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    Lect 3

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    Sarah Salam

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    Lect 3

    Uploaded by

    Sarah Salam
    1 views9 pages

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    © © All Rights Reserved

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    Lect 3

    Uploaded by

    Sarah Salam

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    © All Rights Reserved
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    of 9

    Crown & Bridge Prosthodontics

    Lecture 3 Dr. Lamis A. Al-Taee

    Evaluation Abutment tooth

    Abutment in fixed prosthodontic terminology is a tooth or portion of a tooth


    that supports and/or retains a fixed bridge or part of the bridge, to which the
    retainer is connected (cemented).

    All forces that are absorbed by the missing tooth are transmitted, through the
    pontic, connectors, & retainers to the abutment teeth. Abutment teeth must
    withstand forces that are normally directed to the missing teeth, in addition to
    those usually applied to the abutments, therefore, the choice of abutment is
    important because it has to withstand the forces that acting on it and on the
    pontic.

    1
    So the clinician have to evaluate the abutment teeth carefully

    Considerable time & expense are spared by thoroughly investigating each


    abutment tooth before proceeding the preparation. Radiographs are made &
    the pulpal health is assessed by evaluating the response to thermal & electrical
    stimulation.

    Evaluation Aids:

    They include; clinical examination using examination tools, vitality test,


    radiographs, diagnostic casts, & periodontal probe.

    Requirements:

    1- The abutment must withstand forces normally directed to the missing teeth,
    whenever possible the abutment should be vital tooth.

    2- A symptomatic endodontically treated teeth with a radiographic evidence of


    good seal & complete obturation of the canal can serve as abutment (post &
    core for retention & strength).

    3) The supporting tissue surrounding the abutment teeth must be healthy &
    free of inflammation.

    4) Abutment teeth must not exhibit any mobility, since they will be carrying an
    extra load. Sever uncorrectable periodontal disease is contraindicated for
    FPDs.

    2
    Abutment evaluation (selection):

    Factors related to tooth (abutment)

    1. Shape:

    Some teeth have conical, peg, bulbous or tapered crown form that interfere
    with the preparation parallelism, necessitating full coverage crowns to improve
    aesthetics and retention. Examples; Peg laterals, anterior teeth with poorly
    developed cingula and short proximal walls, mandibular premolars with poorly
    developed lingual cusps & short proximal surface, and thin incisors.

    Peg form

    3
    2. Crown length

    - Abutment teeth must have adequate occlusocervical crown length to achieve


    sufficient retention. Full coverage restorations & crown lengthening are
    considered with short clinical crowns to ensure adequate retention.

    3. Size of the crown:

    It determines the type of retainer to be used. For example: short, thin, conical,
    tapered teeth are poor indication for partial veneer crown.

    3. Health of abutment (caries or pulpal):

    - A sound abutment tooth permits ideal type of preparation. Carious tooth may
    be used as abutment if the caries is removed with pulp protection (lining) and
    then restored to its original form by suitable filling material.

    - Degree of mutilation of the crown: The size, number &


    location of the carious lesion or restorations in a tooth will
    influence the type of the retainer on the abutment. If the
    caries is small and far away from the margin, the retainer
    design will extend beyond the caries area. If the
    mutilation/fracture is severe, removal of the tooth might be indicated.

    -Vital teeth are preferred, however, pulpless teeth can be used only after
    endodontic treatment. Pulp capped teeth should be avoided because they are
    under risk of requiring RCT.

    4
    - Modifications like dowel core and pin retained restorations may be needed to
    restore crown morphology in grossly destructed teeth.

    4. Axial relationship:

    a) Rotation, tilting, over lapping, malposition might lead to a decision of


    excluding such a tooth to be used as abutment (because rotation or torque
    can damage the supporting structure or cause retainer to become loose).

    b) It may indicate the use of specific retainer (over reduction lead to weaken
    the tooth & endanger pulp health).

    c) Rotation lead to either increase or decrease of space available for pontic


    (size of pontic planned).

    Factors related to root

    1. Root configuration (root shape, angulation & length)

    - The shape of the roots determine the ability of the roots to handle the occlusal
    forces. Root that is wider labiolingually than mesiodistally with elliptic cross-
    section offers better support than a tooth with similar root surface area but
    has a circular cross-section.

    - Parallel-sided roots with developmental depressions are better to resist


    occlusal forces than smooth-sided conical roots which can be used for short
    span bridge, if the other factors are optimal.

    - A single-rooted tooth with irregular configuration or with some curvature at


    the apical third of the root is preferable than tooth that has a nearly perfect
    taper.

    - Multi-rooted teeth with separated roots provide greater stability than single-
    rooted teeth or teeth with conjoined roots.

    5
    - Teeth with longer root are stronger abutment than shorter one, since root
    length is directly proportional to the stability & strength of the prosthesis.

    2. Crown - root ratio: It is a linear measurement of the length of the tooth


    occlusal to the crest of alveolar bone (crown) compared to the length of the
    tooth that is embedded in the bone (root).

    - 2:3 Crown/Root ratio is the optimum for a tooth to be used as abutment.

    - 1:1 Crown/Root ratio is the minimum acceptable ratio. It might be considered


    adequate if the opposing occlusion is mobile or periodontally involved, or it
    composed of artificial teeth, which reduce occlusal forces that acting on the
    abutment which means less stress on the abutments.

    6
    Factors related to Gingivo-Periodontal complex

    - Abutment teeth must be free from periodontal disease, periodontal pockets,


    osseous defect, and gingival inflammation with adequate zone of attached
    gingiva.

    - The supporting tissue surrounding the abutment teeth must be healthy & free
    of inflammation. The abutment teeth should not exhibit any mobility, since
    they will be carrying an extra load. Intra oral radiograph should be used to
    evaluate bone architecture.

    - The alveolar bone support is one of most important factors that aid to evaluate
    an abutment which must be healthy, have good trabecular architecture with
    no sign of bone defect or bone loss.

    3. Root surface area (Periodontal ligament area):

    - The periodontal ligament area can be used as a scale or measurement to


    determine the potency of an abutment for FPDs.

    - Tylman stated that “Two abutment teeth could support two pontics”.

    - Johnston et al improvised Tylman’s statement and proposed the famous


    ANTE’s Law

    Periodontal surface area “Ante's law”:

    - The root surface area of abutment teeth (embedded in bone) (pericemental


    area) must be equal or greater than root surface area of teeth to be replaced.
    - If the periodontal surface area seems inadequate, the use of multiple teeth
    for abutments may be indicated depending on other biomechanical factors.

    7
    Example: Missing 1st molar alone or with 2nd premolar, the root surface areas
    of both are equal to the root surface area of abutments (second molar & first
    premolar).

    According to this premise:

    - One missing tooth can be successfully replaced if


    abutment teeth are healthy. In selected case and in
    order to increase the capability of the bridge to
    withstand the loading force 1st premolar can be
    used as a secondary abutment.
    - If two teeth are missing, a FPD can probably
    replace the missing teeth but the limit is being
    approached.
    - If three missing posterior teeth (1st molar & two
    premolars) or when the root surface area of the
    teeth to be replaced by pontics are greater than that
    of the abutment teeth, then a high risk or an
    unacceptable situation for FPD is exists.

    8
    - Jespen (1963) reported average measurements of root surface areas that
    can be used to calculate the abutment to pontic ratio

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