Planning and Making Crowns and Bridges 4th Edition by Bernard Smith, Leslie Howe 0415398509 9780415398503

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ISBN 10: 0415398509

ISBN 13: 9780415398503

Author: Bernard G.N. Smith; Leslie C. Howe

This highly successful text, which has achieved wide acclaim among practitioners and is a recommended text in the major dental schools, has again been revised and updated to keep it at the forefront of clinical practice.

Planning and Making Crowns and Bridges 4th Table of contents:

Part 1 Crowns

1 Indications and contraindications for crowns

General indications and contraindications for crowns

Crowns versus fillings in the treatment of caries

General indications for crowns for other reasons

Badly broken-down teeth

Primary trauma

Tooth wear

Hypoplastic conditions

To alter the shape, size or inclination of teeth

To alter the occlusion

As part of another restoration

Combined indications

Multiple crowns

Appearance

Function

Mechanical problems

Indications for anterior crowns

Caries and trauma

Non-vital teeth

Tooth wear

Hypoplastic conditions

As part of other restorations

What are the alternatives to anterior crowns?

Internal and external bleaching

Internal bleaching

External bleaching

Composite restorations

Composite and porcelain veneers

Appearance

Reversibility

Cost

Surveys of success and failures of veneers

Physical properties

An alternative to porcelain veneers –resin bonded ceramic crowns

Restoration of badly broken-down teeth

Restoration of root-filled teeth

As part of another restoration

What are the alternatives to posterior crowns?

Bonded or pin-retained amalgam restorations

Tooth-coloured posterior restorations

Gold inlays and onlays protecting weak cusps

Ceramic inlays and onlays

Choosing the right posterior restoration

2 Types of crown

Anterior complete crowns for vital teeth

Ceramic crowns

Traditional porcelain jacket crowns (PJCs)

Pressed ceramic crowns

Laboratory milled cores and crowns

Zirconia cores

Chair-side milled restorations

Cast ceramic systems

Reinforced porcelains

Thin ceramic resin bonded crowns (see also Chapter l)

Choosing between ceramic crowns

Advantages

Disadvantages

Metal–ceramic crowns (Figure 2.1k and l)

Advantages

Disadvantages

Other types of anterior complete crowns

Cast metal acrylic or composite faced crowns

Fibre-reinforced composite crowns

Anterior crowns for root-filled teeth

Composite (or glass ionomer) core and crown

Post and core and separate crown

Post shapes

Comparisons of post shapes

Parallel: smooth or serrated (Figure 2.5b and c)

Tapered: smooth or serrated

Parallel: threaded

Tapered-threaded (Figure 2.5d right)

Choosing between post systems

One-piece post crown

Other types of crown for root-filled teeth

Posterior complete crowns

Cast metal crowns

Metal–ceramic crowns

Ceramic crowns

Posterior partial crowns

‘Three-quarter’ crowns

Other types of posterior partial crowns

Cores for posterior crowns

Cores of amalgam, composite or glass ionomer cement

Cast posterior cores

3 Designing crown preparations

The principles of crown preparation design

Related to materials

Metal crowns

Ceramic crowns

Metal–ceramic materials

Related to function

Occlusion

Future wear

Related to appearance

Labial, buccal, incisal and proximal reduction

Occlusal reduction of posterior teeth

Crown margins

Related to adjacent teeth

Clearance to avoid damage to adjacent teeth

Path of insertion

Oral hygiene and technical considerations

Related to periodontal tissues

Related to the pulp

Retention

Mechanical retention

‘Adhesive’ retention

Retention for conventional crowns

Retention against vertical loss

Interlocking minor undercuts

Taper of the preparation

Length of the preparation

Retention against other displacing forces

Avoiding failure from other causes

Fracture or distortion of tooth tissue

Fracture of ceramic crowns

Distortion of metal

Casting difficulties

Designing specific crown preparations

Posterior complete crown preparations

All-metal crowns

Metal–ceramic crowns

Anterior crown preparations: crowns for vital teeth

Ceramic crowns

Metal–ceramic crowns

Post-retained crowns

Posterior partial crown preparation

4 Occlusal considerations

A functional approach to occlusion

The functional compared with the orthodontic approach

Fixed compared with removable prosthetic approaches

Mandibular movements and definition of terms

Terminal hinge axis (THA) and the retruded arc of movement (or closure)

Intercuspal position (ICP)

Retruded contact position (RCP)

Mandibular movements

Retrusive movements

Protrusive excursion

Left and right lateral excursions

Occlusal interferences and occlusal harmony

Occlusal interferences

Occlusal harmony

‘Premature contact’

Occlusal stability (not the same as harmony)

Occlusal vertical dimension (OVD)

Creating interocclusal space for teeth to be crowned

Temporomandibular dysfunction (TMD)

Examination and analysis of the occlusion

Clinical examination of the occlusion

Clinical aids

Articulating paper or foil

Wax

Occlusal registration silicones

Plastic strips

Study casts

Articulated study casts

Occlusal adjustments prior to tooth preparation

Occlusal objectives in making crowns and bridges

Clinical and laboratory management of the occlusion

Avoiding loss of occlusal relationships

Maintaining occlusal relationships with temporary restorations

Recording the occlusion

Hand-held models

Simple-hinge articulator (Figure 4.11)

Semi-adjustable articulator (see Figures 4.10 and 4.12)

Fully adjustable articulator

Laboratory stages

Trimming the casts

Articulating the casts

Shaping the occlusal surfaces

Adjusting the occlusion of restorations in the mouth before cementation

Occlusal marking materials

Adjusting in intercuspal position

Adjustments in lateral, protrusive and retrusive excursions

Stability

Adjustment techniques

5 Planning and making crowns

History and examination

Considering the whole patient

Patient attitude and informed consent

Age

Sex

Social history

Cost

Considering the whole mouth

Oral hygiene

Condition of the remaining teeth

Considering the individual tooth

The value of the tooth

Appearance (Figure 5.2)

Condition of the crown of the tooth, the pulp and periodontium

Occlusion

Root length

Decisions to be made

Is the tooth to be kept or extracted?

If the tooth is to be kept, is it to be restored by a crown or a filling?

If the tooth is to be crowned, is any preparatory treatment necessary?

Detailed planning of the crown

Appearance

Shade

Clinical modifications

Assessing the remaining tooth structure and its environment

The need for a core

The choice of the type of crown and the material

Detailed design of the preparation

Planning and executing the clinical and laboratory stages

Appointments

Clinical and laboratory stages

6 Clinical techniques for making crowns

Planning stages before preparing the tooth

Study casts and opposing cast

Photographs

Planning the tooth preparation

Planning the appearance

Diagnostic wax-ups

Shade

Technique for shade selection

Planning the impression

Making a special tray (Figure 6.4)

Planning the temporary crown

Preformed temporary crowns

Chair-side temporary crowns

Laboratory temporary crowns

Building up the core

Managing worn, short teeth

Tooth preparation

Choice of instruments

Stages in the preparation

Preparing teeth for complete posterior crowns

Occlusal reduction

Axial reduction

Buccal and lingual surfaces

Mesial and distal surfaces

Margins

Finishing

Preparing teeth for complete anterior crowns

Incisal and proximal reduction

Labial reduction

Gingival-palatal reduction

Incisal-palatal reduction

Finishing

Preparing anterior teeth for post crowns

Post hole preparation

Removing the root canal filling

Shaping the post hole

Finishing the preparation

Temporary crowns

Preformed temporary crowns

Polycarbonate temporary crowns

Stainless-steel temporary crowns

Aluminium crown forms

Chair-side techniques for making temporary crowns

Injection or pouring techniques

Moulding techniques

Temporary post crown techniques

Differences between temporary and provisional crowns

Laboratory-made provisional restorations

Cementation of temporary and provisional crowns

The working impression

Impression materials (Figure 6.21)

Silicone impression materials

Polyether impression material

Reversible hydrocolloid

Impression techniques

Single material technique (e.g. polyether)

Two viscosity material technique (e.g. light- and heavy-body silicone)

Putty and wash (e.g. silicone)

Polymer materials and gloves

Gingival retraction

Compressed air (Figure 6.23a and b)

Kaolin pastes (Figure 6.23c, d and e)

Cord and impregnated cord (Figure 6.23d)

Electrosurgery (Figures 6.14a and 6.20a)

Occlusal records

Silicone occlusal records

Wax occlusal records

Removing temporary crowns

Trying in the permanent crown

Safety precautions

The checking procedure

Checking and adjusting the fit

Checking retention

Checking and adjusting contact points and axial contours

Checking and adjusting the shade

Checking and adjusting the occlusion

Cementation

Choice of cements

Zinc phosphate cement

Resin-based and adhesive cements

Glass ionomer cements

Cementation technique

Preparing the crown

Preparing the tooth

Mixing and applying the cement

Inserting the crown

Oral hygiene instruction and maintenance by the patient

Recall, assessment, maintenance and repair

Assessment

Oral hygiene

Margins

Structure of the crown

Appearance

Radiographs

Adjustments and repairs to crowns in situ

Part 2 Bridges

7 Indications for bridges compared with partial dentures and implant-retained prostheses

General terminology

General advantages and disadvantages of replacing missing teeth

Advantages of replacing missing teeth

Appearance

Ability to eat

Occlusal stability

Other advantages

Disadvantages of replacing missing teeth

Damage to tooth and pulp

Secondary caries

Failures

How long do bridges last?

Effects on the periodontium

Cost and discomfort

The choice between fixed and removable prostheses

General considerations

Patient attitude

Age and sex

Confidence

Occupation

General health

Appearance

General dental considerations

Local dental considerations

Examples of specific indications for bridges, dentures and implant bridges

Scope of this book

8 Types of bridge

Conventional and minimum-preparation bridges

Basic designs, combinations and variations

The four basic designs (Figure 8.1)

Fixed–fixed bridge

Fixed–movable bridge

Cantilever bridge

Spring cantilever bridge

Combination designs

Hybrid design

Variations

Removable bridges

Advantages and disadvantages of the four basic designs

Choice of materials

Metal only

Metal–ceramic

Ceramic only

Combinations of materials

Types of minimum-preparation bridge

Advantages of minimum-preparation bridges in general

Disadvantages of minimum-preparation bridges in general

9 Components of bridges: retainers, pontics and connectors

Retainers

Major or minor

Complete crown (full crown), partial crown, intracoronal or minimum-preparation retainers?

Materials

Criteria for choosing a suitable retainer

Appearance

The condition of the abutment tooth

Conservation of tooth tissue

Alignment of abutment teeth and retention

Occlusion

Cost

Pontics

Principles of design

Cleansability

Appearance

Strength

The surfaces of a pontic

The ridge surface

Wash-through (Figure 9.4a)

Dome-shaped (Figure 9.4b and c)

Ridge-lap and modified ridge-lap (Figure 9.4d, e and f)

Saddle

The effects of pontics on the ridge

The occlusal surface

The approximal surfaces

The buccal and lingual surfaces

Materials

Connectors

Fixed connectors

Movable connectors

10 Designing and planning bridges

Criteria for selecting a bridge design

Support

Conservation of tooth tissue

Cleansability

Appearance

Planning bridges

Collecting information about the patient

Consideration of the whole patient

Clinical examination

Assessing abutment teeth

Length of span

Occlusion

Shape of ridge

Predicting the final result

Study casts

Intra-oral trials

Partial dentures

Other reversible intra-oral modifications

Temporary and provisional bridges

Practical steps in choosing a bridge design

General approach

Details of stages in the design process

Selecting abutment teeth

Selecting the retainers

Selecting the pontics and connectors

Planning the occlusion

Examples of the bridge design process

11 Clinical techniques for bridge construction

Preoperative procedures

Occlusal adjustment

Preparations for a temporary bridge

Preparing the abutment teeth

Preparations for minimum-preparation bridges

Preparations for conventional bridges

Paralleling techniques for conventional preparations

Paralleling by eye

Extra-oral survey

Paralleling devices for crown preparations

Making temporary and provisional bridges

Choice of material

Choice of technique

Chair-side construction

Laboratory-made provisional bridges

Cementing temporary and provisional bridges

The working impression

Occlusal records

Trying in the metal framework or separate units

Localization techniques

Try-in and trial cementation of finished bridges

Permanent cementation

Minimum-preparation bridges

Summary of clinical techniques for minimum-preparation bridges

First appointment

Laboratory stage

Second appointment

Success with minimum preparation bridges

The cementation of conventional bridges

Oral hygiene instructions and maintenance

Part 3 Implants, splints and maintenance

12 Dental implants

The purpose of this chapter

Basic principles

Osseo-integration

General indications for implants

General contraindications to implants

Choosing between implants and bridges

Designs of dental implants

Abutments

Screw- versus cement-retained

Restorations

Implant survival

Planning

Implant numbers and position

Lack of bone and grafting

Appearance

Radiographs

Surgical stent

Provisional restorations

Surgical procedures

One stage

Two stage

Immediate placement/restoration

Restorative procedures

Abutment choice

Impressions

Placing the restoration

Maintenance

Complications

13 Fixed splints

Indications for fixed splints

Trauma

Periodontal disease

Orthodontic retention

Cleft palate

Additional retention

Short-term, intermediate and permanent splints

Short-term splints

Intermediate-term splints

Permanent splints

Fixed splints compared with removable splints

Types of short-term, intermediate and permanent fixed splint

Examples of short-term splints

Acid-etch retained composite splints (Figure 13.3)

Wire and composite splint (Figure I3.4)

Examples of intermediate- and long-term splints

Fibre-reinforced splint (Figure I3.5a)

Flexi-wire splints (Figure I3. 5b)

Cast metal intermediate and permanent minimum-preparation splints

Complete-crown splints

Intracoronal splints

The appearance of anterior splints

Selecting an anterior splint

Clinical techniques for permanent splints

Tooth preparation for complete-crown splints

Temporary splints

Impressions

Cementation

14 Crown and bridge failures and repairs

General considerations of success and failure and the value of survey data

How long will it last?

There are difficulties in defining failure

How long do crowns and conventional bridges last?

How long do minimum-preparation bridges last?

How long do porcelain veneers and inlays last?

How long do implants last?

How long have modern restorations been available?

A rough guide for advice to patients, to be modified by knowledge of the patient’s specific circumstances

Causes of failure and some solutions

Loss of retention

Conventional fixed–fixed bridges and splinted retainers

Minimum-preparation bridges

Other bridges

Solutions for loss of retention

Mechanical failure of crowns or bridge components

Porcelain fracture

Failure of connectors: soldered and laser welded

Avoiding soldered or welded joints in the first place

Distortion

Occlusal wear and perforation

Lost acrylic facings

Changes in the abutment tooth

Periodontal disease

Problems with the pulp

Caries

Fracture of the prepared natural crown or root

Movement of the tooth

Design failures

Abutment preparation design

Inadequate bridge design

Under–prescribed bridges

Over-prescribed bridges

Inadequate clinical or laboratory technique

Marginal deficiencies

Positive ledge (overhang)

Negative ledge

Defect

Poor shape or colour

Occlusal problems

Techniques for adjustments, adaptations and repairs to crowns and bridges

Assessing the seriousness of the problem

Adjustments by grinding and polishing in situ

Repairs in situ

Occlusal repairs

Repairs at the margins

Repairs to porcelain

Repairs by removing or replacing parts of a bridge

Replacing lost facings

Removing and/or replacing entire sections of a bridge

Removing abutment teeth

Extending bridges

Removing crowns and bridges

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