Dr.

Shahinaz Alfaki
Msc Cairo University
 Selection of prosthesis type

 Missing teeth may be replaced by:

1. Implant supported fixed partial denture.

2. Tooth supported fixed partial denture.

a. Conventional F.P.D

b. Resin bonded F.P.D

3. Removable partial denture.

 Selection of prosthesis type
 While selecting a treatment plan, the following sequence
is important:
1. Implant is preferable if indicated at any situation.

2. Resin bonded-bridge is the 2nd choice to restore missing

one tooth (except missing lower two centrals).

from the 2nd premolar resin bonded bridge comes after

conventional designs because of less retention &
resistance.

3. Conventional bridge design.

 Factor affecting the different designs for
replacement of missing teeth

1. Span length & position:

 longer than 2 teeth posteriorly
 Or than 4 teeth anteriorly

 Canine with two or more teeth Removable

 Free end dentition
 Bilateral or multiple edentulous areas

 Missing 2 teeth or less posteriorly

 Or 4 teeth anteriorly as maximum Conventional
 Usually with distal abutment
 Free end dentition can be used with short cantilever bridge.
 Factor affecting the different designs for
replacement of missing teeth

1. Span length & position:

 Single tooth Resin Bonded
 Bounded & short span

 Not affected by length i.e up to 6 units

 Single tooth

 Pier tooth in long span Implant

 Free distal abutment
 Factor affecting the different designs for
replacement of missing teeth
2. Abutment condition:

 Short clinical crown Removable

 Less number of abutment

 Good & bulky Conventional

 Vital & non vital

 Defect free Resin Bonded

 Not touched Implant

 Factor affecting the different designs for
replacement of missing teeth
3. Abutment position:

 Tilted or rotated teeth Removable

 Widely divergent abutment

 Tooth inclination with less than 25o Conventional

 Rotated with some modifications.

 Tooth of minimal position variations Resin bonded

 Need surgeon restorative coordination Implant

 Factor affecting the different designs for
replacement of missing teeth
4. Occlusion:

 Adaptable to normal & abnormalities Removable

 Normal occlusion with favorable Conventional

load in magnitude, direction & duration.

 Normal occlusion & Resin bonded

 not used in deep vertical overlap

 Vertical forces are better. Implant

 Factor affecting the different designs
5. Periodontal condition:
 When primary abutment is weak
 use secondary good one Removable

 C/R ratio not less than 1:1

 Good alveolar support.

 No mobility. Conventional
 Good root morphology.

 No mobility Resin bonded

 can be used in periodontal splints.

 Dense bone Implant

 Factor affecting the different designs

6. Ridge form :
 Used in gross loss in residual ridge Removable

 Moderate resorption with no gross loss. Conventional

 Moderate resorption with no gross defect. Resin.B

 Broad flat ridge. Implant

 Factor affecting the different designs
7. General features:
 Acceptable oral hygiene Removable

 Simple treatment for advanced age

 Dray mouth increases risk to F.P.D

 If mandibular tori or palatal lesion exist

 Large tongue size. Conventional

 Increased gagging reflex.

 Unfavorable attitude to P.B.D

 Factor affecting the different designs

7. General features:

 In young patient Resin bonded

 Can be used in dry mouth.

 Instead of questionable abutment Implant

that need massive treatment & will still be weak

 Unfavorable attitude to partial dentures.

 Guidelines for bridge designing
1. Abutment selection:
• Should be vital whenever possible.

• If endodontically treated it should be asymptomatic &

good canal seal

• Failure occur if abutment have - short root or little

remaining tooth structure, therefore added (secondary)
abutment should be taken.

• Secondary added abutment also used in case of weak

abutment or improper C/R ratio.
 Guidelines for bridge designing
1. Abutment selection:
• Pulp capped teeth should not be used.

• Terminal abutment: preferable to end the bridge on strong

abutment not weak one as upper laterals or lower centrals.

• Endodontically treated: should not be used for cantilever or

long span bridges.

• Third molars: rarely used as abutment why?

• They have short /fused root, usually show incomplete

eruption, or mesial inclination, the unattached mucosal tissue
the distal will be inflamed even with well fitted crown.
 Guidelines for bridge designing
2. Retainer selection: (factors affecting retainer selection)
a) Alignment of a abutment:
• If the abutment teeth are not parallel complete crown with
C.Path of insertion will not be possible unless R.C.T is done.

• SOLUTION: * use partial coverage retainer, * change design ,

*Orthodontic up rightening.

b) Appearance:

• All ceramic better than metal or metal-ceramic

• According to clinician judgment in some cases full coverage

retainers may may have better apperance than partial coverage or
resin bonded bridge.
 Guidelines for bridge designing

2. Retainer selection: (factors affecting retainer selection)

c) Condition of the abutments:

• If abutment has intact facial surface/adequate height & bulk,

therefore partial coverage retainers can be used.

d) Occlusion:

• In case of heavy occlusal forces/ deep bite, resin bonded

retainers are contraindicated.
 Guidelines for bridge designing
3. Connector selection:
• Should be large to withstand occlusal forces BUT not affect
the periodontal health (embrasure space for plaque control).

• Rigid connector is usually used but non rigid connectors are

used: - to decrease the load on the abutment or - solve
problems of malaligned abutments.

• In case of fixed support the support must be place on the

anterior abutment with cast restoration (inlay).

• In case of multiple diastemas, fixed fixed bridge can be used

with palatal loop connector.
 Guidelines for bridge designing
4. Pontic selection:
• Cleansability:
• Appearance
• Strength

5. Material choice:
• Metal
• Metal-ceramic
• All ceramic
 There are few points that must be considered

during designing the conventional bridge pattern

 The support must be done on the anterior restored abutment
according to force direction.

 If the primary abutment is weak for any reason add a

secondary abutment .

 Cantilever bridge is used to restore missing lateral or upper

central case of diastema but non lower central.

 In case upper & lower 4 cantilever bridge can be used if the

span is short, or 5 & 6 is restored before, with necessity of
canine guided occlusal.

 Restoration of upper 3 differs than the restoration of lower 3

( group function).

 Difficult to replacing canine because , lies outside the inter

abutment axis, lateral & 4 are a weakest teeth .
 If more than one teeth missing, added means of retention to
retainer.

 Missing upper 4,5,6 can be restored with FFB on 3&7 if

they are strong, but canine guidance is important, if
opposing partial denture , good prognosis.

 Cantilever can be used to restore last molar & the pontic

here is used as an occlusal stopper to prevent over eruption
of the opposing tooth.

 Missing upper central or lateral has 5 choices to be restored,

while the missing lower incisors have only 2choice for their
restoration.
Special Problems
 Special problems
1. Pier abutment:
 It is tooth between two edentulous spaces.

 Problem occur:
 Stresses in long span bridge.
 The tendency of prosthesis to flex.

 Stress concentrated around the abutment.

 The middle abutment (pier) acts as a fulcrum.

 Loosness of the retainer.

 Marginal leakage ----- caries

 Special problems
1. Pier abutment:
 Solution:

a. The use of non rigid connector (stress

breaking design) on the distal aspect of
the pier abutment ??.
 consists of a t-shaped key attached to the
mesial side of the Pontic, that placed within
the retainer of the pier tooth at distally.
b. Cantilever the first pontic if periodontal
support is adequate.
c. Implant.
 Special problems
2. Cantilever bridge:
 This type of bridge is fixed from one side and free(no abutment) at
the other side. Therefore harmful stress on the abutment teeth with
high torque.
 Problem occur:
 Tipping of the abutment.
 Rotation of the abutment.
 Drifting of the abutment
 Some precautions must be considered:
a. use two abutment at least in other cases.
b. reducethe length of the pontic mesiodistally.
c. if replacing maxillary lateral incisor, no occlusal contact in
centric or lateral excursion. canine used as abutment
 Special problems
3. Tilted lower molar abutment:
 It is a common problem occurring when the lower first molar
tooth has been extracted long-time ago.

 Problem occur:
 Difficult to obtain a common path of insertion. Therefore line
of treatment depends on:
i. The degree of tilting.
ii. as well as if the third molar is present or not
 Special problems
3. Tilted lower molar abutment:
 Solution:

1. Orthodontic up righting of the tilted molar is preferable,

remove the third molar to facilitate the distal movement of
second molar.

2. If the third molar is present and slight tilted with the second
molar, slight reduction of its (3rd molar) mesial side (on
enamel) + fluoride application then construction of the fixed
bridge.
 Special problems
3. Tilted lower molar abutment:
 Solution:

3. If heavy contact exist between 2nd & 3rd molars, ½ crown on

the 2nd is indicated but distal surface should be intact &
caries free.

4. Use non rigid connector on the distal aspect of the premolar

5. In sever tilting telescoping crown following the long axis of

the 2nd molar is done, which is covered by thin coping then
construct the bridge with a retainer fitted over the
telescoping crown.