STABLE MI

 Bridge just one side

keep same VD
mount in MI
place wax record only on prepared teeth
1st we mount the study model cast (no prepared teeth) then we mount the working cast
(prepared teeth)

 Bridge same side upper and lower

keep same VD
mount in MI
place wax record only on prepared teeth

 Bridge 2 opposite side one in upper one in lower

if we mount both side together we will mount in CR
if we prepare separately MI

 Bridge opposite side but same arch

if we mount both side together we will mount in CR
if we prepare separately MI

At MI always start with posterior CROWN/BRIDGE

IN CASE OF LOST OF VD  FULL MOUTH REHABILITATION

Indirect provisional at the final VD
Final record taken at the final VD
Wax record in CR 2 mm or more
Incisal pin 0
Reline with PMMA (provisional filled with PMMA) Self curing acrylic resin powder + liquid
Group function
Remount procedure mandatory

PROVISIONAL
Provisional OVOID can reshape the gum
When extraction just been done ovoid pontic direct to reshape the gum
If extraction long time ago use a bur then the ovoid pontic
Always splint provisional
Never splint definitive crowns (except perio problem and little retention)

To cement provisional
Zinc Oxide Eugenol Cement (ZOE)
Zinc Oxide Eugenol Free Cement
Calcium hydroxide cement

NEVER PLACE FIXED ALETA VESTIBULAR IN FIXED PROSTHO

VENEERS
Central and lateral incisors TYPE 2 veneers
Canine TYPE 1 veneer
Always mock up

OCCLUSION IN FIXED PROSTHO

 When we can Mutually protected articulation
protrusion anterior teeth touch
lateral movement canine
 Never balanced articulation
 When no canine we do group function (canine + premolars + 1st molar)
also when too much overjet, no overbite, edge to edge occlusion, crossbite, openbite
 When in protrusion movement we have posterior contact INTERFERENCE
 PREMATURITIES is when we have posterior teeth contact in CR
 We can introduce prematurities when mount in MI when doing teeth 4 5 6 7
 We can introduce

VERY DARK TEETH

Zirconia
PFM
Emax high opacity

SEVERE BRUXIST
Monolytic lithium disilicate crown
PFM
Zirconia
Protect antagonist with splint

IMPRESSION
Never when bleeding (not the same day as extraction)
Material that can be used : addition silicone, polyether (good for implant, bad for perio),
hydrocolloid (alginate, agar)
Retraction cord double when inflamed area

TRY IN
Compulsory framework (core) try in in PFM crown/bridge
Compulsory bisque try in in full porcelain crown/bridge and when doing lots of crowns
Always check occlusion before and after cementation
Try to not do anesthesia during try in

 to check prematurities
if mount in MI check in the mouth with articulating paper
if mount in CR check articulator
 to check interference
we can do it on articulator when done in MI
PFM
Metal core can be done in laser sinthering (the one we do), milling (the best) or casting (the
worst)
SPACE
More than 10mm of teeth Metal free (connector 4-4)
Less than 10mm of teeth PFM (connector 2-2)

ESTHETIC AREA
 PFM with ceramic shoulder (1mm juxtagingival round shoulder in buccal and 0,5mm
chamfer in palatal
 Zirconia

EXTRACTION
When grade II or III mobility
When subgingival decay more than 1 mm
Bone loss more than 50%

BRIDGES
 PFM always
 Zirconia
posterior max 3 teeth
anterior max 4 incisors
choose monolythic
retains less plaque than PFM
 Lithium disilicate
max 3 teeth

Prosthesis concepts
Biological 
- Prep must be 2mm away from bone crest – don’t invade the biological margin =
inflammation

Retention 
- Too conical = less retention
- Too little conicity = piston
- 3 degrees = more retention
- Molars = 10 -10
- Premolars 7-7
- Too narrow tooth = build guide grooves or boxes
- Short and wide = bad
o Make minimum conicity
o Boxes/grooves
o Crown lengthening
o Move finish line apical
o Prepare little of occlusal
o Decrease m-d b-l  make it short + narrow (need 10mm wide for every 4mm
high
Occlusal reduction:
- PFM = F 2mm, NF 1-1.5mm
- All ceramic = F2 – 2.5mm, NF 1.5 – 2mm

Periodontal patients = Supragingival prep (uncontrolled)

PFM = CAST metal coping + feldspathic porcelain

- Buccal finish line 1.2-1.5mm ROUND SHOULDER
- Palatal finish line 0.5mm CHAMFER
- Yuxta or supra]

PFM can be made from

- Lost wax/cast
- Cad/cam
- Cad + laser sintering
- + Layered feldspathic on top of the coping

ALL CERAMICS:

Feldspathic - layered only

High strength feldespathics – GLASS with filler

- Empress 1 – leucite
- Empress 2 – lithium disilicate + lithium orthophosphate – NEEDS layering on top
- Emax – lithium disilicate – CUT BACK OR FULL CONTOUR, pressed or
cad/cam (HT-HO)

ALUMINOUS GLASS FREE - NOT FOR BRIDGES

- Coping only – always layered on top
- VITA IN CERAM ALUMINA (99% alumina)
- IN CERAM ZIRCONIA (67% alumina)
- Procera all-ceram

ZIRCONIA GLASS FREE

- VITA INCERAM YZ
- Procera zirconia
- Lava

SINGLE Crown Anterior Posterior

 Normal color EMAX  Zirconia - for
Zirconia / alumina /PFM high esthetic
Dark color demand
 Alumina
 PFM – GOLD
STANDARD  if
they don’t care
 Full contour OR
CUT back emax,
Lithium crown –
high esthetic
dement

BRIDGE Anterior Posterior

Normal color Emax - lithium disilicate–  Zirconia
3 max  PFM – MORE
Dark color Zirconia – if its not too recommended
long
PFM – if it’s a long bridge
e.g 3-3

YOU CANNOT MAKE BRIDGES WITH ALUMINA

NEVER USE EMAX BRIDGE IN POSTERIOR

Never do a 3-3 bridge – curved areas are the worst – try to make 2 bridges
If not for the upper you must always take the premolars and canines if implants are not an
option

10mm

VENEERS:

- Into enamel only = more adhesion

- 0.3mm finish line
- 0.5mm buccal
- Adhesive resin cement – light
- Good for:
o Tetracycline staining
o Fluorosis
o Hypoplasia
o Tooth that cant be bleached
o Microdoncia/conoid
o Fractures
o Erosion
o Broad cervical embrasure (period patient)
o Diastemas
 o MINOR crowding and malposition’s

- Contraindicated in
o Severe crowding
o Caries + bad oral hygiene
o Untreated periodontal disease
o Erupting teeth

Type 1 – buccal only

TYPE 2 – USE THIS ONE BUCCAL AND INCISAL
Type 3 - b+ I + p – COULD BE FOR LOWER INCISORS

BUCCAL – finish line 0.3 round shoulder / deep chamfer = Yuxta or sub

 (Staining use sub) (Go a bit deeper in very stained teeth 0.4-0.5mm finish line + 0.6-
07mm on the rest) aka add 1-2mm to original values

INCISAL – 1.5-2mm reduction

Double retraction cord impression for veneers.

Veneer – no staining Feldspathic LAYERED

IPS EMAX - + feldspathic on top

Veneer - stained tooth or bruxism PROCERA ZIRCONIA COPING +

feldspathic on top

Cementing a veneer

On the feldspathic veneer =

1. Etch with fluoridic acid + ultrasonic bath
2. Silane + hot air
3. Adhesive + bonding NOT light cured

Tooth=
1. Retraction cord
2. Etch orthophosphoric + wash
3. Adhesive + LIGHT CURE IT
4. Cement

With zirconia  not etching no silane JUST METAL PRIMER + ADHESIVE +

CEMENT

ENDODONTICALLY TREATED TEETH – POSTS

Contraindications:
- Root fractures
- Infection
- Resorption
- No apical seal
- Radiolucency
- Subgingival restoration >1.5 = extract

LENGTH
- 1:1 minimum!!!!
- 8mm minimum crown
- 2/3rds root ideally
- 4-5mm apical seal
- 1mm dentin walls either side
- 1/3 width tooth max

FIBRE POSTS – never provisional cement

- Cement with ADHESIVE COMPOSITE RESIN ALWAYS  DUAL OR self
-

METAL POST – never provisional cement

- Zinc phosphate – fortex
- Glass ionomer
- Or adhesive resin

BRIDGE

- OVOID PONTIC THE BEST always use in anterior

- Modified ridge lap can be used in posterior = esthetic + hygienic

CANTILEVER BRIDGE –
- When we don’t have a pontic on one side
- Lever effect
- Lateral incisor
- 1st premolar
- First molar
- Only can be used for lateral incisor replacement WITH canine+ premolar abutment
- In 6’s you can use it if you make the 6 ½ the size of 4+5

INTERLOCKS
- NON PARALLEL ABUTMENTS
- Or INTERMEDIATE ABUTMENTS
- PATRIX ON MESIAL SURFACE OF PONTIC
- MATRIX ON DISTAL OF THE RETAINER abutment tooth
- Can cause intrusion
(only lost wax technique)
TELESCOPIC CROWN BRIDGE
- Primary coping = cemented to the abutment
- Secondary coping = not cemented to the primary coping but cemented to the
restorative tooth that is removable

INTERMEDIATE ABUTMENTS

INCLINED TEETH OPTIONS

- Ortho
- Telescopic crown
- Interlock

PERIODONTAL CONDITION
- 4mm or more = we need to do perio treatment and wait
- 2mm attached gingiva
- 1:1 crown to root max (bone loss)

BIOMECHANICS
- Length = directly proportional to bending  1p = 1x /2p = 8x/ 3p = 27x
- Thickness = Indirectly proportional to bending  t = x  t/2= 8x
- More curved = more bending

How to decrease torque =

- Thicker pontic
- More rigid alloy
- Use more abutment teeth

SPLINTING
- WHEN DO WE USE IT
o Periodontal disease
o Small abutments

EXTRACT 3RD MOLARS NEXT TO BRIDGES unless its perfect or alveolar nerve is at
risk