Dr. Ang - FPD Compilation

FIXED
PARTIAL DENTURE
SEVILLA, MA. PATRICIA DAWN DR. AUSTIN U. ANG
INTRODUCTION § Implant Prosthodontics

1. Prosthodontics - Phase of dentistry concerning the
ü Branch of dental art and science pertaining restoration following implant
to the restoration and maintenance of oral placement
function by the replacement of missing teeth
and associated structures by artificial 6. Prosthesis
devices ü Replacement of an absent part of the human
ü Extracted tooth à gingiva disappears à body by an artificial part (ex. artificial leg)
bone resorption à bring back its function à
in the form of pink resin for additional lip ü Dental Prosthesis – Artificial replacement of
support 1 or more teeth and/or associated structures
ü Divided into:
§ Fixed 7. Crown
§ Removable ü Anatomic – Portion of a natural tooth that
- Removable Partial Prosthodontics extends from its dentinoenamel junction to
- Complete Denture Prosthodontics the occlusal surface or incisal edge
ü Artificial – Fixed restoration of the major
2. Removable Prosthodontics part of the entire coronal part of a natural
ü Branch of prosthodontics concerned with the tooth. Usually metal, gold, porcelain/ceramic,
replacement of teeth and contiguous synthetic resin, or their combination (acrylic
structures for edentulous or partially crown not a good candidate for long term
edentulous patients by artificial substitutes use of crowns)
that are readily removable from the mouth § In a crown, everything is extracoronal. (if
ü Only partially edentulous or has remaining majority of restoration is intracoronal
natural dentition and can be removed then it is an inlay or onlay)
anytime § Before placing an artificial crown, your
prepare the tooth first (make it smaller)
3. Fixed Prosthodontics ü Can be a complete veneer crown or partial
ü Area of prosthodontics focused on veneer crown
permanently attached (fixed) dental
prostheses. 8. Complete or Full Veneer Crown
ü Such dental restorations, also referred to as ü Restoration that covers all the of the clinical
indirect restorations, include crowns, bridges crown (until gingival line)
(fixed dentures), inlays, onlays, and veneers
ü Use dental cement to attach teeth 9. Partial Veneer Crown
ü Covers portions of clinical crown
4. Maxillofacial Prosthodontics
ü Involves rehabilitation of patients with 10. Bridge / Fixed Partial Denture
defects or disabilities that were present when ü Restoration of one or more of, but less than
born or developed due to disease or trauma all of, the natural teeth
ü Artificial replacement to restore the function ü Primarily supported by the teeth or roots
of the face ü It is often designated as “Fixed Bridge”
ü Different from maxillofacial surgery
ü Ex. Artificial eye
5. Implant Prosthodontics
ü Best material that has good compatibility
with bone is TITANIUM
ü Dental implant is an artificial tooth root
replacement and is used to support
restorations that resemble a natural tooth or
a group of teeth
ü Dental implant is a device made from one or
more biomaterials that is intentionally placed
within the jaw to support and/or retain a
dental prosthesis
ü 2 Stages:
§ Surgery
- Open gums à drill a hole à place
implant à cover then wait for the 11. Abutments
bone to integrate with the implant à ü Natural tooth or root used for the support or
4-6 months later, open it again à attachment of a fixed or removable
do the prosthetic part prosthesis
ü Either terminal or intermediate
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PROSTHODONTICS 1 – FIXED PARTIAL DENTURE 2
DR. AUSTIN U. ANG
12. Pontics Ø Porcelain Fused To Metal Crown (PFMC) à there is

ü Artificial tooth being replaced on a fixed always an exposed metal on the lingual
partial denture Ø All Metal Crown à only on the posteriors
ü Replaces the lost or missing natural tooth,
restores the function, and usually occupies Ø BIOLOGIC WIDTH à areas immediately below the
the space occupied by the natural crown gums (attached gingiva); area approximating the
attached gingiva à if the crown goes in below the
13. Retainers gums, encroach on attach gingiva à soft tissue
ü That part of a fixed partial denture which inflammation à increased osteoclastic activity à
attaches the prosthesis to the abutment resorption à mobility à pocket formation
ü Maybe be an inlay, partial veneer crown, or a
complete crown Ø The selection of the type of material and the design of
ü Covers the abutments the restorations are based on these factors (use
composite or crown?):
14. Joint or Connectors - Destruction of tooth structure
ü Part of a fixed partial denture that unites its - Esthetics
component parts - Plaque control
ü I.e. Pontics & Retainers
ü May be rigid or nonrigid FIXED PROSTHESIS
DIAGNOSIS & TREATMENT PLANNING Basic Requirements of Fixed Prosthesis
1. Diagnosis 1. Restoration of normal function
ü Identification of any abnormality 2. Biologic acceptability
ü History 3. Acceptable esthetics
§ Medical History
- Any medication being taken Objectives of Fixed Prosthesis
- Any allergic reactions to medicine 1. Restoration of masticatory function
§ Dental History 2. Restoration of proper phonetics
- When was the last treatment 3. Restoration of acceptable esthetics
- When was the prosthesis made 4. Maintenance of health of investing tissue
- History of extraction (periodontium)
- Any allergic reaction to anesthesia 5. Maintenance of arch integrity
6. Maintenance of stable occlusion
2. Treatment Plan 7. Pulpal protection (covering exposed dentinal tubules)
ü OP 8. Splinting of teeth when indicated (perio surgery)
ü Exo
ü Endo 4 Elements of a Good Diagnostic Workup in Preparation
ü Perio For Fixed Prosthodontic Treatment:
ü VERY LAST: Prostho 1. History
2. Intra-oral Exam
st
v 1 Treatment Plan: Implant 3. Diagnostic Cast
- Patient has no caries, no previous 4. Full Mouth Radiograph
restoration, adjacent PM and molar
are in perfect condition, young Indication For Fixed Prosthesis
nd
v 2 Treatment Plan: Maryland 1. Whenever properly distributed & healthy teeth exist to
Bridge/Etch Cast Restoration serve as abutments
- Patient is diabetic, heavy smoker, 2. Prove that these teeth have suitable crown to root
has heart problems taking blood ration, and on the basis of radiograph, diagnostic
thinner (contraindications) and cant cast, and oral exam, seem capable of sustaining the
afford implants additional load
- Porcelain metal crown 3. In General, an FPD is preferred to a removable
- Attachment on the lingual (metal prosthesis/denture
wing) bonded by composite 4. Teeth and the immediate adjacent oral structures
- Etch the metal by the technician have also a direct influence
- Etching of enamel and dentin for 15
seconds à wash à dry with cotton
à apply bonding agent à use
special composite luting agent
(composite designed as a cement)
rd
v 3 Treatment Plan: Fixed Bridge
Ø Implants supporting a CD (attachment on the implant

and on the denture) à denture is supported by
tissues, mucosa and residual bone; retention is the
implant à IMPLANT RETAINED TISSUE
SUPPORTED DENTURE
Ø Porcelain Jacket Crown/All Ceramic Crown (PJC) à
blends with the original
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FIXED PARTIAL PROSTHODONTICS a. Opposing occlusion is artificial (removable
dentures) à diminished forces (not as
Abutments strong) à mastication force is only 10%
- Should be careful in choosing an abutment because b. There will be diminished occlusal forces with
they will also be carrying the load of the pontic along less stress on abutment teeth
with their own load - Use radiographs to check this
- Should be in good optimum health
- No periodontal disease, good bone support, no 6. ANTE’S LAW
inflammation of the gums, no resorption of bone, no - States that the root surface area of the abutments
widening of the periodontal ligaments should equal or surpass that of the tooth or teeth
being replaced with pontic(s).
Factors Influencing the Design of the Prosthesis
When designing and fabricating a FPD, since the 7. PERIODONTAL HEALTH
forces which would normally be absorbed by the missing tooth/ - Poor periodontal health often lead to bone loss
teeth are transmitted through the pontic, then the connectors - When there is extensive bone loss, there is a need to
and retainers to the abutment teeth, abutment teeth are use more abutment teeth, or a treatment option of
therefore called upon to withstand the forces normally directed using a removable partial denture
to the missing teeth, in addition to those usually applied to
abutments. 8. MOBILITY
- Normally, abutment teeth should NOT exhibit greater
1. CROWN LENGTH than normal mobility since they will be carrying the
- Must have adequate occluso-cervical crown length to load coming from the pontic. Premature contacts or
achieve sufficient retention of the restoration error in restoring back to the patient’s normal
- Want it to be very long occlusion, upon delivery of a FPD, will lead to tooth
mobility on the affected areas.
2. CROWN FORM - Healthy tooth = slight mobility due to periodontal
- Advantage of a larger sized coronal form ligament space
- To achieve sufficient retention - Pathologic mobility = bone loss already
- Want it to be very big/bulky - When checking for mobility of the tooth, get the end of
- Most desirable candidate: Canine, Upper CI, Post. 2 mouth mirror and place one on the buccal and one
Teeth on the lingual (has to be blunt instruments) and move
- Least desirable candidate: Lower CI and Upper LI it back and forth
- Don’t use fingers because they are soft
3. DEGREE OF MUTILATION
- Are the teeth restorable? 9. SPAN LENGTH & THICKNESS
- Location of carious lesions - A long span bridge will be less rigid; prone to bending
- Amount of tooth tissue destroyed and deflection especially with a poor metal
substructure design and not enough abutment
4. ROOT LENGTH & FORM support
- Roots that are broader labio-lingually than they are - Double Abutments – are sometimes used as a mean
mesio-distally are preferable to roots which are round of overcoming problems created by unfavorable
in cross section crown to root ratio and a long span FPD
- Shape of upper PM root: Irregular shape (offers better - The longer the bridge à more flexing of the bridge à
stability) create problems on the abutment due to too much
- Shape of CI: Circular shape force exerted à break the porcelain
- Multi-rooted posteriors with widely separated roots will - Anything more than 3 units = Chances of error
offer better periodontal support than roots which increases
converge, fuse or generally present a conical - Thickness should be cervico-occlusal
configuration
10. PIER ABUTMENT
- A tooth to be used as an abutment which has an
edentulous space on both the mesial and distal,
creating a lone free standing tooth. It will act as a
fulcrum when it forms a part of a FPD
- Non Rigid Connector (a broken stress mechanical
union of retainer to pontic) allows a slight movement
without involving the pier abutment
5. CROWN-ROOT RATIO - A tooth to be used as an abutment, free standing with
- Is a measure of a tooth occlusal to the alveolar crest a tooth missing on the mesial and on the distal in a 5
of bone compared to the length of root embedded unit bridge
within bone - 5 unit bridge = Lever arm
- Rarely achieved, but the ideal crown to root ratio for a - Tooth in the middle = Fulcrum
tooth to be utilized as abutment is 1:2, 1:1.5 has - To lessen the forces on the pier abutment, split the 5
generally been considered to be satisfactory, whereas unit bridge into 2 parts (3 units & 2 units) à use a
1:1 ratio is considered minimal non-rigid connector to connect the 2 parts
- 1:1 ratio may be considered adequate, IF: - Problems of teeth with a pier abutment: Sensitivity,
pain, widening of periodontal space = Trauma form
occlusion
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v A bridge only supported on one end ü If you’re very near the pulp already, before
instead of both ends = CANTILEVER à placing composite or amalgam, place Calcium
Danger = Movement Hydroxide first à put protective layer of glass
v NEVER place a cantilever on the ionomer à composite
posterior ü Some put Glass Ionomer Liner first
ü Preservation = Talking about the tooth in its
entirety not the actual prep
ü Ex. Patient goes to you with a badly broken down
tooth, due for exo but you found a way to restore
it (RCT, resto inside root canal, composite) à
prepare tooth à cover with crown à preserve
remaining tooth
2. RETENTION AND RESISTANCE FORM (SHAPE OF

PREP)
11. PATH OF INSERTION ü For a restoration to accomplish its purpose, it
o Abutments should always be prepared must stay in place on a tooth. No dental cements,
parallel no matter how strong or bio-compatible posses
the adhesive properties requirede to hold a
12. AGE OF PATIENT restoration in place.
o Younger patients have larger pulp so there is ü Resistance of restoration to displacement
a danger of accidental pulp exposure ü RETENTION
o What you do: minimal prep à put an acrylic § Prevents removal of the restoration
crown for the mean time à can easily along the path of insertion or long axis
degrades, change color à change every 6 of the tooth preparation
months until the right age (16 yrs old) à § Good Retention Form
remove acrylic crown à do correct amount - The shape of the prep prevents the
of reduction à final impression à more crown from displacement from the
permanent restoration long axis of the tooth
13. ESTHETIC / ALVEOLAR RIDGE FORM

- If the edentulous area exhibit severe bone resorption,
and is to be restored with a FPD, esthetic will be
compromise on the cervical area, and create large
embrasures to restore facial contour
PRINCIPLES OF TOOTH PREPARATION

Types of Forces That Are Directed Against a Prosthesis ü RESISTANCE
During Function § Prevents dislodgement of the restoration
1. Tipping Force by forces directed in an apical or
ü Bucco-lingual or mesio-lingual horizontal or oblique direction and
2. Twisting or Rotational Forces prevents any movement of the
ü Restoration move circumferentially around the restoration under occlusal forces
prepared tooth § Good Resistance Form
3. Path of Insertion Forces - The shape of the prep prevents the
ü Can be apically or occlusally directed, depending crown from displacement in any
on whether the mandible is closing into a bolus of other direction except from the
food or opening with sticky food in between long axis
ü Mandible chews in a TEARDROP CYCLE
PRINCIPLES
1. PRESERVATION OF TOOTH STRUCTURE
ü In addition to replacing lost tooth structure, the
restoration should also reserve the remaining
tooth tissue after preparation
ü The whole surface of the tooth structure must not
be needlessly sacrificed just for the sake of
convenience. This entails more than simply
avoiding excessive destruction and requires
designing a restoration that can reinforce and ü RETENTION AND RESISTANCE ARE
protect the remaning enamel and dentin even INTERRELATED AND OFTEN INSEPARABLE
when this mean sacrificing a small amount of QUALITIES
additional tooth structure ü Geometric Form/ Shape:
ü If a large carious lesion is removed, a suitable o The geometric form or shape that
base material must be placed over in proximity to determines the orientation of the tooth
the pulp restoration interfaces to the direction of
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the forces encountered. The shape of § Even with a good fitting crown over the
the preparation is perhaps the most prep, there are still microscopic spaces
important factor under the dentist control, § Cement covers these gaps
which determines whether or not a ü Degree of tapering
restoration will remain cemented to the § As you increase the degree of taper,
preparation you reduce the amount tooth tissue to
resist displacement
RETENTION: § Still want a slight taper
o Two opposing surface with a 6° taper is - If you provide a slight taper, it will
the basic unit, an increase of more than be easier for the technician to
6-10° greatly reduce the retention for the withdraw the wax pattern from the
fixed restoration. Always remember that die
a taper of 6° is a very slight one, any - The technician finishes the crown, it
conscious attempt to create a taper can will be easier to fit the crown on a
easliy result in an over taper tapered prep on the master cast
o Retention is also the result of the - For the clinician, it’s easier to fit
proximity of the axial wall of the during try in
preparation to the inner surface of the - Easier to sit the crown during
restoration. To put it simply, preparation cementation
on large teeth are more retentive than
preparation on small teeth
o Retention can also be improved by
geometrically limiting the number of
paths along which a restoration can be
removed from the tooth. Maximum
retention is achieved when there is only
a single path
RESISTANCE FORM: § Occlusal wider than cervical = Creates

o Placement of grooves and boxes an undercut (divergent)
o Adequate occluso-cervical height/ length § Over tapered prep = Place grooves or
or axial wall height boxes à limit the path of withdrawal to a
single direction à good retention and
resistance
§ Sufficient height for good retention and
resistance
*Shape of prep should be tapered 3°-5°

*Combined taper is 6°-10°
3. STRUCTURAL DURABILITY
ü Tooth preparation must be adequately prepared
ü Passive Fit
and designed so that it will be possible to have
§ Want to see the space inside the crown
adequate bulk of material to the restoration for
and the shape of the prep fit in a way strength and rigidity to withstand the forces of
that it’s not too tight or too loose mastication
§ Influenced by the technician ü One of the important features is adequate
ü Good retention and resistance form for an inlay occlusal clearance after tooth preparation.
§ When preparing a cavity prep for an
Inadequate occlusal reduction doesn’t have the
inlay, NEVER put an undercut
needed space for the restoration to achieve
§ For inlay to stay in place, there should
sufficient thickness
be close adaptation between the inlay
ü Strength of final restoration
and the cavity wall ü Always make sure that the master cast you
§ The closer the fit, the better retention provided is accurate à where the technician
ü Preparing a crown make the restoration
§ NEVER use an undercut ü Adequate thickness makes the crown strong à
§ There should be close proximity
by providing the space needed for the technician
between the internal wall of the crown
à through adequate reduction
and the external wall of the prep
ü Functional Cusp Bevel – providing a wide 2 to 3
mm bevel on maxillary lingual cusps and
ü Purpose of cement mandibular buccal cusps. This is a way to
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DR. AUSTIN U. ANG
provide space for an adequate bulk of restorative chamfer. Average width is 1.20/ 1.25
material in an area of heavy occlusal contact. mm
4. MARGINAL INTEGRITY
ü Margin or Finish Line – the point at which a
preparation terminates on a tooth 4) Shoulder with bevel – forms an obtuse angle
ü Functions: with the axial wall. May be used on the facial
o A measure of the amount of tooth when preparing tooth to receive a PFMC. There’s
structure already removed, it delineates a bit more reduction and the bevel part is always
the extent of the cut in an apical located subgingiva
direction - Why bevel? It enhance fit, good when
o Evaluate the accuracy of the impression doing multiple unit FPD, but difficult to
o On the die, a distinct finishing line helps prepare and temporize
in the evaluation of the quality of the die
o For correct marginal adaptation of wax
patterns
o For evaluating the quality of the
restoration
o To check if the restoration is properly
seated during cementation.
ü Several Forms of Finishing Line

1) Chamfer – use/ prepared on all lingual
surfaces of tooth to receive ceramo-metal crown
or complete veneer metal crown; Shown to
exhibit the least stress, easily developed or
prepared, and quite distinct 5) Beveled Shoulder – Butt joint that’s angled
more than 90 degrees. Not difficult to prepare
compared with shoulder with bevel; It also
enhance better fitting around the margin
ü When fitting the crown over the prepared tooth

there should be a perfect seal
ü Seal is not good à microscopic opening à
debris will go in à cannot clean it à becomes
bacteria à eats enamel and dentin à secondary
caries
ü Finishing line = Just the line itself
ü Margin = Covers a wider area
2) Knife Edge – usually use/ prepared on tipped ü Crown should terminate exactly on the margin or
teeth to lessen the amount of tooth reduction in finishing line
the tipped area; not as well define as chamfer ü Types of Margin (in preparing a PFMC)
§ Shoulder
- Buccal
- Wider
3) Shoulder/ Butt Joint – finish line of choice for

all ceramic crown (PJC) and facial surface of a
PFMC. There is adequate tooth reduction to
achieve proper color through material thickness
- Since the metal substructure follows the
§ Chamfer
form of the shoulder, this makes it more
- Lingual
resistant to distortion during porcelain
firing. Maybe difficult to prepare, the - Narrower and rounder
- Correct use = Only use half the diameter
level of finish line changes height. Width
of the chamfer width
of a shoulder margin is wider than a
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DR. AUSTIN U. ANG
margin extend into the gingival sulcus, the more

severe the inflammatory response
ü According to Christensen, experienced
restorative dentist could miss margin defect up to
74% of proximals of a PFMC
ü According to Scholer, some of the “legitimate”
reasons why we do subgingival margins:
a. Existing caries
ü Location of the Finish Line b. Extension of previous restoration (s)
§ Whenever possible, the finishing line should c. Retention and esthetics
be placed in an area where margins of the d. Subgingival tooth fracture
restorations can be finished by the dentist e. Root sensitivity
and kept clean by the pateint ü A crown margin should not be placed closer than
§ Supragingiva, Equigingiva, Subgingiva? 2 mm, away from the alveolar crest or bone
- Esthetic consideration resorptio will occur
- Existence of previous restoration or ü Biologic width – combined width of the epithelial
caries and connective tissue attachments and is
- In relation to free gingival health normally about 2 mm. Inflammation will result if
- Consider retention & resistance form crown margin intrudes into this area
Supragingiva
TOOTH PREPARATION
- Advantage:
o Less periodontal irritation
o Healthier, easier to make an - Orientation grooves, depth cuts, control or guide
impression grooves
- Disadvantage: o It is the channeling of tooth structure to
o Ugliest crown provide a harmonious reduction, thereby
o Original enamel is visible preventing over and under reduction. They
- NEVER USE due to esthetics are made at a depth equal to the reduction
-
nd
Exception = On 2 molars and the desired
lingual surfaces - Porcelain Fused to Metal Crown
o Consist of a layer of porcelain bonded to a
Equigingiva thin metal casting, It combined the strength
- Balance between supra and subgingiva and accurate fit of the cast restoration with
- A compromise the esthetic effect of porcelain.
o With a metal substructure, PFMC have a
Subgingiva greater strength than all ceramic crown
- BEST due to esthetics o Average of 1.5-2 mm reduction in order to
- Emergence profile à an illusion as if the accommodate the different layers of the
tooth is growing out of the gingiva PFMC
- Disadvantage:
o Periodontal inflammation - Basic Steps of Tooth Preparation
1. Proximal Reduction
ü To isolate the tooth right away
ü Use pointed diamond so that you won’t cut the
adjacent tooth
ü To prevent injury on the adjacent, you can insert
matrix band
2. Labial Orientation Grooves
ü Usual size of reduction = 1.5-2mm 3. Incisal Reduction

§ Achieve this by using the diamond ü Long tapering flat end
§ Make a series of cuts
§ Orientation grooves 4. Labial Reduction
ü How will you know that your guide is right? à ü Labial surfaces are not flat à cut labial in 2
MARGIN planes (Biplanar Reduction)
ü 2 Planes
rd
5. PRESERVATION OF PERIODONTIUM § Cervical to middle 3 à straight
ü G.V. Black stated that decau does not occur as § Middle to incisal à slightly curved
long as margins are covered by reasonably
healthy gingiva tissue 5. Lingual Reduction
ü Numerous clincians however found out that ü Chamfer diamond
there’s a correlation between subgingival margin
termination of restoration and gingival 6. Lingual Concavity
inflammation. This may be due to direct irritation ü 2/3 from cingulum to incisal
and plaque retention. The deeper the restoration ü Oval diamond
ü To cut the fossa
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v How would you know your lingual reduction is TYPES OF RESTORATIONS

sufficient à patient to close mouth and check for
space à at least 1mm space à enough to make
crown à structural durability I. ACRYLIC JACKET CROWN
v There should be no sharp corners (to prevent fracture) - One of the cheapest
- Advantages:
o Economics
o Ease of fabrication (laboratory processing,
trimming and polishing), easily repaired
- Disadvantages:
o Poor color stability
o Easily abraded
o Does not possess the natural tooth shades
o High dimensional change owing to water
sorption and thermal changes
- Indications:
o For very young patient (because of
prominence of pulp)
o Economic reason
o Very often as a temporary/ provisional
restorations
II. PORCELAIN
- Proved to be one of the most esthetic full coverage
restorations available to dentistry
- Advantages:
o Durable, greater strength
o Color stability
o Meet most esthetic requirements (color,
form)
- Disadvantages:
o Require artistic skill and experience to
manipulate
o More equipment for fabrication
o More expensive
III. PORCELAIN FUSED TO METAL CROWN

- Indication:
o When the incisal angle have been fractured
beyond a point where a conservative
restoration cannot severe equally well in
terms of function and esthetics
o When proximal caries is excessive or has
caused multiple restorations to be placed in
the past
o Discolored teeth which may be due to
mineralization disturbance
(hypocalcification), tetracycline stains, after
endodontic treatment and cannot be
corrected by simple bleaching procedures
o When anterior teeth are rotated or laterally
displaced and ortho treatment is not feasible
o Where maximum esthetics is required for
professional reason
o Used in conjunction with ortho treatment
o Single or multiple restoration for both
anteriors and posteriors
o Retainers for RPD
o Teeth with morphologic variations (ex. Peg-
shaped lateral)
o Splinted periodontal prosthesis
IV. PORCELAIN JACKET CROWN (PJC)/ ALL

CERAMIC CROWN
- More expensive (laboratory fee) than a PFMC. Older
technique requires the use of platinum foil, the newer
generation uses the castable ceramics
- No metal substructures
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- Capable of producing the best esthetic effect of all OCCLUSION/TEMPOROMANDIBULAR JOINT

dental restorations
- A brittle material because it is built entirely of ceramic Bones Comprising It
that is susceptible to fracture 1) Temporal Bone
- Should be used only when maximum esthetic is o Glenoid fossa or Mandibular Fossa
essential 2) Articular Eminence
- Contraindication: o Distal Slope – doesn’t make up directly the
o Younger patient with large vital pulp (large TMJ but it affects mandibular movements
pulp size does not permit removal of o Mesial Slope
sufficient tooth structure to achieve an 3) Condylar Process
esthetic thickness of porcelain without pulpal o Located a little anterior to the fossa
damage or gross overcontouring) 4) Meniscus or Articular Disk
o Individual engage in contact sports and o Between the condyle the fossa is a cartilage
rigorous occupation where the incidence of o Can only see this when you open up the
fracture is high cadaver
o Patients who have a reduced interocclusal
distance or relationship or edge to edge
occlusion, that is accompanying heavy
musculatory musculature
o Cervical erosion making tooth preparation
impossible or impractical
o Anterior teeth with constricted cervical
circumference
o Short clinical crown
o Incisor that are thin labio-lingually
V.
COMPLETE VENEER METAL CROWN
-
Indications:
*Generally in posteriors where esthetics is
not a problem
o Extensive caries and to prevent further
fracture
o Existing large defective restorations
o Tooth fracture
o A need to change tooth contours especially
around the abutments that re to receive a
RPD
o Short occluso-cervical height
o Long edentulous span (without porcelain,
bridge is not subjected to porcelain firing at a
very high temperature)
o Greater than average occlusal forces
Mandibular Fossa
o Abutment alignment that requires full
- Located anterior & below the audtory meatus, it runs
coverage preparation to achieve adequate
forward and meet the articular eminend which is the
retention
posterior end of the zygomatic process.
MARGIN FACIAL LINGUAL
- Longer antero-posteriorly and shorter laterally, that;s
Metal Chamfer Chamfer why the condyle tend to project out beyond the distal
All Ceramic Shoulder Shoulder part of the fossa.
PFMC Shoulder Chamfer - Can easily palpate the condyles
METAL - The ones being palpated are the lateral pole of the
- Has less reduction than PFMC à absence of ceramic condyle à the fossa is narrower than the width of the
ALL CERAMIC condyles
- Prone to fracture à provide sufficient thickness for
crown à more reduction Articular Disc
PFMC - Fibrous connective tissue found between the fossa
- Always has an exposed metal on the lingual and condyle
- Needs sufficient reduction on the labial à shoulder - Has very little movement in the first opening
- Lingual has just metal à chamfer movement of the mandible when the condyle merely
rotates
v CONCLUSION: - When you open the condyles à the articular disc
The type of final restoration determines the type of follows
margin to be used - There is a clicking à when opening the condyles
nd
(mandible) the articular disc is left behind à leaving a
v Lower 2 molar à short clinical crown à grooves or space
boxes for retention-resistance form à instead of - LOCK JAW
equigingiva, make it subgingiva to increase height of o Condyles are displaced in front of the
the crown (gain 1mm in height) à for retention- articular eminence
resistance form o Bilateral of Unilateral
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DR. AUSTIN U. ANG

Mandibular Movements
- Imaginary lines
1) HORIZONTAL
o Movement in a sagittal plane
o Produces a rotational opening & closing
movements around the hinge axis which
extends through both condyles
o Mandible can rotate on its axis by opening
and closing the mouth
o Hinge Axis à imaginary line on horizontal
plane
Centric Relation/Terminal Hinge Position

- Condyles are at its most superior anterior position in
relation to the distal slope of the articular eminence
- Can’t keep the mandible open for a very long time
because you are straining the muscle and pulling the
ligaments
- Always goes back to the centric relation position
- Habitual, most comfortable position for the patient and
it is repeatable
- Teeth not in contact when in centric position
2) VERTICAL - When you occlude the teeth in centric relation à
o Occurs in a horizontal plane when the MAXIMUM INTERCUSPATION
mandible moves into lateral excursion
o Center of rotation is a vertical axis extending Definition of Terms
through the working side condyle - WORKING/ FUNCTIONAL/ LATEROTRUSSIVE
o On a vertical plane in one condyle SIDE
o During lateral movement - NON WORKING/ BALANCING/ NON-
ü One condyle more or less remains FUNCTIONING/ MEDIOTRUSSIVE SIDE
stationary - When you move your mandible to the RIGHT
ü Movement of working side condyle o WORKING SIDE à the right side
à rotates and moves laterally and ü It is the direction where the
posteriorly mandible moves
ü Right Posterior Working Side &
Right Working Side Condyle
o NON-WORKING SIDE à the left side
ü It is away from the direction of the
movement
ü Left Posterior Non-working Side
& Left Non-working Side Condyle
- When you move your mandible to the LEFT
o WORKING SIDE à the left side
o NON-WORKING SIDE à the right side
- Condyle on the Non-working side will arc forward
and move medially
- Condyle on the working side will shift laterally and
usually posterior
Bennet Movement/Immediate Movement

3) SAGITTAL - Lateral or bodily shift of the mandible
o When the mandible moves to one side, the - When you move your mandible to the left or right,
condyle on the side opposite from the don’t rotate right away à there is a slight, immediate
direction of movements travels forward bodily shift (1-2 mm) before the rotation
o As it does, it comes in contact with the
articular eminence and moves downward Mandibular Opening
immediately - 2 Stages:
o On a horizontal plane but in a single condyle o Maximum Hinge Opening
o Forward and downward movement (also ü There is rotation of the condyles
medially) on a non-working side à due to o Maximum Opening of the Jaw
the DISTAL SLOPE ü 2 Movements
§ Rotation
§ Forward & Downward (due to
the DISTAL SLOPE) à
TRANSLATION
DMD 2017

DR. AUSTIN U. ANG
§ It will cause deflection of the

mandible in a posterior, anterior
and/or lateral direction
The Determinants for Mandibular Movements

- Posteriorly – the right anf left TMJ
- Anteriorly – the teeth of the maxillary and mandibular
arches
- We don’t have control over the posterior determinants o WORKING
(TMJ), they are unchangeable, The anterior § Occur when there is contact
determinants, the teeth, provides guidance to the between the maxillary and
mandible in several ways: mandibular posterior teeth on the
o The posterior act as a vertical stop same side of the arches as the
o The anterior help to guide the mandible in direction in which the mandible has
right & left lateral excursive movements and moved
in straight protrusive movements § If that contact is heavy enough to
- The closer to a determinant that a tooth is located, the disocclude anterior teeth, it is an
more that it will be influenced by that determinant interference
- When it comes to POSTERIORS
o They are closer to the TMJ so the shape of
the posterior should conform to function of
the TMJ movement à determined by the
movement of the TMJ
o The posterior will be influenced partially by
the joints and partially by anterior
guidance
- When working with ANTERIORS
o They are further away from TMJ à have a
little control over them o NON-WORKING
o The anterior will be influenced greatly by § An occlusal contact between
anterior guidance and only slightly by the maxillary and mandibular teeth on
TMJ the side of the arcehs opposite the
- Dentists have indirect control over this determinant, direction in which the mandible has
whereby procedures done to the teeth may be moved in lateral excursion
reflected in the response of the neuromuscular
system
- Try to restore the teeth to be in harmony with the TMJ
à result to less stress on the teeth and less effort by
the neuromuscular system to produce mandibular
movements à smooth gliding contact
v If you don’t adjust the shape of the tooth à

ABRASION of the natural teeth
Interference o PROTRUSIVE
- When the teeth are not in harmony with the joints and § A premature contact occuring
with the movement of the mandible between the mesial aspects of
- When you move the mandible to the RIGHT or LEFT mandibular posterior teeth and the
o The working side should have CONTACT distal aspects of maxillary posterior
o On the non-working side there should be NO teeth
CONTACT
- When you protrude the mandible à Edge to edge
o There should be NO CONTACT between the
posteriors
- 4 Types:
o CENTRIC
§ A premature contact that occurs
when the mandible closes with the
condyles in their optimum position
in the geloid fossa
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DR. AUSTIN U. ANG
- Among the different interferences, NON-WORKING Border Movement of the Mandible

SIDE & PROTRUSIVE should be corrected if present - The outer limit of all excursive movements à
à There shouldn’t be any contact on the non-working POSSELT’S ENVELOPE OF MOTION
side and during protrusion on the posterior
- TREATMENT: Enameloplasty à trim à smoothen à
put fluoride
Criteria for Occlusion

1. Firm contacts of all teeth when the condyles are in an
anterior superior position
2. Anterior guidance which harmonizes with the patient’s
cutomary envelope of movements
3. Disclusion of the posterior when the mandible
protrudes
4. Disclusion of the posterior on the non-working side
during lateral excursions
3 Concepts of Occlusion
- For artificial dentition (complete denture)
1) Bilateral Balance Occlusion
o There should be contact on both the working
and non-working side
o A purely prosthodontic concept and not
found in natural dentition
o Useful in complete denture occlusion to
prevent tipping
2) Unilateral Balanced Occlusion
o Contact of the teeth only in the working side **During mandibular maximum opening, moves forward
during lateral movements of the mandible and downward due to distal slope
o Found in a lot of natural dentition - Translation is happening
o If there’s tooth/teeth contact on the non-
**From CR to F, mandible protrudes and opens to
working side, it should be recontoured to be
maximum
free of any contact
o There’s group function of the teeth on the - There’s no translation because translation already
working side happened à dipping line
o Contact in on working side only and not on
non-working side POSTERIOR TOOTH PREPARATION
3) Mutually Protected Occlusion - Bevel the FOC à Chisel
o Canine Protected Occlusion or Organic o To satisfy the principle of structural durability
à crown with sufficient thickness
Occlusion
- For posteriors at least 2 mm occlusal space for
o Researchers have found out that in many
mouths with healthy periodontium and PFMC
minimum wear, the overlap of the anterior - For lower molars
teeth were so arranged that they prevent the o Outline is a rounded square
posterior teeth from making any contact on - Should always have a mesial and distal incline
either the working and non-working side
during mandibular lateral movements
o During lateral movement
ü The anteriors carry the load
ü Posteriors are open
ü Anteriors protect the posteriors
o The anterior teeth bear all the load while the
posterior teeth are discluded during
excursive movements of the mandible
o In the position of maximum intercuspation,
posterior are occluded with the forces
directed along their long axis anf the anterior
teeth are slightly out of contact, relieving
them of the oblique forces
o During maximum intercuspation
ü All the load is carried by the
posteriors
ü Anteriors are open
ü Posteriors protect the anteriors
o As a result, the anterior teeth protect the
posterior teeth in all mandibular excursions
and the posterior teeth protecting the
anterior at the intercuspal position
DMD 2017

DR. AUSTIN U. ANG

ARTICULATORS & FACEBOWS PROVISIONAL RESTORATIONS
- A mechanical devide which represents the TMJ, the Provisional
upper and lower jaw, to which maxillary and ü Means established for the time being, pending a
mandibular casts may be attached to stimulate jaw permanent arrangement
movements ü May have to function for an extended period
ü Aside from esthetics, place a provisional to protect
Classifications exposed dentinal tubules (tooth will be sensitive) and
1) SIMPLE HINGE to prevent fracture
- Capable of accepting a single static registration
- Vertical motion is possible but only for convenience Provisional Restoration
- Permit horizontal and vertical motion but do not orient ü Protect the prepared tooth/teeth, for patient’s comfort
motion to TMJ while restoration is being fabricated by the dental lab
- Does not allow a facebow transfer ü Takes 4 working days to make
2) SEMI-ADJUSTABLE Temporary Restoration

- Accepts facebow transfer, thereby stimulating the arc ü May connote laxity (not important), ignoring certain
of closure and opening requirements
- Condylar pathways or inclincation can also be
stimulated **If patient like the provisional restoration (shape and position),
make an impression then send it to the technician for him to
3) FULLY ADJUSTABLE follow
- Can accept a 3 dimensional registration
- A kinemtic facebow may be used Requirements of a Provisional Restoration
- There is a more accurate mandibular movements, use ü These are interrelated forces
primarily for extensive treatment
BIOLOGIC REQUIREMENTS
2 basic Designs of Semi-adjustable Articulators 1) Pulp Protection
1) Arcon § To prevent sudden change of temp inside
o “Articulator Condyle” the mouth, there should be good adaptation
o Condyle is on the lower member of the margins of provisional to prevent
o Stimulate ‘normal’ anatomy leakage of saliva
2) Non-Arcon § May cause irreversible pulpitis with
o “Fossa” is on the lower member consequent need for RCT
o Non-articulator § To cover exposed dentinal tubules and
o Condyle attached to the upper member protect the pulp
o Doesn’t follow anatomy 2) Periodontal Health
§ To facilitate plaque removal, a provisional
Facebow restoration must have good marginal fit,
- A caliper-like devide to record the relationship of the proper contour & a smooth surface
jaws to the TMJ, and to orient the cast on the § This is important when the crown margin will
articulator to the relationship of the opening axis of be placed subgingival
the TMJ § Check for any gingival impingement,
- Records the gleno-maxillary relationship ischemia is likely & can be detected initially
- Aids in supporting the cast while mounting as tissue blanching (pale in color). If not
- Need an anterior reference point à nasion (Whipmix), corrected, a localized inflammation or
ala of the nose (Phenar??), infraorbital foramen necrosis may occur
(Hanao) § Inflammation may result to hyprtrophy,
- Transfer facebow record from patient to the articulator gingival recession or hemorrhage during final
à FACEBOW TRANSFER cementation
§ Under contoured margins (margin is short)
**Ball bearing represents the condyle may lead to tissue proliferation à Gingiva
will grow under à Becomes fibrotic and
Border Movements tough à Gingivoplasty
- The outer limits of all excursive moevements made by 3) Provide Occlusal Compatibility & maintain Tooth
the mandible Position
- They are controlled by ligaments, as such, they are § Restoration of occlusal function will aid in
repeatable patient’s comfort especially during
- It is important to duplicate these movements on the mastication
articulator and if the articulator nearly stimulated the § Prevent migration, drifting or extrusion of the
posterior determinants (the TMJ) of the occlusion, the opposing which may require a lot of
restoration will be improved because of the harmony adjustments or remake of the final
between TMJ, posterior determinants and the restoration
restorations § Failed to restore contact:
- The large dissimilarity between the highe axis of the o Short Term – food debris in
simpe articulator and the hinge axis of the mandible between
will produce a large discrepancy in the art of closure o Long Term – there will be mesial or
of the articulator distal drifting of the teeth; if there is
no occlusal contact à
DMD 2017

DR. AUSTIN U. ANG
Supraeruption (upper) or Passive Provisional

Eruption (lower) à Restoration Can Be Done in 2 Ways
wont fit anymore 1) Direct
4) Protect Against Fracture § Inside patient’s mouth
§ Protect teeth weakened after crown 2) Indirect
preparation § In the cast
§ Usually occur on provisional coverage for
partial veneer crown Steps in Relining
§ Even a small chipping of tooth structure will - Trim à Make sure there is proximal contact
make the final restoration unsatisfactory & - Fill up with Tooth Colored Self Curing Resin
necessitate a time consuming remake - When resin starts to set, there are thermal changes,
§ Put a provisional with a Class IV composite starts to shrink, irritating to patient
à Provisional was not properly done à Big - Don’t wait for doughy stage of resin à Work fast
crack on provisional when patient comes - To protect the pulp from relining, place PETROLEUM
back à Composite is gone under à When JELLY/COCOA BUTTER not Color guard (only for
crown is fitted, RETENTION & gypsum; Thin Foil Substitute)
RESISTANCE FORM is affected - Take out excess with blunt instrument
- If there are areas with a gap à Get instrument à Wet
MECHANICAL REQUIREMENTS with monomer à Pick up resin à Cover
1) Resist Functional Load - Can dip in warm water (60° C): Wait for initial set à
th
§ The strength of self curing resin is only 1/20 Remove then dip in warm water à Do it several times
(20%) that of a PFMC, making fracture more until final set
likely **WHY remove it back and forth:
§ A FPD functions like a beam in which Sometimes there are excess in cervical à If
substantial occlusal forces are transmitted to you let it set it can catch on adjacent
the abutment undercut (to clear the undercut)
§ This creates high stresses on the connector **WHY dip in warm water: Faster setting
which are often the site of failure time and for removing excess monomer
§ Easily repaired which is irritating to the patient
2) Resist Removal Forces
§ Displacement is best prevented through Good Appearance
proper tooth prep & a provisional with a ü Translucent
closely adapted internal surface ü Color controllable
§ This is the importance of relining the pre- ü Color stable
formed crown
3) Maintain Interabutment Alignment Good Patient Acceptance
§ Positional stability is of utmost importance to ü Non-irritating
prevent drifting or extrusion of teeth which ü Odorless
may require a lot of adjustments or remake
of final restoration Vacuum Forming Machine
ü Heat template for 5-10 min
ESTHETICS ü Place on cast
ü Although it may not be possible to duplicate exactly ü Creates a shell
the appearance of an unrestored natural tooth, tooth ü Mouth guard, night guard, custom tray
contour, color, translucency and texture are essential
attributes Instruments
ü Provisional should also be easily contourable 1) Saliva Ejector
§ Use properly: Working on left side à Place
Ideal Properties of Provisional Restoration Materials on right à Turn the head towards the saliva
1) Convenient handling ejector tube à Gravity
§ Adequate working time, easily moldable, 2) Svedopter
rapid setting time § Metal or plastic
§ Only property applied to self curing resin § Has a metal tip
2) Biocompatibility § Acts as a SALIVA EJECTOR and TONGUE
§ Non-toxic, non-allergenic, non-exothermic DEFLECTOR
§ When acrylic starts to set, emits heat 3) Bite Block
3) Dimensional Stability During Solidification § There’s an opening for protection à Tie to
§ Self curing has poor dimensional stability dental floss then attach to patient à
4) Ease of Contouring & Polishing, Adequate Strength & Prevents accidental swallowing
Abrasion Resistance 4) Another instrument that works as a Saliva Ejector,
Tongue Deflector and Bite Block
**Instead of self curing resin, you can use denture teeth then 5) Vacuum Tip
cut part of it § Removes fluid at faster rate and bigger
volume
**Can use COMPOSITE BASED PROVISIONAL MATERIAL § Need an assistant à Can help you deflect
- Advantages: non-exothermic, better dimensional the tongue or cheek
stability, no monomer, some can be light cured
- More expensive
- Self curing but its composite
DMD 2017

DR. AUSTIN U. ANG

TISSUE DILATION OR SOFT TISSUE MANAGEMENT o Shrinks gingival tissue
o Help control seepage of gingival
tissue
ü Because a good marginal adaptation or fit is essential Two Types of Gingival Retraction Cord
in preventing caries, gingival irritation, the finish line of 1) Braided Cord
the preparation must be reproduced on the § Have a tendency to “double up” à When you
impression start cutting, opens up à Hard to insert
ü Gingival tissue in the anterior region deserve special § Can be too thick for atraumatic intravascular
attention because they are fragile and vulnerable to placements
mechanical trauma 2) Knitted Cord
ü For esthetic reason, it is essential to maintain the § Doesn’t shred easily à Cords are
level of the free gingival margins and to avoid a interlocked à Diameter remains the same
permanent gingival recession when cutting
ü Retraction material and techniques should be § Maintain their shape during handling
selected to create as little tissue trauma as possible
and to avoid irreversible loss of tissue height Chemicals Used
1) Racemic Epinephrine
Classification § Vasoconstrictor
1) SURGICAL § May cause harmful systemic effect to
§ Used if chemical and cord don’t work hypertensive patients or those suffering from
§ A small part of the gingiva is removed using heart disease
dental electro surgery creating a space in the § Chemical we try to avoid à Epinephrine
tissue (ELECTRO SURGICAL increases heart rate, etc.
INSTRUMENT) 2) Aluminum Chloride
§ Used when gingival displacement cannot be § Has astringent and chemically react with
handled by retraction alone capillaries
§ To enlarge gingival sulcus and to control 3) Iron or Ferric Sulfate
hemorrhage § Effective in controlling bleeding
§ CONTRAINDICATION: Patient with cardiac § Most common
pacemaker; Not to be used in the presence 4) Aluminum Sulfate
of a flammable agent § Highly recommended
§ Create a trough (space) § It is one of the least irritating but has been
suspected of possibly inhibiting the setting
2) MECHANICAL reaction of vinyl silicone impression
§ Tissue are displaced by purely mechanical 5) Potassium Sulfate
means
§ Ex. Copper Band Things to Remember
ü Cylinder made of copper then insert 1) Use the smallest cord that fits the sulcus
between gum and margin 2) Don’t push cord too apically
ü Contour with heavy duty scissors to 3) Don’t push cord farther than the finishing line
make it fit 4) Acc. To Albers & Nemetz, impregnated cord can be
ü Cover with modelling compound placed for up to 10 mins
ü Fill up inside with rubber base 5) Blot the cord dry when immersed in chemical
ü Tray filled with rubber base placed 6) Area to receive cord shouldn’t be completely dry
on top à OVER IMPRESSION § If too dry, might induce bleeding (cord sticks
Cord without chemicals to sulcular wall)
Gingival Retraction Cord
ü Insert cord between sulcular wall **To make IRM weaker, add a dash of petroleum jelly.
and margin - Powder à Zinc Oxide
- Liquid part of IRM (Eugenol) may tend to weaken
3) MECHANO-CHEMICAL resin (problem for long term) à Never use IRM as a
§ A cord is used and impregnated with base if final restoration is composite
chemical
§ Medicated Cord **If a patient comes with missing teeth and you’re planning to
o Has more hemostatic (stops blood) do a FPD, always dismiss the patent with a provisional bridge
success
o Packing inside the sulcus must be **If there is a missing tooth when making template using
delicate and as atraumatic as vacuum forming machine à Use denture tooth
possible
o Acc. To Wilson & Maynard, when **When placing the retraction cord, use two instruments and
involving subgingival preparation, insert slightly in an angulated way
by delaying the final impression 2-3
weeks in cases involving anterior **For a big sulcus, you can use a smaller retraction cord inside
preparation, tissue will be firmer and a bigger one outside/on top
and more resistant to string packing
§ Astringent
o Chemical used
o Cause transient ischemia à
Temporary stoppage of blood
DMD 2017

DR. AUSTIN U. ANG

IMPRESSION MATERIALS & TECHNIQUES - Can be used for
duplicating master cast à
Impression Hollow cylinder with 2
- An imprint or negative likeness removable disks on each
side à Place cast inside
Requirements of a Good Impression - Pour softened agar then
1) Exact duplicate of the prepared tooth, including all the cover
preparation and enough uncut tooth surface beyond - Liquid to gel by cooling it
the preparation to allow the dentist and technician to down
be certain of the location and configuration of the - Suction cup to remove the
finish line cast à Create a mold
o Area apical/below the finishing line (open space
gingiva to capture finishing line) § Used in the Clinic
2) Other teeth and tissue adjacent to be prepared tooth - Agar-Alginate Impression
must be accurately reproduced to permit accurate Technique
articulation of the cast and to allow proper contouring - Agar placed in special
of the restoration syringe à Boil for 10 min
o Some better quality labs will reject quadrant à Liquid form
impression à prefer full arch impression to - Place in tempered water
check for occlusion à Inject agar around prep
3) Must be bubble free, especially in the area of the and margin à Assistant is
finish line mixing alginate and
o Applies to all impression making loading on tray à whole
impression will be alginate
Desired Properties for Impression Materials - Agar on prep to capture
1) Detail reproduction tissue detail
2) Dimensional stability - Rest of teeth is alginate
3) Resistance to deformation impression à Pour right
4) Tear strength away
5) Sufficient working time ü Advantages:
6) Moisture compatibility § Moisture compatible
7) No taste and odor § No unpleasant odor or taste
8) Ease of use § No mixing and little waste
§ Inexpensive
Hydrocolloid § Finer tissue detail than alginate
2 Types § Excellent dimensional accuracy
1) Irreversible § Inexpensive
o ALGINATE § Can capture fine tissue detail
ü Rim lock and perforated tray ü Disadvantages:
§ Perforations for retention § Technique sensitive
ü Advantages: § Low tear strength
§ Inexpensive § Poor dimensional stability
§ Easy to manipulate § Must pour immediately
§ Pleasant taste and odor
§ Readily available Elastomers or Rubber Base Impression Materials
ü Disadvantages: Advantages of Elastomers over Alginate
§ Unstable 1) Stronger
§ Easily tears 2) More flexible (Remove from undercut)
§ Not accurate especially for fine 3) Dimensional stability
tissue detail 4) For all types of impressions
§ High deformation upon 5) Captures fine tissue detail especially around the
stretching margin
§ There will be distortion if not 6) Can delay pouring
poured immediately 7) Can be poured twice with equal accuracy
§ Not a good indication for FPD 8) Automix device (catalyst and base comes side by side)
à can’t capture finishing line à Practically no air incorporated and makes it more
§ Low adhesive property on the homogenous (2 colors)
tray
Disadvantage of Elastomers over Alginate
2) Reversible 1) Expensive
o AGAR (sol à gel; gel à sol)
ü Used for crowns and bridges 4 Basic Types
ü Can be softened using heat à 1) POLYETHER
liquid to gel then liquid again o Excellent dimensional stability
ü 2 Purposes but with Different o Can delay pouring of stone
Consistencies o Finishing line easily read
§ Used in the Laboratory o Advantages:
ü Long term dimensional stability
ü Good accuracy
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DR. AUSTIN U. ANG

ü Good surface details ü Available in automixing device
ü Good tear strength ü Can be poured more than once
ü Rigid setting in tray stabilization o Disadvantages:
ü Hydrophilic ü Relatively expensive (Most)
o Disadvantages: ü Sensitive to contaminants
ü Unpleasant odor and taste ü Short delay time for pour à
ü Poor recovery from deformation Hydrogen (?) Gas
ü Can be too stiff and cause die Viscosities/ Consistencies
breakage 1) Low Viscosity
ü Difficult to thoroughly mix o Light body/Wash/ Class III
ü One of the more expensive o Syringeable materials
elastomers 2) Medium Viscosity
o Regular body/ Class II
2) POLYSULFIDE 3) High Viscosity
o Also has high accuracy o Heavy body/ Class I
o Strong odor and can easily stain clothing o Tray material
o Hydrophobic o Mix with spatula and mixing pad
o Long setting time may irritate patient 4) Very High Viscosity
o Requires a custom tray because it lacks one o Putty
consistency à No putty to hold the light body o Mix with hands
o Advantages: o Tray material
ü High tear strength
ü Good surface details **For crown and bridges, Light Body and Putty go together
ü Relatively inexpensive
ü Sufficient working time and set time Elastomeric Impression Techniques
(4-6 mins) - Always paint tray with adhesive and air dry before placement
ü One of the more economical among of mixed elastomers
rubber bases 1) Single Step Impression Technique
o Disadvantages: o Using “Auto Mixing” Device
ü Unpleasant odor and taste ü Uniform
ü Poor recovery from deformation ü Less chances of incorporation of air
ü Poor dimensional stability ü Comes with syringe tip
ü Should be poured within 1 hour o 2 Paste system
ü Should be used with a custom tray ü Spread thinly on the mixing pad à
ü Not readily available locally Eliminate air
ü Scrape over mixing pad using
3) CONDENSATION SILICONE impression syringe the mixed
o Catalyst comes in liquid form material
o Less dimensional stability than the rest of the ü Extrude a little amount of material
elastomers out of the syringe to get rid of air
o Has pleasant odor o Simultaneous putty wash and impression
o Should pour shortly after removal technique
o Finishing line can be easily read o Mixing of putty
o Disadvantages: ü Remove gloves because of sulfur
ü Hyrdophobic à poor moisture contamination à Impedes setting
compatibility time
ü Poor dimensional stability ü Create a dimple and place over the
ü Immediate pour required area of the prepared tooth/teeth à
ü Poorer bond to tray adhesive Prevents the light body from being
ü Poor wetting characteristics à Hard pushed away by the heavier putty
to pour stone à More air o Squeeze light body material on prepared
incorporated tooth and the margin
ü Low tear strength o Simultaneously load putty on tray then take
ü Different surface tension à hard to the impression à assistant
pour o While you’re squeezing the tip should always
be surrounded by rubber base à To void
4) ADDITIONAL SILICONE (VINYL incorporation of air
SILICONE/POLYVINYL SILOXANE) o Air syringe the light body to further push the
o Greater dimensional stability material below the margin
o Most manufacturers require the removal of o If single step, you can put light body only on
latex glove during handling of putty the prep itself unlike 2 steps technique, you
o Advantages: need to put light body on the entire arch
ü Most accurate material available
ü Good tear strength 2) 2 Steps Impression Technique
st
ü Excellent recovery form o 1 Step
deformation ü Place tray adhesive on the tray
ü Long term dimensional stability before putting the putty
ü Hydrophilic
ü No unpleasant taste or odor
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DR. AUSTIN U. ANG
ü Mix equal amounts of putty material 4) It can be removed easily and replaced back on the
and make it homogenous (remove master cast
gloves à affects setting time ) 5) It should have margins that are carefully and
ü Putty used to make an impression accurately marked with colored pencil
of the entire arch 6) It should have an accurate reproduction of the entire
ü Cellophane/plastic sheet is used to arch to ensure both positive contact points on the
act as a spacer à Provide room for restoration and good occlusion
light body
ü Cellophane removed à Space 2 Types of Fabricating a Die
provided for the entire arch PIN SYSTEM
nd
o 2 Step - Laser pin setter
ü Light body dispensed/applied on - “Pindex” system
the entire dental arch - Uses a special drilling unit to ensure accurate pin
ü Syringe over the patients prepared placement
teeth - Usually 2 pins à Buccal and Lingual à To prevent
movement/rotation
**To clean spatula easier, pick up catalyst first then the base - Pins look like a butt of a rifle à Flat end à Provide
**Putty is placed U-shaped in the tray even on the upper (no stability and prevent movement
putty on the palate) for crown and bridge à No palate on the - Each pin has a plastic sleeve à Provides friction so it
die tray won’t become loose à plastic sleeve stays with the
**Double Bite Tray base
- Mesh in between - Sectioning
- Place regular body on top and bottom ü Pin system, cut until the junction of the die
- Still light body on prep stone and the base
- Place adhesive on tray
- Ask patient to occlude TRAY SYSTEM
- For inlays and onlays - Uses a specially articulated tray for precise reassembly of a
- Advantage: sectioned master cast
o Make impression of the prep 1) Di-Lok System
o Make impression right away of the opposing o Can attach to plaster mount
o You register the occlusion o Not user-friendly à Disassemble everything
**Elastomer as bite registration materials
- Squeeze on the occlusal and ask patient to close 2) Accu-trac System
- Squeeze around buccal then once it sets place on o User-friendly
master cast or to be used in maximum intercuspation o Has a magnet on the back à Can put on the
**There is a need for a strong bonding tray articulator
**Tray position/Size of tray o Expensive
- To prevent distortion à Stabilize the tray inside - Sectioning
patients mouth ü Section on the mesial and distal of each prep
**You need to properly seat the impression ü If its tray system, cut all the way
**Problems from early removal from mouth
**Pouring problems Ditching
- If there is excess on retromolar pad or distal part of - Removal of stone/gingiva close to the margin
soft palate à Placed on the table à Distort the without…
anatomy à Lift the impression from the table to - Provides easy access to margin à For the technician
prevent distortion to make an accurate fir
- Cleiod-discoid
To Minimize Putty Defects - Carbide
1) Use immediately after mixing - Technician needs 2 casts à 1 with ditching and 1
2) Minimize moisture without (for ceramic and for fitting)
3) Align while seating
4) Immobilize Over-ditching
- Do not create a deep ditch
DIE/WORKING CAST - Apical to margin which would lead to poor gingival
Die contour in the completed restoration
- A positive reproduction of the form of the prepared
tooth in any suitable materials or hard substance, Die relief
usually in specifically prepared artificial stone or metal - Painting the die
- Use die stone - Purpose: Space for cement
- Crown will be fabricated on the die
Properties of a Removable Die - Internal fit won’t be exactly the same à Slight
1) It should be made of a hard, dense material (Type 4 difference
high strength dental stone) - Provides room for the cement
2) It should seat on the master cast accurately, positively - Used for action figures à Tamia
and solidly - Can’t use nail polish/acrylic paint à Too thick
3) It should be an accurate reproduction of the
preparation especially that of the margin Die Strengthener
- Margin is the most abused portion
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DR. AUSTIN U. ANG
- Place a drop of glue on the margin then spread with - Distal is preserved
air syringe - Usually for mandibular, mesially tilted
- To provide a thin film of glue on the margin molar
- Cyanoacrylate glue - Can be used as a retainer for a bridge
§ 7/8 CROWN
Die Fabrication - Everything is prepared except the facial
- The accuracy of the margin is a function of the surface of the mesiobuccal cusp
st nd
completeness and accuracy of the impression - Used in maxillary 1 and 2 molars
- The die cannot contain more information than the - Place the groove adjacent to the MBu
impression from which it was made cusp
§ REVERSE 3/4 CROWN
*Role of technician is to make a restoration that will fit the - Looks like a regular 3/4 crown but
master cast rotated 180°
- Can be used on lingually tilted lower
molar
PARTIAL VENEER CROWN - Used when there is a carious lesion on
the buccal
o If a surface of the tooth structure can be preserved - Preserve the lingual
without compromising needed retention, strength, or
coverage, that surface should be saved Advantages
o Restoration that covers 2 or more surfaces but not all 1) Preservation of tooth structures compared with tooth
the surfaces of the tooth to receive a complete veneer crown
o In general a PVC is called a 3/4 Max/Mandibular 2) A great deal of margin is in an area accessible to
Anterior/Posterior crown dentist for finishing and to patient for cleaning
o Disadvantage: Retention Resistance form is 3) Less proximity of the restoration margin to the gingival
compromised à Put grooves or boxes crevice, therefore, less chance of periodontal irritation
o Pin Holes à Danger of pulp exposure 4) Can be easily seated completely during cementation
o Groove on the mesial and distal à Looks like a clamp 5) With at least part of the margin, visible, complete
à Resistance form to lingual displacement seating of a partial veneer crown is easier to verify by
direct observation
6) A portion of enamel is not covered and therefore
accessible for “pulp testing”
7) Esthetically superior to complete veneer crown
8) Reduced pulp irritation
Design
o A clamp-like locking effect of a partial veneer design
minimizes the possibility of a tooth fracturing from
forces of mastication
Disadvantages
1) Some display of metal
2) Dos not have the retentive quality of a complete
A – Definite lingual walls resist displacement near the buccal (longer veneer crown since a major portion of tooth surface
giving better retention)
B – Oblique lingual wall (no definite wall) offers poor resistance
are not covered
C – Too far from the buccal, undermined enamel causing fracture 3) Doesn’t have the much needed rigidity when used as
D - Groove shouldn’t be placed on the middle a retainer for FPD
o For grooves (made parallel), use long tapering flat In Endo

end or tapering bur in resto o Use a Pulp Tester to check for the vitality of the pulp
o For upper teeth, create a V-shaped notch running o Handpiece should come in contact with any exposed
from one groove over the occlusal going to the other tooth structure and not an artificial crown
using a big inverted cone bur à OCCLUSAL OFFSET o Patient should elicit a response à Like an ice cube on
o Purpose of occlusal offset à Big portion of occlusal is the tooth = Vital pulp
exposed à Not rigid enough so it tends to flex à
Offset connects 2 parts of partial veneer provides
Structural Durability
o For the lower teeth, instead of occlusal offset, make
an OCCLUSAL SHOULDER and provides rigidity
o For upper, finish right on the buccal cusp tip but for
lower cover or go beyond the buccal cusp à The
lower is a functional cusp
o For Canine, preserve part of the proximal contact à
So that the metal won’t be seen à Create INCISAL
OFFSET
o All PVC don’t necessarily preserve the facial à There
are modifications wherein the facial is prepared
§ MESIAL/PROXIMAL HALF CROWN
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DR. AUSTIN U. ANG

CEMENT WAX PATTERN
o A dental cement fills up minute spaces, always
present between the crown and prepared tooth,
provides a little mechanical retention
Different Cements
1) ZOE
o Lowest compressive strength
o Used in temporary fillings, thermal insulating
bases, root canal filling and for cementing
provisional
o Long term use, the eugenol can affect the
quality of the resin
2) Zinc Phosphate
o One of the oldest among the dental cements
o Used as a luting agent and base in
temporary restorations
o Advantage: High compressive strength Wax Pattern
o Disadvantage: Irritates the pulp à acidity of o Is the precursor of the finish cast (metal) or PFMC
zinc phosphate restoration which will be placed on the prepared tooth
o A few minutes spent of the wax pattern can often
*2 materials with almost the same features: save hours that might be spent in correcting the
3) Polycarboxylate casting
o It is anti-cariogenic because of fluoride o When making a wax pattern try to make it look good,
content remove rough areas. In molars, try to remove pits,
4) GIC scratches or lines because if not removed you will see
o Has adhesive properties between the the SAME thing on the casting metal.
cement and the tooth is chemical à No
adhesion between cement and artificial
crown because it is purely mechanical)
o Tooth colored
o Comes in many viscosities:
§ Liner
§ Filling material
§ Luting agent for cementing crowns
and bridges
5) Resin Cement/Composite Luting Agent

o Composite is so flowy that it is used as a
luting agent in cement
o Can be used on all types of restorations but
best indication for this is for All Ceramic
Crown, PFMC and for cementing Maryland
Bridge
o Set composite by light curing Processing
o For PFMC, has metal so can’t use light o Process of converting wax to acrylic
curing à Can’t penetrate the metal à Has a
Dual Cure à Material can be light cured and Casting
self cured by using a catalyst to set it o Process of converting wax to metal
chemically o INLAY WAX (Blue)
o 2 Types: o Like how jewelers make jewelry, same process
§ Modified Resin Cement o PMFC à Start with the METAL PART of the PFMC à
- 2 advantages from 2 dental First thing the technician will do a wax pattern of the
materials à GIC (adhesive metal layer (through the process called “Casting”) à
property and fluoride content) The METAL will be finished à Then the porcelain will
and Composite (strength) be placed on top.
- So expensive
§ Pure Resin Cement Indirect Technique
o The pattern is waxed on a stone cast or die made
Cementing of Crown from an accurate impression of the prepared tooth
o Load cement only on the margins o Allow most of the procedure to be done away from the
o Amount of cement is only minimal if done correctly patient
o Remove excess during Initial Set so it will be easier to o Hardly done on the patient’s mouth
clean and doesn’t stick to the porcelain o Uses pink wax for acrylic
o Use an explorer and for the proximal use dental floss
o If cement is left behind, acts as calcular deposits à
Gingivitis
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DR. AUSTIN U. ANG
Requirements of a good inlay wax (dark blue/green à when

you bend it should break)
1) It must flow readily when heated without chipping,
flaking, or losing its smoothness
2) When cooled, it must be rigid
3) It must be capable of being carved precisely without
chipping, distortion, or smearing
o How to check if the inlay wax you bought is good? à
Should snap easily (Good inlay is brittle) or by
scrapping the sides, nails should not embed within.
“Stresses”
o Occur in the inlay wax as a result of the heating and
manipulation during wax up
o To minimize distortion, pattern should never be left off
the die and they should be invested as soon as
Check Margin Carefully for the Following Discrepancies
possible after fabrication
1) Overwaxed Margins
o Wax pattern should be invested as soon as possible
o Part may break off when pattern is
and not just left in hot places to avoid distortion
withdrawn from die
o Master cast sent to lab (PFMC is the request to the
o It may also result in a short margin, may
lab) à Technician will first cover tooth prep with thin
spring back if didn’t break and will prevent
layer of wax à Wax will be converted to metal à
proper seating
Once the layer is converted it is called coping.
2) Short Margins
o Will not provide an adequate seal for the
Coping/ Thimble
finished restoration
o A term used to describe the metal substructure of a
single unit metal-ceramic restoration
3) Ripples
o For individual crown à Metal is called Coping
o Any roughness will be duplicated in the
o For a bridge à Metal is called Metal Substructure
casting and collect plaque
o Shape of coping influences emergence profile
4) Thick Margins
o Will cause periodontal problems
First Step of Waxing When Fabricating a PFMC
5) Open Margins
o Fabrication of a thin coping or thimble (old term) of
wax on the die
**Shape of crucible former to hold the wax pattern and acts a
o It will serve as the foundation for axial contours and
funnel for the metal to come in and is made of rubber, dome
occlusal anatomy
shaped
o Provides the fit
**Use baby oil before wax pattern
o Metal à covers the entire margin
**Place Sprue on the bulkiest portion for all teeth
o The coping will be sent to the dentist à Dentist will
**Sprue serves as a passageway for wax to come out and then
check the fit à If the fit is good it will be given back to
becomes a HOLLOW SPACE (MOLD SPACE)
the lab à The technician will now make the ceramic
**Incomplete Casting à When the metal doesn’t completely
(Tell technician what color to use)
flow
“Cone Waxing” or “Wax Added Technique”
*3 Individual Coping in 1 Casting Ring to save time and money
o “Cone” represents the cusps
o Create the shape of the tooth in small stages or in
sequence, making it easier to detect errors in form,
size and location
o Waxing involves a lot of small details, inexperience
person may become lost when attempting to
reproduce the enter shape of a tooth
o Used on posterior for ALL METAL CROWNS
o If you request for an ALL METAL CROWN it means
no more COPING
o Wax until the middle third (junction of the middle third
to the occlusal third à Use a special instrument to
add cones à Cones represent the cusps à Then
create the final shape Centrifugal Casting Machine
o Uses Centrifugal Force
o Turn it 2-3 times counterclockwise à Release pin à
Spin à Metal goes in
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DR. AUSTIN U. ANG

POST INSERTION PROBLEMS 5) Trauma to Cheek or Tongue
- Can happen in 24 hours
1) Thermal Sensitivity - Due to poorly polished areas or presence of
- Pulpal discomfort from temperature change is sharp areas
frequently encountered following cementation of - Wrong position of pontics/s
FPD - Absence of horizontal overlap
- Sensitivity to cold following insertion of the - Teeth have a buccal overlap à To deflect soft
restoration is considered a normal response for tissue away from the teeth
only a few days - Soft tissue with constant trauma à Scarring of
- Lasts hours or a few days cheek area
- Other procedures that cause sensitivity to cold:
o Failure of the provisional to cover all 6) Sensitivity to Sweets
prepared tooth surfaces - Can happen after several months
o A loose provisional that allows seepage - Inside the crown, secondary carious lesion may
of oral fluids over the prepared surface occur à May be due to insufficient removal of
o A provisional that places excessive caries during preparation or there was a leakage
occlusal forces on the prepared teeth and saliva goes in, can’t clean, leading to
- You should spend time in making a good secondary carious lesion
provisional - Failure to cover the entire tooth
- Loose abutment retainer due to dissolution of
2) Discomfort during function cement
- “Pain during chewing” à May be due to - A carious lesion occurring on the abutment or in
premature centric occlusal contact à Only the the immediate area
crown and teeth will be in contact à Increase
sensitivity à Pain 7) Tooth Mobility
- If not corrected: - Result if you don’t adjust premature occlusal
o Immediate reaction à Widening of contact à Mandible will shift to a more
periodontal ligament space; comfortable position
inflammation; tender to percussion - Nature’s way of protecting the dentition
o Long term à Bone resorption and tooth o The porcelain will break
mobility o There will be abrasion of opposing
- If tooth is out of contact for several years, there’s o Widening of periodontal ligament space
no stimulation of periodontal ligament space à à Bone resorption à Mobility of tooth
New crown restores original tooth contact à à To avoid affecting the others
Tooth is under loading à Feel a little sensitivity o TMJ problem
- Excessive contact during eccentric mandibular - Poor occlusal relation
movement - Inadequate bone support
- If not corrected, pulpal damage may result - After checking maximum intercuspation, check:
- Tooth that has been out of function and o Lateral excursive movement à
placement of the prosthesis brings it back to Posteriors
normal function o Protrusive movement à Anteriors
- Lasts hours or a few days
8) Gingival Recession
3) Gingival Inflammation - Result of gingival inflammation
- May happen after a few weeks or months - May be due to faulty margins
- May be due to faulty cervical contour, marginal fit - Over or under contoured restoration
or embrasure form of the prosthesis - Residual cement and incorrectly processed
- Incomplete removal of excess cements à veneering material
Calcular deposits
- Poor oral hygiene instruction from the dentist and 9) Neuromuscular Discomfort
poor implementation from the patient - Happens if you don’t adjust premature contact
- Excessive retraction - Pain in the TMJ or associated muscle
- Rough or poor fitting provisional (considered as a serious problem)
- Bulky cervical contour à Initial reaction to trauma - May be due to interfering occlusal contact
is inflammation, bleeding
10) Nonspecific Complaint
4) Retention of Food - Some patients may feel different or slightly
- Collection of food can’t be avoided especially for uncomfortable because of a new prosthesis or a
FPD à Can’t insert floss in between the Pontic Pontic occupying and edentulous area
and abutments o If patient had a missing tooth for several
- Need proper oral hygiene instructions and years à Feels different
implementation - Concern about esthetics which that patient is
- Lack of occlusal contact may allow eruption to reluctant to discuss
occur with a resulting loss of proximal contact - Concern over the cost à Always discuss fee with
- If patient doesn’t accept this, make an implant à patient
No retention of food, can insert floss
**A provisional bridge is a TRANSITION PHASE/TREATMENT
from initial to final bridge à Helps patient to get used to it
DMD 2017

DR. AUSTIN U. ANG

PONTICS Design of a Pontic is dictated by:
1) Function
ü A suspended member of a FPD, replacing the lost 2) Esthetics
natural tooth and its function 3) Ease of Cleaning à HYGIENE
ü Usually occupying the space of the missing natural
tooth Requirements
ü Pontic 1) Restore function of the tooth it replaces
- Pontic does not replace the lost tooth because 2) Meet demand of esthetics and comfort
supporting tissue are lost when the tooth is removed 3) Biologically acceptable to tissue
and because the Pontic lies over the tissue rather 4) Sanitation
than growing from it 5) Prevent tissue inflammation
- Abutment caries the load
Pontic Design
ü Excessive - The occlusal is determined by its function
- Excessive tissue contact from Pontic has been - The only thing different is the undersurface
cited as one of the major cause of the failure of 1) SADDLE TYPE
FPD - Looks most like a tooth, replacing all the contours
- Excessive tissue contact on the EDENTULOUS of the missing tooth
MUCOSA (no more gingiva because tooth was - Fills the embrasure and overlaps the ridge with a
already extracted) large concave contact
- Bone underneath when no more teeth is called - Impossible to clean, will cause tissue
RESIDUAL ALVEOLAR BONE inflammation. Should never be used
- Concave à Looks and feels like a natural tooth
ü The Pontic à Acts like a food trap à Cant clean
- Must be carefully designed and constructed, not - DON’T USE SADDLE TYPE
only to facilitate plaque control of the tissue
surface and around the adjacent abutment teeth 2) CONICAL (BULLET OR SPHEROIDAL)
but also to adjust to the existing occlusal - The shape is cleanable but triangular spaces
condition around the tissue contact have a tendency to
collect debris
ü Posterior Pontic - Convex undersurface
- With lesser esthetic requirements, overly small - Minor problem:
Pontic are unacceptable because they trap food o Triangular spaces will trap food à Can
and are difficult to clean. be cleaned
- When orthodontic repositioning is not possible, it - Indication:
may be better to increase the proximal contour of o Newly extracted teeth à Patient has to
adjacent teeth than to make an FPD with go to another country à Can’t place a
undersized pontic permanent bridge because it takes
- Small diastema = make 2 small Class IV months to become a rounded
edentulous space à Make a conical
ü Pontic shouldn’t type Pontic à Tell patient there will be
- Exert any pressure on the ridge and the portion recession of gingiva and resorption of
approximated the ridge should be as convex as bone
possible o Cement a bridge temporarily à Patient
- The embrasure to the mesial, distal, and lingual comes back after a few months à
of the Pontic must be wide open to allow patients Remove then technician will add more
easy access for cleaning ceramic on that area
- Undersurface of Pontic should be CONVEX = - Not a good idea for anteriors à UGLY
Wont trap food so it is easier to clean
3) HYGIENIC (SANITARY PONTIC)
ü The Pontic - Do not have any contact with tissue; Also restore
- Must be slightly narrower at the expense of the function and stabilize adjacent teeth. Use on non
lingual surface appearance zone
- The smaller the occlusal table will have less - May be made entirely of metal
masticatory force generated towards the - Thickness shouldn’t be less than 3mm, therefore
abutments, and to avoid an uncleanable, require adequate space, vertically
overhanging “shell” - No contact à Ease of cleaning
- Want a narrower occlusal table - Limit:
× Smaller surface underloading o Can only put on non-esthetic zones
× Lesser load on abutment (posteriors)
× Smaller portion exposed to mastication
× Smaller overhang à Easier to clean 4) RIDGE LAP
- Give the appearance of being a tooth but all
**The success or failure of the bridge depends largely upon the surface are convex for ease of cleaning
design of the Pontic - Triangular space found near the ridge crest may
trap debris
- Highest portion of ridge = CREST
- Part that goes down to buccal and lingual =
SLOPE
DMD 2017

DR. AUSTIN U. ANG
-
For anterior and posteriors - Get final impression
- Triangular spaces tend to trap food à Can be - Crown
cleaned
- Almost the same as modified ridge lap à Differs ü Most teeth that are endodontically treated have been
in undersurface so mutilated by caries, previous restorations and
endodontic access that there is little of the clinical
5) MODIFIED RIDGE LAP crown left which can be used for retaining the final
- Contract starts at the crest of the ridge, whereby restoration
the lingual has a slight deflective contour in order
to prevent food impaction and minimize plaque ü Only the root remains to be used for retention of the
accumulation crown
- There a slight bucco-lingual concavity on the
buccal side of the ridge ü For teeth with little or no clinical crown, that have
- Contact starts on the ridge crest à Deflects food roots with adequate length, bulk or straightness, a
away from the undersurface of the Pontic dowel or a post, and core can be utilized
ü POST & CORE

- A restoration consisting of a post that fits a
prepared root canal and a core placed to
establish the proper coronal preparation form
- Made with a rigid material which when cemented
into the root canal and pulp chamber, provides a
solid foundation restoration that is well retained in
the tooth
ü Reinforcement of the tooth is essential when selecting

a dowel and core technique. The procedure should
not weaken the tooth or risk the lost of endodontilc
seal. There should be sufficient tooth structure to
retain the post and core during mastication
ü In a study
- By Guzi ’79, Hunter in ’89, Ko in ’92, have
determined that no significant reinforcement or
strengthening as a result of post placement
- Putting a post has nothing to do with reinforcing
Pontic Design Mesiodistally
the tooth
- No contact with the interdental papilla
- Purpose of the post = To retain the core
- Exaggerate the height and triangular space à Easy oral
hygiene maintenance
ü Over enlargement of the root canal can perforate or
weaken the root which then may split during
**Metal or Porcelain on the undersurface or the tissue side of
cementation of the post or during subsequent function
ontic
- Both can be utilized as long as they’re properly
ü The amount of remaining tooth structure is probably
polished or glazed
the single most important predictor of success. Indeed
if more than 2mm of coronal tooth structure remains,
**In the design of the FPD pontics, if insufficient attention is
the post design probably plays little role in the fracture
given to the mechanical principles, they prognosis will be
resistance of the restored tooth
compromised
**Mechanical problems may be due to improper choice of
ü The once common clinical practice of routine coronal
materials, poor framework or substructure design, poor tooth
reduction to the gingival level before post and core
preparation or poor occlusion
fabrication is outmoded and should be avoided
These could lead to fracture of the prosthesis or displacement
(Greater force are transmitted to the tooth)
of retainers
RESTORATION OF MUTILATED & PULPLESS TEETH Kinds of Dowel

1) CAST POST & CORE
ü RCT à Gutta percha à Badly broken down tooth - Custom fitted to irregularly shaped canal
- Create a post space - They are not cylindrical as in preformed dowel
- Drill our the gutta percha (not all) à Endodontic - These are cast in one unit rather than two
Seal separate materials
- Choose a post (coronal and radicular part) - Inject rubber base then insert something to hold
- Screw it in the rubber base
- Then cement - 2 materials used inside
- Acid etching o Inlay Wax
- Bonding agent o Duralay
- Light sure composite × Self Curing Resin
- Trim × Doesn’t shrink as fast as
- Now have a Post & Core regular self curing resin
DMD 2017

DR. AUSTIN U. ANG
-
Use toothpick to bring inlay out à Shave it to 2) Too much tooth substance has been lost through
make it rough and small to fit the diameter of the caries or trauma that retention of a conventional filing
canal material is not possible
- Lubricate (petroleum jelly) inside of root canal à
soften inlay wax in 3 stages (initial, middle and 3) Re-alignment of malposed tooth wherein the
apical) à Insert the toothpick with wax then take preparation would inevitable cause an exposure of the
it out à Then do the coronal part pulp
- Stronger (metal all throughout), better fit (custom
made) than Pre-fabricated Type Factors to be Considered in Assessing a Tooth for a Post-
- You fabricate a post with the existing canal Crown
1) Length of Root
2) PRE-FABRICATED TYPE - The length of the post within the canal should be
- Readymade posts that’s made of different as long as possible extending up to 5 or 3 mm
materials and comes in different sizes and short of the apex
shapes - The importance of a radiograph
- Have to adjust the shape of the canal to fit the
post 2) Alignment of the Root
- For core you can use composite or amalgam - Will affect the insertion of a post
Recommended Length of Dowel Preparation 3) Quality of the Root Filling

1) Equal to the length of the artificial crown - Root filling should be well condensed, especially
rd
2) 2/3 the length of the root in the apical 3rd
3) Below the crest of the alveolar bone if periodontically
compromised Special Problems
4) 3-5 mm of endodontic seal should remain intact ü Apicectomized
ü Malposed tooth
6 Features of Successful Design ü Subgingival extension of margin
1) Adequate apical seal ü Apicectomy
2) Minimum canal enlargement - Root canal, endo seal
- No undercuts remaining - Make a flap (fistula) à Remove bone à Apical
- If you make the canal very big, make the portion of tooth à Curette à Remove infected
cementum very weak tissue à Chop of the apex à Medication à
3) Adequate post length Close flap à Suture
4) Positive horizontal stop - Length of tooth will be compromised
- To minimize wedging ü Curved root
5) Vertical wall - Amount of space for post will be compromised
- To prevent rotation - Perforation
6) Extension of the final restoration margin onto sound
tooth structure
INTRODUCTION TO DENTAL CERAMICS
**Check if seal is done properly by taking a radiograph/x-ray
Porcelain
Post Length -‐ Composition of different crystalline materials, such as
- Studies have shown that as post length increases, silica, feldspar and alumina in a matrix of glass
retention also increases, however, the -‐ Finely ground ceramic particles that are pigmented to
relationship is not necessarily linear provide colors that approximate natural tooth structure
- Post that is tooth short will fail, whereas one that
is too long may damage the seal of the root canal Composition
rd
fill or risk root perforation if the apical 3 is 1. Feldspar
curved or tapered -‐ 75-85%
-‐ Gives the porcelain translucency
Post Diameter -‐ Acts as a matrix for quarts
- Increasing the post diameter is an attempt to
increase retention is not recommended because 2. Quartz
it may unnecessarily weaken the remaining tooth -‐ 12-22%
-‐ Acts as a strengthener
Post Surface Texture -‐ Forms a matrix for other materials to fuse
- Serrated or roughened post is more retentive -‐ Stabilize the mass at high temperature
than a smooth one
3. Kaolin
Peeso Reamer or Gates Glidden Drill -‐ 4%
- Used to remove gutta percha because of its blunt, -‐ Act as a binder
non-cutting tip -‐ Binds all the materials together when porcelain is still
- These instruments will follow the path of least unfired
resistance – the gutta percha in the canal
4. Pigments
Indication for Post & Core -‐ Metallic substance to produce the color of the
1) For root filled or root canal treated tooth wherein a porcelain
fixed restoration is indicated
DMD 2017

DR. AUSTIN U. ANG
Dental Ceramics v Over expanded metal (Loose à THICKER CEMENT =

-‐ All starts with powder, mix, then shape as a tooth, Don’t want this) on the other hand will rely heavily on
then FIRING the cement luting agent for its retention than on good
internal adaptation. Therefore, the metal should have a
3 Different Types (According to fusion temperature) passive fit and provide both internal adaptation (correct
1. High Fusing seating) and marginal integrity (seal).
-‐ 1288 to 1371 C
-‐ Use for porcelain denture teeth (don’t really use this v The metal should be as thick as possible for strength
anymore) and rigidity, yet as thin as possible so as not to
compromise esthetic by adding excess bulk to the
2. Medium Fusing restoration
-‐ 1093 to 1260 C
-‐ Use for all ceramic crown v When on the die, the coping fits perfectly but when
placed on patients mouth there is a gap à Clinician is
3. Low Fusing at fault during IMPRESSION MAKING
-‐ 871 to 1066 C
-‐ Used on PFMC v Metal can flex on a tight spot but not ceramic à All boils
down to fit à Want a PASSIVE FIT
v Porcelain fused to metal or metal-ceramic restorations
-‐ Consist of a metal substructure supporting a ceramic v Can’t use pure gold for PFMC à Gold starts to soften at
veneer that is mechanically and chemically bonded to very high temperature à Change shape à
it Manufacturer’s add ALLOY
-‐ The chemical component of the bond is achieve
through firing (“baking”) v PLATINUM is a very rare metal
2 Major Components of a PFMC Oxide Layer

1. Metal Substructure -‐ The metal oxide form on alloy surface after heat
2. Porcelain Veneer treatment procedure
-‐ Opaque porcelain -‐ Play a key role in bonding to dental porcelain
-‐ Dentin of body porcelain
-‐ Enamel porcelain Classification of casting alloy
1. High Noble Metal
METAL SUBSTRUCTURE -‐ Called PRECIOUS METAL before
-‐ PFMC or metal-ceramic restoration -‐ Gold-Platinum-Palladium
o Combine the natural esthetic of a brittle a. Gold-Platinum-Palladium
material such as porcelain with the durability b. Gold-Palladium-Silver
and marginal fit of a metal casting c. Gold-Palladium
o Metal provides the FIT and STRENGTH
-‐ Thermally, mechanically compatible with veneering 2. Noble Metal
porcelain a. Palladium-Silver
o Should be rigid, resist deformation, b. High Palladium
elongation, and corrosion § May include cobalt, copper, or
o Ease of casting silver-gold
-‐ FPD requires an adequate bulk of metal -‐ Silver improves the castability of the alloy
o To insure rigidity for strength and porcelain -‐ Can have gold but at a lower percentage
should be nearly of equal thickness
throughout 3. Base Metal
-‐ Significantly majority of the porcelain to metal bond -‐ Less than 25% by weight of noble metal with no
failure occur requirements for gold
o As a direct result of improper substructure a. Nickel Chromium (NiCr)
design which is given very little attention or is § With beryllium or without
poorly understood by the dentist § Many stay away from this due to
nickel à Some patients may get
Primary function of metal hypersensitivity reactions à
1. Casting provides the fit of the restoration to the DISCOLORATION OF FREE
prepared tooth GINGIVA
2. Metal forms oxides that bond chemically to dentin b. Cobalt Chromium (CoCr)
porcelain § Used for RPD
3. Coping serves as a rigid foundation to which the -‐ Beryllium improves castability and lessen the
brittle porcelain can be attached to increased strength tendency for the alloy to form a thick oxide at high
and support temperature
4. Restores the tooth’s proper emergence profile
-‐ Starts as early as COPING Thickness of coping according to alloy used
1. 0.3 mm for noble metal
v If the metal binds against tooth, this will stress -‐ Thicker than base metal because gold is very soft so
porcelain-metal bond and most likely will not seat or you have to compromise with the thickness
seal completely 2. 0.2 to 0.25 mm for base metal, which can be finished
thinner and still withstand distortion because of their
DMD 2017

DR. AUSTIN U. ANG
ranges, moduli of elasticity and yield

high melting -‐ Once it is glazed and you do adjustments, cant polish
strength it chairside à You need to send it back to the
technician again to be glazed
Why are the low fusing type of porcelain suitable for PFMC -‐ POLISH = ACRYLIC
fabrication and for binding to metal? -‐ GLAZE = CERAMIC
1. The have high coefficient of thermal expansion
2. They fuse (melt) below the melting range of alloy Two techniques of glazing
3. High, medium, and aluminous porcelain are not 1. Applied Glaze
thermally compatible with metal ceramic casting alloy, -‐ A thin layer of colorless porcelain is applied and then
therefore, these porcelain would not remain attached fired
to the metal substructure
2. Autoglaze, Natural Glaze, Self Glaze
Different layers of various types of porcelain are applied to -‐ By heating the porcelain to the point that the surface
coat the metal flows and becomes smooth and continuous
1. Opaque Porcelain -‐ The rougher the surface, the longer the required
-‐ Very thin layer that covers the metal glazing time
-‐ If you don’t put a coping, there will be a dark shadow
in the tooth **Provisional restoration plays a big role here à Have to send
-‐ First layer that initiates the bond with the metal back the porcelain to lab several times
-‐ Porcelain shade development begins with this layer
-‐ There’s high concentration of insoluble oxides, fused Microcracks
directly to coping in a thin layer, about 0.2 mm 1. Mismatch in coefficient of thermal expansion of the
-‐ The layer that bonds to the metal coping or metal and porcelain
substructure 2. The heat generated by injudicious grinding when
-‐ Conceals or masked out the gray colored metal contouring or adjusting occlusal relationships (Failure
underneath to glaze after adjustment or grinding the porcelain)
-‐ Purposes: 3. The abrasion and corrosion that are ever present in
o Establish porcelain-metal bond the environment of the mouth
o Mask the dark color of the metal
substructure 4 Factors that determine the bonding of porcelain to metal
o Initiate the development of the selected 1. The chemical exchange between the oxides of the
shade of porcelain metal and the oxides of the porcelain at the interface
2. The mechanical bonding of porcelain to the
2. Dentin or Body Porcelain microscopic roughened crevices of the metal
-‐ Contained colored oxides which are then fused to the substructure
opaque layer to build the contours or bulk of the 3. The compressive retention created by the difference
crown between the slightly greater coefficient of thermal
-‐ Available in wide selection of shades to match expansion of metal than that of porcelain
adjacent natural teeth -‐ Porcelain creates a great compression around the
-‐ This is also the layer that impart the dentin shade metal
associated with usually the gingival 2/3 of the tooth 4. The surface tension and wetting of the porcelain to
-‐ Minimum thickness of 0.5-1 mm and a maximum of the metal
1.5-2 mm
-‐ One of the thickest layers Oxidation (Degassing)
-‐ The process of heat treating a metal substructure,
3. Enamel (Incisal) previously believed to release entrapped gases
-‐ Contains the least amount of colorants -‐ Purpose is to burn off surface impurities, cleanse the
-‐ This portion of veneer has intentionally not been porcelain beating surface of contaminants and to form
labeled the “incisal” layer so as not to mistakenly an oxide layer
include that these porcelain must be restricted to the -‐ Removes any entrapped gas = DEGASSING (old
incisal 1/3 of the build up term)
-‐ Enamel layer ends at the cervical
**The metal will be contaminated with saliva, debris, etc. à
4. Surface or External Glaze The technician (good laboratory) will clean it first on an ULTRA
-‐ Generally colorless low fusing porcelain that possess SONIC CLEANER through vibration à It will then be subjected
considerable fluidity at high temperature to a STEAM WASH à Then the metal will then be subjected to
-‐ This is the final processing step in the fabrication of OXIDATION to form an OXIDE LAYER which helps in the
metal ceramic restoration wherein the crown is fired to bonding with the OPAQUE (Opaque and metal bonds at the
a temperature as recommended by the porcelain OXIDE LAYER)
manufacturer to produce a glaze
-‐ Produce a tooth surface that reflect light in a similar **Firing Porcelain Furnace
manner as do natural teeth. To establish a smooth -‐ Opening below the chamber
surface that does not readily accumulate stains and -‐ Place porcelain that is still soft on the platform that is
from which plaque can be readily removed preheated
-‐ When you get the porcelain from the technician it is -‐ Platform slowly raises increment by increment until
still UNGLAZED à Need to make the it is completely sealed and the porcelain is baking
adjustments/change the shape during unglazed -‐ Cant place porcelain that is from room temperature on
a preheated furnace à It will explode
DMD 2017

DR. AUSTIN U. ANG
-‐
When you reach the 900 degree firing temperature à 2. Object
Buzzing sound -‐ Modifies the light that falls upon it by absorbing,
-‐ There is a black colored drum at the back of the reflecting, transmitting, or refracting part or all of the
machine à COMPRESSOR à Sucks out all the air light energy, thereby producing the quality of color
from the chamber a. Surface Color (Reflection Color)
-‐ No air between metal and porcelain = BETTER -‐ Colors due to reflection from the surface of
BONDING opaque substance (Usual color)
-‐ Firing of ceramic is called VACUUM FIRING
b. Penetration Color
Delamination -‐ Colors seen through transparent substance
-‐ Describe a porcelain-metal bond failure when the such as color glass sheets or through a
porcelain is removed cleanly from the metal surface “glass of wine”
-‐ Translucency in the ENAMEL
Vacuum Firing
-‐ The firing of dental porcelain in a furnace in which the c. Other Colors
air or atmosphere has been removed in order to -‐ Color produced by spectrum, interference,
create a denser porcelain restoration scattering, and diffraction of light
-‐ Less air between porcelain grains -‐ Due to the saliva and light source
-‐ Better for shade selection is NATURAL
Occlusal Contacts LIGHT
-‐ If occlusal contacts are placed directly on or close to -‐ Ex. Rainbow, Soap bubbles, Pearl, Diamond
the porcelain-metal junction
o There is an increased likelihood the 3. Light Source
porcelain will chip or fracture at the point of -‐ Natural light, incandescent, and fluorescent
contact
-‐ Porcelain is strongest under compression and Selection and effects of light sources
weakest under tension. 1. Sunlight
o It is therefore important to design the metal -‐ Reddish early in the morning and late afternoon
substructure so any tensile stress in the -‐ Bluish at noon
porcelain are minimized
-‐ Dental porcelain is more abrasive of enamel than 2. Incandescent
other restorative material such as gold or amalgam, -‐ Predominantly red yellow and lacking in blue
and has been implicated in severe occlusal wear, -‐ Tend to make red-yellow stronger and blue weaker
particularly when porcelain is not glazed
3. Fluorescent
v Porcelain that is built (stacked) and fired above the -‐ Increase in blue green and low in red
2mm maximum height is considered unsupported by -‐ Used if no more natural light
metal and more prone to fracture
v Harmless stress can form in thick, unsupported 3 Characteristics of Color
porcelain sections thereby increasing the risk of crack 1. Hue
propagation within the veneer -‐ Quality which distinguishes one color form another
v For uniformity of shade and maximum strength
o It is highly desirable to have an even 2. Chroma
thickness of porcelain covering the metal -‐ Saturation or strength of hue
substructure -‐ Quality of color by which we distinguish a strong color
o By some estimate, the minimum total from a weak one
thickness of porcelain may be between 1.2 -‐ Strength of the color
to 1.3 mm at the middle third of the -‐ Ex. Gray has a higher Chroma than White
restoration and 1.5 to 1.6 at the incisal edge
(Yamamoyo ’85) 3. Value of Brightness
-‐ Relative amount of lightness or darkness in a hue
COLOR -‐ Quality by which we distinguish light color from a dark
-‐ A phenomenon of light or visual perception that one
permits the differentiation of otherwise identical -‐ Brightness of a color
objects -‐ Ex. Pink has a higher Value than Red, White has a
higher Value than Gray
Vita Shade Guide
-‐ SHADE GUIDE as a whole v In shade selection
-‐ SHADE TAB if its single only o If it is not possible to achieve a close match
-‐ If you’re colorblind, ask help from assistant or the with a shade guide to the natural tooth, a
technician lighter shade should be selected, since it can
-‐ Start with the value then select the chroma easily stained to a lower value
o A1 – A4 à Smaller number = Higher
Color depends of 3 factors VALUE; Bigger number = Higher CHROMA
1. Observer
-‐ Some practitioner suffer from color blindness in v Observation
various degree and incapable of seeing certain colors o Should be made quickly
DMD 2017

DR. AUSTIN U. ANG
o
Longer the gaze, less will be the ability to
discriminate
o Only 10 seconds
v Aging
o There’s a change in color, translucency, and
reflectivity in the deep portion of the tooth
v China like appearance

o Lack translucency
v Piano key like appearance

o Inadequate 3 dimensional fabrication or
disharmony in shades
Teeth have irregular surfaces

-‐ Light striking an object causes diffused reflection on
the object surface
-‐ Each of the irregularities of that surface act as if it
were one spot radiating light by itself
-‐ All of these irregularities make use feel the existence
and shape of the object
-‐ A perfectly polished smooth and flat surface such as
glass or mirror cause only regular, but not diffused
reflection
-‐ When light strikes, there will only be highlights on the
tooth
DMD 2017

Dr. Ang - FPD Compilation

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INTRODUCTION § Implant Prosthodontics

12. Pontics Ø Porcelain Fused To Metal Crown (PFMC) à there is

Ø Implants supporting a CD (attachment on the implant

2. RETENTION AND RESISTANCE FORM (SHAPE OF

13. ESTHETIC / ALVEOLAR RIDGE FORM

PRINCIPLES OF TOOTH PREPARATION

RESISTANCE FORM: § Occlusal wider than cervical = Creates

*Shape of prep should be tapered 3°-5°

ü Several Forms of Finishing Line

ü When fitting the crown over the prepared tooth

3) Shoulder/ Butt Joint – finish line of choice for

margin extend into the gingival sulcus, the more

2. Labial Orientation Grooves

ü Usual size of reduction = 1.5-2mm 3. Incisal Reduction

v How would you know your lingual reduction is TYPES OF RESTORATIONS

III. PORCELAIN FUSED TO METAL CROWN

IV. PORCELAIN JACKET CROWN (PJC)/ ALL

- Capable of producing the best esthetic effect of all OCCLUSION/TEMPOROMANDIBULAR JOINT

Centric Relation/Terminal Hinge Position

Bennet Movement/Immediate Movement

§ It will cause deflection of the

The Determinants for Mandibular Movements

v If you don’t adjust the shape of the tooth à

- Among the different interferences, NON-WORKING Border Movement of the Mandible

Criteria for Occlusion

2) SEMI-ADJUSTABLE Temporary Restoration

Supraeruption (upper) or Passive Provisional

o For grooves (made parallel), use long tapering flat In Endo

5) Resin Cement/Composite Luting Agent

Requirements of a good inlay wax (dark blue/green à when

ü POST & CORE

ü Reinforcement of the tooth is essential when selecting

RESTORATION OF MUTILATED & PULPLESS TEETH Kinds of Dowel

Recommended Length of Dowel Preparation 3) Quality of the Root Filling

Dental Ceramics v Over expanded metal (Loose à THICKER CEMENT =

2 Major Components of a PFMC Oxide Layer

ranges, moduli of elasticity and yield

v China like appearance

v Piano key like appearance

Teeth have irregular surfaces

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