PROSTHODONTICS 1

FINALS LECTURE

LAMINATE VENEERS

6. Endodontically treated teeth

LAMINATE VENEERS a. Poor receptive surface for bonding
● A conservative esthetic restoration of anterior b. Indicated for full coverage restorations
teeth to mask discoloration, restore malformed
teeth, close diastemas and correct minor tooth COMPARISON OF VENEER SYSTEMS
alignment. DIRECT COMPOSITE VENEER
● Directly fabricated on patient’s mouth
Advantages:
● Dentist directly controls form & color
● Reduced cost to the patient
● Repairable
● Only one appointment is required
Disadvantages:
● Monochromatic appearance
● Staining
● Loss of luster occuring over time
INDICATIONS
1. Stained/defective restoration
2. Diastema
3. Fractures
4. Attrition
5. Large pulps
6. Discoloration
7. Malformation
8. Slight malpositions
9. Root exposure
10. Erosion/ abrasion INDIRECT PORCELAIN
● It involves laboratory fabrication of the veneers
which compensate for the short comings of the
direct composite resin technique
● are thin facings of ceramic porcelain affixed
directly to teeth
Advantages:
● Dentist may use the t ime saving & artistic skills
of a ceramist
● Multiple units can be placed with less chair time
CONTRAINDICATIONS ● Porcelain is the optimum material for color
1. Insufficient coronal tooth structure stability, esthetics, wear resistance & tissue
a. Fractured teeth with more than 1/3 loss compatibility
of toot structure,
b. Grossly carious
c. Extensively restored teeth
2. Actively erupting teeth
3. Parafunctional habits like bruxism
4. Severe periodontal involvement
5. Crowding

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 with colour laboratory
ADVANTAGES OF PORCELAIN LAMINATES blending. support and
(compared to metal-ceramic crown) -Artist dentist can correct patient
1. Frequently do not require anesthetic & less produce excellent selection.
stressful to patients result.
2. Usually do not involve dentin, averting pulp
sensitivity Expected -Some brands in -Should last more
3. Maintain natural contacts & incisal guidance longevity current generation or less 10 yrs.
of resin now With esthetic
4. Limit tissue-margin contact to facial
observed 7-8 yrs. of acceptability if
5. Provide a polishable, nonsoluble luting agent at success. -Should laboratory
the margin last at least 5-10 constructs
6. Do not compress interproximal gingiva yrs. With aesthetic correctly and
7. Eliminate metal collars or gingival metal display acceptability if placed correctly.
8. Do not usually require temporization placed correctly.

Ease of -Tooth preparation -Tooth

placement easy. preparation easy.
-Placement -Placement
moderately difficult difficulties are:
because dentist >Veneer is fragile
must to have and can break.
esthetic sense for >Selection of
color and contour. cement colour
>Loss of glaze
through finishing

DIRECT INDIRECT Repair -Simple. Remove -Difficult. Must

COMPOSITE PORCELAIN difficulty defective portion replace veneer or
RESIN down to enamel patch with resin
surface, etch, bond with esthetic
Indication -Need to cover -Typical, routine and repair with difference
s multiple color stains veneering for resin. between resin
of dark striations. patients without and porcelain.
-Bruxer, clencher, deeply stained or
abusive occlusal striated teeth.
habits -Dentist does not
TOOTH PREPARATION PRINCIPLES
-Patient with like to develop
financial difficulty tooth anatomy. ● CONSERVATION OF TOOTH STRUCTURE
-Single teeth -Multiple ○ Preparation should be conservative
preparations ● RETENTION IS SOLELY BY ADHESION
○ Adhesive luting or bonding using resin
Contraind -Dentist does not -Bruxer, clencher, cements is the main contributor to
ications like to develop tooth abusive occlusal retention rather than tooth preparation.
anatomy. habits.
● RATIONALE
-Does not have -Difficult to cover
ability with colour. dark stains and ○ To provide adequate space for porcelain
striations without opaquing and composite resin luting
placement of materials.
underlying ○ To remove convexities in the surface
opaquers before and provide a definitive path for
impression for insertion
veneers.
○ To assist veneer seating during
Esthetic -Good-excellent if -Excellent with placement and bonding the laminate
potential dentist has ability high level ○ To facilitate margin placement

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 ○ To provide adequate contour and colour
without over contouring

TOOTH PREPARATION DESIGN

Labial Reduction

TYPES OF PREPARATION
A. Feather Type/Flat Incisal Edge
B. With Incisal Lapping/Wrap-around Type

Proximal Reduction
● Depth can be 0.8 - 1mm
● Proximal reduction should stop just short of
breaking the contact

Feather Type/Flat Incisal Edge

● Does not cover the incisal edge
● Retain natural enamel over incisal edge

Reasons to preserve contact area:

Feather Type/Flat Incisal Edge
● More extensive tooth reduction
● Covers the incisal edge and terminates lingually
● Provides a positive seat for luting the veneer
● Indicated for extensive changes in color/shade
and contour.
● It is an anatomical feature that is extremely
difficult to reproduce.
● It prevents displacement of the prepared tooth
between the preparation and placement
appointment if no provisional restoration is
planned.
● Post insertion oral care is easier
● Simplifies try-in; no need to adjust the contact
● Simplifies the bonding and finishing

Sulcular Reduction
● Supragingival location
● Light chamfer finish line

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Incisal Reduction (for wrap-around type)
● 1mm reduction
Advantages:
● As porcelain is stronger in compression than in
tension, wrapping the porcelain over the incisal
edge and terminating it on the lingual surface
places the veneer in compression during
function.
● It also provides a vertical stop that aids in proper
seating of the veneer. Improves translucency.
● Enhance mechanical retention
● Increase surface area for bonding
Indications:
● The incisal thickness is too thin to support the
veneer.
● A lengthening of the incisal edge 1ʹ2mm is
desired.
● Facio-incisal margin is visible and unaesthetic.
● Incisal margin is structurally compromised.
Lingual Reduction (for wrap-around type)
CEMENTATION
Cement of Choice: RESIN CEMENT
NOTE: Final appearance of veneer is affected by the
shade of the cement used.
1. Verify marginal fit & evaluate proximal contacts.
2. After try-in & shade determination of cement,
clean the veneer & pumice the tooth.
3. Isolate teeth with Mylar strips.
4. Apply 30% phosphoric acid etchant gel to the
prepared tooth & leave for 1 min.
5. Rinse thoroughly with water for 30 sec & air dry.
6. Apply silane coupling agent or primer to the
internal surface of the veneer & allow to remain
in contact with the etched porcelain for 1 minute.
7. Air dry with syringe by blowing air parallel to &
slightly parallel above.
8. Apply small amount of composite resin luting
agent to the internal surface of the veneer &
brush to evenly distribute.
9. Seat in the veneer on the dry etched tooth using
finger pressure.
10. Light cure for 10 seconds ; then verify if veneer
is placed correctly.
11. After initial set, remove carefully flash.
12. Continue polymerizing for additional 45-60
seconds
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 MAINTENANCE
● For 72-96 hours following insertion, patients
should avoid highly colored foods, tea, coffee,
hard food and extreme temperatures.
● Routine scaling should be done and ultrasonic
scalers should be avoided.
● Abrasive and highly fluoridated tooth pastes
should be avoided.
● Excessive biting forces such as nail biting and
pencil chewing habits should be avoided.
● Soft acrylic mouth guard can be used during
contact sports.
FAILURES

MECHANICAL
● DEBONDING ʹ use of expired cement, faulty
veneer/tooth preparation during luting
● FRACTURE ʹ poor positioning of incisal margin,
less incisal thickness, margin too subgingival
BIOLOGICAL
● POST-OPERATIVE SENSITIVITY ʹ improper
curing of cement, poor marginal adaptation
● MARGINAL MICROLEAKAGE ʹ poor fit and
extension
ESTHETIC
● IMPROPER SHADE SELECTION
● GINGIVAL RECESSION ʹ over-contour and
improper subgingival placement

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 CONNECTORS FOR PARTIAL DENTURE PROSTHESIS

CONNECTORS
● Components of a partial fixed prosthesis or
splint that join the individual retainers and
pontics together

Disadvantage:
● Access to proximal margin is impeded
● And the pattern cannot be held proximally
during removal from the die

SOLDERED CONNECTORS
● Connectors to be soldered are waxed to
final shape but are then sectioned with a
thin ribbon saw
● The surfaces to be joined are flat, parallel,
and a controlled distance apart

TYPES OF CONNECTORS
● Rigid Connectors
● Non-Rigid Connectors

RIGID CONNECTORS
A. Cast Connectors
B. Soldered Connectors
C. Loop Connectors

CAST CONNECTORS
● Connectors to be cast are also waxed on
the definitive cast before reflowing and
● Soler (metal alloy whose melting
investing of the wax pattern
temperature is lower than that of the parent
metal) is melted and allowed to flow and
wet the soldering gap
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Welding
● Another method of rigidity joining metal
parts
● Connection is created by melting adjacent
surfaces with heat or pressure
● A filler metal whose melting temperature is
about the same as that of the parent metal
can be used
Requirement of solders:
a) Fuse safely below the sag or creep
temperature of the casting to be soldered.
b) Ability to resist tarnish or corrosion
c) Free flowing
d) Match the color of the units that will be
joined
e) Strong

Soldering gap width:

Soldering flux
● An even soldering gap of about 0.25mm is
● This substance is applied to a metal surface
recommended
to remove oxides or prevent their (oxide)
● As gap increases, soldering accuracy
formation
decreases
● Without the oxides, the solder is free to wet
● Extremely small gap widths can prevent
the clean metal surface
proper solder flow and lead to an
● Borax glass – most frequently used
incomplete or weak joint

SOLDERS
● Dental Gold Solers are given a fineness
designation to indicate the proportion of
pure gold contained in 1000 parts of
alloy
○ E.g. 650 fine solder – contains 65%
gold

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Soldering flux RIGID CONNECTOR DESIGN
● Is used to limit the spreading of solder ● The size, shape, and position of
● Is placed on a casting before the flix connectors all influence the success of
application prosthesis
● Graphite (from a pencil) is often used
○ Disadvantage: evaporates at higher
temperature
● Iron oxide (rouge) – more reliable

Soldering investment
● Are similar in composition to casting
investments

● Must be sufficiently large

○ To prevent distortion or fracture
during function
● But not too large
○ Otherwise they interfere with
effective plaque control and
contribute to periodontal breakdown
■ Embrasure for oral hygiene
aids cervical to the connector

LOOP CONNECTORS
● Rarely used
● Sometimes required when a existing
diastema is to be maintained in a planned
fixed prosthesis

● Faciolingually
○ The tissue surface of connectors is
curved to facilitate cleansing
○ Elliptical shape
● Mesiodistally
○ It is sloped to create a smooth
transition from one partial FPD
component to the next
● Highly polished

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 Design:
a. Mortise (female component of keyway)
● Distal of anterior/middle retainer

NON-RIGID CONNECTORS
● Indications:
○ When it is not possible to prepare
two abutments for a partial FPD with
a common path of placemens

b. Tenon (male component or key)

● Mesial side of the distal pontic

○ Used in pier abutments

○ If there is uncertainty about an
abutment prognosis
■ If the abutment fails, only a
portion of the FPD may need
to be remade

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 PONTIC DESIGN

SANITARY HYGIENIC

● Bending indirectly proportional to

occlusogingival thickness

MODIFIED SANITARY HYGIENIC

PONTIC CLASSIFICATION
● Two general groups:
○ Mucosal contact
■ Ridge lap
■ Modified ridge lap
■ Ovale
■ conical
○ No mucosal contact
■ Sanitary hygienic SADDLE RIDGE-LAP
■ Modified sanitary hygienic

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 CONICAL/BULLET SHAPED

OVATE

MODIFIED RIDGE-LAP

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 PONTIC DESIGN

ALVEOLAR RIDGE FORM

● When there has been considerable bone
loss of alveolar process
● Management:
● Regardless of the choice of the pontic
○ Ridge augmentation
material, patients can prevent inflammation
○ Indicate the use of removable partial
around the pontic with meticulous oral
denture
hygiene

SIEBERT’S CLASSIFICATION OF ANTERIOR

RIDGE DEFECTS

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 Alveolar ridge deficiency (Siebert, 1983)

Class I Buccolingual loss with crestal

height maintained

Class II Vertical loss with buccolingual

width maintained

Class III Combination of buccolingual and

vertical loss

RIDGE AUGMENTATION

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 DISPLACEMENT OF GINGIVAL TISSUES

➔ To obtain adequate access to the prepared

tooth to expose all necessary surfaces.
➔ To obtain a complete impression on a tooth ➔ To obtain a complete impression on a tooth
preparation with equigingival or preparation with equigingival or
intra-crevicular finish line. (Prepared and not intra-crevicular finish line.
prepared surfaces)

➔ To create an intra-crevicular finish line.

◆ Before tooth preparation is started
with the use of chemico-mechanical
tissue displacement.
➔ To control fluids in the sulcus, particularly
when a hydrophobic impression material is
used. (Elastomers or Rubber-based
Impression Materials)

TECHNIQUES OF TISSUE DISPLACEMENT

1. MECHANICAL

➔ Physically displacing the gingiva.

➔ Armamentarium:
◆ Copper band
● Serve as a means of carrying
the impression material.
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 ●As well as a means to ● Amount of absorption
displace the gingiva. depends on:
◆ Rubber dam ○ Degree of exposure
◆ Non-impregnated cord of the vascular bed
● To displace the gingival ○ Time of contact
tissue laterally not apically. ○ Amount of medication
● Cord must be packed in the cord
laterally. ● Contraindication:
○ Cardiovascular
disease
○ Hypertension
○ Hyperthyroidism
○ Diabetes
○ Allergic to
epinephrine
◆ Aluminum chloride, Alum, Aluminum
sulfate, Ferric sulfate
● Compared to epinephrine as
to:
○ Displacement
effectiveness
○ Hemorrhage control
○ Gingival inflammation
◆ Over-the-counter drugs used as
nasal and ophthalmic
decongestants: (Vasoconstrictors)
2. CHEMICO-MECHANICAL
● Tetrahydrozoline
hydrochloride 0.05% (Visine)
● Phenylephrine hydrochloride
0.25% (Neosynephrine)
● Oxymetazoline hydrochloride
0.05% (Afrin)
◆ Antimicrobial rinse
● 0.12% chlorhexidine
gluconate (Peridex) =
indirectly controls
➔ Principal chemicals impregnated in hemorrhage
Retraction Cords:
◆ Epinephrine
● Produces hemostasis =
control bleeding
● Causes local
vasoconstriction = gingival
shrinkage
● Elevation of blood pressure
● Increased heart rate
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PROCEDURE OF RETRACTION CORD
PLACEMENT

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 4. SURGERY
➔ Rotary Curettage
◆ “Gingitage” or “Denttage”
◆ Troughing technique
◆ Purpose is limited removal of
3. CHEMICAL (FERRIC SULFATE SOLUTION) epithelial tissue while a chamfer
finish line is being created.

1. Not interfere with the setting of impression

material.
2. Not stain the prepared tooth permanently.
3. Not cause irreparable damage to local ➔ Electrosurgery
tissue. ◆ Surgical reduction of sulcular
4. No systemic damage. epithelium using an electrode to
produce gingival retraction.

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 IMPRESSION TAKING FOR INDIRECT RESTORATIONS (FIXED PROSTHESIS)

2. Poor tear strength especially in thin

sections
● 350-700 gm/cm² vs 3000
CLASSIFICATION OF IMPRESSION MATERIALS gm/cm² (elastomers)
3. Dimension stability is poor
Aqueous Elastomers ● Imbibition
(soluble containing Non-Aqueous
Non-Elastics ● Syneresis
water & rubbery Elastomers
compound) 4. Can’t be refined
→ Impression → Reversible → Polysulfides
Compound Hydrocolloids (Agar) (Mercaptan)
NON-AQUEOUS ELASTOMERS
→ Impression → Irreversible → Polyethers ● Elastomeric means having elastic or
Plaster Hydrocolloids (Alginate) rubber-like qualities
→ Silicones ● Also known as rubber impression material or
→ Waxes ● Condensation
Silicones elastomers
● Addition
Silicones POLYSULFIDE
(Polyvinyl
● Permlastic (SDS/Kerr)
Siloxane)
● Coe-Flex, Omniflex (GCAmerica)

POLYETHER
AQUEOUS ELASTOMERS ● Impregnum F, Permadyme (3M ESPE)
ALGINATES ● Polyjel (Dentsply/Caulk)
● Advantages:
1. Ease of mixing and preparation ADDITION SILICONES (Polyvinyl Siloxane)
2. No elaborate equipment required ● Examix, Exaflex (GCAmerica)
3. Economical ● Express, Imprint (3M)
4. Material is elastic ● Reprosil, Aquasil, Hydrosil (Dentsply/Caulk)
● Impression comes out easily
from undercuts CATEGORIES OF ELASTOMERS BASED ON
VISCOSITY
● Disadvantages:
1. Reproduction of the surface detail is Type 0 ● Very high viscosity
● Putty
lower than agar and non-aqueous
● High viscosity
elastomers Type 1
● Heavy body
● Medium viscosity
Type 2
● Medium body
● Low viscosity
Type 3
● Light body

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COMPARISON OF PHYSICAL PROPERTIES OF
ELASTOMERS 4. Stiffness (from most to least)
1. Dimensional Stability (from best to worst)
● Addition silicones (Polyvinyl siloxane)
○ Polymerization shrinkage is
0.17%
○ Dimensionally stable even after
1 week
○ Multiple pours
● Polyethers
● Polyethers
○ Exhibit a 24-hr shrinkage of
○ Care not to break the teeth
0.1%
when separating cast
○ Imbibition
● Addition Silicones
○ Should not be stored in
● Polysulfides
refrigerator
● Condensation Silicones
● Polysulfides
● Alginate
○ Polymerization shrinkage of
○ Comes out easily from
0.45%
undercuts
○ Storage shrinkage
○ Must be poured within 30
5. Wettability (from best to worst)
minutes
● Condensation Silicones
Elastomer Wettability
○ High curing (polymerization Polyether Excellent
shrinkage) Condensation Poor
● Alginate Silicones (care to avoid bubbles when
○ Imbibition pouring cast)
Addition Poor
○ Syneresis Silicones

2. Setting time (from longest to shortest)

Elastomer Setting Time Mixing Time

Polysulfide 5-8 min 30-45 sec
Silicones 5-8 min 30-45 sec
Polyethers 3 min 30-45 sec
Alginates 1-4 min 30-45 sec

3. Tear strength (from greatest to least)

Elastomer Tear Strength (gm/cm²) 6. Accuracy of Reproduction

Polysulfide 7,000
Silicones 3,000
Polyethers 3,000 Graph 1. Measurement of discrepancies between stone cast
Alginates 350 - 700 and master model. The data are shown as means and the bars
indicate standard deviation

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 PUTTY WASH METHOD
● Preliminary impression is made using medium or
heavy body
● After setting, the 2nd phase (light body) is
loaded and allowed to set)

REQUIREMENTS OF AN IDEAL IMPRESSION

MATERIAL
● No dimensional change during polymerization
● No dimensional change during storage
● Suitable working time
● Adequate detail production BASIC IMPRESSION TECHNIQUES FOR POLYVINYL
● Good tear strength SILOXANE (DOUBLE-MIX)
● Easy to mix 1. The dentist prepares the tooth or teeth for the
● Compatible with dye and model materials impression
● Non-toxic and non-irritating ● Dry
● Acceptable odor and taste ● No bleeding
● Long shelf life ● Finish lines are exposed
● Requires minimal equipment for use ● Tissue displacement

IMPRESSION MAKING TECHNIQUES FOR

ELASTOMERS
SINGLE MIX
● A medium body is used in both the syringe and
the custom tray

2. Take an impression

DOUBLE MIX – Preferred method due to time saving

factor
● Light body material in the syringe and medium
or heavy body in the tray

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3. When the impression material has reached final
set, the impression is removed and inspected for
accuracy.

4. The impression is disinfected, placed in a

biohazard bag, and reached for the laboratory
technician.

Impression Disinfection
Immersion in:
Alginate
→ dilute hypochlorite solution or
→ iodophor
Immersion in:

→ iodophor
→ diluted hypochlorite solution
● (1:10 dilution of bleach to liquid (1
part bleach and 9 parts water)
Non-Aqueous → Chlorine dioxide
Elastomeric → Glutaraldehyde
Impression → Complex phenol

Method should be verified with the material

manufacturer.

Spraying uses less solution but increases

staff exposure to the hazardous chemicals.

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 SHADE SELECTION

COLOR
● perceived, is the result of a light source, the
object that absorbs, transmits, reflects or
scatters the light from the source, and the
interpretation of the result by the human visual
system.

● Quality by which we distinguish one color from

LIGHT another.
● form of visible energy that is part of the radiant TEN Color Families
energy spectrum. Radiant energy possesses ● Red
specific wavelengths, which may be used to ● Yellow-red
identify the type of energy. ● Yellow
● Green-yellow
● Green
● Blue-green
● Blue
● Purple-blue
● Purple
● Red-purple
VALUE
● Quality by which we distinguish a light color from
a dark one (lightness or darkness)
● Munsell Color System extends from zero to ten,
black is zero and white is ten.
CHROMA / SATURATION
● Quality that describes how the color differs from
MUNSELL COLOR SYSTEM
a grey of the same lightness
● used to describe a definite color system in a
● Starting at zero on the center line and increasing
visual color system.
to 10 up to 18.
● Some hues have more distinguishable
saturation.

SHADE SELECTION
General Principles:
1. The patient should be viewed at eye level.
2. Shade comparison should be made under
different lighting conditions.
Three dimension or qualities of color: a. Initial selection — done under incandescent or
1. HUE fluorescent light.
2. VALUE b. Color confirmation — in natural daylight. Normally
3. CHROMA the patient is taken to a window.
HUE
3. The teeth to be matched should be clean. If
necessary, stains should be removed by
prophylaxis.
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 4. Do not blow the tooth dry with air - and do not
place cotton rolls for shade selecting. Enamel 3. Digital Color Imaging
dries very easily and once dry, it looks more
opaque and brighter than when it is moist.
5. Shade selection should be made at the
beginning of a patient’s visit.
6. Brightly colored clothing should be draped &
lipstick removed. The operatory walls should not
be brightly painted.
SHADE SELECTION CHART
7. Shade selection should be made quickly , with ● The tooth is divided into three regions:
the color samples placed under the lip directly a. cervical
next to the tooth being matched. b. middle
8. If you are undecided between two shades, c. incisal
choose the darker one. ● Each region is matched
independently to the corresponding
SHADE SELECTION DEVICES area of a commercial shade sample.
1. Commercial Shade Guides
For Composite Restorations:
- Determine enamel shade at the incisal edge of
the tooth that is being repaired
- Determine dentin shade on the basis of the
cervical shade of the canines.
1- Shade
The tints are first of all organized by shades:
● Reddish-brownish : A1 - A2 - A3 - A3,5 - A4
● Reddish-yellowish : B1 - B2 - B3 - B4
● Greyish : C1 - C2 - C3 - C4
● Reddish-grey : D2 - D3 - D4
2- Brightness
● Within these shades, either A, B, C or D, the
shades are classified by a number from the
lightest,
● 1, to the darkest and most intense, 4.
● Thus, a shade A1 will be a reddish-brown
shade, just like shade A2, but the latter will be
darker.

2. Dentin Shade Guides

● When using a translucent all-ceramic system for
a crown or veneer, communicating the shade of
the prepared dentin to the dental laboratory is
helpful. In addition, to selecting the shade of its
adjacent.

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 WORK AUTHORIZATION
1. Tooth-Colored Polycarbonate crown
-Communication between the dentist and the laboratory - can provide excellent coverage for anterior
-Written instruction with 2-dimensional drawings or teeth
photographs, shade guide, articulated casts or poly-vinyl
siloxane impression

TEMPORIZATION
( Provisional Restorations)

-The placement of an interim covering on a tooth after

preparation
WORK AUTHORIZATION
Provisional Restoration 2. Anatomic Metal Crown
- used primarily for posterior teeth -
● protects the prepared teeth & simulate the form malleable, to allow the shell to rapidly
& function of the definitive restoration conform to the occlusion
● preserves the vitality of the pulp and secures pt’s
comfort and for esthetics
● can also be a healing matrix for the surrounding
gingival tissue & adjacent edentulous mucosa

Types of provisional restorations:

● Prefabricated
● Custom Made

PREFABRICATED PROVISIONAL RESTORATION

1. Tooth-Colored Polycarbonate crown

2. Anatomic Metal crown
3. Clear Celluloid Shells
4. stock aluminum cylinders (tin cans)

Note: Prefab can only be used for single-tooth

restoration

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 3. Clear celluloid shells
- consists of a thin, soft & transparent material - sizes &
shapes can be selected from a mold guide

Custom crowns & FPD

- Fabrication of several different kinds of resins by

variety of methods, direct or indirect
™ Template-Fabricated Provisional Fixed Partial Denture
I. Direct technique- is done on the actual prepared -a template formed from clear thermoplastic
teeth in the mouth resin
II. Indirect technique- accomplished outside of the -it is shaped on a diagnostic cast, using a
mouth on a cast made of quick- set plaster vacuum forming machine or an impression tray
filled with silicone putty. The template is filled
Different resins used for custom provisional with resin & applied to the prepared teeth to a
restoration: fast setting plaster cast of the prepared teeth.
‡ poly (methyl methacrylate)
‡ poly (ethyl methacrylate)
‡ poly (vinylethyl methacrylate)
‡ Bis-acryl composite resin
‡ Visible light-cured (VLC) urethane dimethacrylate

Techniques for custom provisional restoration:

™ Overimpression-Fabricated Provisional Crown
- may use elastomeric impression or alginate
- an overimpression is made on the cast, or in the
- mouth, before the tooth preparation begun

™ Template-Fabricated VLC Provisional Restoration

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 Custom crowns & FPD

‡ Material of choice:
- Zinc-Oxide Eugenol

ͻ Not recommended:
Zinc Phospate
Zinc Polycarboxylate
Glass Ionomer Cements
Because of their comparatively high strength.

™ Shell-Fabricated Provisional Restoration
- A thin shell crown or FPD can be made of
autopolymerizing resin in an impression prior to
the preparation appointment by alternately
dripping monomer & gently blowing polymer with
atomizer. The resulting form is relined after the
tooth or teeth are prepared.
Cementation Procedure:
1. To facilitate removal of excess cement, lubricate the
polished external surfaces of the restoration.
2. Mix the ZOE cement & apply a small quantity, just
occlusal to the cavosurface margin.
3. Seat the restoration & allow the cement to set.
4. Carefully remove excess with an explorer & dental
floss.

™ Overimpression-Fabricated Bis-acryl Composite Resin

- its polymerization produces very little heat, & it
has minimal toxic effect

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 DENTAL CERAMICS
Ceramic- product made from non-metallic material
by firing at a high temperature
•Application in dentistry is promising:
ØHighly esthetic
ØStronger, wear resistant
ØImpervious to oral fluids and biocompatible
Porcelain - ceramic material formed of infusible
elements joined by lower fusing materials
Dental ceramics/porcelain: related to
● Chinese porcelain vases
●  engine mouldings,
● ballistic protection,
●  roof tiles
● heatproof tiles on NASA’s space shuttle
 Kaolin
-Type of clay used in ceramics
-“Dental porcelain” is a term now incorrect
-Little or no kaolin is used in dental version
● Opaque
● Influences the optical properties
● Non aesthetic
Feldspar and silica
● Dental ceramics need to be Translucent
● Dental ceramics are therefore
really glasses called 
feldspathic ‘porcelains’.
● Pigments are also included to improve and
optimize the aesthetics
DENTAL CERAMICS
DENTAL LABORATORY PROCEDURE
● Building up dentine portion
● Building up enamel portion
● Firing: first bake (shrinkage)
● Firing: subsequent bakes
● Staining
● Glazing
CLASSIFICATION OF DENTAL CERAMICS
• Silicate ceramics
- An amorphous glass phase with a
porous structure. Main component is
SiO2. Dental porcelain fall in this
category
• Oxide ceramics
- Presence of mainly oxides
(Al2O3, MgO with either no glass phase
or Small content of glass phase 
-
• Non-oxide ceramics
- Impractical for dentistry - high
processing temp, unaesthetic color &
opacity
• Glass ceramics
- Partially crystallized glasses that are
produced by nucleation and growth of
Crystals in the glass matrix phase
PROPERTIES OF DENTAL CERAMICS
● Aesthetics
- Best dental restorative material
- Stable color
- Smooth surface
-High level of translucency
● Chemical stability
- Resistant to chemical attack
- Biocompatible
- Good soft tissue compatibility
*strong acids can etch ceramics
(hydrofluoric acid)
● Thermal properties
-Have great similarity with tooth tissue
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 -Thermal expansion & thermal diffusivity ADVANTAGES:
close to natural tooth tissue
-Slower rate of heat transfer 1. Biocompatible
-Thermal diffusivity poor vitality test 2. Esthetic
difficult to interpret 3. Thermal properties similar to enamel and
dentine

● Dimensional stability DISADVANTAGES:

-This property makes a ceramic is 1. High hardness- causes abrasion to
challenging material opposing teeth
-Shrinkage
2. Low tensile strength so it is brittle material-
-Shoulder ceramics
fracture
-Shrinkage at margins of prep
- open margins leads to leakage

● Mechanical properties
-Strong in compression
-Brittle
-Low flexural strength
-Must always be supported with an
underlying structure
-Low fracture toughness

Static fatigue- decrease In strength

overtime
Slow crack growth- Moist envt lead to
fracture

● Effects of tooth preparation

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 ● Sprue formers are attached to the:
LABORATORY PROCEDURES
○ Full coverage
(Metal Ceramic FP & All Ceramic Crowns) - incisal edge of anterior patterns and
Metal-Ceramic Fixed Prosthesis (Crowns and Fixed to one of the cusps on posterior
Bridge) patterns
- CONVENTIONAL POWDER-SLURRY
SYSTEM ● Facially veneered castings
- thickest portion of posterior wax
PROCEDURES patterns
1. Wax Pattern Formation
2. Reducing the Wax Pattern for Veneering ● Sprue former is angled so that the molten
3. Re-adaptation and Sprue Former Attachment alloy is dispersed evenly to all areas of the
4. Pattern Orientation in the Ring mold.
5. Investing Procedures
6. Casting Procedure
7. Investment Removal and Cleaning
8. Preparing the Casting for Porcelain Application
9. Porcelain Application and Completion
10. Shaping
11. Glazing
4. Pattern Orientation in the Ring
1. Wax Pattern Formation ● sprue former is attached to the crucible
former.
● Full crown contour in wax Advantage:
- accuracy with which the cervical area of the
crown is reproduced which is critical from a
periodontal standpoint

2. Reducing the Wax Pattern for Veneering

● Wax is removed from the full-contour wax
pattern so that a form is developed that is
suitable for veneering.
● 2 different shapes are created (depending
on whether the final restoration will
possess)
a. full porcelain coverage
b. facial veneer of porcelain
2 Types of Phosphate-bonded investments:
3. Readaptation and Sprue Former
Attachment
5. Investing Procedures
● Phosphate-bonded investments
- withstand higher temperatures
(1149-13720 C or 2100-25000 F)
(melting point of metal- ceramic alloys)
● Gypsum-bonded investments break down
at these temperatures and liberate elements
that contaminate alloy.
a. Type I
- Casting base metal alloys for
metal-ceramic crowns
b. Type II
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 - Casting base metal alloys for
removable partial denture
Procedure:
1. The wax pattern is coated with an appropriate
cleansing and surface- tension-reducing agent.
2. Ring lining procedures

Alloy type # of liners

Gold-platinum-palladium 1
Gold-palladium 1
High palladium 1
Base metal 2
● ADA classification for alloy systems used for
metal-ceramic restorations.

3. Vacuum mixing and hand- investing for

metal-ceramic wax patterns. b. Melting and casting
● Armamentarium:
○ Natural Gas and oxygen or propane
6. Casting Procedure
torches are required.
○ Centrifugal casting machines
Procedure: ● After casting the ring is allowed to bench
a. Burnout cool for 15 minutes.
● 2-stage Burnout: ● The ring is then quenched in cold water.
○ Temperature hold at 200 to 3000C
(392 to 5720F) for at least 30
minutes II.
○ Complete the burnout

7. Investment Removal and Cleansing

Procedure:
a. The bulk of the investment must be
removed by hand.

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b. Residual material adhering to the cast
can be eliminated:
● All types of alloys:
○ In a container of detergent
solution in an ultrasonic
cleaner for 15 to 20 minutes
ii.
○ By an air abrasive unit
(employing 50 um aluminous
oxide particles) followed by
20 min of ultrasonic cleaning
in distilled water.
● Noble alloys:
○ In a sealed container of 52%
hydrofluoric acid, and the
container is subjected to
ultrasonic action for 10- 15
minutes.
● Casting should be thoroughly rinsed
away of residual cleaning material
(detergent solution or hydrofluoric
acid)
8. Preparing the Casting for Porcelain Application
Procedure:
a. Casting with voids in the veneering
surface should be discarded.
● Voids are areas from which cracks in the
porcelain often propagate.
b. The metal thickness of the veneering surface
is measured with a gauge and reduced when
necessary until a thickness of 0.2 to 0.3 mm is
achieved.
c. After the grinding procedures are completed,
the metal casting must be thoroughly cleansed.
● Pickling - 52% hydrofluoric acid and
ultrasonic cleaning
● Air abrasion and ultrasonic cleaning
d. The casting is next placed on a firing tray and
heated in a porcelain furnace (Degassing cycle).
● To decontaminate or degas the metal
● To oxidize the surface or create an oxide
layer (metalceramic bond)
● Metal-ceramic bonding
○ Mechanical Bonding
■ Porcelain flows into the
surface irregularities created
during air abrasion and
surface grinding
e. Degassing cycle
● Metal-Ceramic Bond
○ Mechanical Bonding
○ Chemical Bonding
■ Tin oxide from the metal alloy
combines with the porcelain
during firing
■ The temperature should be
about 280 C (500 F) above
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 the highest fusion
temperature.
■ Casting is held for 10
minutes in a vacuum, then
removed and allowed to cool
in air.

b. Dentin and Enamel Application

● Since porcelain shrinks at firing, the dentin
should be 10 to 20% larger than the final
desired size.

● Cutback form enamel placement

f. The casting is ready for application of opaque

porcelain when it has cooled.

9. Porcelain Application and Completion

Procedure:
a. Opaque application
● Should mask the underlying metal casting
w/out an excessive thickness.
● And then fired. ● Mixed enamel porcelain is added to the
cutback.

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 ● The complete build-up is placed in a firing
tray in front of the open muffle of the
furnace to dry for a period of 10-15 minutes

b. Glazing is accomplished by:

i. Autoglazing- Heating the porcelain
to the point a natural sheen on the
prosthesis is produced.
ii. Applying a layer of porcelain glaze
powder to the surface.
● After proper drying, the porcelain is fired in
iii. Overglazing - A thin layer of mixed
a vacuum.
porcelain is applied on the surface

10. Shaping

c. Firing is done in air, not vacuum

Procedure:
● Proximal contacts refined.
● Cervical adjustments.
● Occlusion is adjusted.
● Surface characterization is completed.

11. Glazing

Procedure:
a. The restoration must be ultrasonically
cleaned in distilled water for 5 minutes.

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