script number (1) , Title : Indications for crown and bridges , Date 28 / 1 / 2014

Indications for Crown and Bridges

Eman Nazzal

Dr. Ahed wahadneh

28 / 1 /2014

script number (1) , Title : Indications for crown and bridges , Date 28 / 1 / 2014

INDICATIONS AND CONTRAINDICATIONS FOR CROWN AND BRIDGES PT TITLE

SCRIPT NUMBER (1)

First : CROWNS
Genaral Indications :

-Firstly , you have to suppose that your friend , sister , brother etc has a missing upper central , or discolored or fractured . The first problem with this patient is esthetic . -Also if he has missing 6 what is the problem ? function ( he wants to eat , simply ) . -Sometime maybe we have problem with Phonetics - If you extract lower 6 then upper 7 will over-erupt and 5 , 6 will tilt , so Occlusion .

General Indications : esthetic / Function / Occlusion / Phonetics

From Caries to crown we start with caries , end with a crown ( not every case but it is general speaking ) , if we have a caries we remove the caries then if it is small cavity so we need a filling , But if it is large cavity and no enough tooth structure then we need a [ cast restoration ] so our choices are : if there is enough tooth structure Filling if there is no enough tooth structure inlay onlay overlay
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script number (1) , Title : Indications for crown and bridges , Date 28 / 1 / 2014

Inlay Onlay

(mesial or distal cavity ) ( MOD cavity )

Overlay ( MOD cavity including the whole cusp ) CROWN (the tooth is entirely destructed )

If I have a destroyed tooth so I have to do preparation to remove enough tooth structure to accommodate new crown But if I have missing tooth for example 6 , so I have to prepare 5 and 7 to put the bridge , SO :

BRIDGE is a prosthesis to restore missing tooth ,

by preparing the 2 adjacent teeth .

CROWN it is a prosthesis to restore entirely destructive tooth , by preparing the tooth itself to receive this prosthesis

script number (1) , Title : Indications for crown and bridges , Date 28 / 1 / 2014

Other Indication :

1) Badly broken-down teeth

2) Heavy filled tooth : I do cavity and do filling but the filling will not be strong enough so I want to protect my filling. 3) Fractured tooth : ( bcz if I put a filling it will not withstand the biting force). 4) Tooth wear : ( abrasion , attrition , abfraction , erosion etc) if the pt has attrition and he will lose the vertical dimension .

5) Hypoplastic condition : ( like amelogensis imperfecta dentinogensis imperfecta ) this will affect texture and structure of the tooth so will affect esthetic .

6) Alter shape or size or inclination of the teeth Example of changing shape pig lateral Also if I have slightly inclined tooth and I want to modify it I might need crown.

7) Alter the occlusion To correct the occlusion and vertical dimension I might need crown . 8) As a part of other restoration : When we have missing tooth the crown will be part of the bridge , when the crown is a part of bridge its name will be ( retainer )
we will explain it later

script number (1) , Title : Indications for crown and bridges , Date 28 / 1 / 2014

Ok I have to think about something other than crown .. bcz crown is very destructive procedure , you have to remove from tooth structure , I have to reduce from tooth size so Ill be closer to the pulp .. so I will danger the pulp so Im doing something will cause a problem So what is the alternatives ?

1) bleaching
If your problem with esthetic you have to think about it
It is conservative, you dont remove tooth structure but I dont like bleaching bcz it is recurrent , it is good for short time , ur enamel and dentine will absorb coffee , tea , argela etc so ur original teeth color will return )

2) Resin composite or restoration:

If I have discolored upper central I can put composite facing ( very thin composite ) , it is cheaper for the patient , quicker time in one visit

3) Inlay and onlay ( gold , ceramics .. etc . )

It is more conservative bcz u cover the tooth structure without doing the full preparation , only on the occlusal surface , on some cusps or part of them , but not the whole tooth structure .

4) Porcelian laminate VENEER .

VENEER very thin porcelian, exactly like the nail of finger. You have to remove very thin layer of enamel, you cement it the pt mouth. It is very aesthetic and conservative .. It is the Best solution in Dentistry.
For example if you have flourosis with some pits like this patient , you cant do preperation for this tooth ! so the best solution is to do veneers See here how the veneer is very thin just like ur finger nail

script number (1) , Title : Indications for crown and bridges , Date 28 / 1 / 2014

5) Esthetic filling : composite / GIC .. etc 6) Implant :

If you have missing tooth we can do implant We dont touch the adjacent teeth , we go inside the bone and soft tissue , we drill and put titanium implant and leave it for 4-6 months ( according if it is upper or lower ) until we reach the osteo-integration ( in Arabic ) and this titanium become as your root .

TYPES OF CROWNS
1) Full Ceramic crown 2) Full Metal crown 3) Ceramometal crown

Which [ filling , inlay or onlay ] should I choose ? Ok , now , I will not spend much time in this topic bcz you take it in conservative .. If you have lower 6 with large class 5 , what filling I have to use ? (amalgam, composite , GIC .. ??) There are many factors affect the choice like moisture control ( sensitivity ) / enough tooth structure / Aesthetic / Vision zone/ occlusion / strength So I prefer amalgam for lower 6 or GIC , ok u can use composite but if it is sub gingival it is difficult to etch and difficult to have a good moisture control.

script number (1) , Title : Indications for crown and bridges , Date 28 / 1 / 2014

Second : Bridges
Bridge is a prosthesis to replace a missing tooth If you have missing tooth what is the options ? First option , is to do NOTHING unless your patient has a problem with esthetic, function ,occlusion ..etc . For example your patient has missing 6 from 10 years and his occlusion is stable now , and no over eruption no drifting no any problem , so no need to spend ur effort and time and your patients money in replacing it and he dont need it ?!

The second option , it is the most conservative ,cheapest , quickest is the PRD ( partial denture ) The Third option is bridge Or implant ( they are at the same level )
And we will talk about It in more details later on

Types of bridges

1) Fixed-Fixed bridge
All of the parts are connected to each other in one unite .

2) Fixed-movable bridge
it is composed of 2 part attached to each with an attachment that called Precision attachment or stress breaker friction attachment it is the part that connects the bridge with a crown . (Dr said : you have to read it by yourself )

script number (1) , Title : Indications for crown and bridges , Date 28 / 1 / 2014

Very Important NOTE : It is not REMOVABLE , it is MOVABLE .. if u write it in exam removable you will get ZERO Movable means that it is moving . Removable means you can remove it away . You have to differentiate !!

So this movement of the fixed-movable bridge >> will reduce the stress from the masticatory forces that applied on the bridge and on tooth structure .

3) Resin bonded bridge what is the difference between normal bridges and resin bonded bridge ? Resin bonded is more conservative , I remove from the palatal surface about 0.5 mm , while the other bridges I need about 2 mm , also it will need temporary filling , needs anesthesia , but the resin bonded needs nothing , Now the survival rate for the other bridges is higher ( each of them has an advantages and disadvantages ) Any way .!

Advantages

1) appearance 2) occlusal stability 3) The Ability to Eat

4) speak and phonetics

5) periodontal splinting 6) feeling of confidence 7) orthodontic retention 8) To restore the vertical dimension

script number (1) , Title : Indications for crown and bridges , Date 28 / 1 / 2014

Disadvantages: 1) Destruction to the tooth It may lead to pulp exposure 2) Artificial margins . When we put the crown we will have artificial margins which may accumulate the plaque leads to caries. 3) Failure . 4) Effect on the periodontum: (if you remember the fatal mistake in amalgam is OVER HANG not carving the reason in almost cases is the student dont put the wedge )) 5) cost and discomfort: Let the patient to choose unless he asked your advice .

The Choice Between The Removable And Fixed Prosthesis

1) Patient attitude Some pt doesnt care of appearance other pt they care 2) Factor age and gender: some thinks said that female who look for something fixed and nice On other hand , the young is not like the old man . 3) Confidence : when u have a nice and healthy teeth , you will be self-confidant 4) Occupation : like the interviewer on TV , it is not acceptable if he has a broken tooth for example !

script number (1) , Title : Indications for crown and bridges , Date 28 / 1 / 2014

5) General health For example you have a patient with cancer , you cant bring him for 3 visits or 4 visits . So the easier is to do RPD ( this is an example ). 6) oral hygiene 7) Appearance 8) Local consideration This mean that you have to examine each tooth alone and then to decide The first Example : If I have missing lateral , and I have upper central and upper canine , and the canine and central are mobile , shall I do bridge for him ? No because bridge will apply more stress on the abutment , and already I have a mobile tooth , So Best choice is partial denture . But the problem is that the PD is not as kind on soft tissue than the bridge , and it cause periodontal disease more than bridge , bzc P.denture covers more soft tissue while bridge will cover less area . Another example , if you want to replace a tooth but the adjacent tooth is periodontaly involved , you cant do a bridge , you have to do P.D OR you can extract it and it will be as a part of the bridge .

And Finally I hope this script was easy and interesting and sorry for any mistake .. Eman Nazzal ! . .. . : [ / ]
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