Crown and Bridge 1

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The Dr starts the Lec reminding us about the introduction lecture
we spoke about the definition of dentistry
we spoke about the rationale behind the studying dentistry
we saw that ppl never like to go to dentist
They never like to have their teeth drilled,
we learn how to make the right and easy for your pt
how your pt will accept you
so the dentistry is about passion
is about rapport between you and your pt
is about pain free
is not sense that pt feel pain
I mention that last time that the pt you have to treat him as member is
your family (like your sister and your father)
You treat the pt as one member of your family and you will not except to
not to work as best as you can.
Dentist is not an artist cuz the skills that he should have is an acquired,
you have to follow principles and rules, read books, you have to see the
dentists who have an experience and they are better that you, later on
you will have your own way.

Dentistry is about dexterity and technology

You have to have best equipment and material that are good enough to
deal with, then better surface to work on.
time.
environment.
the compliance of the pt.
The purpose is not just to finish, you have to give yourself time and your
pt time, dont rash in things talk to your pt,
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ask him about his name and his occupation if he feels ok etc.
then you start your work drilling
The text book of this course is planning and making crowns and bridges
3rd edition.
However the dr. copied the chapters and he will give it to us.

Indications and Contraindications For Crown & Bridge

We will see next whats crown means, and whats types of crown we
have.
The type of material that we use to manufacture this crown when we use
them
As general speaking,
CROWN: is prosthesis to restore
=Function
=aesthetic
=occlusion of the tooth

BRIDGE: is prosthesis to replace missing tooth.

The life cycle of the dental pain : teeth in the

human being start with bacteria destroyed teeth
cuz of food, poor oral hygiene, end up with caries.
This is the G V plaque the father of caries
You end up doing filling for pt
or may you do cast in the lab and you do thing called
INLAY, ONLAY, OVERLAY

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If you are an endodentist and you do good endo, the pt will not notice it,
he cant see the canals, or full operation.
If u do filling with very well carved the pt will not notice it.
but when you do a crown he will notice the appearance of it,
and he will comment on it, is it look nice or bad?
So you have to be meticulous, and do good planning for treatment.
If u want to collect money, the most branches of dentistry will do that, are
the ortho and crown and bridge. These are the courses that will do that :D
If you interest in donning something nice, to change ugly teeth to
beautiful teeth, you have to study crown and bridge.
You have very interesting Lec, about esthetic dentistry porcelian limited
veneer ,and all ceramics.

So rather than doing cavity we might do cast restoration in the lab we

called INLAY
If we go MOD more than this and a little bit covered the cusps we called it
ONLAY
If it covered the whole cusps we called it OVERLAY
Any pt have destroyed teeth so it has problem in:
= Esthetic
From the pic we can tell that the pt has esthetic problem.
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= Occlusion if the pt has attrition and he will lose the vertical dimension
Define the Vertical Dimension

= Function

Crown versus fillings in the treatment of caries :

not every single tooth should be replaced.

if the missing tooth doesnt do esthetic problem, or doesnt effect on
the function or occlusion, like lower 6 or 7 extracted for long time and
the patient is okay with it
Incipient Cary: If you have pt with incipient caries we do oral hygiene
instruction and follow up
Class 1: If the caries extend to dentine the restoration will be class 1.
Class 2: if it massive may be we go for class 2.
Crown: If there was not enough tooth structure, when the caries is
aggressive and massive, here we need something to retained and protect
the tooth which is the crown.

What is the difference between the filling and the cast of

restoration
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When we do the filling we should have enough tooth structure
cuz the filling is just restore the missing part of the tooth structure
,If the is not enough tooth structure the filling will broke and fall
down.

So the 1st indication for crown is for a cavity that is too

large to be restored with a filling " badly broken-down
teeth " .
There is no set of rules clear to decide if this cavity is indicated for
filling or crown, this become with experience and more knowledge.
This course gives u just general concept.
**Look at this pic the cavity is big so I have to do something to
protect the remaining of tooth structure so I do crown

if you have pt has filling need to change you should ask yourself can
I make better than the old one.
I said before from the 1st week you see your filling is excellent and
by time after month or a year it becomes bad.
so dont rash in judgment of your work.
We have a lots of factors that affect we will discuss it later on.

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2) FRACTURE:

U have to judge the fracture, would this composite lasts in this fracture
Again nobody can give perfect answer but for me I think composite is not
suitable here.
We are talking about crown fracture , how ever ,Fracture in the root, you
have to extract the tooth as you know.
So generally You have to JUDGE if:
# The filling is massive.
#The caries is massive.
#The fracture is massive.
so we indicate crown for restoration.
((about fracture you cant judge easily cuz you have to know is
the pt feeling pain and do some diagnostic test in the upper 3 rd part
of the tooth(crown), you have to take X-ray etc. ))

3 ) tooth wear :

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#Attrition:
is the loss of teeth structure by mechanical forces from opposing teeth.

#Abrasion:
is the loss of tooth structure by mechanical forces from a foreign element
toothbrushes, toothpicks, floss

#Erosion:
is the irreversible loss of tooth structure due to chemical dissolution
by Acidics problem in pt stomach.

When you have aggressive tooth wear no single filling will withstand in
this case.
you have to do diagnosis you have to do preventive manager by the
end of the day you will end with crown, filling cant have place here cuz it
will go out.
If you drill a teeth suffer from tooth wear then you do a conservative
dentistry, here you destroyed the pt teeth you do huge mistake.
also The teeth will be harmed if we do 2 crown for it.
So when we think about crown you have to think about something :
costy , needs time , extra visit for pt

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Also we have general indications for crown like:

- ((hypoplastic indication)) like amelogensis imperfecta

dentinogensis imperfecta
anything will affect the appearance of the teeth will needs crown
fluorosis, tetracycline staining
- To alter shape or size or inclination of the teeth : # like peg
lateral , anything odd .

- To alter the occlusion :

=Occlusion and Vertical Dimension:
To correct the occlusion and vertical dimension .

- As a part of other restoration : Crown is part of the bridge we

will see pic and you will understand it.
= Crown could be part of another restoration
we will explain with details about bridges.

- combined indications.
- Appearance.
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-----------------------------------------------------

BRIDGE:

When we have missing tooth with 2 sound teeth.

You prepare the sound teeth, then take impression and sent it to the lab.
Lab will make crowns on the prepared teeth + pontic.
So crown is part of a bridge.
*We call it Crown when its alone.
*When it is part of the bridge, we call it RETAINER.
* what are the alternatives to anterior crowns ?
1) bleaching :
Sometime pt has fluorosis or tetracycline staining, but the teeth are
sound.
So what shall I do? You will say bleaching,
yes I can do bleaching.

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BLEACHING:
what's Good and whats bad about bleaching ?
this is what we call decision making
In bleaching we use certain material like
hydrogen broxid, bromid to make teeth white it could be done
with single visit or home visit you have to read about this.

The Advantage of Bleaching:

It is conservative, you dont remove tooth structure.
The Disadvantage of Bleaching:
It is recurrent the pt needs something permanent, almost in 6
month there will be relapse.

2 )Resin composite or glass inomar restoration:

we can do composite facing, but again we have to decide if it is
satisfactory in term of esthetic.
3 ) gold or porcelian (inlay and onlay).

4) VENEER:

like lenses or nails . very thin !

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I can do 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, even the dentist will not notice
the veneer.
**This is the pic about bleaching before and after**

5 )Aesthetic Filling:
Composite, if there is enough tooth structure

These teeth is sound (pic), what did you do?

A Crown and you will remove too much of tooth structure>> NO Veneer
which is 0.5 mm thin and more conservative>>the right choice.

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INLAYS:
metal restoration rather than doing filling

6 )IMPLANT:
when you have missing tooth you go for implant.

Types OF Crowns:
the type is basic on 2 things material / finish line
1- Full ceramic crown.
2- Full metal crown.
3- Ceramometal.

When we do a filling, you have to think which filling should be the choice
(amalgam, composite).
There are many factors affect the choice like:
*moisture control
*enough tooth structure
*Aesthetic
*Vision zone
*occlusion

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*costy (amalgam the least costy, then GI, then inlays , partial
crown, full crowns)
** now the doctor is giving us information about general but really
important terminology :
BRIDGES:
If I have missing tooth, shall I have do bridge directly or shall I think of
something else (like implant, partial denture)??
==Taking Decision more important than Making Restoration==
Some Terms:
Bridges:
Is prosthesis to replace a missing tooth using adjacent teeth so we have to
prepare the adjacent teeth.
Abutment: The tooth which is prepared(adjacent teeth) we call it
Abutment.
Retainer :The crown over the prepared teeth we call it Retainer.
Pontic: The prosthesis that replace the missing tooth we call it Pontic.
Connecter: The attachment between the Retainer and Pontic we call it
Connecter.

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In bridge also we have

-full ceramic
-full metal
- ceramometal
-resin bonded bridge
we dont prepare the whole tooth (the best choice after the
implant)

Implant:
Is titanium metal, drilled by the surgeon inside the bone. we leave it for 3
mon to reach the osteointegration, (the bone and titanium integrate
together) after that you do crown or bridge.
In implant I dont need to prepare the adjacent teeth..
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Some pt will refuse to put partial denture so we go for implants then fixed
bridges.
Year by year partial denture is disappearing.
Other classification of bridge:
1st type of bridge Fixed Fixed
one unite connect to each other.

2nd type of bridge Fixed Movable

2 pieces attached to each other here we have
attachment, and we have several type of attachment
(rational attachment, stress breaker)

3rd type of bridge Resin bonded bridge

cuz it is cemented with resin cement
or called Minimal Preparation of Bridge (not accurate
name cuz some theories said that we can do it without bridge !!
some books call it marinnan.

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The advantage of Resin Bonded Bridge that when we have sound teeth
and I want to prepare it to make bridge we do minimal preparation for
the teeth in the palatal side, the shape of it is metal wing, metal wing like
butterfly on the palatal side.
The advantage of replacing missing teeth:
1st appearance by replacing the missing teeth
2nd occlusal stability:
if we extract for ex lower 6, the lower 7 and 5 will have drifting
and the upper opposing teeth they will have supra eruption
This is what we call occlusal instability to prevent that happened we
make bridge for the missing tooth.
Sometime the pt have occlusal stability and he have a missing teeth
and he doesnt have TMJ problem, he looks fine
in this case he doesnt have to put bridge
3rd The Ability to Eat
4th speak and phonetics >>
when you do crown and bridge for anterior teeth and you
dont be meticulous and you and the dental laboratory dont
work in perfect manner especially in the palatal side over
contoured.
5th periodontal splinting:
Ex canine is sound and lateral is mobile
some dentists connect the 2 teeth together to prevent the
mobility. The dr dont agree in this. but it is in many books
and some dentists do that .

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6th feeling of competence:
to be the set of teeth complete this help the pt to be comfortable
when he speak and laugh
7th orthodontic retention:
suppose canine not in the right position and you distalized it (send it
distally)
may be relapse would happened you can do bridge between
centrals and canine to prevent any canine movement
8th to restore the vertical dimension
Freeway space is more than normal we may need crowns
9th wind instrument (who play on xylophone )
--------------------------------------------------------------we finish the advantage , Now what are the disadvantage?
Disadvantage Of Crown And Bridge:
1st preparing the teeth
It may lead to pulp exposer.
((you have to be responsible when you treat your pt if you see a
filling before you remove it. Ask yourself can I make better than the
old one if youre not you will waste the time, take extra tooth
structure and extra money for nothing))
2nd artificial margins:
When we put the crown we will have artificial margins which may
accumulate the black leads to caries.

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3rd Failures:
May be immediate failure or later (if later then you do something
excepted to failed )
4th 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 ))
5th cost and discomfort:
In Britain the cost of one bridge is 350 bound
if the pt has more than one bridge the cost will be high for him and
failure will not be acceptable for him.
you have destroy his teeth and his pocket here he was have a
problem and you make it bigger .. the pt when he bite.. he had pain
cuz of high spot you made it.

The Choice Between The Removable And Fixed Prosthesis:

both are prostheses the pt is the one who will drive the factors for
the right choice
1st factor pt care:
Some pt doesnt care of appearance other pt they care
2nd factor age and gender:
some thinks said that female who look for something fixed
and nice
Also male after age of 18 (philosophy of growth )!!

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3rd confidant:
like person on TV (interviewer).
4th oral hygiene:
Pt who has poor oral hygiene we give him oral hygiene
instruction
If you have to choice bt the denture and bridge the choice will
be the bridge cuz
The denture covers more soft tissue while bridge will cover
less area
5th local (!) consideration
if I have mobile teeth the choice may be removable every
single case has its own way to solve.
>>> Done By Seba Hawass

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