared to metal
structure ceramic crown
  Adverse effects on pulp and  Subject to fracture because porcelain is  Proper preparation extremely critical
periodontium brittle
 Among least conservative preparation
 Vitality test cannot be done  Difficult to obtain accurate occlusion in
glazed porcelain  Brittle nature of material
Disadvantages  Display of metal
 Shade selection can be difficult  Can be used as single restoration only
 Restorations may be restricted to
maxillary molars/mandibular  Inferior esthetics in comparison with
molars/premolars all-ceramic crown

 Patients object to display metal  Expensive

 Extensive destruction from  Esthetics  High esthetic requirement

caries/trauma
 If all-ceramic crown is indicated  Considerable proximal caries
 Endodontically treated teeth
 Gingival involvement  Incisal edge reasonably intact
 Existing restoration
 Endodontically treated teeth with post
 Necessity for maxillary retention and and cores
strength
Indications
 Favorable distribution of occlusal load
 To provide contours to receive a
removable appliance

 Other recontouring of axial surfaces

(minor corrections of malinclinations)

 Correction of occlusal plane

Contraindications  Less than maximum retention  Large pulp chamber  When superior strength is warranted
necessary and metal-ceramic crown is more
 Intact buccal wall appropriate
 High esthetics need (anterior teeth)
 When more conservative retainer is  High caries index
  Intact buccal/lingual wall technically feasible  Insufficient coronal tooth structure for
support
 If treatment objectives can be met
with more conservative restoration  Thin teeth faciolingually

 Unfavorable distribution of occlusal

load

 Bruxism

 Tapered carbide or diamond for  Tapered, round tipped diamond for  Tapered diamond for depth grooves
depth grooves for occlusal reduction incisal (occlusal) reduction guide for incisal reduction, incisal reduction,
and for functional cusp bevel grooves, incisal (occlusal) reduction, depth grooves for facial reduction,
labial reduction guide grooves (two facial reduction and depth grooves for
 Regular-grit, round-tipped plane), axial reduction cingulum reduction
diamond for occlusal reduction (half
at a time)  Tapered, flat tipped diamond for  Tapered and football-shaped
labial reduction (two-plane) and diamonds for depth grooves and
 Tapered diamond for alignment finishing of shoulder (or beveled lingual reduction
Armamentarium
grooves for axial reduction, for axial shoulder)
according to sequence of
reduction (half at a time), and  Square-tipped diamond for lingual
use
finishing of chamfer  Football-shaped diamond for lingual shoulder preparation
reduction
 Wide, round-tipped diamond or  Fine-grit diamond or carbide for
carbide for additional retentive  Hand instrument for finishing finishing
features if needed

 Tapered carbide and fine-grit

diamond or carbide for finishing

Preparation 1. 1 mm on nonfunctional (noncentric) 1. 1.2 to 1.5mm of reduction for metal and 1. Approximately 1.3 mm deep to allow
cusps and 1.5 mm on functional porcelain for additional reduction during
(Ideal reduction (centric) cusps finishing; perpendicular to long axis
measurements) 2. All line angles rounded and preparation of opposing tooth
1. Occlusal/Incisal 2. Adequate chamfer width (minimum surfaces smooth
Reduction 0.5 mm) is important for developing 2. 0.8 mm
2. Facial/Lingual optimum axial contour 3. Shoulder must extend at least 1mm
Reduction
3. Extend below adjacent tooth contact lingual to proximal contact area 3. Shoulder should be at least 1 mm
3. Proximal Reduction
wide
4. Retention & Resistance
4. Taper of about 6º 4. Taper of approximately 6 degrees
Form
4. Clinically acceptable convergence
Ideal taper of opposing
angle of between 10° and 22°
walls

PARTIAL VENEER INLAY ONLAY

 Extracoronal metal restoration that  pre-molded filling fitted into the  indirect restoration
covers only part of clinical crown grooves of your tooth
 partly intracoronal and partly
Description  Cast-gold restoration which covers ¾  used as restoration for cavities that are extracoronal that covers all the cusps
of the crown centered in your tooth instead of along of a posterior tooth
the outer edges or” cusps”

Advantages  Conservation of tooth structure  Superior metal properties  Support of cusps

 Easy access to margins for finishing  Longevity  High strength

(dentist) and cleaning (patient)
 No discoloration from corrosion
  Less gingival involvement than with  Least complex cast restoration  Longevity
complete cast crown

 Easy escape of cement and good

seating

 Easy verification of complete seating

 Electric vitality test feasible

 Less retentive than complete cast  Less conservative than amalgam  Lacks retention
crown
 May display metal  Less conservation than amalgam
 Limited adjustment of path of
insertion  Gingival extension beyond ideal  May display metal
Disadvantages
 Some display of metal  “Wedge” retention summary chart  Gingival extension beyond ideal

 Not indicated on nonvital teeth

 Sturdy clinical crown of average  Small carious lesion in otherwise sound  Worn or carious teeth with intact
length or longer tooth buccal and lingual cusps

 Intact labial surface that is not in need  Adequate dentinal support  MOD amalgam requiring replacement
of contour modification and that is
supported by sound tooth structure  Low caries rate  Low caries rate

 No discrepancy between axial  Patient’s request for gold instead of  Patient’s request for gold instead of
Indications
relationship of tooth and proposed amalgam or composite resin amalgam
path of placement of FDP
 High caries index

 Poor plaque control

 Small teeth
  Short teeth  Adolescents  High caries index

 Nonvital teeth  MOD restorations  Poor plaque control

 High caries index  Poor dentinal support necessiting a wide  Short clinical crown or extruded teeth
preparation
 Extensive destruction  Lesions extending beyond transitional
line angles
Contraindications  Poor alignment with path of
withdrawal of FDP

 Cervical caries

 Bulbous teeth

 Thin teeth

Armamentarium  Round-tipped diamond for depth  Round-tipped, tapered diamond for  Tapered carbide for occlusal outline,
according to sequence of grooves for lingual reduction, incisal reduction of marginal ridge and contact proximal boxes, occlusal reduction
use bevel, depth grooves for axial area adjacent to edentulous space and centric cusp ledge
reduction.
 Football-shaped diamond for lingual  Thin, tapered carbide for gingival
 Football-shaped diamond for lingual reduction and proximal bevels
reduction
 Straight carbide fissure bur for ledges  Excavator or round bur for caries
 Tapered carbide fissure bur and and indentations removal
half-round bur for axial reduction
 Tapered carbide bur for pilot channels
 Fine-grit, tapered diamonds (large and pinholes
and small) or carbide for retention
form (proximal grooves and lingual  Finishing stones or carbides for
pinhole finisihing

 Tapered carbide for occlusal outline

and proximal box

 Excavator or round bur for caries

 removal

 Gingival margin trimmer for

axiogingival groove

 Thin, tapered carbide or diamond for

gingival and proximal bevels

 Round carbide or stone for occlusal

bevel

1. lingual incline of the buccal cusp to 1. approximately 1.8 mm deep 1. Adequate dentin for resistance and
join the two proximal grooves (0.5 retention
Preparation
mm deep) 2. Should provide for clearance of at least
0.7 mm 2. 1.8mm deep
(Ideal reduction
2. Should have 1 mm of clearance
measurements)
3. Detectable with explorer tip (0.2 mm 3. 1.5-mm functional cusp; 1.0-mm
1. Occlusal/Incisal
3. Grooves parallel to incisal two thirds deep) nonfunctional bevels cusp
Reduction
of labial surface; should resist lingual
2. Facial/Lingual
displacement; pinhole should be 4. 2°-5° of taper 4. Slightly tapered from the opposing
Reduction
between 2 and 3 mm deep “wall proper” by 2-5 degrees
3. Proximal Reduction
4. Retention & Resistance
4. Taper of about 6º
Form
Ideal taper of opposing
walls