Crown and Bridge

BY
Balsam M.Mirdan
 Fixed Prosthodontics(Crown and Bridge Prosthesis)
Is that branch of dental science that deals with restoration of damaged teeth with
artificial crown and replacing the missing natural tooth by a dental permanent
prosthesis cemented in place
Crown
cemented extracoronal restoration that covers,or veneers,
the outer surface of the clinical crown. It should reproduce
the morphology and contours of the damaged coronal
portions of a tooth while performing its function. It should
also protect the remaining tooth structure from further
damage..
Bridge
Component of several number of crowns connected
together to replace one or more of missing teeth and
can't be removed by the patients. Supported by number
of natural teeth and roots, those tooth are called
abutment tooth
Crown and Bridge is required to:

1. Replace a large restoration when there isn’t enough tooth remaining.

2. Restore a weak tooth from fracturing

3.Cover dental implant

4- Cover discolored or poorly shaped tooth

5- Cover a root canal treated tooth

6- Restore mastication, esthetic and

photonics

7- Prevent over eruption of opposing

arch teeth(preserve occlusion)
 Basic considerations
1. How many units need to be replaced with artificial teeth?
2. The location of the missing teeth/tooth (upper, lower, anterior,
posterior, etc.); choice of between the available options with the
best aesthetic appearance.

3. The condition of the neighboring tooth/teeth. For example,

crooked tooth, caries and unstable abutments affect the stability
of the denture, especially with some different types of the fixed
bridge, such as the Maryland fixed Bridge.

4. Patient oral and overall health can also affect the treatment method. For example, when
the patient is very old, implants might not be a good option for him/her as the implant post
(screw shape) need to be inserted into the jaw bone.
In addition, in some cases, patient’s overall health conditions might not help him/her to do
such surgery.
5. Although implants is one of the best ways to fill the gap of the missing teeth/tooth, a lot
of patients are not in a position to be able to afford this treatment as it is so expensive
compared to the other available options, such as fixed and removable dentures.
Therefore, in some cases the treatment plan could be changed due to financial reasons.
Classification of Crowns
According to the covered surface to:

1- Complete crown: it covers all the coronal portion of

the tooth, such as full metal crown, porcelain fused to
metal crown and full zircon crown.

2- Partial crown: it covers part of the

coronal portion of the tooth such3/4, 7/8 crown.

3- complete replacement ( post and core): It replaces the natural crown entirely.
This type of crown retains itself by means of a dowel(post) extended inside the
root
canal space
 According to the material used:
1. Metal material: full metal crown
2. Plastic material: such as acrylic resin or porcelain
3. A combination: metal and plastic material as
in full veneer crown.
Bridge Classification
1. Fixed-fixed bridge: most common used
anteriorly and posteriorly. The pontics
are connected rigidly to the retainers at
both ends of bridge by solder joint,
so we have only one path of insertion.

2. Fixed-movable bridge: the pontic is

attached to fixed retainer on one side
while the other side is movable joint
that connected with other retainer.
3. Cantilever bridge: is used when support can be obtained only from one
side of the edentulous space. These dentures have compromised support.
The abutment teeth on the supporting side should be strong enough to
withstand the additional torsional forces. Support can be obtained from
more than one tooth on the same side of the edentulous space
a/ simple consist of one or two retainer with pontic that replace the missing
tooth
Advantages
1- Very conservative design especially when a single abutment is involved.
2- When secondary abutments are used, parallel preparation can be easily obtained
because the abutments are adjacent to one another.
3- Easy to fabricate.

Disadvantages
1. Produces torqueing forces on the abutment.
2. Cannot be used to restore long span edentulous spaces.
3. Minor design errors can affect the abutments in a large scale.
b. Spring cantilever: This is a special cantilever bridge exclusively designed for
replacing maxillary incisors but these dentures can support only a single pontic.
Support is obtained from posterior abutments (usually a single molar or a pair of
splinted premolars).
Advantages.
Can be used for diastema cases. Metal crown retainers that
require minimal tooth preparation, can be used in posterior teeth to
replace missing incisors.

.
 Disadvantages.
The connector bar may interfere with speech and mastication.
Deformation of the connector bar may produce coronal displacement of
the pontic. There may be food entrapment under the connector bar,
which may lead to tissue hyperplasia
Components of a bridge;

1. Retainer: its part that seats over (on or in) the abutment
tooth. It could be major or minor.
2. Pontic : It is the suspended member of fixed partial denture
that replaces the missing tooth or teeth. It usually occupies
the position of the missing natural tooth.
3. Connector: It is that part of fixed partial denture that joins the
individual component of the bridge together ( the retainer and
the pontic).
It could be fixed (rigid) or movable (flexible) connector. When the retainer
is attached to a fixed connector, it is ”major retainer”, but when it is
attached to a flexible (movable) connector it is called “minor retainer”
Fixed prosthodontic treatment involves the replacement and restoration of teeth by
artificial substitutes that are not readily removable from the mouth. Its focus is to
restore function, esthetics, and comfort.
Fixed prosthodontics can offer exceptional satisfaction for both patient and dentist.
It can transform an unhealthy, unattractive dentition with poor function into a
comfortable, healthy occlusion capable of years of further service while greatly
enhancing esthetics.
To achieve predictable success in this technically and intellectually challenging
field, meticulous attention to every detail is crucial: the initial patient interview
and diagnosis, the active treatment phases, and a planned schedule of follow-up
care

PATIENT INTERVIEW
TREATMENT PLAN
DIAGNOSIS
Diagnosis
To decide weather the case is indicated for crown and bridge or not,
examination of the followings are required:
Periodontal Examination: The patient should have a proper oral hygiene to
ensure no plaque accumulation would occur at the crown margins which
might lead to carries.
Dental examination:
Visual examination: the occlusion of the patient
Crowding, Spacing, tilting, supra-eruption of the abutment, presence of carries,
quality of existing old filling in the abutment.
Radiographic examination:
The radiograph reveals the shape and number of the root, the
condition of the surrounding structure bone support of the tooth(
crown/root ration), ideal crown root ratio of a tooth to be used as an
abutment for a bridge should be 1:2.
Presence of lesion in the bone surrounding the root, fracture in the
tooth or root, bone loss, unerrupted teeth, these thing affect the
prognosis.
Principles of tooth preparation
Objectives of tooth preparation:
The main objective of tooth preparation
1- To eliminate the undercut from the axial surface of the tooth.
2- To provide enough space for the crown restoration to withstand the
force of mastication depends on material used, so the metal material
needs little space, while other material need more space .

3- Not to enlarge the size of the tooth.

4- To provide good esthetic.
PRINCIPLES OF TOOTH PREPARATION
PATH OF INSERTION

• Imaginary line along which the restoration will be placed onto and
removed from the preparation
• Paths of all FPD abutments must parallel each other
Marginal location(finishing line)

1/ supra gingival
2/Equiginigival
3/ subgingival

Margin should be place supra gingival when it is possible.

Sub gingival margin preferable for increase retention

esthetic reason
presence of carries
 Finishing line requirements
Finishing Line requirements
 Tooth preparation
The process of removal of diseased
and/or healthy enamel, dentin and
cementum to shape a tooth to receive a
restoration
 REQUIREMENT FOR TOOTH PREPERATION

➢ Biological -maintenance of pulp vitality, adjacent teeth & soft

tissues - conservation of tooth structure
➢ Mechanical - retention & resistance
➢ Esthetic - minimal display of metal - adequate thickness of
porcelain- proper shade matching

BIOLOGICAL MECHANICAL

ESTHETIC
Factors Influencing
Fixed Bridge Design
•1. Crown Length
-teeth must have adequate
occlusocervical crown length to
achieve sufficient retention
•2. Crown Form
- some teeth have tapered
crown form which interferes with
parallelism
- incisors possessing very thin
highly translucent incisal edges
•3. Degree of Mutilation
- size, number and location of
carious lesions or restorations affect
whether full or partial coverage
retainers are indicated
- fractured or carious teeth not
restorable should be removed
thereby altering design and creating
the need for a prosthesis
•4. Root Length and Form
- roots with parallel sides and developmental
depressions are better able to resist additional
occlusal forces than are smooth-sided conical roots
- multirooted teeth generally provide greater
stability than single-rooted teeth
- longer root has better retention than short
root
•5. Crown-Root Ratio
- 1:1.5 ratio has been generally acceptable
whereas 1:1 ratio is considered minimal and requires
consideration of other factors (ex. # of tooth being
replaced, tooth mobility, periodontal health) before
it can be used as an abutment
•6. Ante’s Law
-periodontal ligament area/pericemental
area of the abutment teeth should be
equal or greater than the periodontal
ligament area/pericemental area of the
missing tooth/teeth

1
•7. Periodontal Health
- absence of any form of
periodontal disease such as bone
resorption and gingival recession
•8. Mobility
– MILLER MOBILITY VALUE
1o mobility – normal
2o mobility – still acceptable
provided that you must know the
factor that cause the mobility (Ex
age, presence of calculas deposit)
and consider the # of tooth being
replaced
3o mobility – can not be used as
an abutment/for extraction
•9. Span Length
-distance between abutments affects the feasibility
of placing fixed prosthesis
- ideal for 1-2 missing tooth
- loss of 3 adjacent tooth requires careful evaluation
of other factors (crown-root ratio, root length and
form, periodontal health, mobility)

Secondary
Primary abutment abutment
•10. Axial Alignment
- crowns of proposed abutments must be
well aligned
- minor alterations in axial alignment
(tipped/rotated) often necessitate the use of
full coverage crowns to achieve retention or
acceptable esthetics
•11. Arch Form

lever lever

fulcrum line fulcrum line

counter-balancing
•12. Occlusion
- occlusal forces brought to bear
on a prostheses are related to the :
a. degree of muscular activity
b. patients habit
c. # of tooth being replaced
d. leverage on the bridge
e. adequacy of bone support
•13. Pulpal Health
- abutment/s should not be
sensitive to percussion or
vitality testing
- abutments with poor pulpal
health should undergo
endodontic tx prior to tooth
preparation
•14. Alveolar Ridge Form
- not indicated for FPD if there
is considerable bone loss

Horizontal bone loss

Vertical bone loss
•15. Age of Patient
- not indicated in older
patient as well as adolescents
when teeth are not fully
erupted or with large pulps
•16. Phonetics
- patients prefer FPD for
good phonation (provides
sufficient resistance to the
flow of air to allow normal
speech sounds to be
produced) rather than RPD
•17. Long-Term Abutment
Prognosis
- take note of the oral hygiene
-if there is question on the ability of
the remaining supporting structure to
accept additional occlusal forces, RPD is
indicated
- tooth with sufficient loss of
periodontal support and questionable
prognosis may be best treated with an
RPD rather than an FPD
•18. Esthetics
-prefer FPD because it
resembles natural tooth
-but RPD may be indicated
when the use of a pontic
produces large and unsightly
proximal embrasures in a fixed
prostheses.
•19. Psychological Factors
- to most pxs an FPD feels more
normal than an RPD and more
quickly becomes an accepted part of
the oral environment
- px feels more confident and
looks good wearing FPD than RPD
Tooth Preparations
Tooth Preparation
• The tooth is prepared so the cast restoration
can slide into place and be able to withstand
the forces of occlusion.
• Rotary instruments are used to reduce
the height and contour of the tooth.
• Hand cutting and rotary instruments
prepare the gingival margins.
Finish Line
Full gold crown
¾ crown
Retention groove
wrong
Preparation of full metal crown
How to start
Depth orientation grooves (d.o.g)
These are grooves placed on the surfaces of the tooth to act as a reference to
determine when a sufficient amount of the tooth structure is removed.
Steps of preparation
1. Occlusal surface preparation

1.5 mm reduction on functional (centric) cusps (buccal for lower and palatal for upper).
1 mm reduction of non-function cusps.
By using tapered fissure bur, placing one end of which in the central groove and the other end of the bur
on the tip of the cusp, then the remaining occlusal surface should be reduced to the depth of the
groove following the anatomy of the tooth.
2. Buccal surface preparation
Due to the anatomy of the lower posterior teeth, the buccal surface should be reduced into two planes (gingival 2/3
and occlusal 1/3).
For gingival two thirds, the fissure bur should be placed parallel to the long axis of the tooth.
For occlusal third, we should place the fissure bur in remaining occlusal surface at 45º to the long axis of the tooth.
This type of preparation is called two planes or two steps preparation.
The finishing line is chamfer
3. Lingual surface preparation
We should placed (d.o.g) on the center of the lingual surface, and then the remaining part of the tooth is reduced in one
step according to anatomy of the tooth. The finishing line is chamfer.
4. Proximal surfaces preparation
The contact area should be removed carefully by using narrow fissure bur to avoid hitting the adjacent teeth, because
caries may develop later on this surface.
Finally, all sharp angles should be removed. Complete the preparation with chamfer bur.
The preparation should not be started from the proximal surfaces because this may damage the adjacent teeth and cause
loss of correct taper and loss of final occlusogingival crown length.
Taper of the axial walls (buccal, lingual, mesial and distal) = 6º
5. Smoothing and finishing
All line angles should be rounded.
Finishing line should be smooth and continuous.
All undercuts should be eliminated.
Indications for full metal crown
a) Teeth with extensive caries or large amalgam in order to protect the remaining tooth structure from
fracture.
b) As retainer for FPD in case of long span for maximum retention.
c) To protect endodontically treated teeth.
d) Recontouring of posterior over erupted teeth for better occlusal relation.
e) For patients with high caries index.

Contraindications
a) Areas where esthetic is important.
b) Less than maximum retention is required.

Disadvantages
a) Removal of large amount of tooth structure.
b) Not esthetic.
c) Vitality test could not be applied.
Full veneer with facing
 Indications
1. When a complete crown is to be constructed for smiling areas.
a) Anterior diastema.
b) Peg- shaped laterals.
c) Discolored endodontic treated teeth that have sound tooth structure.
d) Fractured teeth without pulp exposure
2. To correct (restore) the lost occlusal vertical dimension (in case of sever attrition).
3. As a retainer for FPD.

Contraindications
1. Teeth with large pulp chambers.
2. Teeth with short clinical crown.
3. Patients with poor oral hygiene.
Disadvantages
1. More tooth structure is removed (than full metal crown).
2. Fracture of facing material (mechanical retention).
3. Discoloration and wear of facing material (acrylic resin).
4. Shade selection sometimes doesn’t match teeth.
5. Subgingival margin (gingival involvement).
Laws of preparation
Preservation of tooth structure.
Retention and resistance
1. Occlusogingival height.
2. Taper of axial wall.
3. Surface area of preparation.

Margin integrity of preparation: cervical finishing line is

smooth and continuous and readily seen.
Steps of preparation
a) Labial surface

Two planes (steps) preparation for central and lateral incisor.

1st step (gingival 2/3) with axial wall taper of 6º.
Cervical finishing line shoulder (1-2 mm) for metal rein crown.
2nd step (incisal 1/3) 45º in order to:

1. Prevent protrusion of incisal edge that could result in bad esthetics.

2. One plane reduction can cause over tapering of incisal edge and could cause
preparation to be too close to pulp.
b) Lingual surface
Two planes preparation
1st plane (lingual axial wall) taper of 6º.
2nd plane (cingulum and lingual concavity) lingual concavity for
canines is done in two concavities one on each side of cervical
lingual height contour (0.7-1 mm only metal).
Cervical finishing line: knife edge or chamfer.
Junction between cingulum and lingual axial wall should not be
over reduced to prevent over shortening the axial wall
(decrease of retention).
c) Proximal surface

Start with flame shaped diamond bur to remove the enamel mesial
and distal without damaging adjacent tooth.
Complete preparation with chamfer bur.
Taper of proximal wall = 6º.
The finishing line should meet
d) Incisal surface

Two mm reduction with palatal inclination 45º for upper central and
lateral.
Labial inclination 45º for lower anterior teeth.
Straight reduction for incisors.
For canines (2 planes reduction mesial and distal slops).
Inadequate preparation leads to poor incisal translucency of restoration.
e) Finishing and smoothing

All line angles should be rounded.

All undercuts removed.
Cervical finishing line well smoothed.
Metal Ceramic Crown
a. PFM-porcelain
fused to metal
b. PJC-porcelain
jacket crown
c. RBPC-resin
bonded porcelain
crown
Which provides best
aesthetics?
Has the least
destructive
preparation?
CONSERVING TOOTH STRUCTURE / keep it in your mind
Full metal: 1.5 mm functional & 1.0 mm nonfunctional cusp reduction
Metal-ceramic: 2.0 mm functional ( metal 0.3-0,5mm, opaque-0,3-0,5 mm, porcelain 1.0-1.2
mm) &1.5 mm nonfunctional cusp
Logical use of metal lessens the amount of tooth reduction
shoulder

chamfer
Type of pontic
Sanitary or Hygienic Pontic
 Zero tissue contact
Occlusalgingival thickness should be at least 3mm
Convex mesiodistally and faciolingually
Space beneath the pontic – 2mm ( Rosenstiel)
- 3 mm ( Tylman)
Adequate space for cleaning
Modified sanitary pontic:- gingival portion
is shaped like a concave archway mesiodistally
between the retainers and convex faciolingually.
Allows increased connector size while
decreasing the stress concentrated in the pontic
and connectors.
Recommended for mandibular posteriors
A modified sanitary pontic
 Saddle pontic or Ridge lap
has a concave fitting surface that overlaps the residual ridge buccolingually,
simulating the contours and emergence profile of the missing tooth on both sides of
the residual ridge.
Saddle or ridge lap designs should be avoided
The concave gingival surface of the pontic is not accessible to cleaning with dental
floss>>>>plaque accumulation>>>>> tissue inflammation
Modified Ridge Lap Pontic
The modified ridge lap pontic combines the best features of the
hygienic and saddle pontic designs, combining esthetics with
easy cleaning.

Overlaps the residual ridge on

the facial (to achieve the
appearance of a tooth emerging
from the gingiva)
• Remains clear of the ridge on the
lingual side.
Tissue contact should resemble a letter T whose vertical arm ends at the
crest of the ridge.
The ridge contact should be upto the midline of the edentulous ridge.
Most common pontic form used in areas of high visibility---
maxillary and mandibular anterior teeth and maxillary premolars and
first molars
 Conical Pontic

egg-shaped, bullet-shaped, or
heart-shaped
• Convex with only one point of
contact at the center of the
residual ridge.
• recommended for the
replacement of mandibular
posterior teeth where esthetics is
a lesser concern.
The facial and lingual contours are dependent on the width of them residual ridge; a knife-
edged residual ridge necessitates flatter contours with a narrow tissue contact area.
This type of design may be unsuitable for broad residual ridges, because the emergence
profile associated with the small tissue contact point may create areas of food entrapment
Ovate Pontic

most esthetically appealing

Its convex tissue surface resides
in a soft tissue depression or
hollow in the residual ridge,
which makes it appear that a tooth
is literally emerging from the
gingiva