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Fixed prosthodontics

Unrestored Tooth Loss Consequences:

▪ Arch disruption
▪ Drifting, tipping, supra-eruption.
▪ TMJ dysfunction
▪ Facial muscle dysfunction
▪ No sequelae.

❖ Abutment evaluation:
Forces that would normally be absorbed by the missing tooth are transmitted
through the pontic, connectors and retainers to the abutments.
Abutment evaluation includes:
1- Coronal Tooth Structure ✓ Coronal Tooth Structure
✓ Pulp Status
Clinical exam, radiographic exam, diagnostic casts ✓ Periodontal Support
(mounted). ✓ Crown to Root ratio
✓ Root Configuration
✓ Periodontal Surface Area
✓ Abutment Inclination
2- Pulpal Status
o Vital, non-vital, Questionable status

✓ Whenever possible, an abutment should be a vital tooth. However, a

tooth that has been endodontically treated and is asymptomatic, with radiographic evidence
of a good seal and complete obturation of the canal, can be used as an abutment.

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 3- Periodontal Support
✓ Inflammation free, Adequate attached gingiva, Probing depth, Normal mobility, Adequate
bone support, Crown to root ratio.

4- Crown-root ratio
✓ The crown-root ratio is a measure of the length of tooth occlusal to the alveolar crest of
bone compared with the length of root embedded in the bone.
✓ As the level of the alveolar bone moves apically, the lever arm of the portion out of
bone increases, and the chance for harmful lateral forces increase.
✓ The optimum crown-root ratio for a tooth to be used as a fixed partial denture
abutment is 2:3; a ratio of 1:1 is the maximum ratio that is acceptable for a prospective
abutment under normal circumstances.

5- Root configuration

✓ Roots that are broader labio-lingually than they are mesiodistally are preferable to roots
that are round in cross section

✓ Multirooted posterior teeth with widely separated roots will offer better periodontal
support than roots that converge, fuse, or generally present a conical configuration.

➢ Periodontal Surface Area:

Ante’s Law

✓ Is an evaluation of root surface area

✓ The root (periodontal)surface area of the abutment teeth should be bigger than of the teeth
being replaced with the pontic(s).

❖ Biomechanical Considerations for Fixed Partial Dentures:

1) Span of the bridge:
→ The longer the bridge, the more flexure or bending will happen, which will apply more
stress to the adjacent teeth and harm them.

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2) Double Abutments (or SPLINTED abutments):
→ It is when two crowns or retainers are attached to each other with a connector and no
intervening pontics. They are used in cases of poor crown-root ratio and long spans to provide
more support and provide additional retention resistance form.
3) Arch Curvature:
→ It tends to happen more in the front of the mouth than in the back.
→ Arch curvatures vary between people. Some may have V-shaped, ovoid or square arches.
→ Therefore:
1) If the arch form is tapered or “v-shaped”, then the anterior pontics will be “hanging
forward” like an anterior cantilever. Such a bridge requires more abutment support.
2) If the arch form is square, then the anterior pontics will pass in a straight line between the
abutments. There will be less anterior cantilever effect.

4) Canine Replacement:
✓ The canines are the “cornerstones” of the mouth.
✓ Regarding canine replacement, there is a difference between replacing the canine in the
maxilla than in the mandible. In the maxilla, it is less favorable than in the mandible, since
maxillary canines deal with more stresses than the mandibular canines.

5) Cantilever Fixed Partial Dentures:

✓ It is a potentially destructive design.
✓ A posterior cantilever is even more destructive than anterior cantilever Because the
force posteriorly is magnified.

❖ Special Problems in designing Fixed Partial Dentures:

1) Mesially tilted second molars:
→ Mandibular first molars are the first teeth to permanently erupt and become carious at
an early age, and so they tend to get extracted early too.

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➢ Ways to manage this kind of case:

I. Orthodontic treatment to fix the position of the second molar.

II. Preparing the tilted tooth in a way that makes it upright.
III. In case of 3-units bridge, we can design a proximal half-crown, covering only the mesial
three quarters of the crown, and we make grooves in the preparation to improve the
retention and resistance form.
IV. Telescopic Crown (more complicated, less used):
First, the tilted abutment is covered with a telescopic coping (the internal part of this retainer)
which is designed to make the tilted tooth upright and parallel to the other abutment. The
bridge is then cemented over the coping on the tilted tooth.
V. Non-rigid Connector

2) Pier Abutments:
It’s when there is a lone standing tooth within an edentulous space (no teeth before and after
it). Therefore, an edentulous space can occur on both sides of a tooth, creating a lone,
freestanding “pier abutment”.

➢ Law of Beam Deflection:

This principle describes how much movement is occurring in a bridge and how much stress it’s
going to create on the retainers and abutments.
The most important factors to consider here are the length and the height of the bridge. The
width is the least important among them.
Therefore, these factors affect the biomechanics of Fixed Partial Dentures:
1. Length of Span
2. Connector Height
3. Connector Width

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1) Length of Span:
→ If the inter-abutment distance / length of the bridge / the number of pontics (p) is
doubled, deflection will be increased 8 times (p3) and the stress on the abutments will
similarly increase.
2) Connector Width:
Width is inversely proportional to deflection, so the width is important but it’s less critical than
connector Height.

3) Connector Height:
FPD flexure varies inversely by t where t is the height (or thickness) of the connector

❖ Principles of Tooth Preparations

➢ The design of a preparation for a cast restoration and the execution of that
design is governed by five principles:
1. Preservation of tooth structure.
2. Retention and resistance.
3. Structural durability.
4. Marginal integrity.
5. Preservation of the periodontium.

PRiSM-P

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1. Preservation of Tooth Structure:
• Partial veneer versus Full veneer crown
• Supra-gingival margin versus sub-gingival: supra gingival is more preferred.
• Conservation of Tooth Structure: don’t remove too little and don’t remove too much.

2. Retention and Resistance:

✓ Retention prevents removal of the restoration along the path of insertion or
long axis of the tooth preparation, such as sticky food and gravity.
→Retention is trying to pull the crown off.
✓ Resistance prevents dislodgment of the restoration by forces directed in an apical or
oblique direction and prevents any movement of the restoration under occlusal forces.
→Resistance is mainly represented by lateral force.
→The essential element of retention is two opposing vertical surfaces in the same preparation
(guide planes).

➢ Retention and Resistance Considerations:

1) Magnitude and direction of the dislodging forces.
2) Geometry of the tooth preparation.
3) Fitting surfaces of the tooth and the restoration.
4) Mechanical properties of the restoration.
5) Cement / Luting agent.
6) Parallelism of opposing axial walls
7) Length (Height of preparation)
8) Height: Base Ratio
9) Supplemental / internal preparation features.
10) Surface area.

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✓ Parallelism:
→Maximum R&R form obtained as opposing axial walls approach parallelism (not parallel).
→Some taper (total occlusal convergence) is required.
→Feature most under operator control.

Taper (total occlusal convergence TOC):

• It is the angle of convergence formed between 2 opposing prepared axial surfaces.
• Historically ideal TOC is 6 degrees.
• As the total convergence angle increases the retention and resistance is decreased.
• For every 5-degree increase in the total convergence ▪ Ideal TOC angle is: 6 to 10 degrees.
angle, the retention and resistance form may decrease ▪ Clinically acceptable TOC angle is: 10 to 20
up to 50%. degrees.

→Clinical studies indicate: ▪ If the TOC angle is > 20 degrees, the

preparation requires modification.
▪ Average TOC is 10-20 degrees.
▪ TOC is generally less with anterior preparations
greater with posterior (molar) preparations.
▪ Mandibular tooth preparations generally have greater TOC than maxillary tooth
preparations.

✓ Two opposing surfaces, each with a 3-degree inclination, would give the preparation a 6-
degree taper.

✓ Theoretically, the more nearly parallel the opposing walls of a preparation, the greater
should be the retention.

✓ Length (height of preparation):

→Tooth preparation height from the incisal/occlusal surface to the margin.

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→May be increased by:
a) adding restorative materials to the occlusal/incisal surfaces.
b) removal of the periodontal supporting tissues (crown lengthening).
→As the preparation length is increased the retention and resistance is increased.
→For every 1 mm increase in preparation length, the retention and resistance form increase
up to 10%.

❖ Length vs. Taper:

→The shorter the preparation the lesser the taper must be (more parallel).
→The longer the preparation, the greater the taper may be.

✓ Height / Base Ratio >/= 0.4:

→Height / Base Ratio – Arc of rotation
→Incisors and Premolars: 3 mm minimum height.
→Molars: 4 mm minimum height.
→(TOC = 10-20 degrees).
→Height/base ratio is more important for resistance form.

➢ Secondary features (Boxes, Groves and Pin holes):

→Sometimes we use supplementary internal preparation features when we can't make the
tooth parallel, so we place grooves, boxes (divergent walls) and pins as part of the preparation
to increase resistance.
→Used when R&R form of primary features is inadequate.
→Establishes parallelism on opposing intra-coronal tooth surfaces.
→Limits the paths of withdrawal.
→Shorten the rotational radius.

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✓ Surface Area:
→Retention is increased with increased surface area in sliding contact.
→The longer the preparation, the greater the surface area, the greater the retention.
→Not as important as TOC, and Height/Base ratio.

3. Structural durability:
1. Occlusal reduction
2. Functional cusp bevel
3. Axial reduction
→Restoration must contain bulk of material that is adequate to withstand the forces of
occlusion.
→This bulk must be confined to the space created by the tooth preparation.
→Only this way the occlusion will be harmonious and axial contours normal.

1- Occlusal reduction:
→One of the most important features for providing adequate bulk of metal and strength to
the restoration is occlusal clearance.
→The basic inclined plane pattern of the occlusal surface duplicated to produce adequate
clearance without over shortening the preparation.
→A flat occlusal surface may over shorten the preparation.

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Inadequate Occlusal Reduction:
✓ Makes the restoration weaker
✓ Will not provide adequate space to
allow good functional morphology
under the anatomical grooves.
✓ The restoration easily perforated by
finishing procedures or by wear in
the mouth.

❖FUNCTIONAL CUSP BEVEL:

•An integral part of occlusal reduction is the functional cusp bevel.
•A wide bevel placed on the functional cusp provides space for an adequate bulk of metal in
an area of heavy occlusal contact.
•Flat preparations should be completely avoided; we must follow the anatomy of the tooth.
→Lack of functional cusp bevel may produce several problems:
✓ Can cause a thin area or perforation.
✓ May result in over contouring and poor occlusion
Over inclination of the buccal surface will destroy excessive tooth structure reducing
retention.

2- AXIAL REDUCTION:
→Plays an important role in securing space for an adequate thickness of the restorative
material.
✓ Inadequate axial reduction will have thin walls subject to distortion or result in over
contouring the axial surface which could lead to periodontal problems.

✓ MARGINAL INTEGRITY:
The restoration margin should closely adapt to the cavosurface finish line of the
preparation to survive in the oral cavity.

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➢ FINISH LINE CONFIGURATION:
1. Chamfer
2. Heavy chamfer
3. Classic Shoulder
4. Radial shoulder
5. Shoulder with bevel
6. Knife edge /Feather edge
• CHAMFER:
✓ The preferred gingival finish line for full veneer metal restoration.
✓ This finish line exhibit least stresses to the underlying cement.
✓ It can be cut with round-end tapered diamond.
✓ Conservative type when compared with shoulder finish line.
✓ We use the bur in the half depth not the full depth at all

✓ Classic chamfer: rounded sharp circle, done by rounded bur, produces slip-joint effect,
which allows most complete seating of the crown.

✓ Torpedo chamfer: obtuse angle (135) not rounded, it’s open and tapered pointed at the
end so the curvature is wider, it’s done with torpedo bur, produces butt-joint effect.

• Heavy\deep chamfer:
- For all-ceramic crowns.
- Used to provide a 90-degree cavosurface angle with a large-radius rounded internal angle.
- The deep chamfer provides better support for a ceramic crown than does a conventional
chamfer, but it’s not as good as a shoulder.
- A bevel can be added to the deep chamfer for use with a metal restoration.

• Classic shoulder:
-Was the choice for the all-ceramic crown.

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 - Sharp, 90-degree internal line angle.
- We use shoulder bur (flat ended) at the full depth.

• Radial\angled shoulder:
- Margin of restoration is porcelain
- Modified form of shoulder used for:

✓ All porcelain crowns

✓ Facial of PFM crowns where maximum esthetics desired

✓ Ceramic inlays and onlays

- The cavosurface angle is 90 degrees, and shoulder width is only slightly lessened by the
rounded internal angle.
- The radius of curvature equals one-fourth to one-fifth the depth of the axial reduction.

• Knife edge\ feather edge:

- permits an acute margin of metal
- It looks like there’s no margin and the preparation continued where almost no depth.
- Although it’s very conservative, it’s not common.

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 ✓ PRESERVATION OF THE PERIODONTIUM:
• The placement of finish lines has a direct bearing on the ease of fabrication and the ultimate
success of the restoration.
• The best results can be expected from margins that are as smooth as possible and are fully
exposed to cleansing action

➢ MARGIN PLACEMENT:
• Whenever possible the finish line should be placed in an area were the margins can be
finished by the dentist easily and kept clean by the patient.
• In addition, finish lines must be placed so that they can be duplicated by the impression
without tearing or deformation
• Finish line should be placed in enamel whenever possible.
• Supra-gingival versus sub-gingival margin.
• Many situations in which sub-gingival margins are unavoidable:
1. Caries 2. Trauma 3. To increase retention 4. Esthetics
5. Extension of previous restoration
➢ Principles of Tooth Preparation:
→Biologic: Maintain periodontal health:
→Axial contours, emergence profiles
→Margin Location
→Marginal adaptation

Supragingival Margins Subgingival Margins (indications)

Easier for the dentist to prepare. Short clinical crown length – to increase R&R
form.
Easier to examine for accuracy. Subgingival caries.
Easier for impression making. Previous restorations extending subgingivally.
Easier to fit, finish and evaluate the Fracture, abrasion, erosion extending
restoration. subgingivally.

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 Easier to examine at recall. Root Sensitivity.
Easier for the patient to maintain Esthetics.

✓ Subgingival Margin Location: No greater than 1⁄2 the depth of the gingival sulcus.

➢ Biologic Width (supra crestal attachment):

→The combined connective tissue-epithelial attachment from the alveolar crest to base of the
gingival sulcus (approx. 2 mm).

→Placement of a restoration margin in this area probably will result in:

a) Gingival inflammation
b) Loss of alveolar crest height.
c) Formation of a periodontal pocket.

❖ Preparations for Full Coverage Crowns:

Full coverage crowns could be:
- Full metal crowns: AKA full metal veneer
- Porcelain fused to metal: metal inside supports the outer porcelain.
- Full ceramic crowns: stand for a long time, do not fracture easily and more esthetic but
still not strong as full metal of PFM crowns.
- Others like indirect composite: not that common anymore because we produce the same
result and even better with the previous methods.

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 Type of metal used:
-Either use base metal or high noble alloy metals.

Indications for
Full Metal Crown
Preparation:

Significant Bridge and partial

Insufficient tooth Teeth needing
defective axial denture
structure remains recontouring
tooth structure abutments.

➢ Pre-Preparation Procedures:
1. Diagnose disease
2. Eliminate pain/temporize
3. Treat periodontal disease and modify if necessary
4. Clean out caries and old restorative material
5. Determine pulpal status and treat if necessary
6. Diagnostic wax-up if indicated
7. Make index for use in making temporary restoration

➢ Preparation Steps:
1. Occlusal clearance (reduction)
2. External retention form and finish lines
3. Auxiliary retention “if we want to do them”
4. Finishing bevels “if needed”

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✓ How to evaluate amount of reduction:

1. Depth-orientation grooves:
• Done by using the diameter of the bur tip.
• We use modified shoulder taper diamond.

2. Depth limiting burs:

• Part of the bur cuts and part doesn’t, it doesn’t let you cut more than how it’s used, so, it
prevents you from cutting more, by that its depth limiting bur.
• Very popular with esthetic restoration, in veneers.
• These burs create like horizontal grooves, and with another bur we connect between these
grooves.
• As you see, the diamond is not connected all over the bur, so it helps me not to cut more.

3. Silicone putty index:

• Done by using additional condensation silicone.

4. Clearance between preparation and opposing dentition:

a. By instruments:

✓ Occlusal clearance measured with ball-burnisher or another instrument (1.0- 1.5 mm

diameter) which should pass freely over occlusal surface from mesial to distal.
b. bite registration material:

✓ Inject bite registration material (wax/silicone) onto occlusal surface. Ask patient to close
after it sets/cools. Remove the “squash-bite” and measure thickness.

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c. Prefabricated Flexible Clearance Guide:

✓ They are plastic sheets come with different thickness, we put

them between teeth and see how much space there’s between
closed teeth.

➢ Molar preparation:

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➢ Anterior PFM Preparation:
Specifically, anterior teeth ACC/PFM the facial surface of upper anterior teeth and even to
some degree premolars but not molars have two planes of reduction. So, at the gingiva we
have one plane and incisally we have the second plane.

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✓ Esthetic requirements:
1- Adequate space for porcelain
2- Masking of metal: -porcelain thickness -optimal esthetics

✓ Now what happens if you don’t do two plane reduction facially. What are your choices?

→So, this is a normal crown (image a) and you can see there is two plane reduction. There is
adequate thickness, and you are not encroaching on the pulp.

→ If you follow the angulation of the gingival third. As one line. I get a lot of retention and
resistance form but what happens?
1. Either they make the porcelain and metal very thin at the incisal edge in which case
you will be able to see the “opaque” layer very clearly when you look anterior it looks like a
white area. It’s very unaesthetic and this appearance is described as “opaque show through” it
shows through enamel layer. (image b)
2. The other choice is to over contour in which case you will wind up with a very prominent
tooth which is unaesthetic. (image c)
→If we follow the incisal plane, we will end up with over reduction, over preparation and will
probably hit the pulp.

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➢ Marginal Placement:
There are different designs with PFM about where you can end your facial margin.
Anterior teeth:
• Facial is often equi- or sub-gingival for esthetics
• Supragingival if no significant esthetic contraindications or noticeable gingival recession
• May depend on the type of ceramic margin used and framework design.

➢ FRAMEWORK DESIGNS:

1. Metal Collar:

✓ You can end your margin with metal and create

another finish line where the porcelain will end.
✓ This way you will have porcelain embedded in
metal, but the actual margin is metal.
✓ When the patient reflects their cheek what they
will see is a black line which is the metal
and it provides adequate strength for the PFM margin.

2. Disappearing margin.
✓ we are ending the ceramic, the metal and even the
cement all at the same point.
✓ Its disappearing because the metal is tapering to a
zero-point.
✓ You can still see a very faint grey line at the
margin because the porcelain is so thin.
✓ The most common

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3. Porcelain shoulder or porcelain margin.
✓ This is probably the best design that is the least
done by the technicians.
✓ the metal is completely hidden on the inside and
the porcelain is on the facial and that’s why you
need a shoulder. because you need an entire
thickness of 1mm or.8mm of ceramic.
✓ This margin has to be 90 degrees.

→Another thing to consider is where the junction between porcelain and metal be on the
palatal surface.
Where should the lower incisor hit the upper anterior tooth? At, above or below the junction?
The weakest point of PFM crown is the junction between the metal and porcelain. So, if
you can avoid it, never design your functional edge or incisal contact to be directly at the
junction. It should either be beyond or below. We tend to place it below, on to the palatal
so, we only have a thin/small metal area.

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• Preparation differs from anterior to posterior:
1- Central incisors: 1/3 gingival, 2/3 incisal
2- Canine: 1/2 gingival, 1/2 incisal
3- Premolars: 3/4 gingival ,1/4 occlusal
4- Molars: upright

❖ Provisional Restorations
Interim Restorations definition: It is a prosthesis designed to enhance esthetics,
stabilization and/or function for a limited period of time after which it is to be replaced by a
definitive prosthesis.

Therefore, Interim Restoration requirements are:

1) Protect the prepared teeth.
2) Maintain periodontal health.
3) Maintain occlusal stability and tooth position.
4) Restore masticatory function.
5) Maintain phonetics.
6) Restore esthetics.
7) Works as a “blue-print” and provides diagnostic information.

➢ Types of provisional restorations:

✓ Interim restorations by technique of fabrication:

A. Direct technique.
B. Indirect technique.
C. Direct- Indirect technique.

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A. Direct technique:
✓ These restorations are made directly, intra-orally; inside the patients mouth.
✓ we place unmixed material which is moldable. It can be composite based or acrylic based,
among some other choices.
✓ These materials are placed inside the tooth, between the external surface form and the
internal surface form. Therefore, they are sandwiched in between these layers. When the
material sets and hardens, we remove the external surface form. And now we have the
shape of the provisional restoration.

B. Indirect technique:
✓ They are made in the laboratory on the cast of prepared teeth.
✓ prepare the tooth take an impression send it to the lab pour it with fast
set gypsum make the provisional restoration in the lab on this prepared cast
send it back to the dentist.
C. Direct-indirect technique:
✓ This is a combination of both direct and indirect for maximum benefits.
✓ This is achieved by; custom interim shell made in the laboratory and relined intra-orally
in the clinic.
✓ It is relined in the clinic since we know that the provisional restoration that was made in
the lab doesn’t fit perfectly in the patient’s mouth.

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➢ Types of interim restorations:
A. Preformed crowns:
i) Single unit restorations
B. Custom mold:
i) Single or multiple unit restorations

A. Pre-formed crowns: (aka prefabricated crowns)

1) Polycarbonate:
✓ crowns are tooth colored, but they only come in one color
✓ The only way to change their color is to reline them with acrylic.
✓ It’s good for single restorations.
✓ they come in multiple shapes and sizes.

2) Aluminum or tin-silver:
✓ come in different sizes.

3) Nickel-chromium or Stainless steel:

✓ come in different sizes.
✓ stay as parts of the crown in the patients mouth.

4) Cellulose-acetate:

B. Custom molded crown or FPD forms:

1)Vacuum formed matrix:
2) Silicone putty matrix
3) Alginate impression
4) Other impression materials

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➢ what are the materials that we use when fabricating provisional
restorations?
A. Acrylic resins:
1) Polymethyl methacrylate’s

2) Poly-R’ Methacrylate’s (R’ = ethyl, vinyl, isobutyl)

B. Bis-Acryl Composites:
1) Chemically Activated
2) Visible light-Activated
3) Dual-Activated

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➢ Problems associated with Interim Restorations:
1) Time required for fabrication.
2) Time interim is in the oral cavity.
3) Materials available for interim restorations.

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➢ Interim Restoration Diagnostic Potential:
1) To determine if adequate tooth reduction has been established to satisfy the functional and
esthetic demands of the final restoration.
2) To determine if the planned restoration will satisfy the functional, esthetic and phonetic
requirements of the patient.
3) To determine the response of the gingival tissues to the planned restoration.
4) Facilitate Periodontal Therapy via:
✓ Improved access
✓ Improved contours:
a. Emergence profiles
b. Embrasures
c. Pontic form

➢ Provisional/interim/temporary cement:
✓ Crowns are cemented with provisional cement which is usually based on zinc-oxide
eugenol.
✓ The eugenol has a sedative effect on the prepared dentine.
✓ Some provisional cements are eugenol-free. These are used when we plan to cement the
final (e.g. all-ceramic) restoration with a resin-based cement.
✓ Most cements have an opaque off-white or ivory color. However, some provisional
cements are formulated to be clear. The opaque cements sometimes show through
somewhat translucent provisional crowns and may appear non-esthetic.

➢ Types of Temporary Cements:

1. Polycarboxylate temporary luting cements present low postoperative sensitivity, adequate
retention, and easy clean-up.
- E.g.: Cling2 (CLINICIAN'S CHOICE) and Hy-Bond (Shofu Dental).
2. ZOE (zinc oxide eugenol) temporary luting cements are commonly used because of their
sedative effect on sensitive teeth. It is well documented that eugenol is able to penetrate and

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diffuse throughout the dentine. And can affect the bond strengths provided by resin materials
used for definitive restorations.
It presents an excellent antibacterial effect.
- E.g.: RelyX Temp E (3M ESPE), Temp-Bond (Kerr), Flow Temp (Premier Dental Products)
3. ZONE (zinc oxide non- eugenol) temporary luting cements are designed to replace eugenol
with various types of carboxylic acids that do not interfere with definitive cementation.
They have the characteristics of being compatible with resin provisional materials, are
compatible with permanent resin cements, and show greater retention compared to ZOE
cements but have no sedative effect on the pulp.
- E.g.: RelyX Temp NE (3M ESPE); Temp-Bond NE (Kerr); Freegenol, Nogenol
4. Resin temporary luting cements present high strength, excellent retention, better
aesthetics, and easy
cleanup. However, these temporary cements have a higher incidence of microleakage,
discoloration, and odor associated with their use.
- E.g.: Systemp.link (Ivoclar Vivadent), Temp-Bond Clear (Kerr).

❖ Impression materials
-Impressions used to Register and Reproduce the hard and soft tissue (negative replica).
➢ Types of impression material:

A- Non- Elastic (Rigid):

• Thermoplastic: impression compound/ green stick and Brown cake
*Greenstick was actually used to make impressions for fixed restorations in the past
• chemically sets: plater/ZOE
*The reason is rigid materials are not used to taking impressions of rigid or hard tissue
structures because they can have undercuts and they can have irregularities

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 so, if you place the material inside the patient's mouth and it sets as a rigid material it will
go into the undercuts when you try to take it out, they will be distorted /fracture.

B- Elastic:
-Aqueous impression materials: (based on water)
• Alginate → is not used in Fixed prosthodontics (not accurate/ very low tear
strengths so, it doesn’t go into undercuts especially within area between the gingival
sulcus the margin)
- Can be used for opposing impression.
• Agar -Agar→ can be used in fixed prosthodontics
- Reversible, thermoplastic material
-it's heated up then it's placed in special tray which actually has a cooling system
-Accurate material: its water based; it works well in moist oral environment.
Two major problems: 1 -special device to heat up the 2- special tray having cooling system
*We don't use it anymore, because it requires this complex equipment

➢ Non-Aqueous impression materials: (water sensitive)/set chemically

-They pick up a degree of accuracy which is much higher than most of the previous
materials other than Agar-Agar.
▪ Not dimensionally stable
a) Polysulfide: very elastic and it is called rubber base it is not used that much
because it stains a lot and have an odor smell.
b) Condensation silicone (it is perfect after 1 hour of taking the impression after all
the evaporation is done)
these two materials set by condensation reaction, have by-products (water/ alcohol)
so, they are not dimensionally stable

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▪ Dimensionally stable:
a) Polyether: the most hydrophilic comparing to the other material. that’s an advantage&
disadvantage at the same time. the advantage is that it will accept having some moist in
the oral cavity while taking the impression buy the disadvantage is that you have to keep in
a close humidity, so it won’t absorb any excess material.
- The only material that was designed to be used in Dentistry.
b) Additional silicone (more accurate than condensation silicone)
-it’s usually hydrophobic but nowadays there is a hydrophilic type.

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➢ TWO ways to look at these materials:
1- How they are used
2- What they are made of.
➢ How to classify materials:

1-Viscosity:
a. Light body (wash).

✓ syringed

✓ High accuracy

✓ Lower amount of filler

✓ Less dimensionally stable

✓ More flowable

✓ Used in a very thin layer

b. Medium body (regular, monophase)

✓ Monophase: simply means that the single viscosity can do almost everything.

✓ Syringed or in tray

✓ essentially is good at everything but not excellent at anything

✓ The monophase is used to fill the tray and stay in it while trying to pour it. and we you put it
in the syringe and push it the actual material will start to flow but not like the light body
material of course. Usually, it is not used for fixed bridges, but it is a good material for cobalt
chromium RPD impression

c. Heavy body

✓ In a Tray

✓ high viscosity, low flowability

✓ more fillers

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✓ less accurate

✓ used in making costume trays for fixed prosthodontics, if we are using it with a stock tray it
is preferable to be a metal stock tray since it doesn’t flex.

✓ better dimensional stability

d. Very heavy body (putty)

✓ start as a dough

✓ high viscosity, low flowability

✓ more fillers

✓ less accurate

✓ better dimensional stability

Note: Heavy body and putty, although they are start as different forms they end up with the
same resiliency (shear hardness).

2-Mixing way:
A- auto mixing:

✓ More expensive

✓ Special gun

✓ Reduce number of bubbles

✓ Even mixing

✓ Improve working time

B- Hand mixing
✓ base and catalyst in mixing pad.

✓ Cheaper

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 ✓ you can't control proportions perfectly the ratio

✓ bubbles into the mix reduce the degree of accuracy

➢ Final impression materials for fixed is based on four materials:

➢They are basically elastomeric impression material.

➢We can use aqueous based material which is usually agar -agar but due to technical
difficulties or complications in the clinic. It’s a very accurate material but we don’t really use it,
so we are left with four other basic materials which are:
1. Addition silicon (AS)
2. Condensation silicon (CS)
3. Polysulfide (PS)
4. Polyether (PE)

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➢ Polysulfide:

✓ rarely used as final impression

✓ lead dioxide essentially gives it a dark Brown or dark gray color
✓ sulfide this material almost has a sulfuric smell or in taste.
✓ it's a messy material
✓ bend it does not tear easily
✓ less dimensionally stable, unless you pour it within an hour.

➢ Condensation silicon (CS):

✓ Used to make an index

✓ Acceleration is stannous octoate. good material but hand mixed which reduces its
accuracy, but the problem is in its dimensional instability after about an hour

➢ Addition silicon:

✓ AS or PVS or VPS: is probably one of most accurate common materials we use in dentistry.
✓ It’s always auto mixed so it comes with handgun mix or there is an automatic machine
✓ No by-product
✓ platinum catalyst (absorb the hydrogen gas)
✓ Latex (natural latex) the processing of natural latex to vulcanized latex used in rubber
gloves involves Sulphur compounds this is called vulcanization. Sulphur acts as an inhibitor
for platinum catalyst. Even if you change your gloves when making the impression.
Bubbles: There is still some residual hydrogen gas.
• There is something called recoil. The material entered an undercut, when we take it out
there will be some slight distortion, but it will go back to its place So, wait half an hour, but no
longer.

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➢ Polyether:

✓ If you put it underwater disinfectant for long period of time or you leave it in a in a wet
paper towel it can absorb water and change the dimension.
✓ can be hand or auto mixed.
✓ Catalyst is aliphatic cationic accelerator opposite of aromatic benzene
✓ There are two types of polyether, but we use the one that sets by an addition reaction.
✓ It has more wettability than addition silicone.

Comparison between the 4 types:

1-AS and PE set according to an addition reaction and there is no by-product.
Which means they are relatively dimensionally stable.

2-CS and PS set according to condensation reaction so there is a by-product.

For CS its alcohol and evaporates so we have dimensional instability.

3-In terms of cost AS is more expensive than CS. PE is more expensive than CS or PS.

➢In the clinic the most popular material in use as accurate material is AS.
There is an additional advantage to PE that it is relatively hydrophilic (less hydrophobic). There
are AS that are more hydrophilic. Hydrophilic elastomers like hydrophilic AS or PE their
advantage is also their downfall.

➢ Setting time:
-Polysulfide takes the longest time to set.

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➢ Distortion (Dimensional change):
-The one that is the most accurate is AS/PE these numbers are only from one study but these
two are very similar accuracy (you can pour them multiple times)
-PS/Cs a bit more distortion over time. (After an hour)
- The most resilient (elastic) is PS.

➢ Interocclusal records and bite registration:

There are silicon materials, but not an impression material come in the same way used for
occlusal registrations
-The difference between it and the impression materials:
shore hardness: How rigid the surface of the material is after elastomeric materials sets

➢ Double bite/ triple tray:

-used when there is one crown
-or inlays /onlays
-sectional tray (one side of the mouth/ anterior /unilateral)
-there are no flanges and there is a mesh at the bottom
Take an impression for:
1-upper teeth
2-the lower teeth
3-register the inter occlusal relation ship
-used only in one half of the mouth.

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 ❖ Fluid Control & Soft Tissue Management
A-fluid control: 1-mechanical 2- chemical 3-both techniques
B-soft tissue displacement: 1- non-surgical 2-surgical

➢ Mechanical Methods of Fluid Control:

1. Rubber dam
2. Suction devices
3. High volume vacuum
4. Saliva ejector
5. Svedopter
6. Cotton rolls

1. Rubber dam:

➢ Uses:
-for core build up
-for cementation
-impression making for inlays and onlays.
➢ Contraindicaion:
- Patients allergic to latex
- Should not be used with poly-viylsiloxane

ADVANTAGES DISADVANTAGES
Isolate one/more teeth Time consuming
Retracts soft tissue Unusual tooth shape or position
Eliminates saliva Patient suffering from asthma

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 2. High volume suction
➢ Uses:
✓ to remove small operatory debris and excess cement.
✓ also used when we remove old amalgam restorations, to reduce aerosol and inhaling
mercury
✓ it's also an excellent lip retractor.

3. saliva ejector:
- low volume suction device
Uses:
-removes saliva from the floor of mouth
- removes water slowly

4. Cotton rolls:

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➢ Chemical Methods of Fluid Control:
it is administered for patients with excessive saliva Methods:
1. Anti-Sialogogues
2. Local Anesthesia

1. Anti-Sialogogues:

✓ Anti-sialagogues: materials that prevents salivary production.

✓ Most common one used is Propantheline Bromide.

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➢ Soft Tissue Displacement:

Classification of gingival tissue displacement:

1- Non-surgical:
-Mechanical:
→Retraction crown/sleeve
→ Mechanical retractor
→Retraction cord

-Mechano-Chemical:
→Retraction cord with Hemostat
→Retraction pastes with Hemostat
2- Surgical.

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➢ Contraindication of epinephrine:
✓ Cardiovascular disease
✓ Hypertension
✓ Diabetes
✓ Hyperthyroidism
✓ Known hypersensitivity to epinephrine
✓ Patients taking: -Mono-amineoxidase
• Tricyclic depressants
• Cocaine
• Ganglionic blocker

❖ Color in Dentistry
How color produced is influenced by 3 main factors:
1- Light
2- Object
3- Observer
•The eye is only sensitive to the visible portion of the spectrum (380 – 760nm)

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➢ Color Reference Standards:
1. Color Rendering Index (CRI)
2. Color Temperature

1. Color Rendering Index:

• CRI = (0-100)
• Indicates how well a light source renders color as compared to a standard source (N.
Daylight)
• Northern daylight (hence CRI) can be affected by:
– Time of day
– Cloud cover
– Humidity
– Pollution

2. Color Temperature
• Related to the color standard black body when heated
• Reported in degrees Kelvin (°K).

➢ Additive Color:

✓ These are the colors obtained by emitted light

✓ Associated with television and computer displays
✓ The primary additive colors are Red, Blue and Green
✓ The secondary colors are Cyan, Yellow and Magenta
• When additive primary colors are combined, they produce white.

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➢ Primary Subtractive Colors:
• A primary subtractive color absorbs a primary additive color (Red, Green and Blue).
– The absorbed wavelengths are “subtracted” from the incident light and are not visible.
• Primary subtractive colors are Cyan, Magenta and Yellow.

➢ Color Perception:
• Rods
– Scotopic (gray scale) vision, interpret brightness
– Interpret brightness, not color
– Highest concentration on peripheral retina
• Cones
– Photopic (color) vision
– Three types (red, green, blue) combine to form an image similar to the additive effect of
pixels in a television picture
– Interpret color
– More active under high light
– Highest concentration on central retina (macula), most color perceptive area of eye

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Metamerism: objects are exposed to different light sources appear different.
➢ Incandescent light is yellowish, it’s not good because it has low color rendering index (CRI).
➢ Primary additive colors: emitted light from for example the projector or the sun
wavelength; colors are red, blue, green and if you mix them you end up with a white color.
➢ Complementary colors: Complimentary Colors colors that are opposite from one
another in their makeup

➢ Color Systems:
1) Munsell Notation:
Teeth fall into the yellow-yellow red
area of the.

2) CIE L*A*B*
• Colors are judged as to relative redness or greenness and yellowness or blueness.
• Lightness _ value
• A _ relative redness or greenness
• B _ relative yellowness or blueness

➢ What is Hue?
✓ it’s the basic color.
✓ Variety of color (red, green, yellow, etc.)
✓ The sensation produced by the various wavelengths of light in the visible spectrum.
✓ Reflected wavelength determines hue
➢ What is Value?
✓ The relative darkness or lightness of a color, or brightness of an object
✓ Range = 0-10 (0=black, 10 = white)
✓ Amount of light energy an object reflects or transmits
✓ Objects of different hues / chroma can be identical value
✓ It is the only dimension of color that may exist by itself.

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 ➢ What is Chroma?
✓ Saturation, intensity, or the concentration of color.

➢ How do you choose the shade?

1. Remove bright colors from field of view
2. makeup / tinted eyeglasses
3. bright gloves
4. neutral operatory walls
5. View patient at eye level
6. Evaluate shade under multiple light sources
7. Make shade comparisons at beginning of appointment
8. Shade comparisons should be made quickly to avoid eye fatigue

➢ Fluorescence:
A property of some objects to emit incident energy at wavelengths higher than the incident
waves.
– Natural tooth absorbs light at wavelengths too short to be visible to the human eye (300
and 400 nm= near- UV radiation).

– Under light sources containing invisible near-UV radiation e.g. a black light, the tooth can
emit visible light (400 to 450 nm, a blue-white color).

➢ Opalecence:
The enamel acts like a spectrum filter which reflects the short-wave, blue proportions of
daylight whereas the long-wave, orange ones pass the enamel.

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 ➢ Color Blindness:
-Defect in color vision
– 8% males
– 0.5% females

• Several variations exist:

– Achromatism – complete lack of hue sensitivity
– Dichromatism – sensitivity to two primary hues – Anomalous Trichromatism – sensitivity to
all three hues, with abnormality in retinal cones affecting one of primary pigments

➢ Vita Classic Shade Guide

• Very popular shade guide
• Tabs of similar hue are clustered into letter groups
– A (red-yellow)
– B (yellow)
– C (grey)
– D (red-yellow-gray)
• Chroma is designated with numerical values
• A3 = hue of red-yellow, chroma of 3.

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