Lesson title: Introduction to Fixed Partial Dentures and Definition Terms Part 1

Lesson Objectives:
At the end of the day, you will be able to:
1. Learn the different types of dentures
2. Learn the different prosthodontic terms
1.

Productivity Tip:
Warm up is a preparation for physical exertion or a performance by exercising or practicing gently
beforehand, usually undertaken before a performance or practice. Athletes and singers do warm ups.
Playing chess or other games (even pc games) that requires concentration can help your brain before
studying. That’s what I did when I studied/reviewed to prepare for the licensure exam and I’m not joking!

B. MAIN LESSON

Activity 2: Content Notes (13 mins)

What is Prosthodontics? (Prosth = artificial + Odont = tooth + ics = associated or dealing

with)- Is the branch of dentistry pertaining to the restoration and maintenance of oral
function, comfort, appearance, and health of the patient by restoration of the natural teeth or
the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial
substitutes or both. Below are examples of prostheses, pl. (a removable partial denture and a
fixed prosthesis (a crown).

Types of dentures/prosthodontics/dental prostheses:

1.) Fixed a.) Fixed partial

b.) Fixed complete

2.) Removable a.) Removable partial

b.) Removable complete

Examples: Fixed partial denture fixed complete denture

 Removable partial denture Removable complete denture

What is Fixed Partial Dentures (FPD) (aka Fixed Prosthodontics)?

Fixed Partial Dentures is the area of prosthodontics that deals with permanently attached (fixed)
dental prostheses. Such dental restorations, also referred to as indirect (direct=fabricated directly
in the mouth, indirect=fabricated outside the mouth, in a cast), restorations, include crowns,
bridges.

The 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
(see Fig. 1-1, A). 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 (see Fig. 1-1, B). Treatment can range from fairly straightforward measures—such as
restoration of a single tooth with a cast (metal) crown (see Fig. 1-1, C), replacement of one or
more missing teeth with a fixed dental prosthesis (metal bridge) (see Fig. 1-1, D), or an implant-
supported restoration (see Fig. 1-1, E)—to highly complex restorations involving all the teeth in
an entire arch or the entire dentition (see Fig. 1-1, F).
(Fig. 1-1, A and B). Treatment can range from fairly straightforward measures—such as restoration of a single tooth with
a cast crown (see Fig. 1-1, C), replacement of one or more missing teeth with a fixed dental prosthesis (see Fig. 1-1, D),
or an implant-supported restoration (see Fig. 1-1, E)—to highly complex restorations involving all the teeth in an entire
arch or the entire dentition (see Fig. 1-1, F).

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. Otherwise, the result is
likely to be unsatisfactory and frustrating for both dentist and patient, resulting in
disappointment and loss of confidence in each other.

Problems encountered during or after treatment can often be traced to errors and omissions
during history taking and initial examination. The inexperienced clinician may plunge into the
treatment phase before collecting sufficient diagnostic information that helps predict likely
pitfalls.

Making the correct diagnosis is prerequisite for formulating an appropriate treatment plan.
All pertinent information must be obtained. A complete history includes a comprehensive
assessment of the patient’s general and dental health, individual needs, preferences, and
personal circumstances.

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What is a “Crown”? – 1. an artificial replacement that restores missing tooth structure by

surrounding part or all of the remaining structure with a material such as cast metal
alloy (Ni-Cr-Co alloy), metal-ceramics (porcelain-fused-to-metal), all ceramic,
composite resin, plastic, or a combination of materials; 2. a single tooth preparation

When to crown (restoration)? – if a tooth has carious lesions that involves more than 1 surface
or extensive in nature and/or when a particular tooth needs esthetic enhancement.

Why do we crown it? –restorative fillings (composites) of carious lesions involving several
surfaces on a single tooth would be time consuming, less retentive and usually has short life
span (<2 yr). We may also need to protect all surfaces as caries may make the hard structures
(enamel and dentin) brittle. In endodontically treated teeth, covering a discolored and
weakened tooth structure is necessary to restore form, function and esthetics.

How do we crown it? – reduce/prepare the tooth using rotary cutting instruments. Shape the
walls according to the “Principles of Preparation”. Fabricate the crown (restoration) in the
laboratory. Available materials are: plastic, composite, metal or ceramics. Use of appropriate
adhesive to fix it permanently to the abutment.

Examples of materials used to fabricate a crown (from left to right) are: (1) metal (Ni-Cr-Co or stainless steel), (2) metal (all gold),
(3) ceramic (porcelain, zirconia, lithium disilicate), (4) plastic (polycarbonate preformed crown used as temporary crowns), (5)
metal-ceramic (PFM) crown in cross section, and (6) a ceramic crown as part of an implant.

What is a “Bridge” n, slang: syn, FIXED PARTIAL DENTURE; any dental prosthesis that
is luted (cemented using appropriate adhesive), screwed, or mechanically attached or
securely retained to natural teeth, or dental implants/abutments that furnish the
primary support for the dental prosthesis and restoring teeth in a partially edentulous
arch; it cannot be removed by the patient. Usually made of crowns (retainers) plus
pontic/s.
When to bridge? When there is an edentulous space with suitable abutments at each end.
Why we need to bridge it? – teeth with no adjacent contacts will move causing
malocclusion/misalignment thereby diminishing masticatory efficiency. Also, a tooth opposing
an edentulous area will supra erupt creating other problems later.
How do we “bridge” it? – reduce/prepare the teeth using rotary cutting instruments. Shape
the walls according to the “Principles of Preparation”. Fabricate the bridge restoration in the
laboratory. Use the appropriate adhesive to fix it to the abutments.

WHAT ARE THE TYPES OF BRIDGES: (BRIDGE BY DESIGN)

Conventional bridge (aka Traditional bridge) design

Conventional bridges are bridges that are supported by full coverage crowns, three-quarter
crowns, post-retained crowns, onlays and inlays on the abutment teeth. In these types of
bridges, the abutment teeth require preparation and reduction to support the prosthesis.
Conventional bridges are named depending on the way the pontic is attached to the retainer.

Fixed-fixed Bridge (same as conventional) design

A fixed-fixed bridge refers to a pontic which is attached to a retainer at both sides of the
space with only one path of insertion. This type of design has a rigid connector at each end
which connects the abutment to the pontic. As the abutments are connected together rigidly
it is critical that during tooth preparation the proximal surfaces of the abutment teeth must
be prepared so that they are parallel to each other

Cantilever bridge design

A cantilever bridge is a bridge where a pontic is attached to a retainer only at one side. The
abutment tooth may be mesial or distal to the pontic. This design is usually done when there is no
suitable abutment anterior or posterior to the pontic. This design is normally not employed and
is obsolete since it creates an unsupported end. Some experts argue that it can be done if it is
part of a long-span multi-abutment design (2 nd pic below) others would totally discredit the
idea since one end is still unsupported. (debated)
 Spring cantilever design
The pontic and retainer are remote from each other and connected by a metal bar. Usually, a
missing anterior tooth is replaced and supported by a posterior tooth. This design creates a
long flexible arm that allows flexing to allow some movement which in turn decreases the
load on the abutment when the pontic is in function such as “biting an apple”. This design of
bridge has been superseded. (Debated). What is the design that supersedes this or what
is/are other options (restoration)?

Fixed-movable
The pontic is firmly attached to a retainer at one end of the span (major retainer) and
attached via a movable joint at the other end (minor retainer). A major advantage of this type
of bridge is that the movable joint can accommodate the angulation differences in the
abutment teeth in long axis, which enables the path of insertion to be irrespective of the
alignment of the abutment tooth. This enables a more conservative approach as the
abutments do not need to be prepared so that are parallel to one and other. Ideally the rigid
connector should attach the pontic to the more distal abutment. The movable connector
attaches the pontic to the mesial abutment, enabling this abutment tooth limited movement
in a vertical direction. (Debated)
 Adhesive bridge (aka Maryland bridge, Resin-bonded bridge, butterfly bridge)
An alternative to the traditional bridge is the adhesive bridge (also called a Maryland bridge).
An adhesive bridge utilizes "wings" on the sides of the pontic which attach it to the abutment teeth .
In case of metal retainers, a base metal is used for increased retention. Abutment teeth require
minor or no preparation. They are most often used when the abutment teeth are whole and
sound (i.e., no crowns or major fillings). (Debated)

Implant-supported bridge
An implant supported bridge is similar to a traditional dental bridge, but instead of being
supported by your neighboring teeth, the bridge is instead supported by dental implants. This type
of bridge is very expensive it is often one of the best possible alternatives. (Debated)

Combination Designs
The incorporation of elements of different conventional bridge designs. A popular
combination design is the use of a fixed-fixed design with a cantilever. (Debated)
 Hybrid Designs
Bridges that incorporate elements of both conventional and adhesive bridge designs. (ex.
Resin-bonded onlay below). (Debated)

KEYPOINTS:

1. What is Prosthodontics? 12. What is a partial crown restoration?

2. What are the different Types of dentures? 13. What are the 4 main components of a
3. What is Fixed Partial Dentures? bridge?
4. What is a crown? 14. What are the abutment types?
5. What is a bridge? 15. What are the pontic types?
6. What is a phantom head? 16. What are the joint or connector types?
7. What is a phantom jaw? 17. What is a framework?
8. What is a tooth preparation? 18. What is a substructure?
9. What is a prosthesis? 19. What is a superstructure?
10. What is maxillofacial prosthodontics? 20. What is an edentulous span?
11. What is a full crown restoration? 21. What is a bridge span
* NOTE: Answer/s may be found on the previous or next module/s so leave it blank first and go
back to it later.

Activity 3: Skill-building Activities (with answer key) (18 mins + 2 mins checking)

1. Problems encountered during or after treatment is due to what?

Click or tap here to enter text.
 2. What is prerequisite for formulating an appropriate treatment plan?
Click or tap here to enter text.

3. What are the materials used to make a crown?

Click or tap here to enter text.

Watch videos about FPD. Click link below for smartphones and tablets. Shift + Right click for pc’s
1. https://www.youtube.com/watch?v=6D3sHiugMGQ
1. https://www.youtube.com/watch?v=OfAvBJ3RknU
2. https://www.youtube.com/watch?v=i3X90DQ5Vio&t=40s

Activity 4: What I Know Chart, part 2 (2 mins)

Review the questions in the “What I Know” Chart, part 1 from Activity 1 and write your answers to
the questions based on what you know now in the third column of the chart “What I learned”.

Activity 5: Check for Understanding (5 mins)

In your own words describe the following: (based on the pictures provided)

1. In your own words, describe a cantilever design?

Click or tap here to enter text.

2. In your own words, describe a “resin-bonded bridge design?

Click or tap here to enter text.
 3. In your own word, describe an implant-retained bridge design?
Click or tap here to enter text.

FAQs

1. Are these the only terms that are used in fixed partial prosthodontics?
ANSWER: NO, these are just some. We will learn them as we go further.

2. Why are fixed partial dentures expensive?

ANSWER: The knowledge and skill the dentist has to acquire is very demanding and the material and
equipment used to fabricate (fabrication usually takes days to finish) fixed partial dentures are also
expensive. If the dentist makes mistake/s usually there will be no profit. So, meticulous attention to detail
from planning to prep to fabrication to insertion is needed to have a satisfactory result.

Contact Information
Dr. Allan Rotello Sia Ebua
 Mobile: +63-929-886-1569
 Facebook/Messenger: https://www.facebook.com/alexstrasz/
https://www.facebook.com/dr.allan.ebua