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James C. Kessler - Fundamentals of Fixed Prosthodontics

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Название:
Fundamentals of Fixed Prosthodontics
Автор:
James C. Kessler
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unrecognised / на английском языке
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неизвестен
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The fourth edition of this popular undergraduate text has been updated and expanded to reflect new research, materials, and techniques in fixed prosthodontics, with the addition of more than 350 new illustrations and three new chapters on the restoration of implants. It is designed to serve as an introduction to restorative dentistry techniques using fixed partial dentures and cast metal, metal-ceramic, and all-ceramic restorations, providing the background knowledge needed by the novice and serving as a refresher for the practitioner or graduate student. Specific techniques and instruments are discussed, and updated information has been added to cover new cements, new impression materials and equipment, and changes in soft tissue management methods used during impression procedures. New articulators, facebows, and concepts of occlusion have been added, along with precise ways of making removable dies. Different ways of handling edentulous ridges with defects that provide better control over the functional and cosmetic outcome are also presented. Finally, the topics of esthetic and implant restorations, which have become increasingly emphasized in dental practice, are given greater attention.

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Fig 739Cantilever fixed partial denture replacing a mandibular first molar - фото 208

Fig 7-39Cantilever fixed partial denture replacing a mandibular first molar, using both premolars as abutment teeth. To minimize stress on the abutments, the pontic is the size of a premolar rather than a molar.

References

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Table 7-1 Types of prostheses used for the replacement of missing teeth

	Removable partial denture	Conventional tooth-supported fixed partial denture	Resin-bonded tooth-supported fixed partial denture	Implant-supported fixed partial denture
Span length	Posterior spans longer than 2 teeth Anterior spans longer than 4 incisors Canine + 2 or more contiguous teeth	Posterior span: 2 or fewer Incisors: 4 or fewer	Single tooth Possible for 2 incisors	Single tooth 2- to 6-unit span
Span configuration	No distal abutment Multiple or bilateral edentulous spaces	Usually has distal abutment but can be used with short cantilever pontic	Abutments mesial and distal to pontic	No distal abutment Pier in 3+ pontic span All abutments at ends and as pier(s) of long span
Abutment alignment	Tipped abutments can be tolerated Widely divergent abutment alignment	Less than 25-degree inclination can be accommodated by preparation modification	Less than 15-degree inclination mesiodistally Should be in same faciolingual plane Preparations are not easily modified because of minimal reduction	Need for implant/abutment alignment requires close coordination between surgeon and restorative dentist
Abutment condition	Short clinical crownsInsufficient abutments	Good if abutments need crowns Nonvital teeth can be used if there is sufficient coronal tooth structure	Defect-free abutments Incisor, premolar replacements	Defect-free abutments requiring no restoration
Occlusion	More adaptable to irregularities in a healthy opposing natural dentition	Favorable loading (magnitude, direction, frequency, duration)	Cannot be used for incisor replacement in presence of deep vertical overlap	Occlusal forces must be as nearly vertical as possible to prevent unfavorable lateral loading of implants
Periodontal condition	Can use alternate (secondary) abutments when primary abutments are weakened	Good alveolar bone support Crown-root ratio 1:1 or better No mobility Favorable root morphology Provides rigid stabilization	No mobility Periodontal splints (with auxiliary resistance in tooth preparation)	Dense bone
Ridge form	Gross tissue loss in residual ridge	Moderate resorption No gross soft tissue defects	Moderate resorption No gross soft tissue defects	Broad, flat ridge
General features	Dry mouth: poor prognosis Limited patient finances Acceptable oral hygiene Reliable recall candidate Treatment simplification Advanced age Systemic health problems More adaptable to dentition in transition to edentulous state	Dry mouth: high caries risk Muscular discoordination Mandibular tori Palatal soft tissue lesions Large tongue Exaggerated gag reflex Unfavorable attitude toward RPD Patient can’t cope with aging, tooth loss Favorable opposing occlusion: removable prosthesis or periodontally weakened natural dentition may permit FPD in less than optimal situations Must be within dentist’s skills	Well suited for young patients Can be used for replacing molars if masticatory muscles are not too well developed	Able to survive in dry mouth May be better choice if teeth will require extensive treatment and will still be weak, questionable abutments Unfavorable attitude toward RPD Must be within dentist’s skills