Lecture. 12 Prof. Adel F.

Ibraheem
Components of Bridge
Connector
It is that part bridge or F.P.D which joins the individual components (retainers or pontics)
together, retainer with pontic, retainer with retainer or pontic to pontic. This can be
accomplished by non-rigid movable (flexible) connector or, most commonly, rigid (fixed)
connector.
Materials used in pontic fabrication
 Maximum esthetics vs. maximum strength
 all metal Connector can be used to provide maximum strength when esthetic is not critical
 Metal ceramic or All ceramic, can be used to provide maximum esthetic when strength is
not critical
Types of Connectors
 Rigid
 All metal
 Metal-ceramic
 All ceramic
 Non Rigid
 Prefabricated in plastic or metal and incorporated into the wax pattern
 Milled into the wax pattern or casting
RIGID CONNECTORS
Rigid connectors in metal can be divided into (according to fabrication technique):
a) cast connectors:
It made by casting multiunit bridge in one single piece. Cast connectors are stronger than soldered
and possible to carve them so that to provide maximum appearance bridge is often cast.

b) Soldering connectors:
Here the pontic and connector have to be made separately. Then after
casting we solder then together by using of intermediate metal alloy whose melting
temperature is lower than that of the parent’s metal.

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 c) Welded connectors:
Melting adjacent surfaces with heat or pressure

d) Loop connectors
Sometimes required when an existing diastema is to be maintained in a planned fixed
prosthesis.

NON RIGID CONNECTORS

Is indicated when it is not possible to prepare two abutment for an (FPD)
with a common path of placement. So segmentally the design of large , complex (FBD) into
shorter compartments (multiple pieces ) to make bridge seating more easier ,furthermore, it can
be used in cases that need reduction of occlusal force that acting on abutment (weak).
Movable Joint (key-key way, slide channel):
This is stress breaking design of joints that allows some movement
between the components of the joint, of 2 pieces:
1) The piece that is attached to the mesial terminal of the pontic (key slide)
2) Key is fitted in the second piece (key way channel) that is attached to the distal aspect of
anterior abutment (minor retainer).

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PRINCIPLES CONNECTORS DESIGN
1-size
Connectors must be sufficiently large to prevent distortion or fracture during function. but not too
large to prevent interference with plaque, periodontal tissue disturbance over time.
2-shape
The shape of the tissue surface of the connector should be curved faciolingually and highly
polished and smooth to facilitate cleaning and patient should be satisfied with the appearance.
3-postion
The location of the contact area should be established correctly to influence the success and
stability of the prosthesis. In the anterior teeth, the connector should place lingually. In the
posterior teeth, located in the occlusal third of the crown and more lingually

Occlusal coverage:
Majer Retainer that is rigidly connect to the pontic (fixed-fixed bridge design) need full
occlusal coverage while Minor Retainer that have movable connection with pontic doesn't
need that. Full Occlusal Coverage is always (nearly) indicated because :

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Adhesive bridge (Resin bonded bridge, acid etched bridge)
Fixed dental prosthesis that is luted to the unprepared or minimum preparation surface of
abutment teeth permanently by acid etching of enamel with some type of resin bonding agent.
1. It is alternative for the conventional bridge.
2. It is involve attaching the pontic via a metal plate to the unprepared lingual surface of
the abutment teeth.
3. The attachment to the abutment is made by composite resin material after acid etch
of the enamel.
4. It is the most conservative methods.
5. It is used when the abutment teeth have sufficient intact enamel, & usually used in
younger patient.

Indications:
1) Adolescents with single missing teeth (traumatic or congenital).
2) Caries- free abutment teeth and good oral hygiene.
3) Maxillary incisor replacements (most favorable prognosis) and Mandibular incisor
replacements.
4) Periodontal splints.
5) Post orthodontic fixed retention
6) Short span edentulous areas(Single posterior tooth replacements).
Contra Indications:
1) Small sized abutments – Peg Laterals
2) Extensive caries.
3) Heavily restored abutments.
4) Deep vertical overbite.
5) Mal-aligned abutments
6) Parafunctional habits
7) Long span edentulous area
8) Allergy to base metal alloys
Advantages:
11)) Conservative.
22)) Saving clinical chairs time.
33)) Not expensive.
44)) Lab procedure is easy & short.
55)) It can be re-cemented if failure occurs.
66)) Good appearance.
Disadvantages:
11)) Not strong as conventional bridge.
22)) Limited use because abutment teeth should have sufficient enamel for etching.
33)) Tendency to de-bond.
44)) Increase thickness of tooth surface by the metal plate.

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Types:
1. Direct:
This type is made by using the crown of patient own tooth as a pontic, for example rapid
replacement of a tooth that lost by traumatic injury. In order to increase the strength of the
bridge (attachment) we add metal mesh or wire (temporary replacement).

2. Indirect adhesive bridge:

According to the mean or way of retention of the metal frame work to the abutment teeth
we have different types:
a) Macro mechanical retention (Rochette).
b) Medium mechanical retention (Virginia).
c) Micro mechanical retentive (Maryland).
d) Chemically retention (Panavia).
a. Macro mechanical retention (Rochette) :
In this types there is multiple funnel shaped undercut perforations in the cast metal frame of
the retainer is used for retention & through which composite flow during cementation and make
mechanical interlocking after setting

b. Medium mechanical retention (Virginia):

Retentive feature cast as a part of the metal frame work (non undercut lumps, mesh, on the fit
surface of the retainer). The size of the retentive feature is intermediate between macro
mechanical & micro mechanical retentive system

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 c. Micro mechanical retentive (Maryland):
In state of perforations, the tooth side of the frame work is electrolytically etched, with
hydrofluoric acid , which produce a microscopic undercuts, the bridge attached with a resin
luting agent that lock into the microscopic undercut of both the etched retainer & etched
enamel.

d. Chemically retention (Panavia):

The resin adheres chemically to recently sand-blasted metal surface and is retained on the
tooth by conventional acid etching of the enamel.

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DIAGNOSIS AND TREATMENT PLANNING IN FIXED PROSTHODONTICS
Successful management of cases begin with a thorough assessment of the patient’s physical
and psychological condition and determining a treatment that will satisfy the realistic
expectations of the patient
 Diagnosis
 The determination of the nature of a disease.
 Treatment plan
 The sequence of procedures planned for the treatment of a patient after
diagnosis
Treatment Plan by Phases

FIVE ELEMENTS OF DIAGNOSIS

 HISTORY
 Clinical examination
 TMJ & EXTRAORAL EVALUATION
 INTRA ORAL EXAMINATION
 DIAGNOSTIC CASTS
 RADIOGRAPHIC EXAMINATION
 Dx photographs, Dx Wax-up, Aesthetic evaluation
DATA COLLECTION (HISTORY)
All pertinent information concerning the reasons seeking treatment, along with any
personal information, including relevant previous medical and dental experiences.The chief
complaint should be recorded preferably in patient’s own words.
1) Personal information: Name, Sex, AGE, Address, Telephone No , Family history,
Socio-economic status ,Physician tel.ph.no.
2) Dental History
3) Medical History
CHIEF COMPLAINT
The accuracy and significance of the patient’s primary reason or reasons for seeking
treatment should be analyzed first
FOUR CATEGORIES of chief complaint
• COMFORT (pain, sensitivity, swelling)
• FUNCTION (Difficulty in mastication or speech)
• SOCIAL (Bad taste or odor )
• APPEAREANCE (Fractured or unattractive teeth or restorations ,
discoloration)

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CLINICAL EXAMINATION
consist of the clinician’s use of sight, touch, and hearing to detect conditions outside the normal
range. Clinical examination involve the following:
General appearance:
 Gait and weight are assessed.
 Skin color: Anemia or jaundice.
 Vital signs: Respiration, pulse, temperature and blood pressure are measured and
recorded.
EXTRAORAL EXAMINATION
 FACIAL ASYMMETRY
 CERVICAL LYMPHNODES
 TMJ
 MUSCLS OF MASTICATION (palpated)
DIAGNOSTIC AIDS
 RADIOGRAPHS
 VITALITY TEST
 DIAGNOSTIC CASTS
 PERIODONTAL PROBE
Pulpal health must be measured before restorative treatment to
 PERCUSSION and
 THERMAL STIMULATION
 VITALITY TESTS
RADIOGRAPHIC EXAMINATION;
The radiograph should be examined carefully for caries , presence of P.A lesion , the quality of
the previous endodontic treatment , alveolar bone level, crown-root ratio , root configuration
,direction of root, Number can be examined ,also the presence of retained root in edentulous
areas should be recorded
Summary of supplement information, to clinical information, provides by radiographic
examination, during this diagnosis phase, are
 Extent of bone support
 Root morphology
 Peri apical pathology
PANOROMIC RADIOGRAPHS
Presence or absence of teeth
Assessing third molars impactions,
Evaluating the bone before implant placement.
Screening edentulous arches for buried root tips.
Diagnostic Casts Examination;
They should be mounted on a semi adjustable articulator
Advantages;
1) Allow an un obstructed view of the edentulous space
2) Allow accurate assessment of the span length and the curvature of the ridge or arch in
the edentulous region
3) The shape and length of the abutment teeth can be measured to determine which
preparation design will provide adequate retention and resistance.
4) Evaluate path of insertion ( axial inclination of abutment) to determine the need for any
modification.

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 5) No., size and location of wear can be evaluated.
6) Over erupted teeth can be easily spotted and the amount of correction needed can be
determine.
7) Evaluate occlusion and Interocclusal space necessary to re-establish a proper occlusal
plane.
8) Evaluate the need for any occlusal correction.
9) Used for diagnostic wax-up.
10) Construction of special try and provisional restoration.
Diagnostic photographs
There is much diagnostic information to be gained by including photography to comprehensive
treatment planning. It allows the practitioner to show the patient a photograph (s) concerning
his complain or problem immediately , thereby helping the patient to co-diagnose, understand
their needs and complications much better when they can see a picture of their own pathology
work with the patient chairside while showing his problem and discus the treatment.
What is an Ideal Treatment plan?
Treatment plan that achieves the best possible long-term outcomes for the patient, while
addressing all patient concerns and active problems, with the minimum necessary intervention.
MOUTH PREPARATION
Mouth preparation refers to the dental procedure that need to be accomplished before
fixed prosthodontics can be properly undertaken. As a general plan, the following
sequence of treatment procedures in advance of fixed prosthodontic should be
adhered to;
1) Relief of symptoms (chief complaint)
2) Removal of etiological factors (eg; excavation of caries removal of deposits)
3) Repair of damage.
4) Maintenance of dental health.
The following list describes the sequence in the treatment of a patient with extensive dental
disease including missing teeth, retained roots, caries and defective restorations.
 Preliminary assessment
 Emergency treatment of presenting symptoms
 Oral surgery
 caries control and replacement of existing restorations
 Definitive periodontal treatment
 Orthodontic treatment
 Definitive occlusal treatment
 Fixed prosthodontics
 Removable prosthodontics
 Follow up care .
SELECTION OF THE TYPE OF THE POSTHESIS
FACTORS CONSIDERED
 BIOMECHANICAL
 PERIODONTAL
 ESTHETIC
 FINANCIAL and PATIENTS WISHES.
Selection should not be less than optimum just because the patient cannot.
Sound alternative to the preferred treatment plan and not apply pressure.

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SELECTION OF THE TYPE OF THE POSTHESIS
 CONVENTIONAL TOOTH SUPPORTED FIXED PARTIAL DENTURE
1) Abutment teeth are periodontally sound.
2) Edentulous span is short and straight.
3) Expected to provide a longlife of function for the patient.
4) No gross soft tissue defect in the edentulous ridge.
5) Reserved for patients who are both highly motivated and able to afford
 RESIN BONDED TOOTH SUPPORTED FIXED PARTIAL DENTURE
1) Defect free abutments where single missing tooth.
2) A single molar (muscles are not well developed).
3) Mesial and distal abutment are present.
4) Moderate resorption and no gross soft tissue defects on edentulous ridges.
5) Younger patients whose immature teeth with large pulps are poor risks for
endodontic free abutment preparation.
6) Tilted tooth can be accommodated only if there enough tooth structure to allow
a change in the normal alignment of axial reduction.
7) Periodontal splints
 Removable partial denture abutment
1) Edentulous spaces greater than two posterior teeth.
2) Anterior space greater than four lncisors.
3) Edentulous space with no distal abutment.
4) Multiple edentulous spaces.
5) Tipped teeth adjoining edentulous spaces and prospective abutments with
divergent alignment
 IMPLANT SUPPORTED FIXED PARTIAL DENTURE
1) Insufficient number of abutments.
2) Partial attitude and or a combination of intra oral factors make a removable
partial denture or FPD a poor choice.
3) No distal abutment.
4) Alveolar bone with satisfactory density and thickness in a broad, flat ridges.
5) Configuration that permit implant placement.
6) Single tooth where defect free adjacent teeth.
7) A span length of two or six teeth can be replaced by multiple implants.
8) Pier in an edentulous span (three or more teeth long).
It is not uncommon to combine two types in the same arch.
In cases where the choice between a fixed partial denture and a removable partial denture is
not clear cut, two or more treatment options should be presented to the patients along with
their advantages and disadvantages
The prosthodontist is the best person to evaluate the physical and biological factors present ,
while the patients feelings should carry considerable weight on matters of esthetics & finances
NO PROSTHETIC TREATMENT ????!!!!!!!!!!!!!!
1) Long standing edentulous space into which there has been little or no drifting or
elongation of the adjacent teeth.
2) If the patients perceives no functional, occlusal or esthetic impairment.

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